The problem, as Billy came to believe, was that nearly half his penis was inside his body. This knowledge was unbearable. His erect penis measured 5 and a half inches, but he felt more hiding there beneath the skin, invisible, absolutely useless. He wasn’t completely crazy. Some doctors claim that all men have extra penis lurking beneath the skin, like roots underneath a tree trunk. One penile surgeon calls it “inner penis.” Billy concluded that his own inner penis was 4 and half inches long. “I knew I had that much penis, but the problem was how to get it out,” says Billy.

This sometimes-irrational hankering for a bigger penis is at least partly responsible for the emergence of a very peculiar corner of the cosmetic surgery industry - penile enhancement surgery. The industry was born in 1991 and currently supports about 30 surgeons. Although neither the American Board of Plastic Surgery nor the American Society of Plastic and Reconstructive Surgeons monitor the industry, it’s estimated that at least 15,000 men have had the operation, which now costs about $8,000.

Demand for the surgery soared in the early 1990s but by 1996, with news spreading that men were stumbling out of these back-street surgery centers with penises that were grossly deformed and permanently limp, business waned. Despite the early setback, demand for the surgery is increasing once again. Surgeons have formed the American Society of Phalloplasty Surgeons (ASPS) to lend their craft an air of respectability, and most have stopped running those advertisements in porno magazines that promised to fulfill men’s wildest dreams and to double their size. And while they may never escape their seedy roots, many surgeons believe the industry is on the brink of a revival. “I am convinced that this is going to be one of the most popular male cosmetic procedures in the next millennium,” says Dr. E. Douglas Whitehead, a surgeon based in New York and president of the ASPS.

The intensity of Billy’s desire is surprising, given his belief that a man is more than the size of his penis. The measure of a man, in Billy’s opinion, is in his ability to accept and hold down responsibility, to provide for his family, to fight for what’s right when the time comes. By his own standards, then, Billy was a man long before his operations, supporting himself and his family through hard work as a coal miner, a logger, a trucker and now as a Christian minister. He is 5 feet 8 inches tall, physically fit despite a paunchy midsection and has black hair that is thinning on top and turning a light shade of gray. He has been married to the same woman for 33 years, since he was 19 and she was 16. From their home in rural West Virginia they raised two children and have seen the births of six grandchildren.

A mining accident many years ago nearly killed Billy. He was crawling on his knees in a seam of coal when the roof caved, crushing him for 12 minutes before the other miners pulled him out. “It was like a car tire slowly running over a frog,” says Billy. “I felt like my guts were coming right out of me.” His back sustained severe injuries and years later a disc ruptured, causing the left sides of his butt, testicles, and penis to go numb. He still had feeling in the head of his penis and along the right side of the shaft, but to get an erection he had to inject it with a chemical stimulant. When the drug no longer worked he had a doctor give him titanium implants. Now his penis is constantly erect. (He wears very loose pants).

His wife first learned of his desire to have the operation in 1993 while they were lying in bed one evening. Billy told her that in addition to wanting a longer penis, he also hoped the operation might restore some of the sensation he had lost when his disc ruptured. Mary said fine, whatever you want. He made a few phone calls and booked an appointment with a surgeon in nearby Virginia.

The procedure to lengthen the penis, the operation that Billy underwent, was developed in the late 1980s by a surgeon in China named Long Daochao. The procedure hasn’t changed much since then. Surgeons say the operation increases length of a penis by about an inch when it’s flaccid and three-quarters of an inch when it’s erect. The surgeon cuts open the skin at the base of the shaft, exposing the suspensory ligament, which anchors the penis to the body. The ligament is cut, allowing the penis to drop down and forward. Some surgeons cut other ligaments. The gap between the shaft and the bone is then covered by pulling down skin from the lower abdomen.

Cutting ligaments requires a careful touch. If the cut is too shallow the penis will not drop and no length will be added. If the cut is too deep the penis becomes unstable, rotating around like a helicopter blade, according to one patient. Severing the suspensory ligament also affects the angle of an erection, causing it to point down instead of up, making it difficult to have sex. In the very worst cases, a cut that is too deep will damage the nerve and make the man impotent.

