Scrotox: Scrotal Relaxation
with Botulinum Toxin
Dr. John Mesa, MD. is the first U.S. doctor to perform Scrotox, at his New York City flagship, New Jersey, and Miami offices.
Scrotox is a nonsurgical, physician-administered treatment that uses botulinum toxin to relax the muscles of the scrotum, smoothing the scrotal skin and allowing the testicles to hang lower and appear fuller. It is performed in the office in about 45 minutes under topical anesthesia.
Dr. John Mesa, MD, a plastic surgeon specialized in facial procedures, is widely recognized as the first U.S. doctor to perform Scrotox.
Handled discreetly. No intimate photographs are required to request a call, and clinical questions can be escalated to Dr. Mesa's team.
Scrotox at a Glance
The essentials in one place. Each row is explained in full below.
| Scrotox Factor | Description |
|---|---|
| What it is | Scrotal relaxation with botulinum toxin, a nonsurgical, in-office treatment |
| What it targets | The dartos and cremaster muscles of the scrotum, not the testicles |
| What is injected | Botulinum toxin (Daxxify® or BOTOX® Cosmetic) |
| What is not injected | The testicles themselves. Injections are placed in scrotal muscle only |
| Approval status | FDA-approved medications; scrotal use is physician-directed and off-label |
| Appointment time | About 45 minutes, under topical anesthesia |
| Onset | Results begin to appear at about 2 weeks |
| Duration | Approximately 3 months; treatment can be repeated |
| Downtime | Minimal; same-day cycling and hot-water soaking restrictions apply (see aftercare) |
| Fertility | May not affect sperm or fertility, injections target scrotal muscle, not the testicles (no controlled studies); tell Dr. Mesa if you are trying to conceive |
| Locations | New York City / Manhattan (Flagship Office), Livingston, New Jersey, and Miami |
The First U.S. Doctor to Perform Scrotox, and the Coverage That Followed
Dr. John Mesa, MD is widely recognized as the first U.S. doctor to perform Scrotox. His work helped drive the national media wave that introduced the treatment to the public in 2018.
Since then, Scrotox has since been covered by major outlets and even parodied on network television. More on that later on this page.
Read the coverage:
- Cosmopolitan, “I Got Botox in My Scrotum (a.k.a. Scrotox)” (2018)
- Men’s Health, “Men Are Injecting Botox Into Their Scrotums for Some Reason” (2018)
- Vice, “I Botoxed My Balls to Make Them Look Nicer” (2018)
- The Independent, “What is Scrotox? Why men are getting Botox in their testicles” (2018)
- Daily Mail, “Men are getting BOTOX injected into their TESTICLES in bizarre ‘Scrotox’ trend” (2018)
- USA Today, “What is Scrotox? Men are injecting Botox into their scrotums” (2018)
- Healthline, “Scrotox: Procedure, Cost, Recovery, Benefits, and Side Effects”
- CBC Life, “Scrotox: Yup, men are botoxing their junk” (quotes Dr. Mesa)
- Hollywood Reporter, “Scrotox: Hollywood’s New Cosmetic Surgery”
What Is Scrotox?
Scrotox is the use of botulinum toxin to relax the muscles of the scrotum. By relaxing the dartos and cremaster muscles, the treatment smooths the scrotal skin and allows the testicles to hang lower and appear fuller. It is a nonsurgical procedure performed in the office.
The name “Scrotox” combines scrotum with Botox, the original brand nickname for botulinum toxin. Patients and the media sometimes call the smoothing effect “ball ironing.” You may also see the treatment described as “Botox for the scrotum.” In clinical terms, this is botulinum toxin injected into the scrotal muscles.
Is Scrotox real? Yes. Scrotox has been performed for many years, and around 2016, Dr. Mesa became widely known for the procedure and came to be regarded as the first doctor in the United States to perform Scrotox. Its origins are partly medical, including the relief of scrotal discomfort and muscle spasm, as well as cosmetic.
Scrotal application of botulinum toxin is a physician-directed, off-label use, which Dr. Mesa discusses plainly with every patient.
How Scrotox Works: The Dartos and Cremaster Muscles
Scrotox works by relaxing two muscles that control the scrotum: the dartos and the cremaster. When these muscles relax, the scrotal skin becomes smoother and the testicles sit lower and appear fuller. See the anatomy diagram for the location of each muscle.
The Dartos Muscle
The dartos muscle is a thin muscle layer directly beneath the skin of the visible scrotal area. It controls how the scrotal skin contracts and wrinkles.
