Fat transfer or fillers for penis enlargement - are there disadvantages to either procedure?

I have written a few papers about penis enlargement, augmentation phalloplasty, and evidence-based outcomes. Safety is always the priority.
Penis enlargement surgery can offer modest improvements in both length and girth, but there are risks and limitations that should be carefully considered. Always go to an experienced provider. Complications can be devastating.
Lengthening Surgery: The most common method involves cutting the suspensory ligament that attaches the penis to the pubic bone, which can result in an increase of about 1 inch in flaccid length. However, this may not significantly affect erect length. Additionally, some men experience a "drooping" effect where the penis no longer rises in erection, but instead points downward.
Girth Enhancement: This can be achieved through fat grafting (using the patient’s own fat) or the insertion of dermal fillers or collagen-based materials. These techniques can add circumference, though fat grafts may have issues with uneven absorption, and synthetic fillers can lead to complications like infection, ulceration, or extrusion. The use of Alloderm (a type of cadaveric tissue) has been controversial due to risks of tissue reabsorption or complications.
Minimally Invasive Alternatives: Non-surgical treatments, like platelet-rich plasma (PRP) injections or fillers, are also options for improving penis girth and overall appearance. These methods generally have shorter recovery times and lower complication risks compared to surgery.
While surgery can lead to some visible improvements, the results may not meet all expectations, and the risks of complications are significant. For those seeking a modest increase in size, non-surgical options may offer safer alternatives. Consulting with an experienced surgeon is essential to determine the best course of action.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

Fillers are temporary and move around and cannot cost effectively provide the same size increase. Fat transfer is permanent, looks more natural, and costs less for same volume while being a permanent solution. Fat transfer can be performed under local anesthesia, so there is really very little role for filler injections into the penis.

Temporary filler and permanent filler are composed differently therefore comparing the 2 are like comparing apples to oranges. Temporary fillers most commonly used for penile enlargement are Juvéderm Voluma XC and Restylane, the same hyaluronic acid fillers that are used for facial rejuvenation. unfortunately, fillers re-absorb, so patients are required to continue getting injections throughout their lives. Therefore, the lifetime cost of fillers can be astronomical.
Fat grafting involves surgically transferring fat from one area to another, often through nonsurgical injections. This procedure comes with its own set of possible side effects and risks:
Fat necrosis from limited blood supply to the areaLumpiness or unevennessFat reabsorption A softer feeling erectionMany nonsurgical options have side effects as well. Male enhancement pills can interact with other medications you take. Exercises, stretchers, or pumps can cause tissue damage or erectile dysfunction.
Here’s the good news: The Prometheus male enhancement procedure is minimally invasive and does not carry the surgical risks of an invasive penile enhancement surgery.

At Shah Aesthetics, we perform male enhancement with filler. We believe filler to be superior to fat because it is much more reliable in terms survival in the tissue as well as its integrity. Many patients become extremely unhappy with fat transfer because much of it disappears quickly and it feels too "squishy". Penis fillers are allowed in the US and are the best and safest male enhancement procedure. Always make sure to see an experienced provider that performs male enhancement for your own safety and to maximize the satisfaction of your results.

To start, it is important to know if you elect to go the filler route, an implant like the Himplant by Penuma is no longer a good option. Patients who have had filler or fat injections in the past are no longer good candidates for the Himplant as this can damage the tissue and increase the risk of post operative complications like infection, delayed wound healing and improper seating of the implant. Though filler may be temporary, both filler and fat injections can cause permanent changes in the tissue and remnants of foreign materials can remain. It's important to make an informed decision about which treatment option is best for you before moving forward with any treatment.

Each procedure has its benefits and its drawbacks. Both have similar side effect profile. One major difference between the two is, Fat can be reabsorbed partially or totally . Whatever remains approximately after 3 months will last for years. Fillers will last anywhere from a few months to 2 to 5 years depending on what kind of filler is used

My recommendation would be to use dermal filler. There are different fillers that are more permanent than others. Fat grafting isn't going to give you the look or feel that you want and can disappear with weight fluctuations. Good luck!

When done properly, both filler and fat work for injection Fat is easier to remove than permanent fillers
If you are not sure what you want, it is not a bad idea to have temporary filler.

Advantage of fat transfer; autologous, nonallergic, compatible with penile tissue. The disadvantage is; It may cause shape deformity due to 20-30% fat absorption. It may require a second application a year later.The advantage of synthetic permanent filling materials and silicone implants; permanent shape. The disadvantages are; may be allergic and cause excessive fibrosis.You can choose based on this information.