penis size · hyaluronic acid · PLLA · fat transfer · andrology
Enlargement, erections and an andrology consultation
Do you feel that your penis is too small? The first step is to establish exactly what concerns you: girth, length, erection quality or its appearance when flaccid. This determines whether the discussion should focus on enlargement, treatment for erectile dysfunction or how you perceive your own body.
We explain the differences between hyaluronic acid, PLLA and your own fat, and where medication, supplements, P-Shot and B-Shot fit into a discussion about erections.
Prepared by: dr n. med. Jakub Kłącz ( Professor of University of Cambridge)
Sources updated: .
Medical review: dr n. med. Piotr
Key points at a glance
- Flaccid size does not determine erect size. The increase in length during an erection varies between men.
- HA, PLLA and fat transfer are primarily used to increase girth. They should not be equated with predictable lengthening of the erect penis.
- An incomplete erection can change the penis's appearance. In this situation, sexual function needs to be assessed.
- Evidence supporting P-Shot and B-Shot for erectile dysfunction is limited. Current knowledge and available alternatives need to be discussed.
“I have a small penis” — where should you start?
How the penis looks in the shower and how it looks during a full erection are different situations. Some men experience a greater increase in length during an erection, while others experience a smaller increase. Comparing flaccid measurements alone can therefore be misleading. [7]
Girth and proportions
If your concern is the thickness of the shaft, you can discuss methods of increasing its girth and their limitations.
Erection quality
If the penis does not become fully rigid, the cause of erectile dysfunction needs to be established first.
The visible part of the penis
Fat above the base of the penis may also matter. It is worth including this area in the examination.
“Structured counseling should be always performed.”
The authors emphasise discussing expectations and carefully assessing the evidence for procedures. Measurements, an explanation of normal variation and a discussion of treatment goals should come before a decision about injections or surgery.
Could the problem be an incomplete erection?
Yes. When the penis is not fully rigid, it may seem shorter and thinner than during a full erection. Treating the underlying cause may help it reach its natural potential. This is not the same as permanent anatomical enlargement. [2]
During an andrology consultation, the doctor asks about matters such as when the difficulties began, morning erections, libido, medication, medical conditions and stress. Metabolic and hormonal tests are selected according to the clinical findings; penile Doppler ultrasound is needed in selected situations, rather than for every patient. [2]
Management may include treating associated conditions, lifestyle changes, psychosexual support or medication such as sildenafil or tadalafil. Choosing a medicine requires an assessment of contraindications — particularly the use of nitrates. [2]
Supplements are considered when indicated. Correcting identified deficiencies may form part of care. Some supplements have been studied in mild erectile dysfunction, but their effect is generally small and does not replace a diagnostic assessment. Tablets and supplements are not a method of permanent penis enlargement. [1]
P-Shot and B-Shot — what should you know before deciding?
Both names appear in sexual medicine, but they refer to different procedures. During a consultation, you can ask about their use and how the quality of the evidence compares with that for standard treatment.
P-Shot: platelet-rich plasma
This involves injecting PRP obtained from the patient's blood. Research findings on erections are mixed. The 2026 EAU guidelines recommend using PRP for erectile dysfunction only within clinical trials. [1]
B-Shot: botulinum toxin
In this context, B-Shot means injecting botulinum toxin into the penis. Some studies have reported improvement, but the EAU currently provides no recommendation for its clinical use in ED because the evidence is insufficient. This is an off-label use. [1]
Neither procedure should be promised to deliver a full erection or resolve dissatisfaction with size. Further information: P-Shot and B-Shot in Gdańsk.
Penis enlargement: hyaluronic acid, PLLA or your own fat?
These methods primarily aim to increase the girth of the penile shaft. The choice depends on anatomy, expectations, health, acceptable risk and the specific product. Research does not justify promising every patient a particular increase in centimetres. [3] [4]
| Method | How volume is created | What to consider |
|---|---|---|
| Hyaluronic acid — HA | Injection of a resorbable filler. | The effect gradually fades; adjustments or repeat treatment may be needed. |
| Poly-L-lactic acid — PLLA | Gradual stimulation of collagen formation. | Results take time; there is no equivalent of simply dissolving HA. |
| Your own fat — fat transfer | Harvesting, processing and transferring fat tissue. | Requires liposuction; some of the transferred fat may be resorbed. |
Hyaluronic acid — a filler to increase girth
HA is injected into an appropriate tissue layer of the shaft. The increase in volume is visible early, but initial swelling is not the final result. Studies have observed an increase in girth, with its persistence depending, among other factors, on follow-up duration and the product used. [3] [8]
Possible problems include unevenness, swelling, bruising and infection; rare complications may include tissue damage. HA can be broken down with hyaluronidase when indicated, but this does not mean that every problem can be easily or completely reversed. [9]
Learn about penis enlargement with hyaluronic acid in Gdańsk.
