The consultation typically lasts 30-60 minutes and includes a comprehensive review of your medical history, a physical exam, and a discussion about your ideal goals. If you choose to proceed with the procedure we ask that you allow 120 minutes for your total visit to include the initial consultation, anatomical mapping, and post-care briefing. We will also take before measurements during this time.

Undergoing a BDE-Girth™ procedure is a streamlined, professional experience. Because we use non-surgical techniques, there is no general anesthesia, no hospital stay, and minimal downtime. Here is the step-by-step roadmap of your transformation.

1. Preparation & Numbing

Your comfort is our priority. Once you are settled in our private treatment room:

• Cleaning: The area is thoroughly sanitized.
• Anesthesia: We apply a local anesthetic block of the entire penis as well as at the sites of the microcannula access holes. Most patients describe the sensation as a minor pinches, after which the entire area becomes completely numb. You will be awake and able to communicate with your provider throughout the process.

2. The Procedure

Once you are fully numbed, the “artistry” phase begins:

• The Cannula Method: We use one to three (depending on your size and shape) tiny entry points to introduce our blunt-tipped microcannulas. You may feel a sensation of “pressure” as the filler is placed, but you should not feel pain.
• Layered Placement: Your provider will strategically deposit the filler (HA, Hybrid, or PMMA) into the specific anatomical layers we identified during your consultation.
• Immediate Feedback: You will see a significant increase in girth before you even leave the table. We often involve the patient in this stage to ensure the volume and shape align with your expectations.

3. Immediate Post-Op (The First 48 Hours)

Once the local anesthetic wears off, the recovery begins:

• Sensation: You may feel some mild soreness, “heaviness,” or a tight sensation. Pain medications are generally not needed.
• Visuals: Mild swelling and occasional bruising at the entry site are normal.
• Activity: You can walk and return to light office work immediately. However, you should avoid heavy lifting or strenuous lower-body gym sessions for the first 48–72 hours.
• No sexual activity for 2 weeks.

4. The Critical “Moulding” Phase (First 72 hours)

This is the most important part of your journey. Because the filler is still pliable during the first 2-3 days up to 1 week, you play a vital role in the final result:

• Daily Moulding: We will teach you specific manual techniques to “smooth” the filler and move filler away from danger areas such as the foreskin and the microcannula access holes. This ensures the material integrates symmetrically and prevents any small pockets of filler from creating irregularities.
• Abstinence: To ensure the filler settles perfectly, you must refrain from all sexual activity (including masturbation) for a minimum of 2 weeks.

5. Follow-Up & Refinement (Weeks 2–4)

Once the initial swelling has subsided and the filler has “set” into the tissue:

Touch-Ups: If any minor asymmetries are present, we can perform a “touch-up” to fine-tune the shape. For BDE-Girth™: Deep and Infinity patients, this is also the stage where we monitor for any nodules that may require specialized smoothing.

Comfort is a priority. We use a combination of local anesthetic and advanced microcannula technique. Most patients report a sensation of pressure rather than pain and are surprised by how comfortable the process is.

Yes. We exclusively use premium FDA-approved Hyaluronic Acid (HA), Calcium Hydroxyapatite (CaHA), and PMMA fillers. While their use for girth enhancement is “off-label,” these products have been used in millions of procedures worldwide and are the clinical standard for non-surgical enhancement due to their safety and reversibility (in the case of HA). Again we must stress that due to the permanence of PMMA (and to a lesser extent, CaHA), unsatisfactory outcomes can be just as lasting as the desired results. During the immediate post-procedural period, minor lumps or irregularities are common as swelling subsides and the product integrates into the tissue. Most of these issues can be resolved through manual massage and moulding. However, for more persistent irregularities, a combination of Kenalog and 5-FU injections may be required to smooth the area. Especially with PMMA, most of the time, nodules are just clumps of dehydrated PMMA microspheres that need to be rehydrated or broken apart with an injection and subsequently massaged smooth.

A microcannula is a blunt-tipped tool that slides under the skin rather than piercing through tissue like a traditional needle. This significantly reduces the risk of bruising, swelling, and vascular complications, allowing for a much safer and more comfortable recovery.

Massage, massage, massage. Keep massaging and moulding the filler in the first 1-3 days and up to 2 weeks with the BDE – Girth™: Deep and Infinity procedures. This will even out most irregularities and nodules. Heat in the form of a microwave warmed wet cloth can be used to soften the filler to become more mouldable prior to massage. Procedure specific after-care instructions will be given to you at the end of your procedure. You may also be given a prescription for medications that will allow help relax the smooth muscle around the penis and improve blood flow to the area. Some men also like to hang with various weight hangers to allow for the filler to “set” with the penis in its most elongated state. We only ask that you use only hangers that do not compress the treated areas.

