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Q: For what reasons do you perform circumcisions? A: The most common reasons for which I perform circumcisions are: · Cosmetic appearance A: The basic difference is that neonatal circumcision is usually done with one of several clamp devices that remove redundant foreskin, stop bleeding vessels, and close the skin edges without the need for suturing. The most common of these devices are the GOMCO clamp, introduced in 1934; the Mogen clamp, introduced in 1954; and the Hollister PlastiBell, introduced in 1950. All three bond the skin edges together, obviating the need for a suture closure. The reason adult circumcisions require suturing is that adults get powerful erections during the REM portion of the sleep cycle, which would disrupt a wound held together only by a crushing of the skin edges. The fact that the wound edges must be sutured in adult circumcision creates one of the largest challenges in the operation, specifically, placing sutures without causing scarring. Also, this is the only elective surgical would which we know will come under tension as the result of nocturnal erections. A general principal of surgery is that one shall not make a wound which is closed under tension. Although when flaccid the wound may not be under tension, when the penis is erect, the would will come under tension unless the circumcision is extremely loose. The tension on the sutures can also cause scarring at the location of each suture. Therefore, it is extremely challenging to attempt to get a wound which must be sutured and in which does not require suturing. The adult procedure is definately a cosmetic challenge. Q: Is a consultation visit necessary prior to deciding on circumcision? A: Yes, it is important to have a consultation visit. The consultation is included and the time required is approximately 30 minutes. Both the consultation and procedure may be performed during the same office visit, requiring an overall time of one and a half hours. Q: Do you treat non-US citizens? A: Yes, we
gladly treat patients from any country. There are many low fares
into Hartsfield Atlanta International Airport and our location
is a convenient 30-minute, $1.75 train ride by MARTA. Travel
information can be found here. A: It is fine to travel home immediately after the procedure. However, if you wish to stay in the area, please feel free to contact our office for our recommendations. Q: What is the recovery time for adults after circumcision? A: I suggest a week of moderate activity following circumcision. Sedentary activity and travel is possible the same day. Q: What technique do you use for adult circumcision? A: I use the free hand or sleeve resection technique most commonly. The incision lines are marked on the inner (mucosal) and outer layers of the foreskin where the patient wishes. Incisions are done with a scalpel rather than scissors as it gives a more precise incision. Skin closure is with absorbable sutures of the quality used for plastic surgical procedures. Q: Will having a circumcision change the size of my penis? A: Absolutely not. The structures of the penis that give it length and girth are deeper in the anatomy than the skin. The skin is the only component that is altered with a circumcision, therefore there is no possibility of altering penile size with a circumcision. Q: Can you perform revisions to improve the cosmetic appearance or tightness of an earlier circumcision? A: Yes, this is a frequently performed procedure in the office. Q: I had an adult circumcision with with I am unhappy due to visible suture marks. Can you do a revision and eradicate these? A: You can see photographic examples of some outcomes of revision in the Outcome Images section on the website. However, I cannot guarantee the outcome of any cosmetic procedure as there are wound healing differences from one patient to another. I have found with experience that revisions tend to heal with somewhat more scarring than initial procedures. This would seem to be the result of the blood supply to the wound edges having been altered (reduced) by the prior circumcision. That being said, it is still worth making an effort at revision, but, with realistic expectations. Q: Do you have an age limitation for circumcision? A: No, in fact, I have performed circumcision for men over eighty years of age. The more important factor is the state of their general health to allow for minor surgery. However, minimum age is 18. Q: How is the local anesthetic done? What medication do you use? A: The injection
