Your surgeon will perform a physical evaluation and examine your medical history, determining what results are realistic. If done for cosmetic reasons such as tightening and lifting the skin of the scrotum, these results are not permanent due to age--with the passage of time, the muscles in the scrotum naturally weaken and thus, it will sag lower. If you choose to have a scrotal lift, it will be performed under general anesthesia by your surgeon. An incision will be made in the skin near the penis, and any excess skin will be removed. Once complete, the incision is closed and sealed with sutures. Regarding sex reassignment surgery, a scrotoplasty is usually performed with other procedures that will create a penis for the patient. A scrotum will be constructed from the skin, tissue, and muscles of the vagina through incisions made in and around the folds of the labia majora. Sutures are then used to keep the newly made shape of the scrotum in place and will dissolve over time.