In recent weeks an in-joke among plastic surgeons has gone from an obscure SNL sketch to appointments on their surgical calendar: Scrotox—injecting botulinum toxins (a.k.a. Botox) into the wrinkled area of a scrotum. To quote the great John McEnroe, you cannot be serious! So we dialed up Dr. Matthew Schulman—a board-certified New York City plastic surgeon with an Instagram that is not for the faint of heart—to find out just what the hell is going on. We learned some pretty interesting stuff about plastic surgery, too.

Walk me through this.
Scrotox. The term has always floated around as sort of a joke. It had a catchy name and I think there was an SNL skit about it. It’s almost like the term existed before the procedure existed. The thinking is that by injecting Botox into the scrotum it can smooth out the scrotum. It would be done for cosmetic issues.

Some people have too much money.
The muscles that are in the scrotum serve a purpose. The Cremaster muscle elevates the testicles to control the temperature… to increase sperm. Not too hot, not too cold. If the testicles are a little cold it elevates them. If things get a little hot the testicles descend. They [also] contract during times of fear.

And Botox will make them do that less?
You have another kind of muscle called the Dartos, a little bit closer to just beneath the skin. Botox paralyzes those muscles. So you would get a larger scrotum and a smoother scrotum. The question is: Is a long, smoother scrotum attractive?

“For 600 dollars I could get rid of your forehead wrinkles and the 11s between your eyes and give you a chemical peel. What do you want to be smoother: Your scrotum or your face?” —Dr. Matthew Schulman, NYC plastic surgeon

Wait, so wouldn’t this just make for flappier testicles? Like during sex?
Yes and it will make the scrotum saggier. Just walking around. Some men just have a large scrotum. They need a lot of support running around. Those are the guys who usually see a plastic surgeon to get skin removed.

So Scrotox is one of those things like, “The Rodeo” that guys laugh about in locker rooms and it’s funny until someone actually does it?
I’m not familiar with “The Rodeo.”

Oh. It’s when you’re having sex with her from behind and two of your friends run out of the closet, one dressed like a clown and the other like a bull and you see if you can stay on for eight seconds and then… you know what? This isn’t a good use of my time with a medical practitioner.
Maybe you and I just don’t end up in the same locker rooms.

If someone came in with money would you talk them out of it?
It’s not my job to regulate taste. If someone wants something done and I can do it safely then I’ll do it.

Like what?
People want their earlobes bigger. They want their nipples smaller. Not just the areola, the actual nipple. Women will request injections into their g-spot to help during sex. Most of the time it won’t cause a problem. Scrotox might not work, but this can cause problems associated with a large scrotum. It can cause problems with fertility.

I wasn’t going to ask this. But seriously: four years of med school and six years of training. Why are you giving rich women new tits instead of curing malaria?
I always wanted to be a surgeon. But the advantage of plastic surgery is we can treat anyone from head to toe. Plastic surgeons are the “surgeons’ surgeons.” When an issue comes up that other surgeons don’t have an answer [for] or when there’s a problem that doesn’t fit neatly into another specialty, they will call a plastic surgeon.

I didn’t know that. I honestly spent 20 minutes trying to find a polite way of saying that your profession sounds worthless. No offense.
None taken. We don’t do “cookbook surgery.” No two tummy tucks are alike. Plastic surgery is like a game of chess. You may have your opening move, but you can never predict from start to finish. You have to be able to think on your feet and adapt.

So there’s two kinds: elective and reconstructive.
Reconstructive and cosmetic. There are a million situations. Treating children with birth defects. It’s a plastic surgeon who would remold the skull. It’s usually a plastic surgeon who does hand surgery. Or [helps] someone who is elderly with arthritis. Plastic surgeons do the reconstruction after breast cancer. Chronic wounds.


Can you imagine a guy ever telling anyone he got Scrotox?
No. I think that guys in general are still secretive about plastic surgery. Millennial women, meanwhile, will post an Instagram from my office.

How much would Scrotox cost?
It’s based on the amount of Botox you need. It would run about 600 dollars. Every three to four months.

So 200 dollars a month for a flappy sack?
Basically a coffee a day. More or less.

OK so I’ve got 600 dollars. I’m in your office. Talk me out of it.
What time you coming? Ha ha. I wouldn’t talk you out of it. But I would tell you why. You can find someone else to do it.

Where’s your spirit of commerce? Take my 600 dollars and make me beautiful in some other way.
Depends on what bothers you.

Oh man. I have this vision of me coming in for Scrotox and you just saying, “So you’re here for a nose job?”
Exactly. People come in all the time and say, “OK, what would you do for me?”

That’s awful. That’s like a women asking, “How old do you think I am?”
Ha ha. For 600 dollars I could get rid of your forehead wrinkles and the 11s between your eyes and give you a chemical peel. What do you want to be smoother: Your scrotum or your face?

Wow. OK. This is like a whole journalism class about why you should never write down your questions beforehand. Thanks for being so open.
My pleasure.


Dr. Schulman is board certified by the American Board of Plastic Surgery. He received his M.D. from Jefferson Medical College, and completed his training in general and plastic surgery at The Mount Sinai School of Medicine of New York University.