Millennium Sex Program
Male Organ Specific Enhancement Surgery Article # 1
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How a Risky Surgery Became Profit Center in Los
Angeles
By LISA BANNON
Staff Reporter of THE WALL STREET JOURNAL
LOS ANGELES -- A sleek promotional video from
Cosmetic Surgery International
here stars satisfied customers offering up
breathless testimonials. "This,"
says a man in his 40s, "is absolutely the best
thing that ever happened to
me." Adds another, "I can't believe I
waited so long."
Just like braces for crooked teeth, the video
explains, this cosmetic surgery
is "simple, safe and effective." But this
is no orthodontia. For $5,900 and a
mere 55 minutes of time, the surgeon in the video
promises to substantially
lengthen and widen a patient's Male Organ.
Like the beginning of breast augmentation in the
1970s, penile enlargement
has become a hot new cosmetic specialty -- and
nowhere is it more prevalent
than here in the nation's plastic-surgery capital.
Popularized only during the
past few years, penile enlargement is now a major
profit center for some
enterprising urologists and plastic surgeons whose
incomes have fallen with
managed care. The fledgling industry has grown
quickly even though the
procedure is unregulated, isn't taught by any
university, can be dangerous --
and doesn't always work.
Toll-Free Advice
Cosmetic Surgery International says its two surgeons
together perform 30 to
45 enlargements each week and are booked through
July. One Southern California
clinic reported revenue averaging more than $1
million a month. Several
medical groups advertise toll-free numbers, like
1-800-SURGEON in Beverly
Hills, which accepts Visa and MasterCard and has
operators ready to explain
the $7,000 procedure to callers in Thai, German,
Vietnamese, Swedish or
French. "I cannot physically talk to everyone
with interest out there," says
Rodney Barron, a Beverly Hills urologist who has
opened sales offices in San
Francisco, San Diego, Orange County and Los Angeles
and says he has performed
more than 3,000 enlargements.
Nationwide, some 20 to 30 surgeons now practice
phalloplasty, as the
procedure is known; about half are clustered in
Southern California. Based on
individual surgeons' estimates of their patient
caseloads, the industry brings
in at least $24 million a year -- a fraction of the
estimated $350 million a
year breast-implant business, but a fast-growing
industry nonetheless.
All this despite the fact that the American
Urological Association and the
American Society for Aesthetic Plastic Surgery both
say the surgery has "not
been shown to be safe or efficacious." To the
extent that the public hears
about the usually hush-hush procedure at all, it is
because of terrifying news
reports of botched jobs and complications, ranging
from scarring and
lumpiness to impotence and even death. A
high-profile surgeon in Los Angeles
has been slapped with dozens of malpractice suits,
while another in Miami is
in prison for the death of a patient.
New 'Outlook on Life'
Yet especially here in Southern California, where a
culture of vanity
prevails, new recruits to the surgery are easy to
find. Cosmetic surgery in
general is more popular here than anywhere else in
the country. In 1994, the
latest year figures are available, 84,300 cosmetic
surgeries were performed in
California -- 21% of all U.S. cosmetic surgeries,
and more than double the
number performed in second-place Florida, according
to the American Society of
Plastic and Reconstructive Surgeons.
"I never felt comfortable or confident about
myself before," says Frank
Whitehead, a Los Angeles entrepreneur who had an
operation to both lengthen
and widen his Male Organ last year. Sitting in the office
of his printing shop in
the San Fernando Valley, Mr. Whitehead, a tall,
affable man with a black
mustache and tufts of black hair peeking through a
plaid shirt unbuttoned to
his navel, says that the procedure "has changed
my whole outlook on life."
"I go out on a limb more than I did before with
business," he says. "Now
[when] I go into business meetings, I'm thinking,
'If you guys had just half
of what I have.' "
Southern Origins
How penile enlargement became so popular here is a
tale more of marketing
than medicine. In the late 1980s, a Miami physician
named Ricardo Samitier,
who had created a niche for himself by performing
silicone lip enlargements,
decided to apply his trade to Male Organes. The result
was a Male Organ-widening
operation in which he injected fat extracted from
the abdomen or other parts
of the body.
Meanwhile, half a world away in China, a surgeon
named Long Daochao had
invented a procedure to lengthen the Male Organ; his new
technique was brought to
the U.S. in 1991 by another Miami physician,
urologist Harold Reed. The
lengthening procedure involves severing a ligament
that attaches the Male Organ to
the pubic bone, allowing the internal portion of the
organ to drop to the
exterior.
For a while, Dr. Samitier dominated the fledgling
field. But his reign was
cut short after one of his patients, a 47-year-old
lounge singer who had been
on blood-thinning medication, died following the
operation in 1992. Dr.
Samitier is now serving a five-year prison sentence
for manslaughter.
That's when Los Angeles urologist Melvyn Rosenstein
stepped in. Dr.
Rosenstein, now 57, had performed a handful of
enlargements in 1993 when he
teamed up with marketing expert Ed Tilden, who had
promoted a Beverly Hills
hair-transplant center and who saw a marketing gold
mine in penile surgery.
