Circumcision Before and After Gallery

Before proceeding, please be aware this page contains anatomical photographs.

Before Images

Outcome of circumcision done elsewhere

After Images

1 and 2 months after revision done by David Cornell, M.D., FACS

Description

This gentleman was in his early twenties and had a circumcision performed for cosmetic reasons by a urologist in a major city in the Pacific Northwest. He was very unhappy with the appearance of his penis after this procedure, mainly because the suture technique resulted in unattractive “railroad track” appearance of the scar. This was the result of surgical technique related to suture size, individual suture placement, and overzealous tightening of the sutures with tying. He is a man with darker skin pigmentation which makes suture marks really stand out. When the sutures are tied too tightly, it cuts off the blood supply to the skin underneath each knot. When skin is deprived of blood flow, the pigmentation is diminished, resulting in the lighter track marks. The technique involved ascertaining that the man had enough remaining penile skin to allow for excision of the old scar and closure of the skin without excessive tension. I make this determination by stretching the penis to simulate erect length and moving the skin from one side of the scar to the other. This man had adequate skin remaining to allow this to be accomplished. I administered a local anesthetic by injecting the agent around the base of the penis. I marked the incision points on either side of the scar. Using a scalpel, I made the two incisions and removed the scarred skin, controlling the bleeding with electrocautery, until the ring of scarred skin had been removed. I then closed the skin with fine absorbable suture material. I applied paper skin closure tapes to further reinforce the wound edges, and applied a sterile compression dressing of conforming gauze anus Coban. Surgical time was about forty-five minutes. The before and after images are presented. The gentleman was very happy with his result.

After Images

After Initial circumcision for a man in his mid 20's

Description

This gentleman elected to have his circumcision for cosmetic reasons. His preferences were for a moderately tight overall skin fit and the incision line fairly close to the glans.

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. 

After Images

Description

This man had an adult circumcision with which he was displeased for the reasons of symmetry of the scar and unsightly suture marks. He sought advice about the possibility of refining the scar. In order to accomplish this, he needed to have the old scar excised completely and the wound sutured. It was important first to ascertain that he had enough penile skin to allow for the scar to be removed. This was done by stretching the penis to simulate erect length and moving the proposed incision lines together. This was done and it was determined that the wound edges would not be under excessive tension. After he decided to proceed, local anesthetic injections were administered around the base of the penis. The adequacy of the anesthetic was ascertained before proceeding. Then the incision lines were marked on either side of the old scar. Symmetry was assured by measuring the marks from the corona of the glans. Incisions were made on either side of the scar and the old scar removed. Bleeding points were stopped with electrocautery. The skin edges were carefully approximated with fine, absorbable suture material. Placement of the stitches very close to the edges and tied with just the right amount of tension result in a very fine scar with no suture marks. Paper wound closure tapes and a sterile compression dressing were applied. 

The images here were taken about four months following the procedure.

Before Images

After Images

Description

This patient sought me out for an initial circumcision for aesthetic preferences. He had a normal retractable foreskin. He wanted to have the frenulum removed and preferred an outcome with a moderately snug skin fit and the incision line about 2 centimeters from the corona of the glans. 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. You can see from the images that the outcome is symmetrical and that no suture scars are present. This requires attention to detail and careful surgical technique. These images were taken about five months after the procedure.

Before Images

After Images

3 months postoperative

Description

This man desired to have a circumcision for aesthetic preferences. He wished to have an exaggerated “high and tight” appearance. What he meant by this was for a long strip of the mucosal (inner) surface to be preserved with the scar line as far back from the edge of the corona of the glans as possible. He also wanted the overall fit of the penile skin to be tight with very little skin movement when erect. His incision lines were carefully marked to ensure symmetry and the foreskin was removed with a sleeve resection technique, the frenulum was removed, and the skin closed with careful attention to optimal cosmetic results. A pressure dressing was applied which was left in place for two weeks.

The images shown here were from before the procedure and about six months postoperatively.

Before Images

After Images

Description

This patient is a middle aged gentleman from the United Kingdom. He had had an adult circumcision done in London for aesthetic reasons but was not satisfied with the outcome because he thought he had too much skin redundancy and had visible suture scars. He wanted a smooth appearance with a cleaner incision line. In order to revise his outcome, it was necessary to make an incision on each side of the old scar. The proposed incision lines were marked with a skin marking pen. A simulation of his erect length was done by stretching the penis and, using a forcep, these two points were moved together. This was carried out to ascertain that the wound edges could be sutured together without excessive tension. In fact a bit more skin was able to be removed in order to give this man the skin tightness he desired. The skin between the incision lines was removed as a single ring of tissue, bleeding was stopped with electrocautery, and the skin edges sutured with a fine absorbable material. The outcome images published here show that the skin lies very smooth, the scar is symmetrical, and there is no trace of any suture marks.

