Ask the Plastic Surgeon

Q:  I'm actually asking this question about my husband because, although he doesn't talk about it, I know he is very bothered by his chest. He has the appearance of breasts. I've heard more and more people talking about "man boobs" and the buzz about men having surgery for it. What kind of surgery is involved?

A: The condition you are describing is called "gynecomastia" which is derived from the Greek words "gyne" meaning woman and "mastos" meaning breast. It is not uncommon in men and there are several potential causes. Puberty is the most likely cause and 90% of the time it will disappear as adolescence wanes. Other causes are steroid use, obesity, naturally occurring hormone imbalances, or it can result as a side effect of some prescription drugs. For many men, gynecomastia can be emotionally devastating. Fortunately, there is a good solution for the majority of the cases that don't resolve on their own. The procedure for treating gynecomastia is fairly straightforward and can be done as an outpatient. The excess tissue, located on top of the pectoralis muscle, can be removed using ultrasonic-assisted liposuction. The procedure is done under a light, general anesthetic and usually takes less than two hours. Following a two-hour recovery room period, the patient is allowed to go home in the care of a responsible adult. There is usually minimal discomfort and bruising. A compressive zip-up vest is worn post-operatively for one to two months. Men soon return to a normal, active life minus the psychological distress and embarrassment.

Q: I 'm finally getting to the point that I would like to have something done to my face to regain a more refreshed, youthful appearance but I confess that I'm frightened of having surgery and the pain that would be involved. Would having the deeper wrinkles on my face treated with some type of filler be a reasonable alternative to having surgery?

A:  It could be a good option for you. My advice is to consult with a board-certified plastic surgeon who can assess your goals and give you realistic expectations of each type of treatment or surgery. If you have good, elastic skin quality and do not have an excess of sagging skin, you may achieve good results with a skin filler. Skin fillers are injected and plump out the tissues, thereby minimizing the appearance of wrinkles. The downside is that you might not be happy with the results because sagging muscles and skin are not addressed. If you are pleased with the improvement, you may be dismayed to find that it might not last as long as you had anticipated. If you have repeated injections, you may have spent almost the equivalent amount of money in fillers as you would have with a facelift without the long-term results. You may be interested to find that facial surgery is relatively pain-free and the face usually remains somewhat numb for a few weeks post-operatively. A board-certified plastic surgeon will be able to give you several choices of procedures and explanations as to what is involved so that you can make the decision that is best for your circumstances.

Q:  I have had a history of side effects from anesthesia. What are my options if I want to have cosmetic surgery?

A:  To begin with, I would suggest making an appointment for a consultation with an anesthesiologist of your choice. Be prepared to bring your medical history, a complete list of the medications you are currently taking, and the details of the problems you have had with anesthesia in the past. The anesthesiologist should be able to assess your history and provide you with some options that would make your anesthesia experience a safe and pleasant one. If you have difficulty locating an anesthesiologist, let your surgeon know and he can assist in arranging a consultation for you.

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