The high/low style is a way of stating how much inner skin is removed. The loose/tight style is a way of stating how much outer skin is removed. These styles are almost totally independent, hence there are four circumcision styles:
Low and Loose
Low and Tight
High and Loose
High and Tight
Dr Khan can discuss the characteristics of high and low cut, tight and loose cut types or styles of circumcision.
1. High and low “cut” circumcision
This concept is due to the scar line from the groove (sulcus) of the head of the penis (corona of the glans) and also depends upon how much inner skin called mucusa is removed. High “cut” means excess outer skin along with shaft of penile skin is cut, leaving long inner skin. Low “cut” means to cut more inner skin so that the scar line is very close to groove of the head of the penis. Some men think completely opposite to this concept. They may think “cut” or scar line is taken in relation to the base of the penis. These high or low styles are not possible in all men. To put a scar line in the middle of the shaft or close to the base of the penis is not recommended as it leaves too long inner skin which can swell up due to lymphatic drainage (lymphoedema) and also over time, the inner skin stretches to become a loose fold of skin which gives unsatisfactory results in the long term. This also involves cutting too much shaft of penile skin.
2. Tight versus loose circumcision
This might depend upon many factors such as how much total foreskin is removed, the mobility of penile shaft skin and attachment of the skin at the base of the penis at the abdomen (penoscrotal junction). Tightness of skin around the penis is sometimes not possible, no matter how much foreskin is removed during the circumcision. This is due to loose attachment of skin at the base of the penis to the body at penoscrotal junction. This might be caused by congenital reasons or the ageing process. Tight circumcision should not be confused with quality of erection which depends upon many factors. Erection is not affected by circumcision. Loose circumcision may also be similar to partial circumcision. These concepts should be taken according the flaccid and erect state of the penis. Tight circumcision is not possible for those who have a considerable difference in size between fully flaccid and fully erect penis. They may have a painful erection during sexual activity in first 3-6 months if a tight circumcision is performed.
American Urologist Dr. Eid described on his website about “Cosmetic Circumcision” where he cut the sleeve of skin at base of penis leaving whole inner skin
However, in Dr Eid experience , great care has been taken so that during an erection, the penis has an excellent cosmetic appearance. For that reason prior to the removal of skin, an artificial erection is induced in all patients so as to precisely determine the amount of skin to be excised. In addition of experiencing improved hygiene and self-esteem, after having a cosmetic circumcision patients are very pleased with the appearance of their penis.
In Dr Khan view, this can be done in very selective number of patients. There are following conditions required to achieve good outcome:
1. Penoscrotal junctions has to be fixed
2. There must be loose foreskin which can easily retract behind the head of penis
3. There must not be in form of buried penis
4. There is no pathological phimosis (tight foreskin)
5. There should not be Balanitis (BXO phimosis) or scarring
6. It needs to have general anesthedsia for get an artificial erection to see for adequate removal of skin from base of the penis