For those wanting ultimate results, I would highly recommend adding the penile botox/neuromodulator treatment to your procedure day to avoid penile retraction and backtracking on your hard earned results.

As stated in many other places, you must refrain from sexual activity for at least 2 weeks. In these early stages, external pressure from sex can cause the filler to migrate to unwanted areas or bunch up into an unsightly mass. Though sexual or manual activity is strictly prohibited in the first week, we do recommend that you induce erections after the first day or so and have the skin move and stretch as it normally does to allow the filler to settle in a way that promotes the usual function of the penile skin.

HA fillers can last upwards of 1.5 years as the body slowly metabolizes the product. HA is interesting in that it’s undergoes isovolumetric degradation where even as it degrades, it keeps most of its volume by holding on to more water. So their bulking effects remain until just before the end of its life span. One last advantage of of HA is if the patient has any issues with the product, it is reversible with hyaluronidase (at the cost of $150 per vial of hyaluronidase required).

Our Hybrid (HA/CaHA) blend is semi-permanent; it stimulates your body to produce its own collagen, providing volume that lasts significantly longer than HA alone, the caveat being that it can also not be fully reversed with hyaluronidase. The body eventually reabsorbs the CaHA particles but the natural collagen that was build around them remain.

PMMA microspheres on the other hand remain in the deposited layer indefinitely stimulating your body’s natural collagenesis to prolong the enhancement for 5+ years.

The primary difference between the three procedures is the filler material. Because of the differences in their qualities, they require different techniques. When choosing between the filler types, the main consideration is matching patients’ goals with expectations. Surface level enhancement is done with HA and provides by-far the most immediate bulk and girth enhancement.

Deep level enhancement is done with our hybrid HA/CaHa blend; though it provides long lasting semi-permanent results, keep in mind that because of the deeper level of deposition, it will require a larger volume of filler to get the same level of impact as surface level enhancement.

The BDE-Girth™: Infinity option is the final tier and is for circumcised men who want permanent results. Please keep in mind that this option also requires the most attention to detail and after-care to ensure desired results. It is also very important to distinguish that both the semi-permanent and permanent options often require multiple treatments to get the desired result despite the permanence of the materials. The semi-permanent and permanent materials do not guarantee a “one and done” result, though some men may achieve their desired result after just one treatment.

Tldr: All three enhancement options may require follow up maintenance treatments.

Personally, our preferred filler for both uncircumcised and circumcised men is the hybrid HA/CaHa blend as it is the “best of both worlds.” You get the immediate bulk from the HA and the long lasting collagenesis from the CaHa all with the peace of mind from reversibility. Surface level HA is also a great value option as it provides the most bulk for the volume of filler used– literally, the best bang for your buck. Lastly we offer PMMA especially for (circumcised) men who have had prior good experience with non-permanent fillers and now want to solidify their results.

The BDE – Girth™ Procedure is designed to provide measurable, significant increases in circumference that are visible and felt in both the flaccid and erect states. Beyond pure volume, this procedure is about anatomical optimization.

Measurable Girth: You will see an immediate increase in thickness. Because we use high-density fillers, the girth feels firm and natural to the touch.

The “Flaccid Hang”: Many patients notice an improvement in flaccid hanging length. This is due to the added weight of the filler, which allows the penis to hang lower and heavier.

Corrective Sculpting: Every anatomy has unique “deficiencies,” such as natural voids, dips, or slight curves. We use the filler to sculpt the area, filling in these voids and smoothing out the shaft for a more symmetrical, aesthetic appearance. Note that we are only visually improving the shape of the penis and that we are in no way treating the abnormalities. The BDE – Girth™ procedures are primarily girth enhancing procedures.

Erect Length: It is important to note that while your girth and flaccid hang will increase, erect length is not affected. The procedure focuses on the bulk and “presence” of the penis rather than extending the internal erectile tissue.

We focus on anatomical sculpting, not just “filling.” By respecting your natural proportions and using specific filler weights deposited to precise intentional layers of the penis, we strive for girth that feels natural to the touch, looks impressive, and remains functional in both flaccid and erect states.