When the dartos is relaxed with botulinum toxin, the surface of the scrotum looks smoother and less tight. This is the effect patients call “ball ironing.”
The Cremaster Muscle
The cremaster is a deeper muscle around the neck of the testicles. It also controls how high or low the testicles hang.
Relaxing the cremaster allows the testicles to rest lower, which many men feel gives a fuller, more relaxed appearance.
The Chess-Board Injection Pattern
Dr. Mesa places the botulinum toxin in a chess-board pattern: some areas of the muscle are relaxed while neighboring areas are left intact.
Because the entire muscle is never paralyzed, the remaining muscle stays reactive. It contracts more in cold weather and relaxes more in heat. This is the reason results look different across the seasons, as explained in the results section below.
Benefits of Scrotox
Many men seek Scrotox for a smoother, more relaxed scrotum and lower-hanging testicles. The benefits below are what patients commonly report. Individual results vary.
Scrotox Before and After Results
The before-and-after results on this page are shown as graphite-style illustrations rendered from actual patient outcomes. They are artist-rendered illustrations, not photographs. To protect patient privacy and to prevent copying, the original clinical photographs are shown privately during your consultation.
Individual patient experience; results vary. Ask to see the original before-and-after photographs at your consultation.
What Is Scrotox and How Is It Performed?
In this long-form video, Dr. John Mesa explains what Scrotox is, how botulinum toxin relaxes the dartos and cremaster muscles, and what to expect during the in-office procedure. It is a plain-language walkthrough for men considering the treatment before booking a call.
Beyond Cosmetic: Scrotox for Scrotal and Pelvic Floor Muscle Spasms
In selected patients, Scrotox has been used to relieve spasm of the dartos and cremaster muscles and related pelvic-floor discomfort. This is a patient-reported benefit in selected cases, not a guaranteed treatment, and not a standard therapy for pelvic floor dysfunction.
Dartos and
Cremaster Spasm
Some men experience painful, involuntary tightening of the dartos and cremaster muscles, often triggered by cold weather or intimate activity.
For some patients, relaxing these muscles with botulinum toxin has reduced that spasm and the discomfort that comes with it.
Pelvic Floor Spasm and Discomfort During Intimacy
Related pelvic-floor and testicular-area spasm can cause significant discomfort, including during intimacy. In selected patients, Scrotox has been part of relieving it.
One patient who had previously required weekly pelvic-floor physical therapy reported meaningful relief.
A Patient-Reported Outcome
“For years I have searched for relief from extremely spastic Dartos and Cremaster muscles. His Scrotox treatments are the only thing that has ever helped me with this condition. It is truly fantastic to feel normal again.”, RealSelf review
Individual patient experience; results vary.
If you have chronic pain or a diagnosed pelvic-floor condition, mention it on your call so the team can advise on the appropriate next step.
Handled discreetly; share only what is necessary on the initial call.
Who Is a Good Candidate for Scrotox?
Good candidates are healthy adult men who are bothered by a tight, retracted scrotum or who want a smoother, lower, fuller appearance. Scrotox is not right for everyone, and no outcome is guaranteed.
Good Candidates
- Men bothered by a retracted or “high and tight” scrotum
- Men who want a smoother, lower, or fuller-looking scrotum
- Men with discomfort from scrotal sweating
- Selected men with dartos and cremaster or related pelvic-floor spasm
Who Should Avoid Scrotox
- Men whose testicles already hang very low or loose, who may see little change
- Men with certain neuromuscular conditions, who should discuss this with their physician before considering treatment
- Men who have had surgery in the scrotal area and developed scar tissue involving the scrotal muscles or skin, as this may limit muscle relaxation, reduce skin elasticity, and affect the final result
- Anyone expecting a guaranteed or permanent result
RealSelf Review
“As one of those ‘high and tight’ guys I had researched and discovered a procedure for scrotal relaxation… While the results were not as satisfying as I had wished, the procedure did help a lot and may work better over time, so I will continue treatments until I get the result I am looking for.”, RealSelf review.
That is honest expectation-setting: some men respond strongly, while others need more than one treatment. Scrotox is also different from surgical options such as a scrotal lift, which removes excess skin surgically. Both approaches have their place, and the right one depends on your anatomy and goals.
Not a cosmetic question, get emergency care first
Sudden or severe testicular pain, especially with rapid swelling, nausea or vomiting, or a high-riding testicle, may be testicular torsion, a time-dependent emergency that threatens the blood supply to the testicle.
Go to an emergency department immediately or call 911; do not wait for a cosmetic consultation. Fever, trauma, a new lump, or other rapid scrotal change also requires prompt in-person medical evaluation; severe symptoms warrant emergency care.
