Too Much – Too Little
This is the most common complaint or concern parents have after a circumcision. Because there is a wide range of what is considered a normal amount of skin left after a circumcision, there is a wide range of opinions on what “looks normal” for a circumcised penis. Furthermore, appearance very much depends on the pubic fat pad around the base of the penis. Because the penis is attached to the pubic bone it does not ‘float’ with skin level. The thicker the fat pad the more the penis goes into the fat pad and the skin over the top of the penis. This can cause even the best of circumcisions to appear as if too much skin remains — even to the extreme where it is hard to determine if circumcision was even done. The best way to judge the amount of remaining skin is to push down on the fat pad at the base of the penis with two fingers and then inspect. Typically the circumcision is OK if the glans is mostly exposed and the skin remaining is satisfactory when pushing down on the pubic fat pad. If the penis skin is too tight, with or without depressing the pubic fat pad, then probably too much skin was removed. In many cases, this becomes an ‘eye of the beholder’ assessment.
Revising a circumcision almost always involves an outpatient surgical procedure with anesthesia. Of course, it is easier to remove excess skin than to correct a circumcision where too much skin was removed. In fact, in most cases, it is best to not surgically revise a circumcision when too little skin remains. With time (care and erections) the too-tight skin will relax and stretch and not require revision.
Too little foreskin may be removed during a newborn circumcision, leaving the appearance of partial circumcision or a look similar to that of a newborn who is born with a “natural circumcision.” This is not a medical concern, but when the desire is to appear or have benefit of a circumcision, then having too little skin removed may be of concern to the parents. Certainly, this is preferred over having too much skin removed.
Irregular or “Lopsided”
Newborn circumcision can cause too much or too little skin to be present anywhere around the 360º circle of the penis. If the clamp or ring is placed crookedly, it will cause asymmetry or different amounts of skin to be present. This can cause an unsatisfactory appearance and care issues. Newborn clamps and rings are intended for use on uncircumcised penises where normal and equal amounts of foreskin are present around the complete 360º of the penis. If a mild birth defect is present (i.e. chordee or webbed penis) prior to the infant circumcision then it is more likely to result in an irregular or lopsided appearance. The provider should take any slight variations in the uncircumcised penis into account when performing the procedure.
Note more white shaft skin near abdomen and significantly less white shaft skin near the scrotum– this was done “crooked” and not ideal.
Penile Skin Bridges