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Q: What is the cost of the procedure?
A: As of January 2012, the fee for first-time circumcisions and revisions is $2500. If the foreskin is non-retractable, the fee is $3000. We do not accept insurance for these services.
Q: For what reasons do you perform circumcisions?
A: The most common reasons for which I perform circumcisions
· Cosmetic appearance
· Phimosis (tight foreskin)
· Paraphimosis (inability to pull the retracted foreskin back
over the glans)
· Balanitis and balanoposthitis (inflammation of glans
· Frenulum breve (short frenulum which tears with intercourse)
· Diseases of the foreskin, including cancer
Q: How does adult circumcision differ technically from neonatal
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
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.
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.
Q: I am traveling into Atlanta specifically for this procedure.
How long will I need to stay and do you recommend any hotels
A: If I had my wish, all my patients would remain in Atlanta for several weeks to allow complete wound healing. This is not practical for most men. The majority of my patients travel out of Atlanta within 48 hours of the procedure and have no problems.
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.
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.
Will having a circumcision change the size of my penis?
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.
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.
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
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.
How is the local anesthetic done? What medication do you use?
A: The injection
is done at the base of the penis utilizing a
combination of a short acting product (Lidocaine) and a long
lasting agent (Marcaine). The patient usually only feels one
needle stick and after that, no discomfort.
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.
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.
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 detracts from the
overall aesthetic appearance.
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.
How do you determine how much foreskin to remove?
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.
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.
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.
Will I have difficulty walking soon after the procedure?
will not be a problem. It will probably be easier and more comfortable,
however, if you wear supportive underwear.
How did you come to specialize in circumcisions?
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
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.
Q: How many circumcisions do you perform?
A: In 2003,
I did 66 procedures. In 2004 that number increased to 154. In
2005, the growth continued and exceeded 275 procedures.
What do you do differently from other physicians doing adult
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.
Q: Why is the compression bandage even necessary?
I perform such a large number of circumcisions, I have had the opportunity to refine the clinical aspects of the procedure. The compression bandage is not bulky or uncomfortable to wear. It prevents almost all edema (swelling) at the operative site and makes the healing process largely painless. By preventing edema in the wound edges, tension on the sutures is prevented. This minimizes suture marks.
Q: What is the most common reason for which you perform adult
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
Q: Will anyone who sees me go into your office know exactly
what I am having done? This seems like it could be embarrassing.
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.
Are there any female employees involved in the actual circumcision
A: No, I
have always had only a male assistant for the actual procedure.
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