Gynecomastia is excess breast tissue in men. In a subset of individuals with gynecomastia, there can be redundant or excess skin. The excess skin affects the outcomes following a gynecomastia corrective surgery. It can mean a longer duration to achieve an acceptable outcome. In some cases, we may do additional surgery to take care of excess skin.
How does skin redundancy present in gynecomastia?
Redundant skin is usually apparent with a clinical examination. The breast tissue tends to sag in such individuals. The breasts appear deflated. There can be visible folds on the lower part, and lateral areas of the chest. The presence of ptosis or sagging gives an aged appearance to the chest.
Who are the individuals prone to get skin redundancy associated with gynecomastia?
The risk factors associated with excess skin in gynecomastia include:
What are the treatment strategies that can be adopted in case of skin excess?
hereAmong individuals with excess body weight, it is always recommended to lose weight before undergoing a surgical correction. Optimizing the body weight before surgery has certain advantages. It is easier to assess the extent of excess skin before surgery. This makes the surgical outcome more predictable. In some cases, we may opt to undertake skin reduction during the time of gynecomastia correction. With weight loss, patients can benefit from the skin recoil beforehand.
In an individual, with excess skin, gynecomastia correction can be done in two different ways. It can be done either with skin excision or without skin excess. Both strategies lead to different outcomes.
When the correction is carried out without a skin excision there may be a postoperative course with an increase in the deflated appearance. This usually improves with time due to the skin recoil. It may take many months before the full extent of skin recoil is appreciated. We usually advise our patients to wait as much as 8 months before deciding on an additional surgery to remove the skin excess. Many patients are usually satisfied with the skin recoil and choose not to have any skin excision procedures. This has the advantage of an initial simpler procedure with shorter scars. Skin excisional procedures are associated with longer and more visible scars.
The second strategy would include gynecomastia correction carried out with simultaneous skin excision. The pattern of the excision can vary depending on the extent of skin excess. Patients with more excess tend to have a greater amount of skin removed. With this technique, the excess skin is addressed in a single procedure. However, it carries the disadvantage of longer scars. In our practice, this approach is less commonly used. We tend to choose individuals with severe excess for this approach.
What are the steps that can be taken by an individual to address excess skin?
The excess skin is usually seen to accompany increased body weight. Individuals should try to maintain their weight close to ideal. This is usually achieved with the help of dietary modifications such as diet and exercise. Weight training helps recruit the excess skin and contributes to reduced sagging over the lower part of the chest. Weight training and accompanying muscle hypertrophy also bring along aesthetic benefits.
Excess skin is seen in some individuals presenting with gynecomastia. This is more commonly seen in those with excess body weight. The skin excess can be tackled with surgery in a staged or simultaneous way. Both strategies have their advantages and disadvantages. A treatment plan is chosen based on individual preferences and extent of excess skin. Individuals with skin excess can help improve this condition with appropriate dietary modifications and exercise.
Learn more about gynecomastia here.
Smoking and plastic surgery
Smoking is bad for plastic surgery. It can lead to complications and adversely affect the outcomes of a surgical procedure. This can be due to various reasons. Let me elaborate.
When to stop smoking before surgery?
The best time to stop smoking is now. The negative effects of smoking reduce after cessation of smoking. We usually advise a period of 4 to 6 weeks of abstinence before undertaking any surgery.
Plastic surgery can involve extensive dissection of the tissues. This makes healing more dependent on adequate blood supply of the treated tissues. Because of the above reasons, smoking is a strong contrindication for surgery. Smoking is also one of the common reasons for postponement of the surgery in our practice. We usually choose to schedule surgery after a period of abstinence from smoking.
For further reading about the effect of smoking during surgery, please visit:
Some of our patients come from another city or a faraway place. The reasons usually cited include, cost, and privacy. Even though most patients tend to have satisfying outcomes, getting surgery at a distant location has its challenges. The challenges usually relate to scheduling the surgery, arranging for a friend or relative to accompany during the surgery, and managing follow-up visits. Any postponement of the surgery can result in a lot of distress. One may need to schedule the surgery during the next vacation.
Being aware of the common reasons behind these issues can help one have a better experience. Let me list out some of the common reasons.
Even though consultation and clinical examination are the best means to assess a condition, examination of images can also give a fair idea of the treatment plan. For individuals who stay faraway, it is a good option to engage with the treatment provider with the help of emails and images.
