Visage Clinic: Dr. Marc DuPéré
101-133 Hazelton Avenue
Toronto, 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: The Trends of Brotox, Scrotox, & More

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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 the “Brazilian shave,” which gives the desired look to one’s genitals by completely shaving and lasering the area. There are also the recent articles in Cosmopolitan, CBC, Maxim, The Independent, and Men’s Health, all confirming the same thing: while still secretive, there are increasing demands for a more youthful scrotal aesthetic.

Scrotum Treatment Options

As with the breasts and labia, scrotums and testicles come in every shape and size. 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)
  • 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 to 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 (a condition 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 the testes 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.

How Does A Scrotal Lift Work?

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 (the small line in the middle of the scrotum, which is the result of the meeting of the 2 sides during embryogenesis). The final scar from surgery is left right in the middle, where this line already exists.

The lift is created by removing skin and closing in layers, as one does in a breast lift.  This process 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), resulting in a well-hidden scar.

It is important to do both muscle and skin repair, as one does with a facelift, for a stronger, longer-lasting effect. Fortunately, the thinner the skin is on the body, the better the scars will heal (think of areas such as the eyelid, lips, labia, areola, mouth mucosa, etc.).

How Does “Scrotox” Work?

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. During a “Scrotox” session for my Toronto patients, I apply a strong topical anesthetic cream and use the tiniest needles. The procedure is painless and requires little to no downtime. On average, 50 units of this muscle-relaxing protein is required and the effects last approximately 4 months.

Other Treatment Choices

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Dr. DuPéré’s rendition of an elongated male scrotum

Some men have an exaggerated attachment of the anterior scrotal skin to the ventral side of the penile shaft. This creates a “web” of skin, giving the illusion of a smaller penis. The webbing can be corrected with surgery, alleviating the scrotal sac, and restoring the true length of the penile shaft.

BOTOX is also commonly used to treat hyperhidrosis, a condition also known as heavy sweating. While typically used to treat heavy sweating of the hands, soles and underarms, I can use 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. There is no shame in correcting aesthetic issues. And as more men become aware of their treatment options, the stigma around scrotal procedures continues to fade.

Browse the before-and-after gallery to see results from satisfied patients. If you would like to learn more about your scrotal lift or “Scrotox” options here in Toronto, request a consultation online or call (416) 929-9800.

35 Responses to The Great Balls of Desire: The Trends of Brotox, Scrotox, & More

    • 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

    • Dr. Marc DuPéré says:

      Good day R, my assistants will be emailing you some information shortly. Let them know which scrotal procedure you are interested in: scrotoplasty/lift, scrotox, penoscrotal webbing, P shot, fat grafting, etc. Kind regards, Dr. DuPere

    • Dr. Marc DuPéré says:

      Good evening Y., it depends on the amount of botox required and the effects you are looking for. You and I will discuss those together and we will establish a plan and a quote will be given prior to treatment. My assistants will be emailing you tomorrow with more information. Kind regards, Dr. DuPéré

  • D.h says:

    Hi I’m 16 and I have an assumably excessive amount of skin on my scrotal area causing my errections to face down, I have no money and I don’t know what to do, please help.

    • Dr. Marc DuPéré says:

      Good morning and thank you for reading our blogs. Happy to see you to discuss your options. Unfortunately, scrotoplasty is not covered under OHIP. Also, it is unlikely the excess of skin is the reason for your erections to point downward. Maybe you consult a urologist? Peyronie’s diseases can give a male a downward erection. Dr. DuPéré.

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