There are four main circumcision styles (high/low and loose/tight) depending on how much inner and outer foreskin is removed.
Discussing these with a urologist and considering your anatomy and foreskin problems is vital for choosing the best option and achieving a successful outcome.
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 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 relates to the scar line from the groove (sulcus) of the head of the penis (corona of the glans) and how much inner skin, called mucosal skin, is removed.
- High cut: excess outer skin along the shaft is removed, leaving long inner skin.
- Low cut: more inner skin is removed so that the scar line is very close to the groove of the head.
Some men think entirely the opposite of this concept, believing a scar line should be taken to the base of the penis.
These high or low styles are not possible in all men.
Putting a scar line in the middle of the shaft or close to the base is not recommended as it leaves too much inner skin, which can swell due to lymphatic drainage (lymphoedema). Over time, the inner skin may stretch into a loose fold, producing unsatisfactory long-term results. This also involves cutting too much shaft skin.
2. Tight Versus Loose Circumcision
This depends on several factors:
- How much total foreskin is removed
- Mobility of penile shaft skin
- Attachment of the skin at the base of the penis toward the abdomen (penoscrotal junction)
Tightness of skin around the penis is sometimes not possible, regardless of how much foreskin is removed.
This is due to the loose attachment of skin at the base of the penis to the body at the penoscrotal junction. Congenital reasons or ageing may also cause this.
- Tight circumcision should not be confused with erection quality, which depends on other factors.
- The erection itself is not affected by circumcision.
- Loose circumcision may be similar to partial circumcision.
These concepts should be considered in both the flaccid and erect state of the penis.
Tight circumcision is not possible in men with a considerable difference in size between fully flaccid and fully erect penis. Such men may experience painful erections during sexual activity in the first 3–6 months if a tight circumcision is performed.
Cosmetic Circumcision (Dr Eid)
American Urologist Dr Eid described on his website “Cosmetic Circumcision,” where the sleeve of skin is cut at the base of the penis, leaving the whole inner skin intact.
In Dr Eid’s experience, great care is taken so that during an erection, the penis has an excellent cosmetic appearance.
Before removing skin, an artificial erection is induced in all patients to determine the precise amount of skin to excise.
Patients reported improved hygiene, self-esteem, and high satisfaction with the cosmetic appearance of the penis.
Dr Khan’s View
In Dr Khan’s opinion, this procedure can be done in a very selective number of patients.
Conditions Required for Good Outcomes:
- The peno-scrotal junction must be fixed
- There must be loose foreskin which can retract behind the head of the penis
- There must not be a buried penis
- There must be no pathological phimosis (tight foreskin)
- There should not be Balanitis (BXO phimosis) or scarring
- General anaesthesia is required for inducing an artificial erection to ensure adequate removal of skin from the base