is done at the base of the penis utilizing a Q: What if I am uncomfortable with having the procedure performed using local anesthesia? A: If you are afraid of needles and/or tend to become faint at the sight of needles, it would be best to have your procedure performed under general anesthesia. Please contact my office to speak with a member of my staff about scheduling the procedure to be performed under general anesthesia. Q: Do you do frenulectomy (removal of frenulum)? A: Yes, I do this if the patient desires it, either at the time of circumcision or as a separate procedure. Q: Do you recommend removal of the frenulum in adult circumcision? A: The frenulum is a structure which is not identical in configuration from man to man. I suggest removing it only if it ditracts from the overall aesthetic appearance. Q: Do you perform circumcision for cosmetic reasons? A: I respect the aesthetic wishes of my patients and will gladly perform circumcisions for purely cosmetic reasons. Q: How do you determine how much foreskin to remove? A: There is no scientific means for determining the exact length of skin to remove in circumcision. It is a visual estimation only. The penis changes dimensions in response to a variety of stimuli, which will alter the tightness of the skin. I get only one oppportunity to see your anatomy. I will do my best to aim for the degree of tightness a patient wishes, but I cannot assure you of any specific outcome with regard to tightness. Q: What is the postoperative care of adult circumcisions? A: Your circumcision will be sutured with absorbable (dissolvable) sutures. There will be a compressive bandage on the penis. You will be told how long to leave the bandage in place after the procedure. After the specified time, the bandage can be removed in the bathtub. The compression dressing should not be changed or removed early. A plastic covering should be used during bathing. Sexual activity may be resumed after approximately four weeks. Q: Will the compression bandage you apply to my penis prevent me from being able to wear regulat street clothes? A: The bandage will not be apparent under your clothing. It is a very light weight and compact dressing. Q: Will I have difficulty walking soon after the procedure? A: Walking will not be a problem. It will probably be easier and more comfortable, however, if you wear supportive underwear. Q: How did you come to specialize in circumcisions? A: My circumcision practice is only one component of my adult urology practice. Please have a look at the other services I provide by going to my other website at www.davidcornellmd.com The circumcision niche is one I have gotten into without meaning to. In late 2002, I was starting an online support group for patients with prostate cancer on one of the major search engines. In the course of searching for existing groups dealing with prostate cancer one of the groups I was directed to turned out to be a circumcision support group. I joined the group primarily out of curiosity. It became promptly apparent that the group members had become frustrated with their experiences attempting to get circumcised and/or their cosmetic outcomes from circumcisions. I felt badly for them and simply posted a few responses to their messages, never thinking men would travel to another city to get a relatively simple procedure performed. To my amazement, within thirty days, men were coming to see me from all over the U.S. The traffic has continued to increase and astound me. It has definitely been a gratifying pursuit and I remain most grateful for the confidence men place in me.
A: In 2003, I did 66 procedures. In 2004 that number increased to 154. In 2005, the growth continued and exceeded 275 procedures. Q: What do you do differently from other physicians doing adult circumcision? A: I treat circumcisions as cosmetic procedures. I always want to incorporate any specific cosmetic concerns each patient presents to me. I make measurements in the attempt to remove enough skin so that no skin rolls over the corona of the glans and that the incision is symmetrical. I close the wound with very fine sutures which are generally used in facial cosmetic surgery. These measures are to make the outcome look very tidy and as free of suture marks as possible.
A: Because I do such a high volume of circumcisions, I have been able to work on refinement of the surgical technique with the goal of giving adults a cosmetic result at least as good as neonates. The primary obstacle we face in doing adult circumcisions is that adults get very forceful erections as part of the normal sleep cycle. Many urologists approach this issue by utilizing thick, heavy suture material which may leave unsightly scars. I have developed a technique of utilizing very thin suture material and protecting the wound with a compressive dressing. The sutures I use are only for skin edge alignment, the dressing holds the wound together while healing occurs. The most recent refinement of technique has now over 100 cases with no wound complications.
A: Almost
all the procedures I perform is for cosmetic/social reasons.
From discussions with hundreds of men, I have learned that many
men experience reduction of self esteem due to being the "odd
man out" in this circumcised American culture. Men seem
to appreciate my practice as a discrete and non-threatening
solution to getting that mainstream
A: I have a very discrete practice of urology. There is no signage to reflect the large volume of circumcisions I do. The door sign is for "David Cornell, M.D.," not "Circumcision Center." "Circumcision Center" is a Web address only. Q: Are there any female employees involved in the actual circumcision procedure? A: No, I have always had only a male assistant for the actual procedure. Return to top |
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