Comparison of Traditional Multipuncture Technique and Atraumatic Cannula Technique for the Penile Girth Enlargement using Hyaluronic Acid

For many men, the size of the penis is a source of deep personal concern, often tied to feelings of confidence and masculinity. While medical science has long focused on correcting anatomical issues that prevent sexual function, a growing number of men seek elective procedures simply to increase the circumference of their penis. This desire has driven the development of various cosmetic techniques, with one material standing out in recent years: hyaluronic acid. This substance, a gel-like filler already familiar to many from its use in facial aesthetics, has been approved for use in penile enlargement because it is safe, breaks down slowly over time, and integrates well with the body's tissues. However, while the material itself is well-understood, the method used to inject it has remained a point of debate among specialists. The core question has not been whether the filler works, but rather how best to deliver it to ensure the result looks natural, feels smooth, and carries the lowest possible risk of complications.

A team of researchers set out to settle this debate by comparing two distinct approaches to injecting this gel. The first method, known as the traditional multipuncture technique, involves making many small, sharp punctures along the length of the penis shaft. Through each of these tiny entry points, the doctor pushes the filler material into the tissue, hoping to build up a uniform layer. The second method, called the atraumatic cannula technique, takes a different path. Instead of many sharp holes, the doctor makes a single small entry point at the base of the penis. Through this opening, they insert a blunt, flexible tube called a cannula. This tube is pushed gently under the skin to create a smooth channel, allowing the filler to be deposited in a continuous, even cylinder around the penis without tearing the delicate blood vessels and tissues. To determine which approach is superior, the researchers reviewed the medical records of hundreds of men who had undergone the procedure between 2022 and 2025, tracking their results over a full year.

The study followed 458 men who completed a full year of check-ups, with 280 treated using the single-entry cannula method and 178 treated with the many-puncture method. When the researchers measured the actual increase in penile girth at three months, six months, and one year, the results were remarkably similar. Both groups saw their penises grow by the same amount, reaching an average circumference of 13.7 centimeters after one year, up from a baseline of 11.4 centimeters. In terms of raw physical enlargement, the study found no significant difference between the two techniques; both successfully added volume to the penis. The doctors also noted that the amount of filler used and the duration of the procedures were comparable between the two groups, suggesting that neither method required significantly more time or material to achieve the same physical growth.

However, the story changed when the researchers looked at how the patients felt about the results and how many complications occurred. The men who received the treatment with the blunt cannula reported much higher levels of satisfaction. On a scale measuring how happy they were with the outcome, the cannula group gave an average score of 4.5, while the multipuncture group averaged 3.3. This difference was statistically significant, indicating that the single-entry method produced a result that patients found more visually pleasing. The researchers believe this is because the blunt tube spreads the filler more evenly, creating a smoother surface with fewer irregularities, whereas the multiple sharp needles can sometimes lead to a less uniform texture.

The most striking difference between the two methods appeared in the safety data. Complications were far less common in the group treated with the cannula. Hematomas, which are collections of blood under the skin caused by bleeding, occurred in only 1.78 percent of the cannula group, compared to 6.18 percent in the multipuncture group. Similarly, the formation of lumps or nodules under the skin was much rarer with the cannula, affecting just 1.42 percent of patients versus 6.74 percent of those treated with the traditional method. Perhaps most importantly, the risk of the filler moving to the wrong place, a problem known as migration, was significantly lower with the cannula technique. Only 1.07 percent of the cannula group experienced migration, compared to 8.42 percent of the multipuncture group. Infections were also almost entirely absent in the cannula group, with only two cases reported in the entire study, both of which occurred in the multipuncture group.

These findings suggest that while both techniques are effective at increasing penile size, the method of delivery matters greatly for the final experience. The blunt cannula technique appears to offer a safer path with fewer side effects and a more satisfying visual result for the patient. By minimizing tissue damage and ensuring a smoother distribution of the filler, this approach reduces the likelihood of lumps, shifting material, and bruising. For men considering this procedure, the study indicates that the choice of technique is a critical factor in determining not just the size of the result, but the quality of the outcome and the peace of mind that comes with avoiding complications. The research concludes that patients who undergo the PGE procedure should be informed especially about the visual satisfaction rate and migration rate after both the traditional multipuncture and atraumatic cannula techniques.