GYNECOMASTIA

Gynecomastia is a medical term that originates from the Greek words for "women-like breasts." This condition is far more common than many realize. Gynecomastia affects an estimated 40 to 60 percent of the male population. It may affect only one breast or both. Although certain drugs such as anabolic steroids, medications containing estrogen, alcohol, marijuana, etc., and medical conditions including cancer, impaired liver function, to name a few, may cause or contribute to enlarged male breasts, it is widely accepted that a large percentage of cases derive from unknown sources.
Men of any age who are healthy and emotionally stable are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.
Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed.

Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible.
Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities.

There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months.
Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue.

SOFT TISSUE FILLERS

The injectables are useful for treatment of firmly established wrinkles or larger lines of facial aging (such as the nasolabial folds).   Fillers restore volume to the face and can add structure as well.  Depending on the type of filler and the depth at which it is injected, you can smooth out fine lines on the surface of the skin, fill out deep lines (eg: nasolabial folds), augment soft tissues (such as the lips), or even effectively augment facial bone structure.  All of these injectable fillers are placed by an injection, so the group carries usual risks of bruising, lumpiness, redness, product specific adverse reactions, and in rare cases local infections.

Many options are available in the filler class, with clinical differences being predominantly governed by how long the effects last, as well as how the filler “feels”.  Generally speaking, very soft fillers (that are best for locations such as the lips) tend to have a shorter duration of effect, while fillers that last longer tend to have more structure and are better suited in regions where they will not be palpable (such as the nasolabial folds).  In the past, the most widely used fillers were based on collagen, with sources ranging from bovine to human.  For some collagen formulations, skin testing before injection is necessary to confirm that you will not have an allergic response to the filler.  Collagen based fillers tend to last 3 to 6 months, and for some indications have a very natural feel.

A more recent class of fillers is based on hyaluronic acid (HA), which is a sugar found naturally in human skin.  When first introduced, a major benefit of this filler class is that allergic reactions are extremely rare, and no pre-treatment skin testing is necessary.  These compounds bind water similar to the way a sponge absorbs water.  Because of this, they hydrate the skin in the treated region and act as a cushion.   Several manufacturers are coming out with versions of HA fillers, and formulations vary with the size of molecules (governed by the amount of crosslinking) and other components of the injectate (such as local anesthetic to help decrease the discomfort associated with injections).  The various formulations expand the repertoire of options available to your injector, as certain products are better suited for different anatomical regions.  Formulations with smaller particle sizes tend to be softer and smoother, and work well in regions such as the lips.  Larger particles have more structure, and are best suited for deep folds such as the nasolabial creases.   Hyaluronic acids are eventually absorbed by your body, and the length of time is dependent on a multitude of factors including the patient, the location of injection, and the particular product used.  Results last from 3 months in high mobility areas (such as the lips), and up to 1 year in regions such as the nasolabial folds, with most patients experiencing the desired effects for 6 months.

A newer class of fillers has been introduced that is based on microsphere technology.  Microspheres are tiny round particles of solid material that are relatively uniform in size.   Radiesse contains mirospheres are made of calcium hydroxylapatite suspended in a gel carrier.  The filler is broken down by the body in two phases, first the carrier and then the spheres.  During this process, collagen ingrowth occurs, which is expected to provide a long lasting effect.  This prolonged degradation process makes Radiesse a longer lasting filler than those previously discussed, with expected results lasting a year or more.