Procedure

Suspensory ligament release

Suspensory ligament release explained: what the evidence actually shows, realistic outcomes, and honest risks — with sources, not guesswork.

Also known as: penile lengthening surgery, ligamentolysis, penile length increase surgery

AnaesthesiaGeneral

Operating time45–170 min

Hospital stay0–1 nights

Days in Türkiye7–10 days

Back to work1–2 weeks (desk work); sex avoided ~6 weeks; many protocols use post-op traction for months

Medically reviewed by Dr. Elif Yılmaz, MD, FECSM

Last reviewed 22 July 2026

✓ Clinician reviewed

Suspensory ligament release — Andrology Abroad procedure guide

✓ Clinician-reviewed information

Key takeaways

Suspensory ligament release detaches the ligament anchoring the penis to the pubic bone, which can increase the visible, exposed length of the flaccid penis.
As a standalone cosmetic procedure it has a genuinely controversial history — multiple reviews describe historical outcomes as inconsistent and complication rates as "unacceptably high", with some experts calling it investigational.
The SMSNA position, as of 2024, is that ligament division may increase flaccid length when performed by experienced surgeons — a cautious, conditional statement, not an enthusiastic one.
Better-controlled evidence exists for this technique as an adjunct during penile implant surgery, where a randomized trial found it improved perceived length and satisfaction, at the cost of a longer operation.
Newer approaches now include explicit pre-operative psychological screening for body dysmorphic disorder — itself a sign of how seriously this field now takes the historical problems with this operation.

About suspensory ligament release

The suspensory ligament anchors the base of the penis to the pubic bone. Suspensory ligament release is a surgery that cuts this ligament. The aim is to let more of the internal part of the shaft — which normally sits tucked inside the body — come forward, increasing the visible length of the flaccid penis. The effect on stretched or erect length is smaller and less consistent.

This procedure has been used in two genuinely different ways, with very different levels of evidence, and this page treats them separately rather than blending them.

As a standalone cosmetic procedure, purely to increase length, it has a troubled history. Multiple reviews describe outcomes as inconsistent and poorly standardised, with indications and results poorly defined, and complication rates in at least one review called "unacceptably high". That review concluded these procedures should be regarded as investigational until better data exists. Known problems include the ligament gradually re-attaching, so some initial gain is lost; a change in the angle of erection, since the ligament normally provides upward support; and, in some men, reduced stability during sex. These are functional concerns, not just cosmetic ones. Reflecting this, the SMSNA’s position is cautious: ligament division, when performed by experienced surgeons, may increase flaccid length — a qualified statement, not an endorsement.

As an adjunct to penile implant surgery, the evidence is more encouraging and better controlled. Perceived shortening is one of the most common reasons for dissatisfaction after an implant, even when the device works well. A randomized trial combined ligament release and fat-pad removal with implant placement in 61 men. The combined approach took longer but improved measured length and satisfaction, leading the authors to conclude the benefits outweigh the risks in this specific context, when done by an experienced surgeon.

Newer techniques are trying to improve the poor historical track record. A 2025 study of a trans-scrotal approach is notable not just for the technique but for its patient selection: every participant underwent psychological assessment screening for body dysmorphic disorder first. Research has also tried to predict who gains the most length, and found this remains genuinely unpredictable — no validated method yet reliably forecasts an individual’s outcome. That honest uncertainty is worth factoring into expectations, whichever context this is considered in.

Multiple published reviews have described historical outcomes as inconsistent, poorly standardised, and associated with "unacceptably high" complication rates, with some experts recommending it be regarded as investigational as a standalone cosmetic procedure.

Outcomes

In a randomized controlled trial of 61 men undergoing penile implant surgery, adding suspensory ligament release and pubic lipectomy via penopubic Z-plasty was associated with improved perceived penile length and higher sexual satisfaction scores at follow-up, compared with conventional implant surgery alone, at the cost of a longer operation (median 170 minutes versus 97.5 minutes).

Source: sciencedirect.com

Who it is for

✓ May be suitable if

•Men undergoing penile implant surgery who are specifically concerned about post-surgical perceived length reduction
•Men being treated by a surgeon experienced specifically in combining these techniques, given the RCT evidence reflects experienced-surgeon outcomes

✕ Not suitable if

•Men considering it as a standalone cosmetic procedure without full disclosure of the controversial, inconsistent historical outcome and complication data
•Men who have not had, or declined, psychological screening for body dysmorphic disorder where clinically appropriate
•Men unwilling to accept that gains may partially reverse over time, and that a change in erectile angle or stability is a recognised possible consequence
•Men expecting a large, guaranteed, predictable length gain, given that outcomes are genuinely unpredictable in the research

Preparing for surgery

Clarify explicitly whether this is planned as a standalone cosmetic procedure or an adjunct alongside penile implant surgery, since the evidence and expectations genuinely differ

If considering it standalone, seek a candid discussion of the historically inconsistent outcome data and consider psychological screening for body dysmorphic disorder

Ask specifically about your surgeon’s personal experience and case volume with this exact technique, given how strongly outcomes are tied to experience

If combining with an implant, discuss the RCT-supported approach directly and ask whether your surgeon has specific experience with the combined technique

Understand and plan for the likely need for ongoing post-operative traction or stretching device use over subsequent months

What recovery looks like

Day of surgery – Day 1–2

Most men go home the same day or after one night. Swelling, bruising, and discomfort at the surgical site are expected.

