Medesthetics

MAY-JUN 2016

MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.

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62 MAY/JUNE 2016 | Surgical Aesthetics SURGICAL AESTHETICS CHEST REDUCTION Noninvasive Options for Pseudogynecomastia Patients who have pseudogynecomastia—excess fatty tissue that is enlarging their chests—as well as over- weight patients with true gynecomastia who do not want to undergo surgery, may benefi t from noninvasive procedures with a fat-reduction treatment, such as Zeltiq CoolSculpting. In September 2015, dermatologist Girish "Gilly" Munavalli, MD, of the Dermatology, Laser & Vein Specialists of the Carolinas published the results of his study, which followed 21 pseudogynecomastia patients who underwent three CoolSculpting treat- ments—two performed on the fi rst day with a 50% overlap and one performed 60 days later. Using surveys to rate their satisfaction, 95% of subjects reported an improvement in the appearance of their chests; ultrasound imaging revealed a fat layer reduction of 1.6mm ± 1.2mm. "People were pleased after the fi rst treatment and really pleased after the second," says Dr. Munavalli. "Close to 90% said they would recommend the treat- ment. The biggest challenge was getting around the vacuum effect of the applicator since the area is so sensitive. We applied a numbing cream around the nipple/areola for 30 minutes before treatment and then wiped it off. That made a huge difference in patient comfort." He notes that thin patients with fatty tissue in their chests will feel more discomfort following treatments because there's less fat to insulate the nerves, and that this procedure addresses only excess fat, not excess breast tissue. The study was published in Dermatologic Surgery. PHOTOS COURTESY OF GILLY MUNAVALLI, MD So no one sees it," he says. "You really cannot afford to do skin excision on men's chests." If it's a very large case and there is a lot of extra skin, "I tell the patient that I don't think he's the best candidate, but if he wants to do it, he will look better—not great, but better," says Dr. Blau. "If he cannot accept that, I don't do the surgery." Dr. Dadvand will perform skin excision, but he notes that these cases are quite rare. "If the patient has excess skin on examination, I tell him that we may need to do some kind of excision procedure and that is going to result in more incisions and more scarring," he says. "But most of these patients are fairly young—between 20 and 40—so their skin tone is good and they tend not to have laxity issues. If they don't have laxity issues before surgery, they typically won't have them afterward. The skin is going to tighten up, and that's pretty predictable based on their starting-off point prior to surgery." The most common adverse events seen in gynecomastia surgery are the same as any surgery—infection, seroma, hematoma, poor healing and scarring. "It's a very clean case; it's not a very bloody case at all," says Dr. Dadvand. "Meticulous surgical technique reduces your hematoma risk signifi cantly, as does making sure patients know that they can't be too active in the fi rst week to two weeks after surgery. There's a lot of raw space, and they are still healing. I am a proponent of compression garments and reducing the patient's activity level for the fi rst four weeks or so after surgery." Risks that are unique to gynecomastia surgery include changes in nipple sensation, necrosis of the nipple and areola, and contour deformities. "It's not uncommon to have some immediate change in nipple sensitivity following

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