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Blog / Cosmetic Surgery / For Men / The Great Balls of Desire: The Trends of Brotox, Scrotox, & More...

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

March 5th, 2017 Share

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.