Week 1

Rest and limited activity advised. Follow-up wound checks typically scheduled.

Weeks 1–2

Gradual return to desk-based work and light daily activity for most men.

Weeks 2–6

Continued healing; strenuous activity, heavy lifting, and sex generally restricted, given the importance of secure healing before mechanical stress is reintroduced.

Months 1–6+

Many protocols involve ongoing use of a traction device during this period, specifically to help maintain gains and reduce the ligament re-attaching — a genuinely important, often underemphasised part of the treatment course.

Risks and complications

Change in the natural angle of the erect penis

since the released ligament normally provides upward support — a functional, not purely cosmetic, consequence

Reduced stability of the erection during intercourse

reported in some men after this procedure

Partial loss of initial length gain over time

as the ligament can gradually re-attach or scar back toward its original position

Historically high complication rates for standalone cosmetic use

described in multiple reviews as "unacceptably high", particularly when combined with fat injection

Infection, haematoma, and general surgical/anaesthetic risks

Genuine unpredictability in how much length gain, if any, an individual experiences

no fully validated method currently exists to reliably predict this in advance

Persistent psychological dissatisfaction

particularly relevant given how frequently body dysmorphic disorder features among men seeking this procedure

Common questions

Does this procedure actually work to make the penis longer?

It can increase the visible, exposed length of the flaccid penis by releasing the ligament that holds part of the shaft tucked internally — but published outcomes have historically been inconsistent, and gains can partially reverse over time as the ligament re-attaches. The evidence is more solid when used specifically alongside penile implant surgery than as a standalone cosmetic procedure.

Is this a controversial procedure?

Yes, honestly — as a standalone cosmetic length procedure, multiple reviews describe historical outcomes and complication rates as inconsistent and, in some cases, "unacceptably high", with some experts recommending it be regarded as investigational. This is not a minor caveat; it is central to understanding this procedure before considering it in that context.

Will my erections still work normally afterward?

This is a genuine concern worth discussing directly — since the ligament normally provides some support during erection, its release can change the natural angle and, in some men, reduce stability during sex. This is a functional consideration, not purely cosmetic, and deserves honest discussion before proceeding.

Why is this sometimes done alongside penile implant surgery?

Because perceived post-implant length reduction is one of the most common reasons for dissatisfaction after an otherwise successful implant, and a randomized trial found combining ligament release and fat-pad removal with implant surgery improved perceived length and satisfaction in this context, when performed by an experienced surgeon.

Will the length gain last, or does it wear off?

This is genuinely variable — the ligament can gradually re-attach over time, which is why some protocols include ongoing post-operative use of a traction device over subsequent months, specifically to try to maintain the gain. It is not guaranteed to be fully permanent for every individual.

Should I be screened for body dysmorphic disorder before this?

This is genuinely recommended, and increasingly built into responsible modern practice for this procedure, given how frequently body dysmorphic disorder has featured among men seeking standalone cosmetic lengthening. This is not a judgement of your concern — it is a recognised, important part of appropriate care here.

How do I know if my surgeon has enough experience with this?

Published outcomes are strongly tied to surgeon experience, reflected explicitly in the SMSNA’s cautious position referencing "experienced surgeons". Asking about case volume, specific outcomes, and complication rates for this exact procedure is a reasonable, important part of your own due diligence.

Should I get a second opinion before proceeding?

Given the mixed and, in places, concerning historical evidence for standalone cosmetic use, seeking a second, independent opinion — ideally from a specialist who did not perform your original consultation — is a reasonable, sensible step rather than an unusual one, particularly for a procedure with this level of documented controversy.

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Sources

The Efficacy of Suspensory Ligament Release and Pubic Lipectomy During Penile Prosthesis Implantation: A Prospective RCT. https://www.sciencedirect.com/science/article/abs/pii/S1743609522006063
Karimian B, et al. Trans-scrotal Suspensory Ligament Release: A Novel Technique for Penile Length Augmentation. Aesthetic Plast Surg. 2026. https://pubmed.ncbi.nlm.nih.gov/40603773/
Morphometric Predictors of Penile Length Increase After Division of its Suspensory Ligament. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11058788/
AUA. Position Statement on Penile Augmentation Surgery. https://www.auanet.org/about-us/policy-and-position-statements/penile-augmentation-surgery