Sitting in the preparation room, the patient tells me his family works in real estate. We chat about our Zodiac signs and the weather before he heads to the operating table.
The man, 43, appears relaxed and unbothered, as if he's preparing to have his eyebrows waxed or teeth whitened. He disrobes and is covered by a surgical sheet with a hole over the groin.
He's calm, even as the plastic surgeon hovers over him, preparing to inject a long needle into his penis.
The injection contains dermal filler - a liquid substance that plumps the tissue between the muscle and the skin of the penis, increasing the size of the organ.
The patient, who has today visited the clinic for his fourth round of 'enhancing' injections, says he can't feel a thing — thanks to a local anesthetic — and is thrilled he'll again have, 'something bigger to play with'.
The patient was in the clinic for his fourth round of 'touch ups' to his genitals. Over time, the effect of the plumping fillers dissipates as its metabolized in the body
Dr David Shafer estimated he performs between four to five Shafer Width and Girth (SWAG) procedures daily.
When the 20-minute procedure is up, he jumps off the table, contented with the injection that allows him to maintain his extra two inches of girth. He pulls up his briefs and continues with the rest of his day, holding his head up higher as he walks down the street.
I am at the Shafer clinic in midtown Manhattan, run by plastic surgeon David Shafer to witness for myself the latest craze in male aesthetics treatments — penis filler.
Just like women who ask for plumping shots in their lips and cheeks, a growing number of men are now seeking Dr Shafer's services to boost the volume in their nether regions.
And demand for the procedure is swelling.
Dr Shafer said he used to do about one procedure per month in 2017, when he first began, and now does 10 to 20 procedures per week.
However, injecting filler into the genitals has not been approved by the FDA, which means this treatment isn’t monitored or regulated by medical authorities, though many doctors insist that when performed correctly, it's perfectly safe.
It turns out most patients who undergo this procedure do not have a 'deficit' that needs correcting. In fact, most have an appendage of average to above average size.
Dr Shafer said: ‘Really it’s people who are normal or larger, but they just want to boost what they have already.'
He added the procedure actually doesn’t work as well on people with below-average penis sizes because there’s less skin to work with.
Kenny, a Texas firefighter, who has had the procedure done said the treatment has helped him get erections more easily, and called it a 'miracle.' With his amended member, he said he felt like he 'couldn't go wrong' in the bedroom.
But even in average men, many are self conscious about their size, either because of a comment made by a former partner or schoolmate, or maybe because of social media, Dr Shafer said.
One study from UCLA that surveyed 52,000 men found 55 percent were dissatisfied with their penis size. The researchers also concluded men who felt they had larger members were more likely to rate themselves more favorably overall.
This suggests, they wrote, that feeling like you have a bigger penis could boost your self-confidence.
This is what Dr Shafer has seen in the patients he treats, telling me: 'For these people, they do it, and they have this new kind of confidence. So, it can be emotional for people sometimes.'
The patient I observed in the New York City clinic, who asked to remain anonymous, sees his regular medical 'tweaks' as no different to the ones women undergo to boost their breasts.
The male plastic surgery industry has been booming since 2000 - procedures for Botox in men have increased nearly 400 percent and butt lifts have increased more than 600 percent, according to the American Society of Plastic Surgeons.
This, overall, represents a 29 percent increase in the number of men having regulated plastic surgery. There are likely more getting unapproved tweaks.
There could be many factors as to why more men are getting these surgeries, but it's likely influenced by both an increased social media presence and increased longevity, Dr Joseph Russo, a New York based plastic surgeon, told the American Society of Plastic Surgeons.
'Partially because we're living longer and better lives, but a lot has to do with the rise in social media. We're not getting older and trying to look younger – we're staying looking young. The trend is shifting because men want to be a part of this,' he said.
So, what exactly is a penis filler procedure — and can it really be safe?
The cannula (pictured), is a long, thin plastic tool that looks like a needle, but is actually dull and rounded on the end. This is less risky than using a needle, which could puncture blood vessels as it moves around under the skin
First, I watched as the doctor cleaned the groin area with an alcohol solution to sanitize before rubbing a brown antiseptic solution all over. This is to prevent infection, he explained.
Next, he injected lidocaine into the man's penis - the same numbing product used in dental work.
Though the patient was calm that day, he remembered the nerves at this point during his first visit. He said he recalls thinking, 'my penis is about to be poked. I don't think any guy wants to imagine any sharp object near their penis.'
From there, the doctor used a small needle to pierce the skin and then threaded a long, thin plastic tube called a cannula into the space under the skin and above the muscle. The cannula is rounded on the end with a small hole on one side.
He then moved the cannula around the area under the skin, distributing syringe after syringe of a brand of filler called Bellafill - six in total in the patient's case - while moving the cannula up and down, like using a brush to clean a pipe.
I could see the cannula as it moved, like spaghetti under a sheet of fabric, and marveled at the fact the patient said he couldn't feel a thing.
This was repeated in three places across the penis to create a more balanced, natural looking appearance, Dr Shafer explained. Then the doctor placed several gauze sleeves over the penis.
