Paraffin injection for penile enlargement and the resulting complications are not rare; however, the optimal surgical treatment is still controversial. The aim of this study was to retrospectively evaluate the clinical findings, surgical methods, and complications of penile paraffinoma. Thirty-nine cases of penile paraffinoma were retrospectively analyzed for the clinical characteristics, operative methods, and surgical outcome according to the extent of the paraffinoma. In 11 cases, the paraffinoma was confined to the distal penile shaft, whereas in the other 28 cases it had spread to the whole penile shaft with or without involvement of scrotum and prepubic soft tissue. After complete excision of paraffinoma and granulomatous tissue, we applied primary closure (12 cases), pedicle scrotal flap (17 cases), or split thickness skin graft (10 cases) on the denuded penis. In the primary repair group, there was each case of wound infection and hematoma. In the split thickness skin graft group, there was one case of minor skin necrosis. But in bilateral pedicle scrotal flap group, several complications were noted: wound infection (2 cases), wound disruption (2 cases), testicular elevation due to reduced scrotum (2 cases), minor skin necrosis (1 case), scar contracture (1 case), and flap necrosis (1 case). These results suggest that the optimal treatment for penile paraffinoma is complete excision and appropriate penoplasty. In our cases, split thickness skin graft gave a more satisfactory outcome than pedicle scrotal flap in patients with extensive penile paraffinoma.