Besides length, there is research on width. One of the first surgeons to experiment with penis widening was Ricardo Samitier, a Miami surgeon who was doing lip enlargements before focusing his skills on penises. The earliest technique, and one still used by many surgeons, is to liposuction fat from another part of the body and inject it underneath the skin of the penis. The problem with this method is that the fat can lump together or migrate to the middle, creating a football-shaped penis that is narrow at the ends and wide in the middle. During sex, the fat can also get pushed down to the base of the shaft and sometimes into the scrotum.

Some surgeons say they can avoid the pitfalls of fat injections with dermal fat grafts. Two long, narrow steaks of flesh are removed from either the patient’s abdomen or underneath his buttocks. The two strips are sewn together. The flesh, about a half-inch thick and the color of processed meat, is then stuffed underneath the skin from an incision near the penis head. Surgeons who use fat grafts say they create a smoother penis than fat injections, but they can leave thick scars on the penis and the donor sites.

The latest method, favored by Whitehead, is to use tissue harvested from cadavers. Like dermal fat grafts, the tissue is stuffed underneath the skin of the penis. After a few days, blood cells populate the tissue and incorporate it into the body. Although the Food and Drug Administration hasn’t approved the use of this harvested tissue, called Alloderm, for penis enlargements, Whitehead says the tissue is disease-free and creates good results without the lumping and body scarring. Other surgeons won’t go near the stuff. “A piece of Alloderm is just like a piece of shoe leather,” says Dr. Robert Stubbs, a penile enhancement surgeon in Toronto, Canada. “It’s dead. Real dead.”

While Long and Samitier may have pioneered the surgery, the “penis surgery king,” in the words of an attorney who represented many of his patients, was Melvyn Rosenstein. According to records from the Medical Board of California, Rosenstein performed his first penile enhancement operation in 1991 and by 1995 had done 4,500. He ran ads in Penthouse magazine and in the sports sections of newspapers calling himself the world’s leading authority on penile surgery and saying that his patients appear as if they have doubled in length.

His surgery center was in Southern California but he had other offices throughout the country where his sales staff worked for a $4,000 fixed salary plus commission based on the number of patients they brought in. He reported revenues of $7.4 million in the first half of 1994, according to the Wall Street Journal, and for a time was performing between eight and 10 operations a day.

He profited, it appears, at the expense of his patients. His staff rarely had more than 15 minutes to clean the operating room before the next man came in. As a result, blood often remained on the floor and liposuctioned fat that had become airborne during previous operations was left sticking to the walls and cabinets. In the later part of 1994, between 90 and 95 percent of his patients developed post-operative infections, butter-colored fluid oozing from their penises. Others walked out with penises that were red and raw, blistered, bent, lumpy, scarred, painful and lifeless. Dozens of men sued. Under pressure from the California attorney general, Rosenstein voluntarily surrendered his medical license in 1996.

The surgeons say those years are over, but problems still occur. Dr. Gary Rheinschild, a penile enhancement surgeon in Anaheim, Calif., says that he operates on about two men every week whose penises have been botched by other surgeons. Another surgeon who won’t do enlargements but who will fix those who have been damaged is Dr. Jack McAninch, chief of urology at San Francisco General Hospital and a past-president of the American Urological Association, which considers enlargements unsafe and ineffective. McAninch says he also sees about two men a week whose penises have been badly disfigured by surgeons. “I must say that most of the men who I see, they’ve got substantial problems,” says McAninch. “I don’t think it’s a procedure with a predictable outcome. I think the outcome has great variability and therefore it’s an unsafe procedure.”

Like many men, Billy didn’t like the results from his first operation. So he went back again and then again. He says his length increased by an inch-and-a-half, but the operations left him severely disfigured. The surgeon had made a cut on his penis in the shape of the letter Z. This is known as a Z-plasty. Like unbuttoning a pair of tight pants, the idea behind a Z-plasty is that by opening the skin, you give the penis room to expand. But in reality thick scar tissue develops and sometimes the penis contracts. “Here I am, I’ve got this penis with a Z-plasty running down it and a great big skin flap and a great big dimple at the base of the shaft,” says Billy. “I looked worse than a stinkin’ road map. He ran zigzags down my penis and stitched me up like Frankenstein.”

He lived with this horror for four years before flying to California with his wife to visit Rheinschild, who repaired Billy’s scars, sent him home to recuperate, and told him to start hanging weights from his penis once the wounds had healed.