PLLA — gradual biostimulation
PLLA, or poly-L-lactic acid, stimulates collagen formation and may gradually increase tissue volume. The result is not assessed immediately after injection. Publications concern different polylactic acid products, so findings for one product cannot automatically be applied to all others. [3] [8]
Possible problems include nodules, inflammatory reactions and asymmetry. Hyaluronidase does not dissolve PLLA or the collagen it has stimulated. Discussing the options for correction beforehand is therefore particularly important. [8] [9]
Read about penis enlargement with PLLA.
Fat transfer — enlargement using your own fat
Fat transfer, also called lipofilling, involves harvesting fat tissue, processing it and injecting it to increase penile girth. It uses the patient's own tissue, but remains a surgical procedure involving the donor site as well. [5]
Some of the fat may be resorbed, and the result can be uneven. Lumps, fat necrosis, infection or a need for correction are possible. The proportion of transferred volume that will persist in an individual man cannot be guaranteed. [5] [9]
We discuss the available procedures and suitability assessment as part of aesthetic urology.
How can the approach be matched to the actual problem?
- Incomplete erections: establish the cause and treat erectile dysfunction.
- Dissatisfaction with girth despite normal function: discuss expectations, risks and possible suitability for a procedure.
- Fat concealing the base: assess body weight and the suprapubic area; a consultation about pubic mound liposuction may be appropriate.
- Severe anxiety despite normal measurements: seek psychosexual assessment before considering an aesthetic intervention.
For your appointment, prepare a list of medications and previous procedures, and identify exactly what you would like to change. Also explain what result you would consider satisfactory. Clarifying these points is an important part of an informed decision. [4] [6]
Patient questions
Do HA, PLLA and fat lengthen the erect penis?
Their main aim is to increase girth. Predictable lengthening of the corpora cavernosa should not be expected, and a change in flaccid appearance should not be taken as evidence of such lengthening.
Does every penis smaller than average require treatment?
No. An average describes a study group, rather than a minimum normal size. Indications depend on the examination, function and diagnosis.
Will P-Shot or B-Shot be enough if I do not have full erections?
That cannot be assumed. The cause needs to be established, and better-studied methods and the limitations of the evidence for both procedures should be discussed.
Do supplements enlarge the penis?
Supplements have not been shown to permanently increase its dimensions. A doctor assesses whether they are appropriate in the context of health and any deficiencies.
Can I choose a method without an examination?
A description of the services can help you prepare questions. The final decision requires a consultation, assessment of anatomy, and discussion of risks, durability and options if the result is unsatisfactory.
Start with an unhurried conversation with a urologist or andrologist
At Wyspa Medycyny Przyjaznej in Gdańsk, you can discuss both concerns about size and difficulties with erections. During the appointment, we establish the main concern and which next steps suit your situation.
Wyspa Medycyny Przyjaznej · Toruńska 15, Gdańsk · telephone bookings Monday–Friday, 09:00–17:00.
Medical references
- EAU Guidelines on Sexual and Reproductive Health, 2026. Erectile dysfunction chapter: PRP, botulinum toxin and supplements.
- Capogrosso P. et al. Erectile Dysfunction: Update on Clinical Management. European Urology. 2025;88:388–399. Assessment and selection of treatment.
- Yang D.Y. et al. Comparison of Clinical Outcomes between Hyaluronic and Polylactic Acid Filler Injections… Journal of Clinical Medicine. 2020;9:1024. Randomised comparison with up to 18 months of follow-up; DOI: 10.3390/jcm9041024.
- Trost L. et al. Cosmetic penile enhancement procedures: an SMSNA position statement. Journal of Sexual Medicine. 2024;21:573–578. Patient selection, limitations of the evidence and safety.
- Chen Y. et al. Penile enhancement: A comprehensive and current perspective. Current Urology. 2025;19:145–156. Review of methods and potential complications.
- Marra G., Drury A., Tran L., Veale D., Muir G.H. Systematic Review of Surgical and Nonsurgical Interventions in Normal Men Complaining of Small Penis Size. Sexual Medicine Reviews. 2020;8:158–180. Source of the quotation; the importance of counselling and assessing expectations.
- Yafi F.A. et al. Grower or shower? Predictors of change in penile length from the flaccid to erect state. International Journal of Impotence Research. 2018;30:287–291. Differences between flaccid and erect appearance.
- Kusumaputra A. et al. Efficacy and complications of hyaluronic acid and polylactic acid for penile augmentation: a systematic review and meta-analysis. 2023. Comparison of outcomes and limitations of filler studies.
- Pignanelli et al. Complications and management of penile enhancement procedures. Translational Andrology and Urology. 2025. Complications of fillers and fat transfer, and limitations of correction with hyaluronidase.
This educational article concerns adult men. Diagnosis and management are determined by a doctor after an individual assessment. Quotations use the original English wording and do not constitute an endorsement of a particular clinic or procedure.