2. Use of health supplements and smoking.
Certain behaviors can result in an increased risk of surgical complications. These include smoking and intake of non-prescription health supplements. Smoking results in increased rates of infection, wound healing problems, and increased risk of bleeding. We insist on abstinence from smoking for one month before any procedure. Non-prescription health supplements maybe associated with an increased risk of bleeding. They should be avoided for a period of 2 to 4 weeks before surgery. Use of any such supplements must be brought to the notice of the health provider early on.
3. Presence of comorbidity (other illness)
These include other diseases like diabetes and hypertension. These need not preclude a surgical procedure. However, they need to be medically optimized before undertaking any elective procedure. Some conditions may require a clearance by a medical speacialist. This helps avoid any untoward events during the procedure.
Some individuals are prone to get skin conditions like folliculitis or acne eruptions. The presence of any skin infection close to the operated site may result in the postponement of the surgery. In case one tends to get such skin conditions it is recommended to undertake treatment by a doctor or a dermatologist before the surgery. These can be carried out with the help of a physician near the patient's place of stay.
4. Possibility of drug interactions.
Some medicines being taken by the patient may interact with medicines used during anesthesia. For example, antihistamines used for allergies can influence the metabolism of lignocaine used during liposuction. We usually advise a drug holiday when there is a significant risk of drug interactions. In case an individual is taking any medicines for any related or unrelated condition, this should be brought to the notice of the surgeon.
5. Lack of a support system.
Surgery is a stressful time even for the most well-prepared individual. Hence it is important to have someone like a reliable relative or a close friend during the recovery after surgery. We usually do not schedule patients for surgery when we are doubtful about the lack of adequate support during the immediate postoperative period.
Postponement of the surgery is usually undertaken when we feel that some modification can result in better outcomes. These could mean the cessation of smoking or a drug holiday. It is also important for patients not to withhold any related or unrelated medical information because of any fear of postponement of the surgical procedure.
To summarise, some of the key points for individuals who are planning to travel to another place for surgery include, interacting with the health provider early on, disclosing any related or unrelated health conditions, and avoiding any behavior that can increase the risk of complications.
Structural fat grafting is a procedure that involves the transfer of fat cells from one part of the body to another. It is done because of various benefits such as improved volume of the treated areas, and tissue regeneration. Emulsified fat grafting is a different procedure during which the tissue is transferred without viable (living) adipocytes (fat cells). The emulsification helps get rid of any viable (living) fat cells.
Why is emulsified fat grafting done?
Unlike structural fat grafting, emulsified fat grafting does not result in increase in the volume of the treated areas. Instead, it leads to an improvement of the regenerative properties of the tissues. This results in improvement in the texture of skin, scars, or enhanced healing of wounds.
How does emulsified fat grafting work?
The fat containing tissues in have fat cells and supporting cells that help in growth and regeneration. The supporting cells are referred to as ADSC. During harvest, both adipocytes (fat cells) and the supporting cells are obtained together. The adipocytes or the fat cells are removed by mechanical disruption. The supporting cells are not affected by this process. These are injected into the body for their beneficial properties. Due to the absence of adipocytes, emulsified fat grafting does not lead to an increase in the volume of the grafted part.
What are the various applications of emulsified fat grafting?
Emulsified fat grafting helps the tissues in growth and repair. The various applications include
How is emulsified fat grafting performed?
Emulsified fat grafting is usually carried out under local anesthesia as an outpatient procedure. The common areas for the harvest of fat are the abdomen or thighs. Small volumes are needed for this procedure. The harvested fat is then processed. The emulsified fat is then injected with the help of fine needles into the treated area. The treated areas are left open. The donor areas are treated with simple dressings that are removed after two days.
What is the recovery from emulsified fat grafting?
The donor area will have some firmness and induration that subsides over the next few weeks. The treated areas can show some swelling that subsides over days to weeks. The improvement in the texture of the skin takes a few weeks to become noticeable. In case of fat grafting into wounds, the following weeks may show accelerated healing. The changes in hair growth in case of injections for male pattern baldness may take a few weeks to become visible.
What are the advantages of emulsified fat grafting?
Emulsified fat grafting is beneficial across a variety of indications. It is also attractive since it is done as an outpatient procedure with a rapid recovery. The beneficial effects of the procedure are also long lasting.
There is an increasing demand for cosmetic procedures with minimal downtime. The advantages are shorter recovery and the ability to return to normal life. One such procedure is non-surgical rhinoplasty.
What is a non-surgical rhinoplasty?
