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

March 30, 1994|LESLIE KNOWLTON | SPECIAL TO THE TIMES

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.

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