Ron Nance, a 47-year-old divorced carpenter, wishes he'd never met the doctor who promised him a larger penis.

Surgery left Mr. Nance infected, racked with pain, impotent and eventually abandoned by the woman he loved. When Mr. Nance, who lives in Capitola, Calif., first read a newspaper ad touting the successes of Dr. Melvyn Rosenstein and his Culver City, Calif., practice, he thought he'd found "the answer to my insecurity problem.''

Like many of the estimated 10,000 Americans who have undergone cosmetic penile enlargements, his concern wasn't sexual performance, but how he measured up -- or appeared to measure up -- to other men. Despite his girlfriend's protestations, Mr. Nance felt further compelled by what he heard from a San Francisco sales representative for Dr. Rosenstein, the nation's busiest penile enlargement practitioner.

"He assured me that it was a relatively painless procedure, so fine-tuned that all the results were 100 percent and that I would be back to work in three days and back jogging in a couple of weeks and -- as he said -- 'back in the saddle in a month,' '' Mr. Nance recalls.

So Mr. Nance took money he'd been saving for a new truck and put $5,900 cash down on the combined lengthening and widening surgery.

"It only took an hour to mess my life up,'' said Mr Nance, now scarred "like someone who stepped on a land mine'' and unable to engage in sex. After corrective surgery, he's smaller than before -- and broke.

Like the 5,000 patients Dr. Rosenstein has operated on since 1991, Mr. Nance forked over his own money for an experimental operation rarely covered by insurance.

At least 30 doctors around the country, many in Southern California, perform the increasingly popular penile augmentations, often in private operating rooms not affiliated with established hospitals.

The practitioners lure potential patients through ads in newspaper sports pages, right in there with strip joints, hair restoration centers and fast cars.Dr. Rosenstein's media blitz also included television infomercials and an Internet site that proclaimed his patients gained an average of 1.5 to 2 inches in length and 30 percent to 50 percent in circumference.

Yet many men who thought a scalpel could give them a larger penis have only scars to show for it -- both physical and mental.

"When I use a rest room, I won't look down. When I do, I get totally depressed, disgusted,'' said Tony, a 35-year-old Arizona man who agreed to be interviewed on condition of anonymity. "I look like some kind of Frankenstein patched together.''

Tony says the procedure and corrective operations left 12.5 inches of unsightly scars and ruined his dating life.

"If I get into situations where it's going to get (sexual), I bow out as fast as I can,'' Tony said. "It's very noticeable and women do say something about it.'' The divorced dad says he's even considered suicide, as have others.

More than 50 men dissatisfied with Dr. Rosenstein's work have sought the services of attorneys, complaining about numbness, deformity and dysfunction. After the Medical Board of California investigated several complaints, it temporarily suspended Dr. Rosenstein's license in February. Now the board wants to shut him down for good.

Charles Palmer, an Irvine, Calif., attorney representing Dr. Rosenstein in the patient suits, did not return five telephone calls. Tom Brown, a Century City attorney representing Dr. Rosenstein in the state case, was unreachable, his office said.

Steve Fabbro of San Francisco represents 21 patients going after Dr. Rosenstein for fraud, medical negligence and false advertising. Keith Schulner, an attorney from Camarillo, Calif., represents an additional 25 former Rosenstein patients from California, New York, Arizona and Texas.

The Medical Board accuses Dr. Rosenstein, a urologist trained at New York University and the former chief of surgery at Brotman Medical Center in Culver City, of violating the state Medical Practices Act. The board alleges he made false advertising claims about what the surgery could accomplish, didn't provide proper pre-operative examinations and counseling, didn't provide informed consent, and failed to render proper post-operative care to patients often plagued with raging infection.

The board also alleges sterility problems in the operating room, illegal use of commissioned salespersons to bring in patients, and that Dr. Rosenstein noted good outcomes in his medical records even when there were complications.

Dr. Rosenstein has testified that the complaints that formed the state's case resulted from professional jealousy and disgruntled employees.

Although the medical community was aware of the potential dangers of such surgery, word never reached Dr. Rosenstein's patients, who paid their $5,900 before ever seeing the doctor.