The procedure can absolutely be performed on uncircumcised men. In fact, there are elements in the BDE-Girth™ procedure developed specifically to optimize safety, function, and appearance for uncircumcised men. We have extensive experience working with uncircumcised anatomy and have nearly built a specialty practice around this. We frequently have men come from out of state to get the procedure done because they were not confident in their local providers. This is simply a numbers game with the majority of men in the United States being circumcised, most providers simply do not get the practice and consequentially do not design their procedures around the nuances of an uncircumcised penis.

The mainstays of the BDE – Girth™ procedure are the strategies we designed to ensure that filler is placed in the precisely correct layers. This includes techniques designed with intention to keep filler out of the mobile foreskin that remain significant challenges for so many other providers. Our goal is to enhance your girth while maintaining the integrity of your unique anatomy, ensuring that the final result looks and feels natural.

Results look excellent on circumcised anatomy. However, every circumcised penis is unique depending on how the original procedure was performed.

The primary consideration here is the circumcision scar line. Scar tissue is naturally firmer and less elastic than the surrounding skin, which means it can act as a “tether” or a boundary that affects how the filler distributes. In some cases, this requires a more strategic, layered approach to ensure the girth is symmetrical above and below the scar.

Secondarily, there is variability in the “laxity” of the remaining skin after circumcision as some men with a “loose” circumcision may still have a significant amount of foreskin that will require the same expertise and techniques used in uncircumcised men. Finding a provider who can navigate you through these nuances is of utmost importance when it comes to penile aesthetics.

During our consultation, I will personally examine the mobility of your skin and the position of the scar tissue. My goal is to work with your existing anatomy to ensure a smooth, balanced enhancement that respects the natural contours of your body.

This fee covers a dedicated medical evaluation with your physician to ensure you are a safe candidate for the procedure. If you choose to proceed with your treatment on the same day as your consult, the full $95 is credited toward your procedure cost.

Every man is different. But on average, patients choose between 10ml and 20ml for their initial sculpting. The rule of thumb is that every 5ml will provide about a 0.5 inch improvement to girth. It is important to keep in mind that larger anatomy requires more filler to achieve the same visible gain. Just as it takes more paint to cover a larger wall, a penis with more length or a wider starting girth has more surface area to cover. If you are starting with a larger baseline, you may need a higher volume of filler to see the same proportional increase in girth compared to someone with a smaller baseline. Additionally, please note that it is easier to mould with more higher volumes of filler. For most men this is between 10-20ml. During your consultation, we will discuss your goals and provide a precise recommendation based on your anatomy.

Yes. We frequently consult with patients who are dissatisfied with results from other clinics—whether due to lumpiness, asymmetry, or poor material placement. Dr. Tonthat takes a methodical and calculated approach to corrective work.

What to expect during a Revision Consultation:

Anatomical Evaluation: Correcting a previous procedure is more complex than starting with a “blank canvas.” We begin with a thorough physical exam to evaluate the current state of your results.

Material & Layer Analysis: We will work to identify what material was used and, more importantly, which anatomical layer it was placed in. Understanding this is vital to determining if the filler can be dissolved (in the case of HA) or if it needs to be smoothed and integrated with new BDE-Girth™ layers.

Honest Assessment & Expectation Setting: Dr. Tonthat will provide an honest opinion on what is achievable. Some cases require “fixing” the existing filler, while others involve “enhancing” the work to bring it into better symmetry and proportion with your body’s natural frame.

A Custom Recovery Plan: Revision work often requires a unique approach to post-op moulding and follow-up. We will discuss a specific timeline and set of goals to ensure you finally achieve the confident, smooth result you were looking for.

While BDE Clinic does not provide direct travel or lodging accommodations, we are proud to be a destination clinic for patients across the country.

Our Chico clinic is located right in the heart of Downtown Chico, making it easy for visiting patients to enjoy a high-end experience before and after their procedure. The area is surrounded by a variety of boutique hotels, local eateries, and unique attractions.

Planning your visit to Chico:

• The Downtown Experience: Since we are located centrally, you are within walking distance of some of Northern California’s best local coffee shops, fine dining, and retail.
• Exploring Bidwell Park: If you have extra time, one of the largest municipal parks in the US is just minutes away, offering beautiful walking trails and scenery.
• Lodging: There are several highly-rated hotels and charming bed-and-breakfasts within a few blocks of the clinic, perfect for a discrete and comfortable recovery.
• Proximity: Chico is easily accessible and offers a more relaxed, private environment for your procedure compared to major metropolitan hubs.

We are happy to provide a list of our favorite local recommendations during your initial virtual or phone consultation to help make your trip as seamless as possible.