A phalloplasty creates a penis using tissue transplanted from another part of the body, most commonly the forearm or thigh. The result is a cylindrical shaft made of living skin and tissue, typically 5 to 6 inches in length, that gains more definition and realism over multiple surgical stages and months of healing. The final appearance varies depending on the donor site chosen, how many stages of surgery are completed, and whether optional refinements like medical tattooing are pursued.
How the Shaft Looks After the First Stage
The initial surgery creates the main body of the penis. A large section of skin and underlying tissue is harvested from the donor site, rolled into a tube to form a shaft, and attached to the groin. At this point, the phallus is a smooth cylinder without a defined head. The skin tone matches the donor area, which may or may not closely match the surrounding genital skin. If forearm tissue is used, any arm hair present on that skin will remain on the shaft.
In the early weeks, the new phallus appears swollen and discolored, with visible suture lines running along its length. The skin looks tight and may have a pink, red, or purplish hue. Over the following months, swelling gradually subsides and the tissue softens, giving the shaft a more natural drape and contour. Full scar maturation takes 6 to 12 months, during which the surgical lines fade from dark red or purple to lighter tones that blend more with surrounding skin.
Glansplasty: Creating the Head
A separate procedure called glansplasty sculpts a defined head at the tip of the shaft. Surgeons create a coronal ridge (the raised rim that separates the head from the shaft on a natal penis) by lifting a flap of skin and placing full-thickness skin grafts underneath it. Quilting sutures hold the ridge in place so it maintains its projection long term. The result is a visible distinction between the head and shaft that significantly changes the overall appearance from a simple cylinder to something that reads more anatomically as a penis.
Glansplasty is typically performed as a later-stage procedure, sometimes months after the initial shaft creation. Like any surgical site, it goes through its own healing period of redness and swelling before settling into its final shape.
Scrotoplasty and the Full Genital Appearance
Many people also undergo scrotoplasty, which creates a scrotum using labial tissue or other local skin. Testicular implants (silicone prostheses) can be placed inside to give the scrotum a filled, natural appearance. With all stages complete, the overall genital area includes a shaft, a defined glans, and a scrotum, closely resembling a natal male anatomy from a moderate distance. Up close, differences in skin texture, scarring, and color variation between grafted and native tissue are more apparent.
What the Donor Site Looks Like
Because phalloplasty requires a significant amount of tissue, the donor site leaves a noticeable mark. The two most common donor sites produce very different scars.
- Forearm (radial forearm flap): This leaves a rectangular area on the inner forearm that is covered with a split-thickness skin graft taken from elsewhere on the body, often the thigh. The grafted patch has a different texture and color than the surrounding arm skin, appearing smoother and sometimes shinier. It can look pinkish or slightly lighter or darker than the native skin even after full healing. This scar is visible whenever the forearm is exposed, which is a meaningful consideration for many people.
- Thigh (anterolateral thigh flap): This option moves the scar to the outer thigh, where it is hidden by regular clothing. However, the thigh donor site also requires a skin graft to close, leaving a hairless, slightly depressed patch that differs in texture from the surrounding skin. There are also secondary scars from wherever the skin graft itself was harvested. Newer techniques using tissue expansion before harvest can sometimes allow direct closure with just a Y-shaped scar and no skin graft, which produces a less conspicuous result.
Donor site skin grafts follow a similar healing arc to the phallus itself. They start out pink or purple and gradually lighten over 6 to 12 months. Some permanent difference in pigmentation compared to surrounding skin is normal.
How Appearance Changes Over Time
The phalloplasty result at three months looks quite different from the result at one year. Early on, everything is swollen, discolored, and marked by visible suture lines. The tissue feels firm and the color contrast between grafted and native skin is stark. Over the first year, several things happen: swelling resolves and the shaft narrows to its final girth, surgical scars fade and flatten, and the skin softens and develops more natural movement. The color difference between the transplanted tissue and the surrounding genital skin also diminishes, though it rarely disappears completely.
The donor site follows a parallel timeline. Initial pinkness and sensitivity give way to a more stable color and texture. Most people find that by 12 months, both the phallus and the donor area have reached close to their final appearance, though subtle changes can continue for up to two years.
Erectile Devices and Their Effect on Appearance
A phalloplasty does not produce erections on its own because the transplanted tissue lacks the specialized erectile structures of a natal penis. For penetrative function, a penile implant can be placed inside the shaft in a later surgery, typically at least a year after the initial construction. The two main options are a semi-rigid rod (which keeps the penis in a constant firm state that can be bent down when not in use) and an inflatable pump system (which allows the penis to transition between flaccid and erect states).
When deflated or bent down, the shaft looks similar to how it did before the implant. When activated, it becomes visibly firmer and straighter. The implant itself is not visible through the skin in most cases, though the pump mechanism for an inflatable device is housed in the scrotum and can sometimes be felt or faintly seen as a small bulge.
Optional Cosmetic Refinements
After the major surgical stages are complete and fully healed, some people pursue additional cosmetic work to refine the appearance. Medical tattooing, also called micropigmentation, is one of the most impactful options. A specialist tattoo artist can add pigment to simulate a dorsal vein running along the top of the shaft, create color variation that mimics the subtle tonal differences found on natal penile skin, and enhance the contrast between the glans and shaft. This is a non-surgical procedure using techniques similar to cosmetic tattooing for areola reconstruction after mastectomy.
Other refinements can include scar revision on the shaft or donor site, fat grafting to improve contour, or adjustments to the glans shape. The cumulative effect of these refinements, combined with natural scar maturation over time, means that the appearance at two years post-surgery can be substantially different from the appearance at six months.
Variation Between Results
No two phalloplasty results look the same. Several factors create significant variation: skin tone and how well the donor tissue matches genital skin, the amount and color of hair on the donor tissue, the specific flap technique used, the surgeon’s approach to glansplasty, and how an individual’s body heals. People with darker skin tones may see more contrast between grafted and native tissue. Those who had hair removal on the donor site before surgery will have a smoother shaft. The choice between forearm and thigh tissue also affects the final texture, as forearm skin tends to be thinner and more pliable while thigh skin is thicker and can appear bulkier.
Photographs shared in surgical literature and patient communities show a wide range of outcomes, from results that are difficult to distinguish from a natal penis at a glance to those where surgical origins are more apparent. The number of stages completed matters enormously. A shaft alone looks noticeably different from a shaft with glansplasty, scrotoplasty, and medical tattooing all complete.