"the vast majority of my patients do not require excision"

[nickdiaz209]

hello good doctors

i posted a thread in the general discussion section regarding concerns about my vaser lipo surgery booked for the 14th. i would be grateful if you guys could take a look at it....

i can't link the thread here- it is near the top of the sub forum entitled "have i made a mistake (vaser lipo)"

it includes pictures and an excerpt from a letter the surgeon wrote for my gp.

basically the surgeon seems to think that only lipo is required in most cases. this is disturbing seeing as everyone on this board seems to think that excision is vital for good outcomes.

i'm having a conversation with him tomorrow, and as it stands, if he cannot guarantee excision i will cancel the operation.

any papers, studies etc that i can refer him to and advice on what to say to him would be very much appreciated.

thanks in advance

[Litlriki]

This article by Dr. Rohrich in the Journal of Plastic and Reconstructive Surgery from 2003 is probably the primary article that has been encouraging to individuals who use ultrasonic assisted liposuction (including VASER) for treatment of gynecomastia, since their assessment was quite positive for patients including those with a fibrous or glandular component. 

Plast Reconstr Surg. 2003 Feb;111(2):909-23; discussion 924-5.
Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction.  Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr.

I recall when the article came out that some of the post-op photographs looked like many of my pre-op photos, with some residual fullness in the nipple-areolar region, as the subareolar tissue was not adequately resected.  I'm not aware of any specific articles that go against the use of Ultrasonic Assisted Liposuction (UAL), but perhaps one of the other surgeons knows something.  Most of us use a combination, even if we use UAL.

Rick Silverman

[Dr. Elliot Jacobs]

Ultrasonic lipo or UAL (ultrasonic-assisted liposuction), including VASER, has been touted for gyne surgery.  Unfortunately, ultrasonic treats only fat, not gland.

'Nuf said.  I don't use it at all.

Dr Jacobs

[nickdiaz209]

thanks for answering, but its not the type of lipo i'm worried about (although VASER sounds a bit gimmicky imo ) it's more to do with the fact that he doesn't think excision is necessary in "the vast majority of cases".

so i'm looking for some good sources to refer him to when i speak with hm tomorrow- so i can show him that what he believes is contrary to the general concensus amongst specialist gynecomastia surgeons- that excision is crucial. (heh that last part was good, i'm gonna use that tomrrow )

[DrPensler]

I think that anyone who actually performs a significant amount of gynecomastia understands that excision is required. Someone can tell you they perform 100 cases a day that does not make it so.There are very few individuals who perform a significant number of gynecomastia cases in their careers, while the number of surgeons who dedicate a majority of their practice to gynecomastia is a small fraction of that number.

[nickdiaz209]

okay guys, 72hours post op for lypo and excision, what do you think?...

i know it's early, but i'm concerned about the right one, seems like it's still sagging a little.

(sorry about the quality)

before





after...