New Surgeries--Just for Men : Health: Procedures to widen and lengthen the penis are gaining favor--and sparking debate over necessity and safety.

Between operations at his Culver City office, Dr. Melvyn Rosenstein, dressed in surgical greens, leans back and discusses his booming business: penis enlargements.

His interest in male sexuality, he says, stems back to the early 1970s, when during his urology residency at New York University School of Medicine he learned to do penile implants. But over the years, he learned that there were other issues that transcended impotence. Many men believed that their penises were not large enough.

About a year ago, Rosenstein, 54, teamed with marketing expert Ed Tilden, who had approached the doctor with a business plan. Since then, Tilden has opened and staffed nationwide sales offices, arranged more than 60 radio interviews and several TV shows, and launched a massive advertising campaign coast to coast.

Men and women (Tilden says about 20% of the calls are from females) who respond to the ads or hear the talk shows telephone Tilden’s sales personnel, who invite them in to discuss the operation plus view diagrams and photographs. Customers are told they can pay for the operation through a signature loan arranged with a finance company. Men who want the operations are sent to Rosenstein’s medical office for the outpatient surgery.

As a result of patient referrals and the ads--which cost $200,000 a month--26 sales offices now take more than 2,000 calls a day, consult with 1,500 patients in person a week and net Rosenstein more than 150 operations a month. (“They’re flying in from all over now,” Tilden says. “We just took a credit card over the phone from Guam.”)

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Ed Tilden sits in his sixth-floor executive suite in the Gateway West building on Avenue of the Stars. It’s here, overlooking the bustling Century City Mall, that he has three salesmen fielding about 130 calls a day.

They purvey penis widening and lengthening operations, two procedures that may be on their way to becoming the most controversial cosmetic surgeries since breast enlargements. Like breast augmentations, they are sparking serious debate in the medical community: Some doctors question not only the necessity of the surgeries, but also the aggressive marketing techniques some employ.

There is also contention over the safety of the procedures--potential physical and psychological risks include nerve injury, embolism and inhibited erections.

And squabbles persist over the absence of studies done on the cosmetic use of these surgeries. Proponents argue that there is no proof that they are unsafe, while opponents maintain that because they are unproven, they shouldn’t be done except as investigational procedures under the auspices of an institutional review board.

Amid the cross-fire, Tilden’s sales team (called “medical assistants”) funnels patients to Rosenstein, a board-certified urologist and one of at least two dozen doctors nationwide performing the operations. But unlike most others, this physician--with Tilden’s marketing expertise--has made enlargements his nationally advertised specialty.

One ad reads, “Most Patients WILL double in size . . . DREAMS DO COME TRUE,” and gives an 800-number for a free 20-minute consultation.

Rosenstein has performed about 1,500 widening and lengthening procedures on about 900 men since 1991. (The package costs $5,900.)

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Penis enlargements involve transferring a man’s body fat to his penis’ shaft and shifting part of the penis’s root outside the body (about one-third of the penis is inside). With penile implants, a device is inserted to aid in erection.

Most doctors who do the operations agree that men want the procedures not because their penises are abnormally small or dysfunctional, but simply because they want to be bigger.

And that troubles Dr. Perry Nadig, a University of Texas clinical professor of urologic surgery.

“Its only purpose is to cosmetically change a perceived deficiency in body image,” he says.

“The emotional and psychological implications of the perceived abnormality of the penis go far beyond the ground that other types of cosmetic surgery tread on,” adds Nadig, who helped draft a recent American Urological Assn. statement that says the two penis procedures are unproven.

“If your ears don’t match, there may be a good reason for surgery,” he says. “But for something lurking out of sight most of the time, who are they doing it for? These men need psychotherapy, not surgery.”

“Ridiculous,” Tilden counters. “Do women get psychotherapy for breast enlargements? For liposuction? For rhinoplasty? Anyone should be able to choose to satisfy themselves.”

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Penis-lengthening operations were first done about 50 years ago for boys born with retracted or deformed penises. The penis-widening operation is newer. It started in 1990 when a Miami plastic surgeon began experimenting on patients; others followed suit. Although both cosmetic operations have been conducted as a package for about three years, their recent popularity has mobilized doctors to express reservations.

Dr. Frederick Grazer, a board-certified plastic surgeon in Corona del Mar, says he informally polled colleagues about the procedures. Reports Grazer: “For the most part, nobody in their right mind would support it.”

And urologist E. Douglas Whitehead, director of the Assn. for Male Sexual Dysfunction in New York, says most urologists feel “very negatively” about the surgeries.

“You’re cutting a ligament (in the lengthening procedure) that’s very near important blood vessels and nerves,” says Whitehead, who is also an associate clinical professor of urology at the Mt. Sinai School of Medicine in New York. “This is a potential danger. And the vast majority who have the surgery are very unsatisfied because their expectations are not met by results. I would not do it without psychiatric clearance: There may be adverse psychological reactions after the operation.”

