I’m standing in the operating room of a plastic surgery center across from the Flynt Publishing Building in Beverly Hills, wincing beneath my protective mask. The lower half of a middle-aged man is splayed upon the table before me, his unimposing three-inch flaccid penis framed in crotchless surgical scrubs like a gag gift at a bachelorette party.
“All I Ask of You” from Phantom of the Opera plays, unironically, on a bluetooth speaker as Dr. James J. Elist, a jolly, nearly 70-year-old veteran urologist — who, among other things, was the first physician to link smoking to impotence — cuts a 2-inch incision into the shaved skin where the patient’s pubic hair used to be.
His fingers curl deep inside the man’s skin, under the fat, searching for the base of the penis inside. “This is the key point of the procedure,” he whispers to me. “Check his driver’s license — he’s going for a ride.” He then pulls the man’s penis out of his body like an inside-out gym sock.
Say you’ll share with me one love, one lifetime! Let me lead you from your solitude!
Elist never intended to get into the penile-enhancement game. His specialty is erectile dysfunction, and for decades, he’s performed an operation in which a prosthesis is inserted into the arteries of the penis to achieve an erection. One of the side effects of the procedure, however, is the formation of scar tissue. That scar tissue, Elist explains, actually resulted in a decrease in length of the penis.
So Elist came up with an alternative: Implant a soft, silicone sheath under the penis to maintain the length. Recognizing the procedure could be done on men without ED, too — namely, any man who wanted to add a couple extra inches to his flaccid dick — Elist patented his Penuma silicone device in 2004 and received FDA clearance to begin performing the procedure. He’s now inserted more than 2,500 of them — from multiple operating rooms, three times a day, six days a week.
The price tag for a larger penis? Around 15 grand, no insurance, though financing is available. A five-year clinical study commissioned by Elist found a 95 percent success rate, leading to an expansion effort spearheaded by his son, a Harvard graduate who took a leave from his job at a top consulting firm. The addition of the younger Elist, as well as a 2016 GQ article, has left the elder Elist struggling to meet worldwide demand for his embellished Johnson.
Elist’s next patient, from Jacksonville, has a micropenis. The one after that, a three-incher, is from Brazil. “This one’s from New Orleans,” Elist says, tugging on the man’s inverted shaft below the head and reaching for the hollowed-out silicone hotdog bun floating in a beaker of antibiotic solution next to me.
My attention drifts due to an abrupt change in music.
“Pandora’s Musica Italiana channel,” the nurse says.
“Andrea Bocelli,” Elist clarifies, explaining he prefers calm music for this part of the procedure.
He wraps the implant and a layer of surgical mesh around the exposed penis. Then, with a fish-hook-shaped needle and 8 to 10 sutures, he attaches it just beneath the head of the penis. (The implant sits 270 degrees around the shaft, leaving room for the urethra.) Every so often, Elist thrusts the whole thing in and out of the body — back and forth, like a playful otter — making sure it all hangs just right.
Next, he leans in and begins to delicately adjust the crown of the penis, like a jeweler setting an opal. “His head isn’t very big,” he explains. I stand closer and immediately grasp the conundrum: If positioned the wrong way, size-wise, the baby head will be indistinguishable from the shaft. “It’s important that the implant sits very natural. Otherwise he’ll have what we call Penguin Dick.”
The risks of your dick resembling a flightless aquatic bird are communicated during the initial consultation. The process begins when a patient submits an inquiry on Elist’s website expressing interest. A member of his team follows up to ask some questions, namely:
- Why are you interested in this procedure?
- Have you had any previous implants or injections?
- Are you circumcised? (It’s a requirement: Luckily, Elist is also one of L.A.’s go-to doctors for adult ritual circumcisions.)
Arrangements are made for out-of-town patients to stay at a hotel in L.A. for roughly a week. A quarter of Elist’s patients come from abroad — Mexico, Canada, Western Europe and Latin America. “This patient flew in from New Orleans two months ago and we circumcised him,” Elist says, pointing to the edge of the crown, which looks to be healing nicely.
“He was very small and felt very uncomfortable dating,” Elist explains, checking the measurements on a notepad. “Just three inches flaccid — that’s way below average.”
The average erect penis is, in fact, just over 5 inches long and 4.5 inches thick according to a 2015 U.K. study of more than 15,000 men across all races and nationalities. The goal of the project was to build “nomograms” — graphs that take into account the average measurements from all ages and races. The graphs are designed to provide “reassurance about what a normal size of a penis is,” according to the study’s author. “Average is one thing,” the younger Elist tells me. “Perception of average is another.”
Take Randall, for example, a 64-year-old retired government bureaucrat in St. Louis who had the procedure in 2016 despite being among the top 5 percentile of Americans, with an 8-inch erect penis (4.5 inches flaccid). “I’ve always gotten a lot of attention because of the size of my penis,” he says. “My nickname in some circles before the surgery was ‘Big Randy.’”
Big Randy travels far and wide to participate in “naturous activities” — including Cap d’agde in France, the largest naked resort in the world — and regularly visits naturist camps throughout the U.S, where he says being the Big Man On Campus can be intoxicating. “Every guy would like to walk through the locker room and feel like he’s the biggest guy there. Even though nothing’s ever said, there’s an unspoken pecking order where the biggest guy gets a little more regard than everybody else. That’s a fun thing to experience.”
Which is presumably much more fun now with a 7-inch flaccid penis. The additional length effectively transforms Big Randy from a grower into a shower. While his erect length won’t significantly increase — it’s 8.5 inches erect now, although Elist assures him that he’ll eventually get an additional inch once the weight of the implant stretches the ligament over time — his “bulge” will, significantly.
But Big Randy says the real victory is his newfound girth. “It’s about 7.5 inches around at the base,” he says. “Which is damn big. When my penis is erect now, it’s bigger around than my wrist!”
