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Circumcision Center FAQs

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Frequently Asked Questions

What is the cost of the procedure?

As of 2013, the fee for first-time circumcisions and revisions is $2500. If the foreskin is non-retractable, the fee is $3000. We do not accept insurance for these services.

For what reasons do you perform circumcisions?

The most common reasons for which I perform circumcisions are:

  • Cosmetic appearance
  • Phimosis (tight foreskin)
  • Paraphimosis (inability to pull the retracted foreskin back over the glans)
  • Balanitis and balanoposthitis (inflammation of glans and foreskin)
  • Frenulum breve (short frenulum which tears with intercourse)
  • Diseases of the foreskin, including cancer

How does adult circumcision differ technically from neonatal circumcision?

Neonatal circumcision is performed utilizing one of a number of clamp devices which remove the redundant foreskin, stop bleeding arteries and veins by crushing them, and bond the skin edges without the need for sutures. The most common devices used are the GOMCO (acronym for Goldstein Manufacturing Company) introduced in 1934, The Mogen clamp introduced in 1954, and the Hollister PlastiBell clamp introduced in 1950. Each one of these creates a pressure bond to hold together the skin edges so that their is no need for sutures. These devices provide an adequate wound closure for infants because they do not have powerful enough erections to pull apart the skin edges. The bond created by these clamps at the skin edges consists of the clamp crushing the two opposing skin edges together. The force of a powerful erection would pull apart the wound edges resulting in wound 'dehiscence' or opening up of the wound thus making it an inadequate wound closure for a circumcision in an older child or adult. Adults require a suture closure (stitches) to provide a secure enough closure to allow the wound to remain intact despite the force of erections. Also, it should be mentioned that careful suture closure leads to a much finer scar once the healing is complete. Sutures guide the healing edges of the wound close together so that the end result is a very fine line. I have performed some circumcisions in which I did not suture (stitch) the wound. The results were scars that were wider than ones I create with suture closure.

Neonatal circumcisions are done with minimal local anesthesia or no anesthesia. Using a clamp device, a neonatal circumcision is a quick, five minute procedure. An adult circumcision is a more lengthy procedure and requires a more elaborate anesthetic. Many urologists perform adult circumcisions with general anesthesia. This is a more complicated and expensive procedure than local anesthesia. I perform almost all of the procedures for my patients utilizing local anesthetics. This involves a series of injections around the base of the penis to encircle the penile circumference with the anesthetic agent. The injections are not particularly painful since the injections are just beneath the skin surface. After the anesthetic is injected, I allow five to ten minutes for the effect to occur and then check the patient’s sensation to ascertain that he is not able to feel pain. I use the sleeve resection technique in which I remove the redundant foreskin with a scalpel. This involves making an incision on the outer surface of the foreskin at the level where the edge of the glans (corona) is visible making an impression through the foreskin. I then retract the foreskin and make an incision in the inner (mucosal) surface of the foreskin following the contour of the glans. I mark the incision lines before making any incision and make measurements to be certain that the incisions will result in removing enough foreskin to meet the patient’s cosmetic preferences and allow for comfortable erections. An adult circumcision should be crafted to accommodate the dimensions of the erect penis. I simulate erect length by stretching the penis. I mark incision lines with an ink marker and then stretch the penis and move the two incision lines into proximity. I want these two points to come together without excessive tension. This will avoid uncomfortable erections. Once I have determined the correct location of the incision lines, I make the outer incision, retract the foreskin and make the inner incision and remove the foreskin as one piece of tissue. Bleeding points are identified and cauterized with electrocautery. The frenulum is then removed if the patient desires this to be done. I then close the wound with fine sutures, placed in a very precise manner so that suture marks and tunnels will not occur, and finally apply a compression bandage to the surgical site. Typical outcome images can be viewed on the circumcisioncenter.com Website.

Is a consultation visit necessary prior to deciding on circumcision?

Yes, it is important to have a consultation visit. The consultation is included and the time required is approximately 30 minutes. Both the consultation and procedure may be performed during the same office visit, requiring an overall time of one and a half hours.

Do you treat non-US citizens?

Yes, we gladly treat patients from any country. There are many low fares into Hartsfield-Jackson Atlanta International Airport and our location is a convenient 30-minute train ride by MARTA. Travel information can be found here.

I am traveling into Atlanta specifically for this procedure. How long will I need to stay and do you recommend any hotels nearby?

If I had my wish, all my patients would remain in Atlanta for several weeks to allow complete wound healing. This is not practical for most men. The majority of my patients travel out of Atlanta within 48 hours of the procedure and have no problems.

What is the recovery time for adults after circumcision?

I suggest a week of moderate activity following circumcision. Sedentary activity and travel is possible the same day.

Are there differences in circumcision procedure and outcome based on patient ethnic background?

