Dr. Miguel Delgado and his staff recently welcomed Dr. Ivan Puah from Singapore to Marin Cosmetic Surgery Center, to further hone his surgical skills in gynecomastia surgery.
Dr. Miguel Delgado shared clinical and surgeries cases with Dr. Ivan Puah. Both doctors exchanged experiences on cases they have seen and performed, including post-surgery complications, surgical approaches, and more.
It was rewarding for Dr. Ivan Puah to receive one-on-one mentorship from Dr. Miguel Delgado in gynecomastia surgeries as well as observation of liposuction and a tummy tuck procedure. At the clinic, Dr. Ivan Puah had the opportunity to observe consultations, pre-operative patients, and management of post-operative patients who were having drain and suture removal.
Dr. Ivan Puah has been practicing medicine for more than 20 years with training in various disciplines including general surgery, orthopedic surgery, urology, dermatology, and many more. Since the establishment of his medical aesthetic practice, Amaris B. Clinic in 2004, Dr. Ivan Puah has been performing various types of surgical body sculpting procedures such as laserlipolysis, liposuction, VASER® Lipo, fat grafting, and gynecomastia.
Dr. Ivan Puah is a certified VASER® practitioner, obtaining his VASER® Body Sculpting training in Colorado and Argentina. In Singapore, he is accredited and recognized by the Ministry of Health to perform surgical body sculpting procedures.
“Gynecomastia is the top main concern for male patients in Singapore. As a doctor, it is important to provide patients with honest, ethical advice, as they put their trust in you; while managing their expectations realistically, working with them on achieving the results they want,” explains Dr. Ivan Puah.
We asked Dr. Ivan Puah on his key takeaway from the training, and he stated, “It was a very fruitful trip. Although I have been performing gynecomastia surgery for years, I am extremely humbled to have the opportunity to receive further training and to be mentored personally by Dr. Miguel Delgado, who is an expert in this field. He is very approachable, yet professional, and always ready to give advice. I look forward to more learning opportunities with Dr. Miguel Delgado in the near future.”
Gynecomastia.org, a popular educational online site, set up by Dr. Miguel Delgado and his team, is dedicated to providing comprehensive information for males who are facing issues with manboobs.
“I am glad that gynecomastia.psstage.com offers a platform for patients to share their experiences, research for the right information for their specific concerns and treatment options. To be listed on the doctor’s panel provides physicians like myself another useful channel to communicate and offer appropriate advice,” says Dr. Ivan Puah.
Visit https://www.gynecomastia.org/ to learn more about gynecomastia.
Gynecomastia specialists’ see too often the cases of male breast reduction done by less experienced surgeons. Many gynecomastia revision cases are necessary because the primary surgeon removed too much fat and tissue leaving a “crater deformity,” or in some cases, not removing enough tissue. A large percentage of revision cases are due to liposuction alone being performed, and there is breast tissue left behind.
How many cases does the surgeon do in a year? It should be in the hundreds.
There should be available an extensive photo gallery of before and after surgery.
Custom Plan For Your Body Type
Gynecomastia surgery is very complex; each patient needs to have a surgery plan based on their unique case. For example, bodybuilders do not need removal of excess fat or skin. However, they can be at a higher risk for bleeding due to an increase in blood flow in the chest muscles that are highly developed.
What to Avoid
Beware of advertised discounts and specials on surgery fees. Specialists have devoted many years to perfecting their skills. Specialists are in high demand; they do not need to “reduce” their fees to attract new patients. Unless they should get an unavoidable cancellation, you may find that you have to wait a few months to get on their surgery schedule. But it will be worth the wait, avoid the possibility of gynecomastia revision surgery which will compromise your results and add additional fees. Remember you get what you pay for.
Surgical Vs. Non-Surgical Body Contouring and Liposuction Procedures
The Myths And The Myth Busters
• What Is Coolsculpting / Non-Surgical
The Myth:
The makers of CoolSculpting State That This Procedure Freezes & Eliminates Stubborn Fat.
The information provided by the company states that this procedure will safely deliver precise, controlled cooling to gently target the fat cells underneath the skin. The information also states that the treated fat cells will crystalize (freeze), then die. Over time, your body is to process the cells and eventually eliminate the dead cells, leaving a more sculpted you. It is stated that while some patients may see results as early as 3 weeks following the first treatment, the most dramatic results are usually seen between 1 and 3 months following a series of treatments along with diet and exercise.
