Many might say, why is there a need to lift the scrotal area? Well, just like women lift their breasts, men can also lift their scrotal area.
Because we live on planet Earth and planet Earth has gravity, our bodies are constantly exposed to this downward force that makes everything fall, and and testes are no exception.
Testes are supported in a cutaneous sac for a reason—to protect spermatozoids from dying as a result of high temperatures. The internal average temperature of the body is 42 °C, but thanks to the scrotal sac, the temperature of the testes is a couple of degrees lower.
However, as it is named, it is a “sack” that supports the weight of the testes, and over time it starts to elongate. This, plus the aging process of this naturally thin skin makes it not only ptotic but wrinkled, making it look old.
The situation is even more evident as today, men tend to shave down there, just like women do. As men, they can go to the gym, even help themselves with some hormone replacement to make themselves look younger, so this elongated and wrinkled scrotal sac just does not fit with this masculine body. Also, with hormone use, the penis size can decrease, making the scrotal sac hang and show even more. This is why more and more men are seeking this type of procedure.
Why Offer a Scrotal Lift?
With time everything falls, and the scrotal region is no exception.
Having a masculine, defined body is synonymous with being young and fit, and an elongated and wrinkled scrotal region just does not match this appearance.
Taking hormones, especially to better define their bodies, can have consequences in men, such as a decrease in penis size, making the hanging scrotal region more evident.
Why It Is Important as Doctors to Offer These Types of Treatments?
As we all know, our specialty was born after there was enough technology to save soldiers that were injured in battle, but even though they were saved, they still did not want to live. Therefore, a group of doctors who were more open to listening to their patients understood that it was more important to work towards improving the quality of life of these patients, rather than to save them but leave them with sequelae that did not allow them to experience life in the same way as before they were injured.
So, if we keep on the same line of thinking, aesthetic plastic surgery is no different. We are here to improve the patient’s quality of life and if a scrotal lift will help develop confidence in a man who is fighting against aging, why not help him?
Important Anatomy
The scrotum is the skin that continues from the lower abdomen and behind the penis, forming a sac surrounding the testes.
The scrotum is made of layers, the skin and the dartos being the most relevant for this scrotal lift procedure.
The dartos or dartos fascia is a layer of connective tissue that surrounds the scrotum and also surrounds the penis, being called in this area the superficial fascia of the penis, and when it extends to the abdomen it becomes Scarpa’s fascia.
Dartos fascia is superficial to the spermatic fascia and is important in reducing the temperature of the testes. Dartos fascia contains smooth muscle responsible for the wrinkling and expansion of the scrotal skin used for temperature control of the area. Its innervation comes from the ilioinguinal and posterior scrotal nerves.
Other Approaches to the Area
It is common for us to recommend hydrating creams and lotions when we have wrinkled skin or to even promote the use of these to prevent wrinkles from appearing. However, the scrotal area is exposed to heat and commonly can sweat. When applying lotions or creams, often the skin can tend to sweat more, so using conventional hydrating creams in this area is not recommended.
Also, using different skin-tightening nonsurgical procedures has not been explored yet, perhaps because scrotal skin is very thin and sensitive to heat exposure, and all these skin-tightening technologies are based on energy devices that produce some kind of heat. Remember that testes should not be exposed to high temperatures.
Expert Approach: Scrotal Lift
Enzo Citarella
Plastic Surgeon
Rio di Janeiro, Brazil
Dr. Enzo Rivera Citarella is well known worldwide as a plastic surgeon for facial rejuvenation, and through time, after listening to his patients, has discovered this innovative procedure, being a pioneer in this field of scrotal lift surgery. Let us see what he has to tell us regarding this unique approach to male genital rejuvenation.
Why did you decide to do this technique?
I realized that scrotoplasty surgery was not readily available and it was something some of my patients had asked me about, as they were concerned that their testes looked aged compared with the rest of their body after undergoing other cosmetic procedures.
When did you learn it or If it is your own, how did you end up doing it?
The urologists, who were the most exposed to these patients’ concerns, had not conceived of this surgery. So, after listening to my patients’ concerns, I decided I really wanted to help them and started to design the surgery myself.
I thought about doing a horizontal incision and where was best to place it, discussed it with a very experienced urologist I knew, and started putting together the procedure. Also, I realized that careful resection of the skin without compromising underlying structures was necessary to have a successful outcome, and therefore I started performing scrotoplasties. As a general surgeon as well as a plastic surgeon, I knew the anatomy, and this was how I started to do the procedure 5 years ago.
What do you consider to be important landmarks and anatomy to be able to better perform this technique?
It is important to identify the dartos fascia as this has to be preserved along with the deeper anatomical structures (external spermatic fascia, cremaster muscle, internal spermatic fascia, and tunica vaginalis). Consequently, just the skin is resected.
Can you explain to us how you do the assessment on a patient asking for the procedure? Can you give us some guidelines for constructing an assessment chart?
The patient has to be unhappy with the excess skin on his testes. This is the most important factor. The patient really has to have excess skin so that a resection can be done. After resection, the skin borders surrounding the testes need to be sutured together with just enough tension, but not too much.
The assessment is therefore done at the preoperative stage and is on an individual basis. The amount of skin to be resected varies from patient to patient, and there are no specific landmarks. Some patients have more excess skin than others. The skin to be resected must be measured before starting the scrotoplasty surgery. The patient is marked while in a standing position, and the markings are done based on a pinch test to measure how much skin will be resected. As the scrotal skin is very elastic, you must not be shy on the resection.
Can you describe your technique?
A scrotoplasty surgery consists of resecting the excess cutaneous tissue while preserving the dartos fascia and the other deep anatomical structures. The skin is marked with a pinch test; a transverse ellipse is drawn in methylene blue.