Occasionally, Elist says, he will send patients — typically the younger ones who’ve watched too much porn — to meet with a sex therapist named Craig Cassidy from the Center for Healthy Sex before proceeding with the procedure. “They’re expecting to be super studly all of a sudden,” Cassidy tells me. “They have to understand that it will take about four to six months for them to experience a moderate increase in length and girth.”
Other times, it’s divorced men who need to tap the brakes before dropping 15 grand on a fake dick, like the male nurse who came to Elist after learning his wife was fucking his best friend. “She said the friend was much bigger,” Elist recalls somberly. “The guy was going to kill himself. These things can really bring people down. I can reverse it with my tool, this procedure, but often it must be in conjunction with sex therapy.”
That’s meant steady referrals to Cassidy, who says he sees about two patients a month from Elist. The first thing he does, he explains, is assess their expectations. “Some mentally unstable people can go into magical thinking about how it will change their lives. They imagine that women aren’t sleeping with them because they can tell that they’re under-endowed from the other side of the room.”
Cassidy’s website explains that he specializes in assisting clients to “awaken and accept their authentic self.” I ask if he thought doing so was antithetical to surgically implanting silicone in your penis to increase its size. Not necessarily, he says. “If your authentic self wishes to have a relational experience that’s filled with healthy sexuality but the universe has blessed you with a 3-inch erection, why shouldn’t we give you the opportunity to have a more successful experience with a partner? Would we deny a paraplegic a wheelchair? No, we give them the apparatus they need to have greater experiences in the world.”
Paul Nelson, a clinical sexologist at The Men’s Sexual Health Project in New York, is less bullish on the bionic dick, however. “The number of men who actually need this procedure is very, very small,” he cautions. “It really doesn’t add anything to the length. The penis may have doubled in length. But that’s just flaccid length. It won’t affect the erection.”
Nelson says that guys who have this problem are often dealing with a body dysmorphia issue or have an anxiety disorder that should be addressed instead. “If men would spend more time with each other naked, they’d know that 90 percent of us are growers. You really don’t want a large dick flopping around. It just gets in the way.”
He’s also concerned about their ability to have sex after the procedure. “Anal sex is tighter than vaginal sex. I’d be curious to know how well this implant does with that. Is there any tearing? Is it uncomfortable?”
Randy, who identifies as pansexual, says he’s especially attracted to trans men but has penetrative sex with both men and women. “The men I’ve had anal sex with haven’t had too many problems with the size,” he says. “There was one time, though, when I was unable to penetrate a man.” The real problem, Randy explains, has been with women. “I was unable to penetrate the first two women I had sex with because I was too big. Certainly for no lack of trying. They were younger, though, and hadn’t born children. It was my doctor who said, ‘Randy, you have to have sex with postmenopausal women!’”
Still, Nelson says he thinks there’s something pathological at play about the focus on size. “What’s the anxiety that’s driving these guys to have such a large penis? If he’s 8 inches, that’s bigger than 95 percent of men!”
Phillip was among that top five percentile of men as a teenager. But while his dick was eight inches long, it possessed the girth of a finger. “It didn’t balance out,” he remembers. “I really wanted the girth to go along with the length.”
Phillip’s partner assured him he was big enough, but he says he’d been conditioned by porn to always want more of his penis. “I was never happy with what I had. I always wanted more, more, more.” He began using traditional methods like jelqing and stretchers after reading peer-reviewed studies by Italian scientists that found if you wear a stretcher for six hours religiously a day for six to eight months, your penis will grow by almost a third. But: “It hurts!” Phillip recalls in defeat. “It’s a pain to have that thing always on. And it didn’t work. I got nothing from it.”
So he began studying the penis-enlargement practices of ancient Arab cultures. “They used to milk the penis by forcing blood through the penis chamber,” he explains. “The idea is that you break down the spongy tissue like when you go to the gym, and it grows back stronger and larger. Some people swear by it. There are all sorts of websites and people who practice it.”
Yet neither stretching nor strangling his dick would suffice. He considered giving up his quest, but not before following a link to Elist’s page, where he began reading some of the testimonials. Is this for real? he wondered.
He figured Elist was a proper urologist in Beverly Hills and had the money so he flew to L.A. from London and had the procedure done just before Christmas. When the bandage came off on the third day, he was ecstatic. “It was unreal to see my new penis. I was at the airport wearing tracksuit bottoms, and the stewards and passengers were looking at me. It was amazing! The girth is insane. At the base, it’s as thick as my wrist!”
Phillip says he was surprised to find so many negative reviews about Elist. “They were endless,” he explains. “It didn’t make sense because my experience had been so perfect. Dr. Elist said the reason these people have problems is because they don’t follow his simple instructions and start having sex and masturbating a few days after and fail to take their antibiotics.” Elist Jr. suspects foul play from a competitor. “My strong instinct tells me that most of the negative reviews are the work of competitors in the space feeling the threat of a new technology that’s actually working and likely reducing the number of patients coming to their clinic to receive whatever procedure they’re offering.”
Back in the operating room, Elist is checking the sutures on the patient from New Orleans. He trims an inch or so of excess mesh and douses the entire region with antibiotic fluid. (He’s inserted a drain tube temporarily to eliminate the fluid.) He leaves a couple extra inches of the implant inside the body. “It’s for the future,” he explains. “That way, when it grows there will be no gap at the base of the penis.”
Next, some final measurements: The length had been three inches.
“Now,” Elist says proudly, extending the tape. “Five-and-a-half inches.”
Instant thickness has been added to the girth, too.
It’s a totally different dick.
“I tell patients, ‘Your penis is now longer and thicker from whatever you remember. The size of your underwear will need to be bigger. Everything is going to change.”