Consultant plastic surgeon Dr Torngee Malu cautions Nigerians against unqualified practitioners, online enlargement products and poorly managed cosmetic procedures
As cosmetic surgery becomes increasingly popular in Nigeria, plastic surgeons are warning that the growing demand for body enhancement must be matched by greater attention to safety, specialist training and proper patient assessment.
From liposuction and tummy tucks to breast augmentation and Brazilian Butt Lift (BBL), procedures once associated largely with overseas medical tourism are now being performed increasingly in Nigeria. But Dr Torngee Malu, a Consultant Plastic Surgeon at Renew Aesthetics, Abuja, says the expansion of the industry has also attracted unqualified practitioners who may not have the expertise required to prevent or manage potentially life-threatening complications.
In an interview with NKECHI ONYEDIKA-UGOEZE, Malu discusses the most sought-after cosmetic procedures in Nigeria, the risks associated with BBL and tummy tuck operations, misconceptions about breast enhancement and breast cancer, and the growing demand for penile enlargement.
He also explains why men who are concerned about penis size should think carefully before seeking procedures or products that promise enlargement.
Liposuction tops the list
According to Malu, liposuction remains one of the most commonly requested cosmetic procedures in Nigeria. It is sometimes combined with fat transfer, while other popular procedures include tummy tuck, breast reduction and augmentation, facelifts, brow lifts, facial rejuvenation and bariatric procedures.
But he stresses that no surgical procedure should be regarded as completely risk-free.
“Every surgery carries risks; it depends largely on who performs it. Even routine procedures such as circumcision can be fatal if complications are not properly managed.”
The growing availability of cosmetic surgery in Nigeria has reduced the need for some patients to travel abroad for treatment. Malu said the country now has specialists who have received extensive training in plastic surgery and are capable of performing procedures locally.
However, he identified the involvement of non-specialists as a major concern.
“Complications can occur even in the hands of specialists, but trained surgeons understand the risks, know how to prevent them and can manage complications when they arise.”
Such complications, he noted, may range from relatively common postoperative problems such as swelling and pain to severe complications that can result in permanent injury or death.
Penile enlargement: a dangerous pursuit?
One of the more controversial areas of cosmetic surgery is penile enlargement, a procedure Malu described as relatively uncommon in Nigeria but particularly risky.
“Penile enlargement is relatively uncommon in Nigeria. For trained plastic surgeons, it is a highly risky procedure with a high likelihood of failure.”
Unlike cosmetic procedures involving areas such as the breasts or buttocks, he explained, the penis has complex anatomical and physiological functions that make attempts at enlargement considerably more complicated.
“The penis is a sensitive and highly functional organ. You cannot simply enlarge it like the breast or buttocks.”
According to him, introducing foreign materials or implants can interfere with the organ's normal function and potentially produce serious complications.
“Most plastic surgeons will not perform penile enlargement because the anatomy and physiology make it impractical and risky.”
The problem, he added, is that some people offering such procedures may not have specialist plastic-surgery training and therefore may be unable to recognise or treat complications when they occur.
Social pressure drives demand
Malu believes the desire among some men to increase penis size is driven less by medical necessity than by social expectations and misconceptions about masculinity and sexual performance.
“It is largely societal pressure. Society creates ideas about what constitutes the ‘right’ penis size, just as it does with breasts and buttocks.”
Men may feel pressure from spouses, friends or broader society to conform to an imagined standard, while social media has contributed to the perception that virtually every aspect of the human body can and should be altered.
“Social media has also reinforced the belief that every aspect of the body can be changed. But the penis is different from other body parts because it has both anatomical and physiological functions.”
Malu said men should also understand that penis size does not necessarily determine sexual or anatomical function.
“Not really. Size does not determine functionality.”
He warned against drugs, herbs and other products sold online with claims that they can permanently increase penis size.
“There are many drugs, herbs and products online claiming to increase penis size. They do not work and can be dangerous.”
He explained that an erection occurs when specialised tissues in the penis fill with blood, meaning that injecting fillers or other foreign substances could interfere with normal blood flow.
Foreign material entering the bloodstream can also travel to the lungs and cause a potentially fatal pulmonary embolism, he warned.
His advice to men is straightforward: “if your penis is functioning normally, leave it alone.”
BBL: popular but not risk-free
The Brazilian Butt Lift remains one of the most sought-after body-contouring procedures, but it has also attracted international attention because of serious complications associated with improperly performed procedures.
Malu said BBL can be safe when carried out by appropriately trained specialists and after careful assessment of the patient.
The procedure involves removing a patient's own fat from one area of the body and transferring it to another to improve body contour and appearance.
But he warned that the procedure requires considerably more expertise than simply removing and injecting fat.
“The problem is that people without specialist training are entering the field because they see commercial opportunities in BBL and liposuction.”
“These procedures involve much more than simply removing and injecting fat. There is a science behind them that requires years of specialist training.”
Malu said there is no universal list of people who should automatically be barred from undergoing BBL. Instead, patients must be assessed individually, with their medical history and overall health taken into account.