Myth Buster:
Anyone that is committed to following a diet and exercise program for 3 months, will likely lose weight and contour their body naturally. This can also be the case for those who are 3 weeks into their diet an exercise program.
• What Is Liposonix / Non-Surgical
The Myth:
Liposonix states that this procedure reduces fat using ultrasound technologies. Like Coolsculpting, Liposonix is also marketed as a non-invasive fat reduction procedure. They state that Ultrasound energy can be used to penetrate through layers of skin to target fat tissue without harming the skin or other surrounding tissues. Fat is then naturally processed through the body. The Liposonix system informs consumers that the procedure uses high-intensity focused ultrasound wave of energy that can destroy targeted subcutaneous fat therefore delivering a more precise result. It is stated that results can typically be seen within 8 to 12 weeks with a healthy diet and exercise.
Myth Buster:
Liposonix states that results can be seen with only one treatment. However, it is more often recommended that the patient may receive 2 to 3 treatments to achieve desired results. Again, like Coolsculpting, anyone that is committed to following a diet and exercise program for 8 to 12 weeks, will likely lose weight and contour their body naturally.
• What Is SmartLipo / Non-Surgical
The Myth:
The makers of Smartlipo state that this procedure is a minimally invasive, laser-assisted procedure that will target troubled areas like the abdomen, arms, buttocks, thighs, and neck, and will permanently eliminate fat. The manufacturer states that for the stubborn areas of your body that does not respond to diet and exercise, this procedure will provide dramatic improvements. They state minimal downtime with less pain than traditional liposuction.
Per the information provided, the technique has three wavelengths to provide targeted treatments that will disrupt the fat, coagulate blood vessels as well as stimulate collagen to improve the elasticity and texture of the skin.
This procedure is performed using local anesthetic to numb only the specific areas that are being treated. What this means, is that you are awake during the procedure.
The Smartlipo laser cannula is inserted through a small incision in the skin, the laser will then rupture fat cell membranes and destroy fat cells permanently. It is stated the fat will liquefy and then gently suction out.
The Myth Buster:
Be careful of fancy marketing words such as “Laser” Liposuction and “minimally invasive”. Fact, the only fat that is responsive to any liposuction procedure is the fat directly beneath the fascia. This is the fat that can be pinched directly underneath the skin. The procedure is performed to address the fat just beneath the skin. Having said that, all liposuction procedures can be considered “minimally invasive”. What this means is, the procedure is performed just below the surface of the skin through a small incision (approx. size of a pencil eraser). Over the years, the word “laser” has become somewhat of a great marketing word. There are always factors to consider prior to having this procedure, as well as any procedure (surgical or non-surgical). Lasers in any form, produce heat, therefore can burn its surroundings. Complications that are often seen with this procedure, can range from cosmetic dissatisfaction to permanent internal damage. These complications are often due to heat from the laser, combined with friction of the technique. This combination can burn the underneath portions of the skin causing a visually wavy/lumpy appearance at the treatment site. Other complications from lasers can also be as severe as an internal burn or injury.
***Lasers have become a great option for external resurfacing such as scar treatments, and hair removal. Lasers have also evolved in technology for anti-aging purposes. When lasers are used in this capacity, the provider can be much more precise in the treatment as well as visibly see how the individual is reacting to the heat. ***
• What Is The Ultrasonic Liposuction Procedure / Surgical Procedure
• What Is Traditional Liposuction Procedure / Surgical Procedure
Ultrasonic Liposuction:
The ultrasonic liposuction procedure is very similar to a traditional liposuction procedure, with one major exception. A sound generator is connected to the cannula, which then generates ultrasonic waves through the tip of the cannula. These waves cause fat cells to dissolve and liquefy, and the liquefied fat is then easily suctioned from the body.
Ultrasonic liposuction can greatly benefit patients that are not the perfect candidate for traditional liposuction. Ultrasonic liposuction uses sound waves to first break up and liquefy fat, which is then removed via suction. Because the fat is liquefied before removal, there is far less blood loss than with traditional liposuction, and can also be effective in areas that tend to be more fibrous.