It involves the injection of fillers into the nose to bring about a difference in appearance. It has more in common with a filler injection into the face than with a routine rhinoplasty. The 'rhinoplasty' in non-surgical rhinoplasty comes because the filler is being injected into the nose to alter its appearance. Non-surgical rhinoplasty is also referred to as liquid rhinoplasty. Why 'liquid'? Because the filler that is injected is a liquid.
What are the advantages of doing a non-surgical rhinoplasty?
The main advantage of such a procedure would be the minimal downtime. Since fillers are injected the time taken to complete the procedure would be very short and would not need any hospital admission.
What can be achieved with non-surgical rhinoplasty?
Compared to a surgical procedure, the benefits of a non-surgical procedure are limited. The benefits of a non-surgical rhinoplasty include,
What are the changes that can't be achieved with rhinoplasty?
It is not possible to make a large nose smaller using injection non-surgical techniques. It is also not useful for the management of a bulbous tip. It is not possible to improve septal deviations with non-surgical rhinoplasty. Surgical rhinoplasty is the gold standard for the management of the deformities of the nose.
How long does the effect of non-surgical rhinoplasty last?
When compared to a surgical procedure, the effects of non-surgical rhinoplasty are temporary. In most cases, hyaluronic acid fillers are injected during this procedure. Hyaluronic acid breakdown with time. The effects may last approximately one to two years. In certain individuals, the effects tend to last for a shorter period. In case of an unfavourable result, it can be removed with the help of a hyaluronidase injection.
What are the risks associated with non-surgical rhinoplasty?
The risks associated with a non-surgical rhinoplasty are similar to those seen with filler injections into the face. These can include tissue death and involvement of the vessels of the eyes and brain. Skin necrosis results due to impaired blood supply of the skin. Embolization of the filler into the vessels of the eyes can lead to blindness. These adverse events have been reported with filler injections, they are uncommon.
Who is a good candidate for non-surgical rhinoplasty?
It would include patients who want a change in the appearance of the nose without any downtime or need for aftercare associated with a conventional rhinoplasty. Patients should have realistic expectations and understand that not all deformities can be improved with a non-surgical rhinoplasty. The effects are temporary and need repeat injections for maintenance of the results.
For more information about rhinoplasty please visit: www.amicusclinic.in/rhinoplasty
Secondary corrections refer to operations undertaken to improve the outcome after primary surgery. Secondary corrections for gynecomastia are done to improve the appearance of the operated site.
Some of the deformities that may be corrected with secondary surgery include the following:
Timing of secondary corrections of gynecomastia.
We usually wait for a year before undertaking secondary corrections. This has some advantages. They include the following,
Various procedures are undertaken during secondary gynecomastia corrections. These may be carried out in isolation or as a combination. They include,
A surgical plan is based on the appearance of the deformity and concerns of the patient. In other words, such plans are customized. Two patients with a similar-looking deformity may undergo different types of surgical correction. A realistic expectation is important since it is usually only possible to make some improvements in the appearance. Also, secondary corrections are usually taken after a year following the primary surgery. During this period patients can help optimize their appearance by the following activities.
Secondary corrections of gynecomastia can help improve the appearance of selected individuals.
For more information about gynecomastia please visit: https://www.amicusclinic.in/gynecomastia
I could also have gone for a title called ‘why am I fond of syringe liposuction?’. Liposuction is a technique in cosmetic surgery for removing fat cells from certain parts of the body. The fat cells amenable to liposuction are between the skin and muscles. We do not perform liposuction on fat deeper than the muscles. Liposuction may be part of another procedure like abdominoplasty or gynecomastia correction.
Liposuction involves the creation of a vacuum. This vacuum helps remove fat cells with small cannulas. Such cannulas are called liposuction cannulas. Cannulas vary depending on their diameter, length, and shape of openings near the end. We use different types of cannulas based on the area treated.
During liposuction, a vacuum is obtained by a machine or a syringe. Syringe liposuction employs a syringe for generating liposuction. A cannula is attached to one end of the syringe. After insertion of the cannula inside the body, the surgeon pulls back the piston and locks it in place. The vacuum created inside the syringe helps move the fat cells into the syringe during to and fro movement. Once the syringe gets filled, the cannula is disconnected and the fat is emptied. The same process gets repeated till the desired endpoint is reached. This constitutes syringe liposuction.
Syringe liposuction is a simple technique with a lot of benefits. This makes it popular among many practitioners. Some of the benefits include the following,
Syringe liposuction was introduced by Toledo in 1989. The advantages of this technique make it very endearing to some practitioners of liposuction. One of them includes me.
