Urologist explains science behind HA penile injections

In an interview discussing rumors surrounding ski jumpers at the 2026 Winter Olympics, urologist Alex Tatem, MD, explained the biological effects and clinical realities of hyaluronic acid (HA) penile injections.

From a tissue-biology perspective, he emphasized that HA is a naturally occurring substance already present in human connective tissue and widely used since 2003 for cosmetic volumization in areas such as the face and lips. Because it is biocompatible and enzymatically reversible, HA differs from permanent fillers like silicone or PMMA, which can cause lasting vascular or lymphatic complications.

When injected into penile soft tissue, HA is strategically placed within a specific anatomical plane—between Buck’s fascia and the dartos layer—where it spreads as a hydrated gel. In this space, it integrates mechanically rather than chemically, adding volume by attracting water and creating structural expansion. According to Tatem, proper placement minimizes disruption to blood vessels and lymphatic drainage while allowing gradual stabilization as surrounding tissue accommodates the filler. Over time, the material slowly degrades through normal metabolic processes, making results temporary but predictable.

Addressing whether injections could measurably alter external dimensions, Tatem cited retrospective clinical data presented at the Sexual Medicine Society of North America and the American Urological Association and published in the Journal of Sexual Medicine. In a cohort of 155 men, average treatment produced about a 0.63-centimeter increase in circumference, while multiple staged treatments yielded gains approaching 3 cm—changes large enough to be externally noticeable and potentially measurable days or weeks later.

Tatem noted, however, that predictability depends heavily on technique. Early international studies showed inconsistent symmetry, limiting adoption. More recent protocols use staged injections, careful healing intervals, and post-procedure stretching—likened to “laying bricks”—to refine contour and correct asymmetries over time. Even so, individual variability remains significant, influenced by anatomy, healing response, and adherence to aftercare, meaning outcomes are reproducible in experienced hands but not identical across patients.