How Scrotox Is Performed by Dr. Mesa
Scrotox is an in-office procedure that takes about 45 minutes under topical anesthesia. Dr. Mesa injects botulinum toxin into the dartos and cremaster muscles as necessary.
Botulinum Toxin Options: Daxxify® and BOTOX® Cosmetic
Dr. John Mesa treats Scrotox patients with two FDA-approved botulinum toxin medications: Daxxify® and BOTOX® Cosmetic.
Daxxify® is his primary option; BOTOX® Cosmetic is also available. Most of Dr. Mesa’s Scrotox patients choose Daxxify®.
Why Daxxify®?
Daxxify is a botulinum toxin that relaxes the scrotal muscles. Most of Dr. Mesa’s Scrotox patients choose Daxxify, and it helps keep the treatment accessible.
BOTOX® Cosmetic
Botox is one of the most recognized botulinum toxin brands and is also used for Scrotox.
Which Is Right for You?
Dr. Mesa selects the product after evaluating your goals, anatomy, medical history, and any prior response to botulinum toxin. Most patients choose Daxxify.
Comparison Table: Daxxify® and BOTOX® Cosmetic
| Medication | Class | How It Works | Notes |
|---|---|---|---|
| Daxxify® | Botulinum toxin | Relaxes the dartos and cremaster muscles | Dr. Mesa's primary Scrotox option; chosen by most of his Scrotox patients |
| BOTOX® Cosmetic | Botulinum toxin | Relaxes the dartos and cremaster muscles | A widely recognized botulinum toxin brand; also used for Scrotox |
Dosing note: Dr. John Mesa uses the same numerical dosing protocol for both Daxxify® and BOTOX® Cosmetic when performing Scrotox, his physician-directed, off-label clinical protocol, starting at 200 units and going up to 400 units depending on goals and anatomy.
The FDA potency units of different botulinum toxin products are product-specific and are not a universal conversion between products.
Scrotox Results: Onset, Duration, and What Affects Them
Scrotox results usually begin to appear at about 2 weeks and last approximately 3 months. Results vary. Most men have good to excellent results, and some need touch-ups.
Safety, Aftercare, and What Is (and Isn't) Injected
Scrotox is performed with FDA-approved botulinum toxin; scrotal application is a physician-directed, off-label use, which Dr. Mesa discusses openly. Aftercare is simple, and treatment targets the scrotum only, nothing is injected into the penis.
Aftercare Rules
On the day of the procedure, avoid riding a bicycle and avoid sexual activity involving devices, because the area is temporarily numb and could be injured without you noticing.
For two weeks, avoid soaking the lower body, especially the genital area, in hot water such as jacuzzis and hot tubs.
Genital Erection
Erection. Scrotox may not affect erection, because nothing is injected into the penis.
No needle touches the shaft or glans, only the scrotum. (Injecting botulinum toxin into the penis itself is a completely different procedure, with different effects. That is not Scrotox.)
No controlled studies have specifically evaluated scrotal injection and erection; this is Dr. Mesa’s clinical counseling based on the anatomy of the treatment.
Sperm and Fertility
Sperm and fertility. Scrotox may not affect sperm production or fertility, because the injections are placed into the dartos and cremaster muscles of the scrotum, not into the testicles, where sperm is produced.
No controlled clinical studies have specifically evaluated scrotal botulinum toxin injection and fertility, so this is presented as Dr. Mesa’s clinical counseling rather than a study-proven fact. If you are actively trying to conceive, mention it during your consultation so Dr. Mesa can discuss timing and your individual situation.
Possible Side Effects
Common local effects may include tenderness, pain, bruising, redness, or swelling at the injection sites. Rare but serious effects can occur if the effects of botulinum toxin spread beyond the injection area, including generalized weakness or problems speaking, swallowing, or breathing.
Seek immediate medical care for those symptoms. Scrotox should not be performed in anyone with an infection at the proposed injection sites or a known hypersensitivity to the product.
Before treatment, disclose your full medical history, including any neuromuscular, swallowing, breathing, or cardiovascular conditions and all medications, so Dr. Mesa can confirm the treatment is appropriate for you.
How Much Does Scrotox Cost?
The cost of Scrotox depends mainly on two factors: the number of units used and the office location. There is no single price, and your personalized quote comes from the Patient Concierge.
Units Needed
Dr. Mesa’s protocol starts at 200 units and can go higher depending on your goals and anatomy. More units means a higher cost.