People with uncontrolled hypertension, diabetes, untreated heart conditions or other significant medical problems may face risks that make surgery inappropriate until those conditions are addressed.
“I have cancelled surgeries because of a patient’s weight, poorly controlled blood pressure or mental state. The decision must be based on individual risk assessment.”
How permanent is a BBL?
For patients considering BBL, another common question is whether the transferred fat eventually disappears.
Malu explained that the procedure involves transferring the patient's own living fat cells. Once successfully established in their new location, those cells can remain there permanently.
However, the transferred fat remains subject to the same biological processes as fat elsewhere in the body.
Consequently, significant weight gain or weight loss can alter the size and appearance of the treated area.
Tummy tuck does not prevent pregnancy
Another misconception surrounds pregnancy after abdominoplasty, commonly known as a tummy tuck.
Malu said women who have undergone the procedure can still become pregnant and carry a pregnancy.
“Yes. A woman who has had a tummy tuck can become pregnant and carry a pregnancy.”
A tummy tuck primarily involves repairing the abdominal wall and removing excess skin. It does not prevent conception or directly affect the womb.
Nevertheless, patients considering cosmetic surgery should discuss their future pregnancy plans with their surgeon because pregnancy can alter the abdominal tissues and potentially affect the cosmetic result.
Breast enhancement and cancer concerns
Breast enhancement is another common cosmetic procedure, with techniques including implants and fat transfer.
Malu said there is no established link between breast enhancement procedures and breast cancer, although the different techniques have their own potential risks and complications.
“There is no established link between breast enhancement procedures and breast cancer.”
Patients, he stressed, should discuss the benefits, limitations and possible complications of the particular procedure with a properly qualified specialist before making a decision.
When cosmetic surgery turns deadly
Although cosmetic procedures are generally performed electively rather than to treat immediately life-threatening illnesses, Malu cautioned that they remain major medical procedures and can have serious consequences when something goes wrong.
“Every surgical procedure carries risks. Safety depends heavily on the surgeon, the medical team and the patient’s assessment.”
Complications can occur during or after surgery, making the competence of the surgical and anaesthetic teams, the quality of the facility and the availability of emergency and postoperative care crucial.
Malu also challenged the assumption that travelling overseas automatically guarantees safer cosmetic surgery.
“Going abroad does not automatically make a procedure safer.”
He argued that Nigerian-trained specialists can have an important advantage because of their familiarity with the physical characteristics and complications encountered among Nigerian and African patients.
“The key issue is not simply where the surgery is performed, but who performs it, the quality of the team and the ability to prevent and manage complications.”
Cosmetic surgery itself is not the problem
Despite the concerns surrounding unsafe procedures, Malu does not believe cosmetic surgery should be viewed negatively.
“No. Cosmetic surgery has existed for centuries and has evolved with advances in medicine.”
When properly performed, he said, cosmetic surgery can enhance or correct parts of the body for aesthetic reasons and may significantly improve patients' confidence and quality of life.
The distinction, therefore, is between properly conducted surgery and procedures carried out without adequate specialist training, patient screening or emergency support.
Nigeria's cosmetic surgery industry is evolving
Malu said Nigeria's cosmetic surgery sector has grown substantially, particularly within the private healthcare system.
But he cautioned that having sophisticated equipment or an impressive facility does not necessarily guarantee patient safety.
“Personnel are more important than buildings and equipment.”
“You can have a well-equipped facility, but without properly trained professionals, the infrastructure is of little value.”
He said Nigeria now has specialists capable of performing cosmetic procedures to international standards, a development that has contributed to a reduction in medical tourism.
Indeed, he said, the flow of patients is no longer entirely out of Nigeria.
“A significant proportion of our clients are Nigerians and Africans living abroad, as well as patients from Europe, America and Australia.”
“The fact that people now travel to Nigeria for cosmetic surgery demonstrates growing confidence in the country’s specialists.”
How patients can avoid dangerous practitioners
For Nigerians considering cosmetic surgery, Malu's strongest advice is to investigate the credentials of the person performing the operation rather than choosing a surgeon based solely on social media popularity, price or the appearance of a clinic.
Patients should seek properly trained, qualified and licensed specialists.
In Nigeria, he said, plastic surgeons should have recognised specialist qualifications, including Fellowship of the National Postgraduate Medical College of Nigeria (FMCP) or Fellowship of the West African College of Surgeons (FWACS) in plastic surgery.
Anyone offering major cosmetic surgery without recognised specialist training, he warned, should be approached with caution.
Patients should also establish whether the facility has appropriate anaesthesia services, emergency care, qualified medical personnel and adequate postoperative support.
Ultimately, Malu said, the most important question is not whether a procedure is fashionable or whether a particular clinic promises dramatic results.
It is whether the person performing the operation has the specialist training and experience to keep the patient safe — and to manage complications if they occur.
“The most important thing is to ensure that the person performing the procedure is a properly trained plastic surgeon.”