Web Log – July 2012 – Male Plastic Surgery

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USS Arizona Memorial

I have been seeing more men in my aesthetic practice lately.  They are usually most interested in surgery on their nose or chest.  Chin implants can also make a man’s weak jaw line look more strong and nationally are up about 70%.  Below is text of my KTVB segments on Gynecomastia and Chin Implants:

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I am a grown man, but have had an embarrassingly large chest since I was in junior high.  Why did this happen and what can I do about it now?

This person likely has gynecomastia and I always see more of these patients as the weather gets warm.  It is a common condition where a male has breast tissue growth more frequently found in a female.  The growth usually starts at about the junior high to high school age.  About 1/3 of adolescent males have gynecomastia, but it usually resolves in a few years.  In the meantime, it can be a great source of shame for a young man – trying to hide his chest in the locker room or at the swimming pool.  The chest can also be tender.
What causes gynecomastia?
It is usually due to a hormone imbalance in adolescence.  You can also see gynecomastia from marijuana use, anabolic steroid use, certain medications such anti ulcer drugs, liver tumors, or testicular tumors.  Sometimes, primary care physicians will do a big endocrinologic work up, but in the absence of suspicious findings, that usually is not necessary.  Enlarged breasts can also be seen in overweight males, but the breast may have a high fat and low breast tissue content and be termed gynecomastia.
What can be done to help these patients?
First, they need a physical exam to rule out any worrisome findings, including male breast cancer.  If the patient is an adolescent and the breasts are not so large that they are socially debilitating, then observation is appropriate.  If they are socially debilitating in a young person, or continue into young adulthood, surgery is indicated.  For grade I disease, there is no skin excess and little breast tissue – this may often be managed with just liposuction.  Grade III disease has excess skin and significant breast tissue – these patients need an open procedure to cut out the breast, but in a way that minimizes scar and flattens the breast – as opposed to a cone shape as desired for a woman.  Grade II disease is somewhere in between and is difficult in terms or how aggressive to be.  Patients need drains and a compression garment.
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How can surgery make my small chin look better?

Make a diagnosis first. Do the teeth line up correctly?  The chin may be fine and you really need oral surgery to move the whole jaw out.  Does the chin extend almost even with the lips?  It may have a projection deficiency.  Is it wide enough to extend to the corners of the mouth?  It may have a horizontal deficiency.  Is it tall enough to be about 2/3 of the facial height below the nose?  It may have a vertical deficiency.  Does baggy skin or extra fat under the chin contribute to the problem?  Is the nose overly projecting?
Once you have diagnosed the problem, what options do you offer the patient?
Most patients get chin implant.  They are commonly made from silicone  and placed through an incision inside the mouth.  There is nothing to reliably hold the implant in good position.  It can migrate so that it becomes uneven, causes bone absorption, or even rubs on nerves in the area.  Porex is more bone like, is placed directly via well hidden incision under the chin, and is held in place with 2 screws.  The mandible may be cut, advanced, and held in place with screws.  It is not offered as commonly because the implants works so well, but may be indicated if there is a large vertical deficiency – something implants do not help much with.
What other options are there?
One situation I really like is adding an implant in the setting of a small chin and baggy neck.  The implant makes the face more proportional and some of the extra neck skin is taken up.  If you do a platysmaplasty as well – tighten the neck muscles and remove extra fat – with or without a lower facelift as indicated, you can get a great improvement. [show patient photos] Adding an implant to the small chin of a rhinoplasty patient can also make the nose look much better proportioned.  The operation is becoming rapidly more popular – greater than 70% over recent years and even more in men.

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