Office Location
The New York City flagship is priced higher than the New Jersey and Miami offices.
Getting Your Personalized Quote
The Patient Concierge provides a personalized quote on your complimentary call.
Discreet and no-pressure; no intimate photographs required.
Real Patient Reviews
The reviews below are individual patient experiences shared on RealSelf. Results vary from one person to another.
Read more on Dr. Mesa's RealSelf profile.
Scrotox in Pop Culture
Saturday Night Live aired a “Scrotox” parody sketch in the late 2010s that helped make the term a household word. It is satire, not medicine.
The sketch jokes about “tightening,” numbness, and “poison.” This is the opposite of how the treatment actually works.
Scrotox relaxes the scrotal muscles, is not intended to remove sensation, and uses a purified, FDA-approved class of medication. The sketch lives on SNL’s official channels; the clinical facts live on this page.
SCROTOX (Scrotal relaxation with BOTOX) by Dr. Mesa in the Media:
These are some of the published articles about the Sctotox procedure by Dr. Mesa:
Scrotox in New York City, New Jersey, and Miami
Scrotox, along with other men’s procedures is available at Dr. Mesa’s three office locations: New York City / Manhattan (Flagship Office), Livingston, New Jersey, and Miami.
New York City / Manhattan (Flagship Office)
Scrotox is available at Dr. Mesa’s Manhattan flagship office in New York City.
Livingston, New Jersey
Scrotox is available at Dr. Mesa’s Livingston, New Jersey office.
Miami
Take the Next Step
Scrotox is a precise, physician-administered treatment, and the clearest way to learn whether it is right for you is a calm, no-pressure conversation.
On your complimentary call, a Patient Concierge will answer your initial questions, walk you through the process, and help you understand the appropriate next step. The call is a starting point, not a medical diagnosis. You can also ask to see original before-and-after photographs at your consultation.
Discreet handling, always: no intimate photographs are required to request a call, and you choose how we contact you.
Scrotox FAQs
Procedure Basics
Scrotox is the use of botulinum toxin to relax the dartos and cremaster muscles of the scrotum. It smooths the scrotal skin and allows the testicles to hang lower and appear fuller.
"Ball ironing" is an informal nickname for the smoothing effect of Scrotox, which softens the wrinkling of the scrotal skin.
Dr. Mesa's clinical protocol starts at 200 units and can go up to 400 units, depending on your goals and anatomy. He uses the same numerical dosing protocol for both products in his physician-directed, off-label Scrotox protocol; the FDA potency units of different botulinum toxin products are product-specific and are not a universal conversion between products.
Both are FDA-approved botulinum toxins that Dr. Mesa uses in his Scrotox protocol. Daxxify® is his primary option; BOTOX® Cosmetic is also available. He selects the product that fits your goals, anatomy, and history during your consultation.
The procedure takes about 45 minutes in the office.
Scrotox is performed under topical anesthesia, and patients describe it as virtually painless.
Candidacy
Men whose testicles already hang very low, those with certain neuromuscular conditions, or those with scrotal surgical scars that may affect muscle movement or skin elasticity may not be good candidates. Scrotox is also not appropriate for anyone expecting guaranteed or permanent results.
Some men pursue lower-hanging testicles through mechanical methods. Scrotox offers a physician-administered path, and Dr. Mesa can discuss how it fits your goals.
Scrotox Results
Results begin to appear at about 2 weeks and last approximately 3 months.
Yes. Most men have good to excellent results, and some are resistant to the treatment and may need touch-ups. No result is guaranteed.
Yes. Because the muscle stays partly reactive, results are less noticeable in cold weather and more noticeable in heat.
Side Effects and Aftercare
Scrotox may not affect either, for a clear anatomical reason. Erection: nothing is injected into the penis shaft or glans, only the scrotum (penile injection is a completely different procedure). Fertility: injections target the dartos and cremaster muscles, not the testicles where sperm is produced. No controlled studies have specifically evaluated scrotal injection for either outcome, so this is Dr. Mesa's clinical counseling based on the anatomy of the treatment. If you are actively trying to conceive, mention it during your consultation.
On the day of treatment, avoid cycling and sexual activity involving devices. For two weeks, avoid soaking the lower body in hot water such as jacuzzis and hot tubs.
In selected patients, Scrotox has been used to relieve dartos, cremaster, and related pelvic-floor spasm, with patient-reported relief. It is not a guaranteed treatment for pelvic floor dysfunction.
Cost
Cost depends on the number of units and the office location. Your personalized quote comes from the Patient Concierge on your complimentary call.