Dermal fillers below the belt: What's safe and what isn't

Injectables such as fillers and neuromodulators have dominated the landscape of minimally invasive cosmetic procedures for more than 20 years. Most people are familiar with their effects on faces, like smoothing wrinkles and plumping lips, but did you know injectables have ventured below the belt, offering aesthetic and functional benefits when applied to male and female genitalia?

Fillers, Botox and injectable platelet-rich plasma (PRP) are being used to increase penile girth, address the aesthetics of the labia majora and may even improve sexual function and pleasure.

The expansion of fillers from facial rejuvenation to genital enhancement may seem surprising and perhaps even risky, but – when performed by a trained medical professional – these procedures provide patients with benefits that extend beyond the bedroom.

A closer look at injectable male enhancement procedures

When it comes to fillers below the belt, there are several male-centered treatments that offer aesthetic or functional benefits, or in some cases both. We reached out to ASPS Member Surgeon Jennifer Walden, MD, FACS, to learn more.

The first of these is described by Dr. Walden as "cosmetic and wellness treatments that use Botox in areas of the male anatomy to improve comfort and quality of life."

While you may see these treatments referred to by different names, one involves injecting a neuromodulator like Botox into the scrotum and the other into the penis.

Botox smooths wrinkles on the scrotum, giving it a fuller appearance when injected into the scrotal skin. However, that's not the only benefit.

"The primary benefit is to smooth out the wrinkles and reduce excessive sweating in that area," said Dr. Walden. "In addition to smoothing the scrotal skin, Botox can facilitate the descent of the testicles, making them hang lower and appear larger."

She also added that "some patients have even reported it has improved their sex life and sensitivity, which in turn, improves confidence!"

Botox injections into the penis are used to reduce muscle tension, but they also do double duty when it comes to cosmetic and wellness enhancements.

According to Dr. Walden, by releasing tight muscles, the treatment can "promote a more lengthened resting appearance and improve blood circulation. When stimulated, this relaxed state allows for increased blood flow, resulting in firmer, more sustainable erections. The treatment delivers long-lasting results with minimal downtime."

Penis fillers also offer a less-invasive option for increasing size without surgery, with some providing temporary results and others offering more permanent enhancement.

Dr. Walden offers two filler-based penile enhancement procedures in her practice. One "uses hyaluronic acids injected into the penile shaft and glans to increase mainly girth – and length to a lesser degree – creating a fuller, more proportionate appearance". The other, she said, "builds on this approach by combining hyaluronic acid fillers with PRP, which harnesses the body's own growth factors. PRP is designed to enhance size and sensitivity by stimulating blood flow and encouraging new tissue development over time, leading to natural-feeling, progressive results."

While these treatments involve a delicate area of the body, in the right hands, they are typically safe and well-tolerated.

"Most patients experience only mild to moderate swelling or soreness following treatment, which typically resolves within a few days," said Dr. Walden. "Following all post-procedure instructions is essential to minimize the risk of complications, such as infection or contour irregularities. When performed by a board-certified plastic surgeon, penile filler procedures are considered low risk and highly effective."

Injectable vaginal rejuvenation and wellness treatments

Fillers have made a place in vaginal rejuvenation, providing a minimally invasive solution to restore volume to the labia majora or enhance sexual pleasure when injected into the vagina or clitoris.

The "labia puff," for example, addresses volume loss or deflation in the labia majora, according to ASPS Member Surgeon Karen Leong, MD, who performs the procedure in her office.

"The majority of my labia puff patients are given the option of biostimulatory calcium hydroxylapatite or autologous fat transfer with or without platelet-rich fibrin (PRF) for additional regenerative qualities," said Dr. Leong. "Hyaluronic acid fillers are used by some, but in my practice, I do not recommend these as there have been documented issues with granulomas and nodules."

Labia puff is performed under local anesthesia, involves minimal downtime and is generally well tolerated. Studies, as well as Dr. Leong's own experience, show patients are "overall satisfied with rejuvenation of the labia majora, from aesthetics to skin quality improvements."

Results are long-lasting but not permanent. Both biostimulatory fillers and fat transfer "eventually will deflate again and require retreatment" after a few years due to factors such as movement, pressure and hormonal changes.

Dr. Leong noted that potential risks are the same as those of other fillers, including arterial occlusion, contour irregularity and infection. Biostimulatory fillers may also cause nodules or allergic reactions.

For female patients wanting to enhance their sexual experience, the "O-shot" may be an option.

"The 'O' or 'orgasm' shot is an office-based procedure where growth factors, platelets and white blood cells from your blood are extracted and injected into targeted areas of the vagina and clitoris to improve the sexual experience and a woman's ability to achieve orgasm," said Dr. Leong.

Despite the name, the orgasm shot is not a single shot, and according to Dr. Leong, "a series of injections are recommended," with the effects lasting from six months to a year.

Leong shared that the O-shot carries few risks "as long as your provider is familiar with the anatomy."

A good reminder that when it comes to any medical procedure – regardless of the area of the body – choosing an experienced, board-certified surgeon is important.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.