Lengthening and increasing girth are the two phases to the procedure for penis augmentation and can be addressed in a single operation or separately.

1/3rd to 1/2th of the penis is inside the body attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone. The suspensory ligament makes the penis arch under the pubic bone and release of this ligament allows the penis to protrude on a straighter path. There are tissue distraction techniques and also the direct tissue stretching that can be achieved over time. The average increase in the penis size seems to be over one inch; occasionally a gain of up to three inches has been achieved. Surgical penile lengthening has its limits; it can help to gain few inches but it will never transform a size 3 into a size 10. A specific gain in length cannot be guaranteed but a moderate increase in girth is expected.

The girth increase is done by Fat Autographs where fat is removed by machine or by syringe suction from a donor area where there is some excess, and injected evenly into the penis through two tiny incisions. The problems with shrinkage, nodule formation and asymmetry encountered in fat injection led to the use of deepithelized dermafat grafts. The grafts are inserted after harvesting two grafts (approximately 10 X 4 cm each), lengthwise through a tunnel made on each side of the shaft. Flaps are the other method where turndown supra pubic flap is raised through parallel subcutaneous suprapubic incisions. This tissue retains blood supply at its base and is tunneled under the shaft skin and anchored near the rim of the head.

A related method involves injection of silicone, PMMA and other materials into the penis and scrotum, to achieve girth enlargement. The results of the study into penile augmentation surgery mentioned above confirm that surgical techniques used to thicken the penis are far more effective than those designed to increase penile length.

The other method is to replace the two corpora cavernosa with inflatable penile implants which is performed for men suffering from impotence. The groin and scrotum are filled with implanted reservoir by cylinders with an implanted pump in order to achieve an erection.