If you want a bigger penis you’ll have to hang weights. There’s no way around it. Without weights, surgeons say, the ligaments will reattach to the body and the surgery will have been for nothing. Typically, the weight routine begins four to six weeks after surgery. Patients attach a small vacuum cup to the head of their penis and hang the weight from a metal hook attached to the bottom of the cup. They start with a pound or two and slowly work their way up to 8 or 10 pounds. They’re advised not to exceed this limit. In addition to hanging weights, which most men do for an hour or two a day for several months after the surgery, they’re also given a 1-pound weight sleeve resembling a heavy sock that they can wear all day long.

Some guys have unusual routines. I talked to a man in Chicago (he asked to be called Adam) who cut a small hole in a plastic chair so he could sit down and watch television while using the weights. Billy also has an interesting routine: “They tell you not to go over eight pounds,” he says. “I’m using 23 pounds. I do it 15 minutes in the morning and 15 minutes in the evening. There ain’t no way I can keep that baby on for any longer. Man, it’s total pull! It’s not comfortable, but if you want the gain you kinda get used to it. Without pain, there is no gain. That’s the basic rule. Weight lifters know it. Everybody knows it. You’re not going to have any gain by hanging a 2-pound weight off the head of your penis.”

Mary says the weights make Billy turn purple. Rheinschild says that’s a bad sign. “God, I get concerned about that,” says Rheinschild. “I really get concerned about that. You’ve got to be very, very careful about hanging weights. Maybe I should talk to him.”

Billy has other tricks, too. “Sometimes, watching TV or something, I’ll be sitting there with a blanket over me, half-naked, and I will pull on the penis. I will get a hold of the penis and keep a good, hard, straight pressure on it. If you really want this bad enough, it’s in your life 24-hours a day.”

His penis now measures 9 and a half inches and his goal is to reach 10. Considering it’s always erect, that’s a lot of penis to carry around, and there are drawbacks. It has been stretched so much that the skin that once covered his lower abdomen is now on his shaft, making part of his penis hairy. He shaves it every three or four days. But he says the sex is incredible. “Between right now and the way I was, my wife wouldn’t for $100,000 go back to the way I was. She likes the difference. My wife is not what I would refer to as a sexual person. Most women aren’t, anyhow. But she tells me that there is a difference and she likes the difference. She tells me that because of the length, she excites way faster. It’s like, bam! She really excites a lot faster now. With the length I’ve got, it don’t take anything at all.”

The promise of a zesty sex life was the reason most of the men I spoke with gave for having the surgery. Take James, a serious-spoken trial attorney in his mid-30s who drives a new BMW and describes himself as highly motivated, highly competitive and mostly monogamous. He had his penis widened and lengthened in March because his girlfriend, an attorney who recently gave birth to her second child, was “a bit on the loose side.” His new penis, which he says is an inch and a half longer and considerably wider, works much better.

As for Adam, his penis is now said to measure 10 inches, 2 inches longer
than before the operation. His wife and the other women he occasionally
sleeps with love it: “The bigger the better. That always runs through your
mind. I love sex and I love women, you know, and whoa! When you got a big
johnson, then you OK.”

Neither James’ girlfriend nor Adam’s wife would talk to me, but Billy’s
wife agreed that she enjoys her husband’s new penis much more than the old one. Some sex therapists, however, believe she’s an unusual woman. According to the latest studies on the subject, the average size of an erect penis is 5 and a half inches to 6 and a half inches, and the vagina may not be designed to handle much more than that.

“I can’t think of a single woman who has come to me and said, ‘I love how long my husband’s penis is,’” says Susan Hubbard, a sex therapist in Boulder, Colo. “I would say it’s pretty unimportant. There is an occasional woman to whom it makes a difference, but it’s better to be in the range of normal. People are basically made to fit together. Many times, if a person is outside the normal range of size, it creates mechanical problems. It’s hard to fit something too big in a space too small. It makes a woman dread having sex with a man.”

Let the sex therapists say what they want: Billy is pleased with his penis and so is his wife. He would do it again, despite the risks, despite the scarring and the pain and the agony of dangling 23 pounds of lead everyday for two years. Sex is great and he only has to stretch his penis another half inch before achieving his goal. The yearning that afflicted him all those years, that voice mocking his ho-hum penis, his pedestrian 5 and a half inch penis, has finally subsided. “I will tell you this,” says Billy. “I have more of a personal peace inside, within myself. It’s not that I’m out in public humping women up, but sometimes when I’m walking around and my penis is hanging down like that and I pass a mirror, it just makes me feel good to see it hanging there.”