Do you like it firm and high or smooth and relaxed? The scrotum that is.
In plastic surgery, the male scrotum is rarely talked about. Until now. There has been growing demand for improving the aesthetics of the male scrotum in the USA and Canada. Consider the trend of having the proper “look” to one’s genitals by shaving and lasering “the area” completely, or significantly — the so-called Brazilian shave. Not to mention the recent articles in Cosmopolitan, CBC, Maxim, The Independent, and Men’s Health, confirming the still secretive yet increasing demands for a more youthful scrotal aesthetic.
As with the breasts and labia, scrotums come in every size and shape, as do the testicles. There is also a great variation in skin colour over the different regions of the scrotum.
The 2 main requests in Toronto are for the scrotal or scrotum lift (also called scrotum reduction or scrotoplasty) and the smoothing of the contracted scrotum with BOTOX, called “Scrotox”.
The scrotum is made of many layers of muscles and fascia, along with the testicles, veins, lymphatics, spermatic cords, etc. Contraction of the scrotal skin (as seen when exposed to cold weather and cold water) serves the purpose of regulating the testicular temperature, as the spermatozoid production is tightly linked to a testicular temperature of 35-35.5° C, so slightly lower than body temperature.
Similar to breasts in women, the male’s ‘sac’ tends to start sagging with age, too – called scrotal ptosis. Some men truly suffer from exaggerated hanging of the testes, making it sensitive when walking and painful during intercourse. Some others just like “them” higher up for aesthetic reasons.
One must first rule out some other medical causes of scrotal enlargement and/or testicular pain, such as testicular torsion, hydrocoele, varicocoele, hematocoele, epididymitis, or inguinal hernia. Assuming it is just from normal aging and/or weakening of the skin with gravity, one can consider a scrotal lift.
The scrotal lift is performed either under general anesthesia or IV sedation with local anesthetic. Often, a large vertical ellipse of skin and muscle is excised from over the central raphe (look closely and every scrotum has a small line in the middle called the “raphe”, which is the result of the meeting of the 2 sides during embryogenesis). So the final scar is right in the middle, where there is already a line. The lift is created by removing skin and closing in layers, as one does in a breast lift. This pushes up the testicles. Occasionally, the excess scrotal skin is so great that one must also have a small horizontal incision completely underneath where the scrotum meets the perineum (that space between the scrotum, or labia, and the anus), therefore resulting in a well-hidden scar. It is important to do both muscle and skin repair, as one does with a facelift, for example, for a stronger and longer-lasting effect. Fortunately, the thinner the skin is on the body, the better the scars are (think eyelid, lips, labia, areola, mouth mucosa, etc.).
—The other request plastic surgeons in Toronto hear is for “ironing out the scrotal skin”, or softening the rugged appearance of one’s scrotum. Some men have chronic contraction of the scrotal muscles (called dartos and cremasteric muscles) and consequently, will “show” a very small and high scrotum, along with high and almost hidden testicles. BOTOX, being a muscle relaxant, has now been used off-label to iron out those tight, rugged, and contracted wrinkles over the scrotum, alleviating the hidden testicles. From this treatment and effect came the highly-searched media-made term “Scrotox”. On average, 50 units of this muscle-relaxing protein — BOTOX — is required and the effects last, like they do in the face, approximately 4 months. I first apply a strong topical anesthetic cream and use the tiniest needles. The procedure is painless, as in BOTOX for underarm hyperhidrosis. Yes, male buddies can now have “Brotox” and “Scrotox”.
Finally, some men have an exaggerated attachment of the anterior scrotal skin to the ventral side of the penile shaft, creating a web and giving an illusion of a smaller penis. This webbing can be corrected with surgery, alleviating the scrotal sac and restoring the true length of the penile shaft.
On a different note, Botox is commonly used to treat hyperhidrosis, a condition also know as heavy sweating. Commonly used to treat heavy sweating of the hands, soles and underarms, I also used Botox to treat heavy sweating of the scrotum.
In summary, aesthetic procedures on the scrotum are the equivalent of the aesthetic surgeries performed on the female labia (i.e., labiaplasty), as both the scrotum and labia are similar in the early embryogenesis of the human.
Dr. Marc DuPéré