For more information about liposuction, please click here.
For more information about gynecomastia, please click here.
Do I have gynecomastia?
'I don't know if I have gynecomastia. Maybe it is fat. So, I came.'
I hear this often in my practice. Gynecomastia is male breast enlargement. It can be diagnosed easily because of its appearance. But sometimes, the presentation can be a bit confusing.
The breast tissue is seen under the nipple and areola. The areola is the pigmented skin immediately surrounding the nipple. Depending on the severity of enlargement, gynecomastia can present as puffiness of the nipple and areola, or it can extend towards the sides of the chest. It can affect one side or both sides. Both sides can look different. In other words, there can be asymmetry.
The word, ‘gynecomastia’ comes from ‘gyneco’ and 'mastia'. 'Gyneco' means female, and ‘mastia’ means breast. Thus gynecomastia translates into the female-looking breast. This occurs due to an enlargement of the breast tissue. Compared to female breasts, male breasts are positioned more laterally (meaning to the side of the chest). Hence, the deformity of gynecomastia is also especially pronounced when viewed from the side.
Hypertrophy of the underlying muscle (pectoralis major) looks different from that of the breast. The muscle animates (moves) in certain maneuvers. This means the muscle contracts during certain activities like flexing the arm against resistance. Also, the lower border of the muscle usually stops at the level of the nipple. Any enlargement that significantly extends below the level of the areola is usually due to breast tissue. The lower border of the muscle is straight or flat. This is easily made out in men who perform weight training. The presence of breast tissue tends to make the inferior border curved. The curved lower part of the breast gives it a feminine appearance.
It is also possible to pinch the breast tissue separately from the underlying tissues. We usually carry this out during a clinical examination of an individual presenting with gynecomastia. Puffiness of the nipple and areola is also associated with enlargement of the breast tissue. It is not associated with hypertrophy of the underlying muscle.
There is an entity called pseudogynecomastia. ‘Pseudo’ means false. This is due to increased fat deposits in the chest. There is no glandular enlargement in pseudogynecomastia. It is usually seen in the setting of obesity with fat deposits that mimic the appearance of male breast enlargement. Losing weight will lead to an improvement in the deformity associated with pseudogynecomastia.
It is usually simple to diagnose a case of gynecomastia during a clinical examination. We sometimes request additional investigations to look for any underlying cause for gynecomastia. Imaging can help us to confirm the condition. Most cases of gynecomastia are benign and are self-limiting. Surgery is undertaken when gynecomastia results in significant distress in the affected individual.
To learn more about gynecomastia, please visit, https://www.amicusclinic.in/gynecomastia
Recently I was asked about home remedies for scars. I usually don't suggest any. Some of my patients describe the benefits of certain types of oils. I do not promote or recommend the use of any particular type of medication on settled scars. Also, I do not caution them against the use of any particular oil.
But there is a definitive role of certain conservative measures that can help improve scars. They are not advised in all cases. The effect of these measures should be understood by those using these. They should be carried out as per the guidance of the treating doctor. Some of the commonly advised measures for scars include the following,
Certain other non-surgical measures are carried out to help improve a scar. Examples would include laser and intralesional injections. But these are carried out by a doctor. Even though home remedies may not have many roles for optimizing scars, certain conservative measures are frequently advised. Most of them help in scar remodeling.
Rhinoplasty is a commonly known plastic surgery procedure to improve the appearance and function of the nose. The function of the nose relates to breathing. As in all surgical procedures, complications can happen. The goal of preoperative evaluation is also to seek out any potential problem. But despite the best efforts, complications can occur.
The incidence of the complications varies. It can vary depending on the type of procedure, and patient factors. It is more common to have a greater incidence of complications in difficult (challenging) cases. Some of the complications are uncommon when compared to others. The complications can be seen under those that are nonspecific to rhinoplasty and those specific to rhinoplasty.
The nonspecific complications can occur in any surgical procedure. It need not be in rhinoplasty alone. These include,
The specific complications of rhinoplasty are those related to aesthetic (appearance) and functional (breathing).
The aesthetic complications include,
Functional problems associated with rhinoplasty include,
Some of the complications are more serious when compared to others. Also, the difficulty level in performing a rhinoplasty can vary depending on the presentation. It is also more so in previously operated noses. It is not possible to eliminate the possibility of complications. However, it is usually possible to reduce their incidence with careful planning and attention to detail.
For more details about rhinoplasty, visit here.
I like to keep it simple.