skin excision photos?

[ihatepropecia]

can anyone direct me to some good skin excision photos that are at least 1 year post op? All the ones Ive seen are pretty soon after surgery and you cant tell how the scars look when its all healed.

[jojo82]

can anyone direct me to some good skin excision photos that are at least 1 year post op? All the ones Ive seen are pretty soon after surgery and you cant tell how the scars look when its all healed.

This is a big problem with the plastic surgery "industry" in general, and it's not completely the doctor's fault. A lot of times, patients will disappear after a while and get on with their normal life. But there is a lack of decent 1-2 year post-op pictures. Oddly enough, that's when issues tend to manifest (especially scarring and distortion due to weight gain).

[Dr. Elliot Jacobs]

jojo82 is correct.

I have a number of skin excision patients -- some of whom are on my website photo gallery.  Some of them refuse to give me permission to put their photos on the web.  Others simply do not come back for long-term follow up exams and additional photos.  Thus, I must make do with the ones that I have -- which are sometimes 6 months or at most one year post op.

Dr Jacobs

[ihatepropecia]

Dr Jacobs, 

can you PLEASEEE take a look at my photo?  I am 1.5 year post op.  I had mild gyno.  Had lipo and gland excision.  As I'm approaching my best weight, I see that my nipples are elongated and chest sags to the side some. I know its due to some slightly loose skin near the nipples and towards the armpit. And I realize that my results may be expected and acceptable to most but the fact is that this slight looseness is making me lose my mind! Its so uncomfortable to deal with when the rest of me is relatively tight.  Im willing to accept scars and I was wondering how this would be fixed? Are there different options? Where would my scars be?  Scars may be unsightly to some but comfort is #1 for me. Please help.  thank you so much! (Im going to post this elsewhere on this site to boost my chances of a response as well)

[Dr. Elliot Jacobs]

You have provided only one photo to look at -- and even that one is not great because you are clutching the camera in your hands, thereby partially distorting the chest.

However, from what I can see, you seem to have a reasonable and acceptable result from your gyne surgery. There is a limit as to how tight skin should be -- at a certain point you have to accept that you are human and that your skin will have some laxity in certain poses.  (This increases with age -- I can attest to that fact!).

When I discuss surgery with patients, I always want to get the very best results possible with the most minimum of scars.  Otherwise, one would be trading one problem (ie gyne) for another (ie scars) -- both of which might make you reluctant to be seen shirtless.  In other words, why not accept a 95% result (or more) with virtually no visible scars than try for 100% with permanent and visible scars on your chest?

I have many young patients who seem to feel that an absolutely perfect result is the only acceptable result -- perhaps that is our culture at the present.  And guess what?  With all their skills, etc, no surgeon (not even another surgeon on this site) can produce a perfect result on every single patient -- there are too many mitigating factors beyond anyone's control. A little maturity and reflection on your behalf might make you accept some of these truths.

As for an elongated nipple -- your photo does not show this.  If indeed there is an elongated nipple, this can be easily treated.

Dr Jacobs

[ihatepropecia]

Dr Jacobs,

Thanks very much for the reply! Sorry the photo wasn't clear enough. I do understand that ultimately, it would be either scars or looseness but to be honest, I'm not comfortable walking around with a shirt off now anyway. Just feeling gross all the time makes me way too self conscious of it. I can literally grab a handful of loose skin on the sides of both sides of my chest in the underarm area. So isn't it better to have scars and feel self conscious BUT comfortable than to NOT have scars and be self conscious AND uncomfortable.  I understand that from a surgeons perspective, you want to treat your patients as friends and look out for what you believe is their best interest if you're convinced they're being unrealistic. But this is a matter of comfort, not vanity.  Trust me, if I thought it would help my skin feel tighter I would have you tattoo a big pink dinosaur on my chest. Scars I can live with. But waking up everyday feeling like I have the chest of a 70 year old man is beyond words. I think I'm going to make an appointment with you soon. Granted my problem is relatively subtle I think, but I cant imagine that nothing can be done, no matter how slight the adjustment may be. Can you comment on this at all? Do you ever disagree with a patient's decision to have a procedure but operate anyway because you understand where they're coming from and understand their goals? I believe myself to be a very mentally sound human being. I don't plan on being on the cover of men's health magazine. I just wanna be comfortable in my own skin.  I think if you understood how I felt, you might agree with me.  Thanks again so much for taking the time to read these.  Just knowing that my comments are being read is very comforting to me and makes me feel like I am making progress.

[Dr. Elliot Jacobs]

I would be pleased to meet with you -- obviously discussion online cannot replace a hands-on physical examination.  And yes, I do learn from my patients -- and have at times acquiesced to a patient's request which differs from my own.  However, you must understand that as a physician, I stand by a major tenet of the profession -- primum, non nocere -- first, do no harm.

Dr Jacobs

[ihatepropecia]

well that sounds like exactly like the type of dr I would trust to do my procedure.  Ill see you soon