Although Dr. Rosenstein has more cases pending against him than any other penile enlargement surgeon, urologists have seen complications from other doctors' work. But tracking poor results can be difficult.

Most men are too embarrassed to admit having surgery to relieve a self-esteem problem that many doctors say might be better addressed through psychotherapy. Like women seeking breast implants, the men have faith that a doctor can make a cut here and inject a few fat cells there to give them the body of their dreams. Unfortunately, surgery is never that simple.

The lengthening procedure entails snipping a ligament in the lower abdomen that attaches the penis to the pubic bone. Once it's cut, some of the penis drops down outside the body, enhancing the appearance of length. The doctor advances skin from the lower abdomen to cover this section of penile shaft.But the loss of support can lower the angle of erections and the newly exposed shaft portion may be covered by unwanted pubic hair. In the worst cases, the ligament can reattach to the pubic bone and retract the penis farther inside than it was to begin with.

The widening involves liposuction, by which the doctor removes excess abdominal fat and injects it to literally "fatten up" the penis. However, fat not attached to blood vessel-rich tissues may reabsorb, become lumpy, or form growths called granulomas.

The American Urological Association has declared fat injection and cutting the suspensory ligament neither safe nor effective. The American Society for Aesthetic Plastic Surgery says penile fat injection is experimental, with "insufficient data to establish its safety and effectiveness."

"It's totally experimental. The results of it have never been published in the peer-reviewed medical literature. That's just not how we practice medicine in the 1990s," says Dr. Mark S. Litwin, a University of California, Los Angeles, assistant professor of urology and public health.

"The problem with it is that the people who do this surgery very often prey upon the insecurities of vulnerable men."

Dr. Jack McAninch, chief of urology at San Francisco General Hospital and a urology professor at the University of California, San Francisco, has developed a reputation for repairing results gone awry.

"The deformities are significant. The scarring that results is significant," says Dr. McAninch, incoming president of the American Urological Association.
In the May issue of the association's peer-reviewed Journal of Urology, Dr. McAninch and two co-authors reviewed a dozen cases of complications from penile enhancements performed by others.

Without peer-reviewed reports on the procedure, they say it's impossible to compute a complication rate or substantiate "claims of patient satisfaction or objective increases in penile length."

Based on another study he co-authored, only 2 in 100 men would be considered subnormal in size -- less than 2.8 inches long and less than 3.5 inches in girth -- when erect.

"The point is that there's not been a single patient that I've seen that's come with one of these complications that was not above the normal range to start with," Dr. McAninch says.

Ron Joseph, executive director of the Medical Board, isn't ready to condemn the procedure -- only the practitioner.

"Penile enlargement is a procedure engaged in by a number of physicians and I don't want to suggest that all of them and all penile enlargement practices are inappropriate," he said. "We have no other active investigations against practitioners of penile enlargement."

A defender of penile enlargement is Dr. Gary Alter, a Beverly Hills plastic surgeon and urologist.

"The point I would want to get across is there are different ways of doing the procedure and there are different quality doctors doing the procedure," Dr. Alter said. To avoid reabsorption of fat, Dr. Alter uses an alternative, called dermal fat grafts. Those are sections of fat and tissue taken from the lower abdomen or buttocks and wrapped under the skin of the penile shaft.

Done correctly, the grafting makes a "very good operation," he says. "The guys I've followed for a couple of years are very stable in terms of the size."

Dr. Alter, one of the Medical Board reviewers on the Rosenstein case and an assistant plastic surgery professor at UCLA, sees no difference between fulfilling men's desires for larger penises and women's desires for larger breasts.

"I'm a plastic surgeon. A woman walks in with B breasts and wants C. Am I going to tell her no? No. With him, the same thing. The men that are done that have good results are extremely happy."

Dr. Alter contends men always have wanted larger penises, although it wasn't until the mid-1980s that a Chinese doctor began attempting enlargements.

"The demand has always been there, it just had nowhere to go," Dr. Alter says. "Now all of a sudden you've opened the door."