Penile augmentation via foreign body injection is a practice prevalent in some cultures in South East Asia. In recent years, we have noticed an increasing trend in patients who presented with self-injection of a mineral oil material that was sold as a traditional topical remedy. Most presenting patients usually present months to years after the initial injection rather than acutely, with symptoms of pain, swelling and rarely ulceration. Ultrasound is usually used for diagnosis and pre-surgical planning. Many patients may not be forthcoming with their history and are evaluated as cases of suspected cellulitis/infection before further imaging reveals the true etiology of their complaint. Review of typical sonographic findings, complications, histo-pathological correlation and current literature. Typical ultrasound findings of symptomatic patients include marked thickening of subcutaneous tissue in the penile skin. There is usually increased echogenicity although the homogeneity can vary. Discrete globules presenting as palpable nodules are sometimes identified. The material can spread along the subcutaneous tissue plane, resulting in “metastatic” deposits distant from site of injections; in areas such as scrotum, perineum and abdominal wall. Complications such as severe deformity or necrotizing fasciitis have been documented. Resected histological specimens demonstrate the presence of diffuse lipo-granulomatous reaction, which supports the ultrasound observations. Penile paraffinoma from self-injection of mineral oil substance are not uncommon. Ultrasound has been used for diagnosis and pre-surgical evaluation of presenting patients. The evaluating physician should be familiar with the typical imaging findings.