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Although the increase in girth size was on the higher end for the men in the present study, previous research suggests that for this increased girth size to be maintained, further HA filler is required around 18 months later, so this is not a permanent outcome.5 The average 3.29-cm increase is at the upper end of size increases reported in previous systematic reviews for HA-based girth augmentations.3,10 It should be noted that fewer than half of the men returned for a follow-up consultation (although all were invited) and so the change in girth size could not be determined for all men involved in the present study. However, we believe relying solely on these fillers in significant quantities poses substantial risks due to the potential for nodule formation. The use of Sculptra and Bellafill has been introduced in some clinics for penis enlargement. We can also create a mix of two fillers with HA in a much greater proportion, possibly adding a small percentage of Sculptra. 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