Together, the two men opened the Men's Institute of
Cosmetic Surgery. It
advertised penile enlargements heavily in national
magazines like GQ and
Penthouse as well as in local newspaper sports
pages, with this slogan:
"Dreams do come true." Dr. Rosenstein,
tall and garrulous, appeared in the ads
as well as in his own promotional video. He eagerly
offered up quotes to
reporters, telling them that his clients included
"a major movie star," two
famous singers, and "CEOs you read about in
Forbes." He declined to comment
for this piece.
The marketing machine worked, spectacularly. Soon,
the two men set up
satellite offices in more than a dozen cities,
including Phoenix, Houston,
Baltimore and New York. The offices were staffed by
young men who, former
associates say, frequently had no medical background
and who were paid $4,000
a month to explain the procedure to prospective
patients. The patients were
then referred to Dr. Rosenstein's Culver City,
Calif., clinic, where he
performed six to 14 surgeries a day. In Los Angeles
County Superior Court
papers, he reported that the clinic's revenue
totaled $7.4 million for the
first six months of 1994. Dr. Rosenstein and Mr.
Tilden have since had a
falling out and are in litigation.
Dr. Rosenstein's business was such a success that
other surgeons quickly
joined in. Many simply read or heard about the
procedure and then set up shop
with no experience. They had little choice; there
were few physicians they
could turn to who would teach them. "Most of
those guys don't want to teach
anybody else because it means giving up
business," says Gary Alter, a Beverly
Hills urologist and plastic surgeon who performs the
procedure.
For some surgeons feeling the pinch of managed care,
the procedure was a
godsend. "Unfortunately, many doctors have
target incomes, and when they see
their incomes dropping down, they start elective
surgery," says Miami's Dr.
Reed, who believes some of the surgeons aren't
performing the operation
properly. "So a cottage industry starts to
develop."
Soon, Los Angeles sports pages were filled with ads
for the likes of
1-800-SURGEON, Surgery Center for Men, the Barron
Centers, 1-800-680-MALE and
the Southern California Specialists in Sexual
Medicine. Some ads promised as
much as a 30% to 50% increase in width and a
two-inch increase in length.
Fortuitously, the World Wide Web was exploding at
just this time, allowing the
California surgeons to tout their expertise all over
the world.
Little Oversight
The surgeons were able to ply their new trade with
little oversight. While
other new medical procedures are backed up by
extensive research and
scientific studies, no comprehensive studies have
yet been completed on penile
enlargement. The Food and Drug Administration, which
oversees breast
implants, doesn't monitor the surgery because no
implant or drug is involved.
Hospitals must approve new procedures, but most
phalloplasty surgeons perform
the operations in their offices or in private
clinics.
Nor do state authorities get involved unless they
receive complaints about
individual surgeons, says California Deputy Attorney
General Elisa Wolfe.
"We're not looking at the procedure
itself," she says. "Experimental surgery
is not illegal. We cannot take on an industry."
Free from regulation, the industry exploded into a
marketing phenomenon.
Currently, there are well over 30 web sites devoted
to penile enlargement.
While no official figures exist, surgeons estimate
that 10,000 to 15,000
widening or lengthening surgeries have been
performed in the U.S. since the
early 1990s. Surgeons try to outdo one another with
slick promotional
materials, including, on the web sites, impressive
before-and-after pictures.
Complaints Pile Up
One thing most of the promotional literature doesn't
mention: the dangers of
the surgery. Soon after Dr. Rosenstein began
performing phalloplasty,
complaints began piling up against him and his
center.
Ron Nance, 47, a carpenter from Monterey, Calif.,
says that following 1994
surgery performed by one of Dr. Rosenstein's
associates, he got a severe
infection. He says he had to fly back to Los
Angeles, and that Dr. Rosenstein
opened up the incision without giving him an
anesthetic. On the plane back
home that afternoon, Mr. Nance says he noticed the
stitches were coming out
again. The complications persisted, and Mr. Nance
says he flew to Los Angeles
a total of nine times for repairs before turning to
other surgeons for help.
His girlfriend left him, he says: "She couldn't
take it anymore."
Nearly two years later, with $20,000 invested in the
operation and repairs,
Mr. Nance says he remains not only permanently
scarred but impotent. "This
procedure preys on men with little self
esteem," he says. "You feel like this
is your ticket to happiness." He has sued Dr.
Rosenstein and the other surgeon
involved in Los Angeles County Superior Court,
alleging sexual dysfunction,
deformity and fraud and deceit, among other things.
Dr. Rosenstein has denied
the charges, and an attorney for the other surgeon
says the charges are
without merit.
More than 50 other lawsuits have been filed by 18
different attorneys against
Dr. Rosenstein in Los Angeles County Superior Court.
Dennis Grant, an Orange
County resident, alleges that he "suffered
disfigurement, shortening and loss
of use of his Male Organ," while Gary Cates, another
former patient, claims he
suffered "pain, swelling" and
"excessive scarring." Other complaints
allege
complications ranging from "lumpiness" and
"shrinkage" to "uneven surface with
what appears to be cysts," and
"impotence." In court papers, Dr.