Finally, the patient was allowed to get up, strap on his briefs, and continue with his day. The whole thing took less than 20 minutes. The patient recalled thinking after his first visit, 'wow, that was actually easier than I thought.'
But that's not the end of the story.
In the days after the filler is placed, it acts a bit like fresh pizza dough, Dr Shafer explained. It's malleable, a bit springy, and tends to stick to itself before it settles into a firm shape in a few weeks.
As such, Dr Shafer recommends that his patients 'roll it like a cigar' then use a gentle 'milking' motion to make sure the filler settles evenly.
If clients masturbate too vigorously or have penetrative sex during this period - the pressure from either can distort the new volume added to the appendage. This could give the penis dimples where the fingers would rest or push the filler toward the base, forming a triangular shape, Dr Shafer said.
The patient was able to put his briefs on immediately after the procedure and go about his day. He said the worst part was the numbing injection
The clinic is based in a high rise building in Midtown Manhattan. It was recently renovated and currently spans seven floors. One floor is dedicated solely to the SWAG procedure
If this happens, doctors can either inject the penis with different solution that dissolves the filler or add in more to balance it out, 'like frosting a cake,' Dr Shafer said.
Once it's healed, the filler has a firm, slightly padded feeling to the touch, the patient said. He said that ‘if anything, it's more sensitive’ than before he was treated.
The FDA has not approved any treatment of this sort for the penis. As such, providers are using these medications 'off label,' meaning they were approved for treating something else than they are currently used for.
This sounds a lot scarier than it actually is, Chris Bustamante, a nurse practitioner who runs Lushful aesthetics, a New York-based medical spa, told DailyMail.com.
Ozempic, is being used off label as a weight loss medication, as it is only FDA approved to treat diabetes, he said.
Bustamante, who performs roughly three penis filler procedures a day in his clinic, said the procedure is safe.
But since it’s not approved, regulators have yet to study this technique widely and conclusively determine its safety. The few studies that have investigated the procedure have found little risk when performed by professionals with adequate experience.
A 2021 study reported approximately four percent of 230 patients who were injected with hyaluronic acid fillers had complications, including one percent who had mild internal bleeding, two percent who developed small painless nodules and less than one percent who got an infection.
Even still, the risk of infection, which can cause the tissue in the area to die, is large enough that providers like Dr David Goldberg, a New York dermatologist, opt out of performing the procedure.
Dr Goldberg told Allure he used to perform penis filler but stopped out of concern.
'Legally, someone can inject Bellafill into a penis for off-label use, but do I think it's smart? No,' he said.
And if the provider did the procedure wrong and injected the filler into a blood vessel, instead of the delicate place in between tissue and skin, it could block blood flow and cause tissue damage, Dr Jason Emer, a board-certified dermatologist based in West Hollywood told Allure.
In addition, some clients want to push the boundaries of what they can handle, which can be dangerous.
The majority of the people that come into the clinic are looking to add an inch or two to their width at most. 'Most people want to look natural,' Bustamante said.
However, there are some outliers who come into the clinic wanting more and more. Though some penises can handle quite a bit of extra filling, everyone has a ceiling on the amount of girth they're able to add.
Since he began injecting patients with penis filler some seven years ago, Dr Shafer estimated he's performed the procedure over 7,000 times.
At the Shafer clinic, they also perform breast augmentation, liposuction and minor procedures, like Botox and lip injections.
If a penis is over filled, then both Dr Shafer and Bustamante warned the skin could become compromised - liable to split open.
Also, too much filler can press on nerves and blood vessels, which could reduce sensation.
Both clinicians said they turn away patients who are seeking overly unrealistic results, or who have other anomalies that would make it likely for them to have a bad outcome - like an active herpes flare up.
The price of the poke ranges based on the clinic you go to, the type of filler used, and the amount needed to give you your desired effect.
At Shafer, prices range from $6,000 to $8,500 for the first five syringes, with the second, third and fourth syringes discounted.
For example, if you were to get 15 syringes of Juvéderm Ultra Plus XC at the clinic, that would run you $14,000.
On a first visit to the clinic, it’s common for patients to need 10 to 15 syringes, Dr Shafer said. In subsequent, top-up visits, patients tend to get less than half that.
But just as fillers in the face slowly dissipate with time, so too do these. If patients wish to keep results consistent, they must come in for touch-ups.
The amount of time between touch ups depends on the amount of filler added and the brand of filler used.
Brands like Volux, Voluma and Radiesse, which are made from hyaluronic acid – a molecule that binds to the water under skin and creates volume - don't last as long as other brands, like Bellafill, which is made from semi-permanent gel spheres.
Regular clients tend to come back every six months to a year, though it varies, Dr Shafer and Bustamante said.
Since that first visit to the clinic, the patient has returned roughly every nine months. The results, he said, are worth it. He's happy, his boyfriend is happy and he walks around with newfound confidence.
He hopes other people curious about the treatment can rise above the stigma and do what they want with their body. For him, it was simple: 'I was always curious what it would be like, you know, to have a bigger penis.
'This is really just a pure want. I'm very, very happy with the outcome.'