After Images

Description

This gentleman in his early thirties from Las Vegas, Nevada sought an initial circumcision for aesthetic reasons. His only outcome preferences expressed preoperatively were that he wanted to preserve a long segment of the inner foreskin (mucosal surface) and wanted to have the frenulum removed. His procedure was done after local anesthetic solution was injected at the base of the penis and his sensation demonstrated to be absent. Incision points on the outer and inner surfaces of the foreskin were identified and marked with a surgical marking pen. The penis was then stretched to simulate his erect length. This man has a greater increase in length when going from flaccid to erect than most men. It is crucial that the fit of the skin after circumcision is comfortable in the erect state. A patient like this gentleman will have some skin wrinkling in his flaccid state in order to have enough skin to give him a comfortable erection. Incision points were identified that would give a comfortable, but snug, erect state. The foreskin was removed using the sleeve resection technique by making incisions on both the outer and inner surfaces of the foreskin. Bleeding was stopped using electrocautery. Then the frenulum was removed. The skin edges were closed with delicate stitches using fine absorbable suture material on the type of needle used for cosmetic surgery. Sterile paper wound closure tapes were applied to help with skin edge approximation. A sterile compression bandage was applied. 

The outcome images were taken several months after the procedure. They show a very smooth erect outcome with no suture marks visible.

Before Images

After Images

Description

This man in his twenties sought a circumcision for personal preference. He had a normal, retractile foreskin. He had no preferences in terms of outcome appearance. For adult circumcision, I use the sleeve resection technique in which the foreskin is removed using a scalpel as a single ring of tissue. In my opinion, this gives a symmetrical, thin, delicate incision line. In addition to a very thin scar line, this technique allows the outcome to be conformed to the patient's underlying anatomy and permits customizing his outcome to achieve a particular cosmetic result he wishes me to produce. This involves making an incision on the outer surface of the foreskin at approximately the point where the edge of the glans (corona) is visible as 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. You can see from the images that the outcome is symmetrical and that no suture scars are present. This requires attention to detail and careful surgical technique. These images were taken about six months after the procedure.

Before Images

After Images

Description

This gentleman in his forties had had a neonatal circumcision which had become loose over the years due to stretching of the skin. He sought me out for circumcision revision. He wanted the outcome to be tight so that the penile skin fit snugly over the functional components of the penis and preferred to have the incision line rather far back from the corona of the glans in order to preserve most of the mucosal (inner) surface of the foreskin. Not every man has the foreskin configuration that allows for preservation of this long of a strip of the mucosa. Specifically, if the foreskin tapers down toward the tip, only the portion of the mucosal side of the foreskin that is the same circumference as the shaft circumference can be retained. If you try to preserve the narrower portion of the mucosa a constricting ring will result leading to prolonged swelling that will spoil the outcome. This patient had a foreskin that was almost the same circumference to the tip. 

1% lidocaine was administered with injections around the base of the penis to provide local anesthesia. The mucosal incision point was marked with a surgical marker. The distance from the corona of the glans to the mucosal incision mark was measured. The foreskin was repositioned to cover the glans and the same distance was measured on the outer skin surface from the corona and marked. The penis was then stretched to simulate the erect length of the penis. A forceps was used to move the two incision points together to determine that the outcome would not be overly tight to allow for comfortable erections. Using a scalpel, incisions were made at the level of these lines on both surfaces of the foreskin. Each incision was developed one cell layer thickness at a time until the foreskin was detached. At this point, the foreskin was removed as one piece. Bleeding vessels were stopped with electrocautery. Once the bleeding was stopped, the wound edges were sutured with very fine stitches placed very close to the skin edges. As you can observe in the outcome images, no scars occurred where stitches had been placed. Paper wound closure strips were applied to take tension off the stitches. The penis was then wrapped with a compressive bandage of gauze and Coban. 

These outcome images were taken several months after the procedure. The patient contributed his outcome images to the Website because he was very happy with the result.

After Images

Description

Circumcision revision for a gentleman in his mid-twenties; no pre-revision photos available.

Before Images

After Images

3 months postoperative

Before Images

After Images

Description

Initial circumcision for a gentleman in his mid-fifties done very loosely by his specification.

After Images

Description

Revision for a gentleman in his early sixties.

After Images

Description

Initial circumcision for male in early 20's.

After Images

Description

Revision using GOMCO clamp by patient request for gentleman in his early 20s.

After Images

Description

Circumcision Revision for 49 year old gentleman.

After Images

Description

Initial circumcision for male in his early 20s.

Before Image

After Images

Description

Initial circumcision for male in his 30s. Procedure done to patient's specifications.

After Images

Description

Circumcision revision for male in his 30s.

After Images

Description

Scrotal recession procedure done for male in his 60s.

Circumcision Surgery - Before And After Pictures

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's surface. After the anesthetic is injected, I allow five to ten minutes for effect to occur and then check the patient’s sensation to ascertain that he cannot feel pain. Only after the patient is comfortable do I begin the procedure.

Which Adult Circumcision Technique Do We Use?

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.

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 the foreskin removed.

I also perform revision procedures for men who wish to have their circumcisions appear different from their current status. They may wish to have the overall fit of the skin on the penis to be made tighter, the frenulum removed, cosmetic appearance of the scar line improved, or symmetry of the skin improved. In performing a revision procedure, I make an incision on each side of the previous scar and remove it along with as much additional skin as the patient desires. The wound closure is the same as for initial circumcisions.

Cosmetic Dentistry

Traveling from out of town?

The Atlanta airport is a massive travel hub that makes it easy for circumcision patients to travel from all over the United States - and the world - to receive the highest quality circumcision treatment.

Patients have come to Dr. Cornell from all 50 states and many other countries.