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• Step 1:

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• Step 2:

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Most guys would never admit it, but probably all of us have given some thought to penile enlargement surgery. Whether out of curiosity, self-consciousness, embarrassment, or a secret longing to be exceptionally well-hung, men very commonly seek information about surgery to increase the length and girth of the penis. In fact, a study of the top searches online shows "penis enlargement surgery" to be consistently among the most popular information requests.

And as anyone who has made such a search can tell you, there are plenty of men who not only wonder about it, but who actually go through with this major surgical procedure in their quest for the ideal penis.

The evolution of penile enlargement surgery: methods

The surgical procedure to lengthen the penis was developed in the late 1980s by Chinese surgeon Long Daochao. By 1991, penis augmentation surgery began to gain momentum -- but without the monitoring or endorsement of the American Board of Plastic Surgery nor the American Society of Plastic and Reconstructive Surgeons. Still, even without a professional organization's safety and quality guidelines, many men sought out the surgery.

Those first patients may have thought they needed a bigger staff, but apparently they had some balls: imagine being the guinea pig for cosmetic penis enlargement surgery! The original methods, which haven't changed much since then, involved attempts to lengthen the penis, increase the girth, or both.

Here's how it works: to add the appearance of length, the surgeon cuts the suspensory ligament that anchors the penis to the body, allowing it to drop down and forward; in this way, it is hoped that the portion of the penis that is normally held inside the body cavity will stretch outward and appear as more length. The penis isn't technically "lengthened" so much as it is uncovered or released from the body.

To add girth, doctors harvest fat cells from the man's body, usually from the buttocks or legs, then inject these cells into the penis to create a thicker shaft.

More recently, surgeons have refined these techniques and use other materials than fat as the implants: grafts of tissue from the man's own body or even from donor cadavers is now used to widen or enhance the penis.

What are the Risks, results and costs?

For most men, the thought of any of these procedures is too difficult to contemplate. But for others, the desire to change their manhood for the bigger and better is still overwhelming. Current estimates show that to date about 18,000 men have had the surgery.

Yet the surgery is still considered somewhat risky and only a relative few surgeons will perform it -- right now, only about 30 in the U.S. -- and then most will do it only if the patient is mature, emotionally stable and has submitted to counseling prior to the surgery.

Outcomes of early penis enlargement surgeries were often disastrous: many men were rendered impotent or disfigured, coming from surgery with freakishly shaped, red, raw, or in the worst cases, terminally limp penises.

Today’s surgeons have more knowledge and experience in performing these procedures, though critics still question the reliability and safety of the operation. The ligament-cutting method may create a gain of an inch or two in length, at the risk of total loss of support of the erect penis, so that, in the words of one man, "it flaps around like a helicopter blade." A surgically severed suspensory ligament can also cause erections to point downward, or even cause total loss of sensation and impotency.

The fat-injection method to increase penis girth can create lumpy, asymmetrical and unappealing results. Once injected, the fat can migrate unpredictably. Sometimes it bunches at the center of the shaft, creating a strange, football-shaped member; other times, the fat randomly lumps up so the penis appears blobby and irregularly shaped. Often, fat will reabsorb irregularly, so that over time the built-up girth is lost in some places more than others. Fat injections almost always feel soft, something like female breast tissue, even when the penis itself is erect.

Currently, the risks have decreased somewhat, but certainly the price tag has not: penis enlargement surgery currently runs an average of $8,000.

Who is a candidate for penis enlargement surgery?

Even after considering all the risks, many men still opt for penile surgery. How do they determine whether this is the right choice for them?

First, a candidate should be in excellent shape, physically and mentally. A doctor can assess overall health, determine whether other health concerns preclude the procedure (high blood pressure, history of urogenital problems, and so on) and make recommendations for counseling or medication if necessary.

Next, it's always wise to thoroughly study any cosmetic procedure, particularly focusing on individual doctors and their results.

Finally, only the prospective patient can gauge how deeply he is affected by concerns about his penis. Risks and costs are weighed against the possible benefits -- but always, a realistic view is the key. Men who dream of having a penis women would die for must consider that their results may not match the image they have in mind.