Rosenstein
has denied the charges.
'Getting Out'
The California Medical Board intervened in January,
and Dr. Rosenstein's
medical license has been temporarily suspended
pending a disciplinary hearing.
The surgeon's attorney, Thomas P. Brown, says his
client "vigorously
contested" the allegations, though he says Dr.
Rosenstein won't attempt to
re-enter the penile-enlargement business in any
case.
"Given the volume of litigation and aggravation
associated with it, Dr.
Rosenstein is getting out of the business and
staying out of it," Mr. Brown
says. "But he still maintains he didn't do
anything wrong."
Some complaints also began surfacing about at least
four other surgeons, who
face a growing stack of malpractice suits in
California, New Jersey and
Illinois courts.
Malpractice insurers sometimes cover physicians who
perform the lengthening
procedure, but rarely cover them for the
fat-injection widening. Mark Gorney,
an executive vice president of Napa, Calif., insurer
Doctors Co., calls the
fat injections "a totally ineffective procedure
and nothing short of fraud."
Critics, including some professors of urology, say
there is no indication
that the lengthening surgery works for everyone, and
that fat injections
result in too high a degree of deformities. "I
challenge them to stop for a
minute and show us the results based on preoperative
and postoperative
measurements," says Harin Padma-Nathan,
assistant professor of urology at the
University of Southern California. The lengthening
operation "appears to be a
sham operation to date."
A New Mop-Up Business
Indeed, the industry is so riddled with problems
that it is now spawning a
mop-up business of its own: An Internet support
group for disgruntled patients
provides information about surgeons, reconstructions
and malpractice suits.
At least two California attorneys now specialize in
penile malpractice cases.
San Francisco attorney Steven Fabbro says he has 30
clients, mostly former
patients of Dr. Rosenstein, while Camarillo, Calif.,
attorney Keith Schulner
says he has 35 clients and spends the bulk of his
time on the Rosenstein
cases.
"This could be the fantastic break that every
attorney has ever wanted," Mr.
Schulner says. "Or it could be a
disappointment. We're going to be clogging up
the courthouse for a while."
Repairing allegedly bungled surgeries has also
become the main livelihood of
Gary Rheinschild, a urologist who operates the
Potency Management Center in
Anaheim, Calif. His business has nearly doubled this
year, he says, to between
five and six surgeries a week. About 80% are
reconstructions costing $4,500
and the balance are enlargements, costing $7,300 for
the lengthening and
widening. Beverly Hills urologist Dr. Alter and San
Francisco urologist Jack
McAninch, the new president of the American
Urological Association, also work
on botched enlargements.
"A lot of doctors are appalled by this and
don't want to talk about it," says
Dr. Rheinschild as he pulls on his surgical gown,
preparing for a lengthening
operation on a 32-year-old aerobics instructor.
"But a lot of people are
jumping in because of the big money. People
shouldn't be doing this unless
they know what they're doing."
Dr. Rheinschild says he has seen a lot of
complications during the past few
years, most of which he says are avoidable. For
example, he won't perform fat
injections because they often result in
"concave areas, nodules and
asymmetrical looking Male Organes." He advocates
dermal grafts, a different
procedure in which two strips of fat are removed
from the patient's gluteal
folds, where the thighs meet the buttocks, and
implanted on either side of the
Male Organ.
Hoping for Legitimacy
Hoping to legitimize phalloplasty, several surgeons
last year created the
American Academy of Phalloplasty Surgeons. But so
far only about a dozen
surgeons have joined, and the academy hasn't yet
published any scientific
studies. One member, E. Douglas Whitehead, has
received approval to begin a
study at Beth Israel Medical Center in New York.
Despite the horror stories, though, the business
shows no signs of slowing.
Even Dr. Rosenstein's colleagues are already back in
the saddle. It turns out
that Cosmetic Surgery International, the outfit that
uses the slick
promotional videotape and is booked through July, is
co-owned by Dr.
Rosenstein's stepson, Jonathan Yaker, along with
Christopher Solton, who is
Dr. Rosenstein's former marketing director.
Promotional literature CSI
recently mailed out displays the name "Rosenstein
Medical Group" and features
flattering newspaper articles about the surgeon.
Mr. Solton, the co-owner, insists that Dr.
Rosenstein has nothing to do with
CSI. "It must have been an old folder," he
says. "It was a mistake." Dr.
Rosenstein's attorney, Mr. Brown, says he has
notified CSI that the surgeon
can no longer be referred to in the clinic's
materials.
Other phalloplasty practitioners say the procedure
isn't going away because,
quite simply, the time is right for it. The surgery
ties into the American
male psyche, they say, making for possibilities that
aren't only lucrative but
limitless.
"You've had a few people who have done large
numbers with bad results," Dr.
Alter in Beverly Hills says. "But in 10 years,
as improvements are made,
you'll see this surgery becoming mainstream. It's a
vain society out here."
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