Not so, Rosenstein says. He says his operation does some men “more good than 10 years of psychotherapy. Why recommend psychotherapy?” he asks. “The only criteria are the way the man feels about his size, how he feels in the locker room. Psychotherapy doesn’t change that, and it’s a lot more expensive.”

Beverly Hills plastic surgeon Dr. Brian H. Novack, who performs penis enlargements, agrees that some men need professional counseling. “(The operation) is not a panacea. It’s like penicillin: It works, but it doesn’t cure cancer. In many cases, I certainly recommend psychotherapy.”

Dave, a patient of Novack’s who asked that his real name not be used, doesn’t think any amount of counseling will change the way most men feel.

“Most guys think they’re not big enough,” he says. “It’s purely a man thing--all in his (mind). But once it’s in there, it starts to take its toll and the only thing that’ll cure it is to be larger. There was nothing a psychiatrist could’ve said to me.”

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What should a patient expect?

There are no guarantees with penis enlargements, Rosenstein says, but he says 90% of his patients add two inches in length and double in diameter. The largest length increase, he says, has been more than three inches.

Unlike other doctors who perform the operations, Rosenstein says the newly exposed part of the penis is significantly longer whether erect or flaccid. And Rosenstein claims--unlike other doctors--that his patients retain 90% of the added girth, although a “small percentage” do opt to return for additional fat transplants.

Novack says a couple of inches in exposed length is “very rare.” Most are in the “one-inch range,” and most of that gain is only in the flaccid state.

About three years ago, he performed his first fat injection to a penis and began studying lengthening techniques; a year ago, he went to China to work with Dr. Long Daochou, a penis-lengthening innovator who Novack says has done 600 operations since 1984. Novack--who charges $5,000 for the package--says he has performed 50 penile package operations and 100 fat-transfer operations, and has given seminars on the procedure.

“We’re just at the beginning of what I think is going to be a very popular surgery,” he says. “But there’s a tremendous amount of incorrect information out there.”

Most men before the surgery are “completely average” with an erection, Novack explains. “But in the flaccid state, there’s a lot of retraction. The surgery makes the penis hang lower.”

Novack says about 70% of the added fat is reabsorbed within four months of the initial transplant. “But after two or three operations, they can eventually get one to two inches that’ll last in girth.”

Adds Miami urologist Harold M. Reed, who has enlarged about 500 penises since 1986:

“The best results I get are seen in girth--I guarantee an inch--with the next best results in the flaccid length and the least consistent in the erected length. And this makes men happy, because they’re really getting the operation out of embarrassment at being exposed to others in the locker room.”

Like Rosenstein, Reed has started advertising nationally, a practice that until recently was not widely done by physicians.

“Traditionally, advertising is not something ethical doctors do, but it’s widely done now. Most doctors feel their own reputations should be the thing to announce themselves, but we’re in a new world now,” Nadig, of the University of Texas, says.

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None of Novack’s or Rosenstein’s patients were willing to release their real names or telephone numbers, but about a dozen called The Times at their doctors’ requests.

“I was very skeptical at first,” says John, 28, a San Fernando Valley firefighter who, after seeing Rosenstein’s newspaper advertisement, had the operations in July. “After all, I only have one (penis). But it’s made a huge difference in my whole overall attitude. I feel so confident now.”

John, who says he’s confided in no one about his operation, describes himself as an “average guy who just wanted to be a little bigger.”

“You think about it subconsciously,” he says. “And you take showers in front of other guys and wonder about yourself. I just figured, if I could have this, then why not?”

John says the operation increased his penis’s erect and flaccid length by 1 3/4 inches and widened it by about 40%. He hasn’t noticed any loss in width since the operation.

“I’m still getting used to it,” he says. “But I definitely feel better about myself. It’s an internal thing.”

Dave, who calls himself an “average middle-class guy in his early 30s,” says there was no specific event that made him start feeling insecure.

“I’ve always been told by women that I’m a good lover,” he says. “But guys just give other guys a hard time and you start to wonder: Am I big enough?”

Earlier this year, he says, he saw Novack on a television show and phoned the doctor, who told Dave that he was average when erect and that when flaccid, he simply constricted more than other men do.

Dave paid $5,000 for the operation, which made his penis a “good inch” longer in the flaccid state and an inch wider. As Novack predicted, much of the initial added girth disappeared, so Dave paid an additional $1,000 for another transplant, which “took better.” He says he may go back a third time.

“I’m more comfortable both outside the house and inside the bedroom,” he says. “It does wonders for your mind.” He pauses. “Size matters. I know it sounds ridiculous, but we’re men, and that’s all there is to it.”