Visage Clinic: Dr. Marc DuPéré
101-133 Hazelton Avenue
Yorkville, ON M5R 0A6
Phone: (416) 929-9800
Fax: (416) 368-3113
Toll Free: 1 (855) 8 VISAGE
Monday-Friday: 8:00 a.m.–5:00 p.m.

The Great Balls of Desire

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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.

WARNING: This feature contains nudity. Please click OK to confirm you are at least 18 years of age and are not offended by such material.


DUP_ScrotoplasyScrotoplasty before and after (immediate results on the OR table). Patient consent obtained.

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”.

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Dr. DuPéré’s rendition of an elongated male scrotum

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

29 Responses to The Great Balls of Desire

    • Dr. Marc DuPéré says:

      Good evening and thank you for your message. We’d be happy to meet you and provide you with an estimate/quote. Most males receive 50-100U under each feet and 50u to scrotum, on average. Some insurance companies may cover part of the units used for hyperhidrosis (heavy sweating). Hope this helps! If you decide to come and visit us in Toronto or Richmond Hill, call us at 416-929-9800. Dr. D.

    • Dr. Marc DuPéré says:

      Good morning! I will email you some details for privacy reasons. I look forward to meeting you. Kind regards, Dr. D.

    • Dr. Marc DuPéré says:

      Good morning! I will email you some details for privacy reasons. Are you looking for the “scrotox”, i.e. botox to the scrotum for relaxation of the scrotal muscles or a scrotal lift, i.e. scrotoplasty, to lift the testicles and give the scrotum a younger look? As you know, I offer both solutions. I look forward to meeting you. Kind regards, Dr. D.

  • Anonymous says:

    Seventy one year old male from Maine interested in scrotal lift to relieve discomfort.
    If all goes well how long a stay would be required and cost of procedure. Thank you Gwc

    • Dr. Marc DuPéré says:

      Thank you for your enquiry. I use dissolving sutures so I would suggest you stay in TORONTO for 5-7 days, after which, it should be easier to travel back home. Stitches will be slowly dissolving over 2-4 weeks. I will email you more details. Dr. DuPere

    • Dr. Marc DuPéré says:

      Thank you for your question. I use botox in the scrotum for both heavy sweating AND also to relax the scrotal muscles to allow the testes to descend. The average is 75 units of Botox but this will vary slightly depending on the size of your scrotum. I also will follow-up with you and we can always add.
      I will email you more details.
      Dr. D.

  • Matt says:

    Hi there,
    I’m 18 and I’m interested in getting a scrotal lift, I have a bit of an excess of skin and would be much happier and more confident with a tighter and more smooth scrotum. Just curious about time of healing an for cost.

    • Dr. Marc DuPéré says:

      Good morning, my assistants will be emailing you this morning with details. I look forward to meeting you! Dr. D.

  • Peter says:

    I am a 53 year old male seeking a scrotal lift. I would be grateful to receive information about the cost, availability and necessary after care.

    • Dr. Marc DuPéré says:

      Good morning. My assistants will be emailing you later today with some information. In the interim, scrotal lift is a common procedure here in Toronto (performed another one 2 days ago!) We can usually fit in shorter procedures such as scrotoplasty within 2-4 weeks. After care is simple: I use dissolving sutures; patients apply polysporin daily, no shower for 3 days, no bath tubs/hot tubs/pool/beach swimming for 4 weeks. Patient wear briefs or boxer-briefs initially to hold the dressing in place. The superficial stitches normally dissolve over 10-14 days. I look forward to meeting you. Dr. D.

    • Dr. Marc DuPéré says:

      Good day and thank you for your interest in my blog and VISAGE Clinic. My assistants will be emailing you information and pricing today or tomorrow. Kind regards, Dr. DuPéré

    • Dr. Marc DuPéré says:

      Good day and thank you for your interest in my blog. My assistants will be emailing you information and pricing today or tomorrow. Kind regards, Dr. D.

  • B says:


    31 and suffering from a really saggy ballsack because of a Titan penile implant pump i had installed when I was 21.



    • Dr. Marc DuPéré says:

      Hi, my assistants will be emailing you shortly with some information. I look forward to seeing you. Best regards, Dr. D.

    • Dr. Marc DuPéré says:

      Hi Wayne, My office will be sending you lots of information later today. Recovery is relatively short. I use dissolving sutures which will melt away in 7-12 days. Most can return to a desk work within 5-7 days. You should refrain from intercourse for about 3-4 weeks to allow proper healing. I look forward to meeting you. Dr. D.

  • JP says:

    I’m a 24 year old male and would like to look into having some webbing removed. How long is recovery time usually?

    • Dr. Marc DuPéré says:

      HI, recovery time is usually short as far as non-physical work is concerned. You will have dissolving sutures for 10 days or so, mild swelling and some bruising for 2-3 weeks. Desk-work can resume 4-7 days later. No physical or intercourse for 6 weeks or so. I will go in more details once we meet. Please call us for your consultation at 416-929-9800. Dr. D.

    • Dr. Marc DuPéré says:

      Hi and thank you for your interest. My assistants will be emailing you details tomorrow morning. Wait time is 3-6 weeks on average. I assume it is for scrotoplasty. Scrotoplasty can be done under local anesthesia or IV sedation and general anesthesia. We have our own surgical centre and usually can accommodate most patients within a reasonable time. I look forward to meeting you. Kind regards Dr. DuPéré

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