Need advice on tricky scarring after botched job and gynecomastia

[zttt90]

Hi first of all I am a 23/m of normal BMI. I was never obese and works out moderately. (I do not take steroids). I first realised I had this problem when i was in my late teens. I do find that my nipple is puffy and aerola pretty big. Therefore i sought out a PS. This PS was the worse decision I have made in my life. During that time, he advised that I did not require any surgery but all I needed was a aerola reduction surgery to solve my problem. However it ended up as a botched job and I am now stuck with bad scarring which I have no idea what could be done to salvage.  It resulted in a halo of aerola outside my aerola making it larger then before.

I have sought using laser to remove the outer halo. But it does not seem to have any effect. I really require some professional advice on what should I do, it is affecting me greatly and sometimes sucidal. Is there anyway that I can resolve the puffiness and get rid of the halo. Preferably without incisions again.. the past botched job traumatised me. I have read up that vase lipo to remove the gland or fats can help but it might result in an inverted nipple. And how can I help the situation of my aerola size.

Thank you in advance. I really am at my ends.

[zttt90]

additional photo

[Litlriki]

Without seeing how you looked before your surgery, I can't tell you if you needed areolar reduction or not.  You would benefit from a proper procedure to address your gynecomastia with liposuction and gland excision, based on the appearance of your chest in these photos.  Generally, the areola shrinks on its own and doesn't necessarily require reduction, but you've already had that done.  In cases like yours, I will generally do the gynecomastia resection in a single stage along with peri-areolar revision to address the scars.  It's tough to know what sort of scarring you could anticipate from a revision of the peri-areolar scars.  The issue appears to be post-inflammatory hyper pigmentation around the scar, and this could happen again. No laser procedure will help--You'll spend lots of money and see no improvement.

You don't need to be suicidal over this--It can be addressed properly, but you need to find a surgeon who focuses on gynecomastia in his or her practice, and have the problem addressed in a comprehensive way.  Don't try half-maneuvers--Liposuction only, excision only, and so on. It might be reasonable to have the liposuction and excision done at one time, and then have the scar revisions around the areolae done under local anesthesia at a later point.  This might also help to minimize the post-inflammatory hyper pigmentation issue.  If you're traveling for surgery, however, this may not be practical (two-staged approach). 

DO YOUR RESEARCH before you commit to anything.

Rick Silverman

[zttt90]

Thank you Dr. Silverman for your insight. Based on your expertise, do you think I should first fix the gynecomastia let things heal. Then do a peri aerolar revision? How long should I wait before going for the next procedure? Im really afraid that a peri aerola revision might make things worse, as my skin might keep resulting in hyper pigmentations. Would it be wiser to seek a dermatologist for the scarring?

Thank you so much. Your advice really means a lot to me

[DrPensler]

There are obviously two issues here. You have gynecomastia and it can be treated. An areolar reduction in and of itself will not improve gynecomastia as you have unfortunately become aware of.The psych issue need to be controlled prior to any surgery because surgery can result in complications which need to be addressed in a calm manner.

[Litlriki]

I think it's very reasonable to address the gynecomastia without dealing with the areolae initially, and you'll at least know what the scars look like. You might use some topical hydroquinone to see if the hyper pigmentation improves at all.  Talk to your surgeon about that.  If you take a staged approach, I generally recommend 9 months to a year for revisions, so I'd probably do the areola revisions at that point.  There is a practical and financial reason for this in my practice--I charge patients an hourly fee for revisions, which just covers office expense.  If they do multiple revisions on separate occasions, they have to pay that hourly fee several times, plus they have to recover multiple times.  If they wait until we can deal with all the unresolved issues at once, they probably end up saving money, and they'll certainly manage with only one recovery period.

RS