I treat any circumcision procedure with an equal concern for the attention to detail with surgical technique. The principal features of technique that impact the quality of cosmetic outcome are 

  1. length of foreskin removed,
  2. symmetry of the incision lines, 
  3. gentleness of handling of the skin and the Dartos fascia layer which lies beneath the skin
  4. careful attention to control of bleeding arteries and veins,
  5. careful attention to aligning the skin edges for wound closure,
  6. delicate handling of the suturing (stitching) process so that suture scarring ("railroad track" scarring) does not result,
  7. suture technique which is performed to prevent suture tunnels (These are NOT the result of stitches remaining in too long but are entirely the result to the surgeon's technique.)
  8. proper postoperative dressing (bandage) application to minimize swelling and stretching of the healing tissues.

For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a single ring of tissue utilizing a scalpel. In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the final result to be customized to the patient's specifications if he has a particular outcome in mind. 

Click Here to Read More

What technique do you use for adult circumcision?

For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a single ring of tissue utilizing a scalpel. In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the final result to be customized to the patient's specifications if he has a particular outcome in mind. 

Many urologists perform adult circumcisions with general anesthesia. This is a more complicated and expensive procedure than local anesthesia. I perform almost all of the procedures for my patients utilizing local anesthetics. This involves a series of injections around the base of the penis to encircle the penile circumference with the anesthetic agent. The injections are not particularly painful since the injections are just beneath the skin surface. After the anesthetic is injected, I allow five to ten minutes for the effect to occur and then check the patient’s sensation to ascertain that he is not able to feel pain. Only after the patient is comfortable, do I begin the procedure. 

For adult circumcision, I use the sleeve resection technique in which the foreskin is removed as a ring of tissue with a scalpel. In my opinion, this gives a symmetrical, fine incision line. In addition to a refined scar line, this technique allows the outcome to be customized to the patient's specifications if he has a particular outcome concept he wishes me to produce. This involves making an incision on the outer surface of the foreskin at the level where the edge of the glans (corona) is visible making an impression through the foreskin. I then retract the foreskin and make an incision in the inner (mucosal) surface of the foreskin following the contour of the glans. I mark the incision lines before making any incision and make measurements to be certain that the incisions will result in removing enough foreskin to meet the patient’s cosmetic preferences and allow for comfortable erections. An adult circumcision should be crafted to accommodate the dimensions of the erect penis. I simulate erect length by stretching the penis. I mark incision lines with an ink marker and then stretch the penis and move the two incision lines into proximity. I want these two points to come together without excessive tension. This will avoid uncomfortable erections. Once I have determined the correct location of the incision lines, I make the outer incision, retract the foreskin and make the inner incision and remove the foreskin as one piece of tissue. Bleeding points are identified and cauterized with electrocautery. The frenulum is then removed if the patient desires this to be done. I then close the wound with fine sutures, placed in a very precise manner so that suture marks and tunnels will not occur, and finally apply a compression bandage to the surgical site. Typical outcome images can be viewed on the circumcisioncenter.com Website.

As mentioned in the initial paragraph, the outcome may be customized to patient preference. Since the incision on the outer surface of the foreskin is made separately from the incision on the inner, or mucosal, surface of the foreskin, these incisions can be made at different distances from the tip of the foreskin. The effect of this is that the incision line may be moved closer to the edge of the glans or further down the shaft. This is a separate issue from the overall tightness of the skin on the penis. The tightness has to do with the overall length of foreskin removed.

To learn more about this technique, click here

 

Will having a circumcision change the size of my penis?

Absolutely not. The structures of the penis that give it length and girth are deeper in the anatomy than the skin. The skin is the only component that is altered with a circumcision, therefore there is no possibility of altering penile size with a circumcision.

Can you perform revisions to improve the cosmetic appearance or tightness of an earlier circumcision?

Yes, this is a frequently performed procedure in the office.

I had an adult circumcision with with I am unhappy due to visible suture marks. Can you do a revision and eradicate these?

You can see photographic examples of some outcomes of revision in the Outcome Images section on the website. However, I cannot guarantee the outcome of any cosmetic procedure as there are wound healing differences from one patient to another. I have found with experience that revisions tend to heal with somewhat more scarring than initial procedures. This would seem to be the result of the blood supply to the wound edges having been altered (reduced) by the prior circumcision. That being said, it is still worth making an effort at revision, but, with realistic expectations.

Do you have an age limitation for circumcision?

No, in fact, I have performed circumcision for men over eighty years of age. The more important factor is the state of their general health to allow for minor surgery. However, minimum age is 18.

Will I be sedated for this procedure?

The injection is done at the base of the penis utilizing a short acting product called Lidocaine. The patient usually only feels several needle sticks and after that, no discomfort.

What if I am uncomfortable with having the procedure performed using local anesthesia?

If you are afraid of needles and/or tend to become faint at the sight of needles, it would be best to have your procedure performed under general anesthesia. Please contact my office to speak with a member of my staff about scheduling the procedure to be performed under general anesthesia.

Do you do frenulectomy (removal of frenulum)?

Yes, I do this if the patient desires it, either at the time of circumcision or as a separate procedure.

Do you recommend removal of the frenulum in adult circumcision?

The frenulum is a structure which is not identical in configuration from man to man. I suggest removing it only if it detracts from the overall aesthetic appearance.

Do you perform circumcision for cosmetic reasons?

I respect the aesthetic wishes of my patients and will gladly perform circumcisions for purely cosmetic reasons.

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