Depending on the individual needs of each person, a more traditional liposuction may be performed directly after the ultrasound procedure in order to better shape the body. Having a Board Certified Plastic Surgeon perform the Liposuction procedure is the safest way of having ANY procedure done. When having a Board Certified Plastic Surgeon perform the procedure, you will have options available that will deliver the best results for you and your body type.
Traditional Liposuction:
During liposuction, a cannula is inserted – or surgical metal tube – through surgically created entrances in your skin. Fat is then sucked through the cannula into a container by the power of a vacuum pump. The experience and skills of our board certified plastic surgeons allows them to act as body sculptor, leading to more proportional and attractive results.
Although liposuction is not intended as a weight-loss technique, this procedure is commonly used to remove fatty areas for body contouring and sculpting. Suction-assisted lipectomy, or lipoplasty, more commonly referred to as liposuction, can be used to improve various areas of the body. Individuals who choose to have liposuction often target their abdomen, hips, thighs, and knees. Men generally target love handles, lower abdomen and enlarged male breasts.
Following any Liposuction procedure, you will be fitted with elastic bandages or compression garments while your skin shrinks to fit your new body.
Your Safety:
*** FOR YOUR SAFETY, IT IS HIGHLY RECOMMENDED THAT WHEN HAVING ANY PROCEDURES PERFORMED, THAT THE PROVIDER BE LISENCED IN THE SPECIALTY AND THE PROCEDURES ARE PERFORMED IN A STERILE ENVIRONMENT AT A LISENCED SURGICAL FACILITY. ***
Do extensive research on the provider as well as the facility itself. Your life and your body are not worth bargaining.
Note: In most cases, if a procedure is not being performed in an Operating Room setting, this will often mean that the provider performing the service does NOT have Operating Room privileges. This can mean that the provider is not licensed to perform the procedure.
Breast asymmetry is unevenness of the breasts, meaning one breast is larger than the other breast. In men, gynecomastia may present in one breast known as unilateral, or gynecomastia may be present in both breast, known as bilateral. The most common gynecomastia diagnosis is when it occurs in both breast at different degrees, this is known as bilateral asymmetry. Glandular tissue can affect the appearance of the size and shape of the breast. The glandular tissue in combination with the breast tissue can change the appearance of the breast, including larger areola in diameter as well as protrusion.
In many cases, men that are suffering with gynecomastia develop insecurities. The insecurities can often lead to low Self Esteem, Depression and social anxiety. This can often interfere with their personal relationships, or in some cases, their day to day relationships.
No two breast are the same. In both men and women, breast will differ in size and shape. In most cases difference is slight and not noticeable to the eye. The degree of the asymmetry can vary in each individual. A Board Certified Plastic Surgeon will do an exam on the patient to determine if they are a candidate as well as determine the asymmetry of the gynecomastia. A procedure plan must be discussed between the individual and the surgeon prior to having surgery.
The asymmetry conditions can often be corrected to some degree in surgery. It is important to be informed of the realistic expectations from the surgery. Individuals should feel that they have been fully informed and educated by their Plastic Surgeon.
Gynecomastia Correction surgery includes removing both the glandular tissue as well as the fatty breast tissue. When removing the breast tissue, this gives the surgeon the opportunity to equal out the symmetry of the breast. This may include removing more tissue from the larger breast to create the same measurements as the smaller breast. This will give an overall appearance of even and symmetric breast.
Do your research on your surgeon, inquire on how many procedures they have performed and look at before and after photos. Realistic expectations are important. However, the most important thing is patient safety and satisfaction. It is highly recommended that you have a “Board Certified Plastic Surgeon”.
As potential patients research all the pros and cons of male breast reduction surgery, there is one issue in particular that comes up from time to time. It is discussed extensively on the forums of this site, and that is the concern of the loss of nipple sensation.
Permanent loss of nipple sensation after gynecomastia surgery is possible although rare, but needs to be considered as a surgical risk. For some men, it may be a deal breaker, and for others the tradeoff is worth it, to be rid of their “man boobs.”
The degree of injury will depend on the extent of surgery and the technique used. Nerves regenerate slowly, depending on the amount of breast tissue that is removed. It is normal for the nipples to be hypersensitive or to lose sensation. This is usually temporary with sensation returning in a few weeks to a few months.
The temporary loss of sensation or numbness is known as neurapraxia and is caused by stretching or compression of the nerves during surgery. It is considered a mild injury with full recovery likely. As sensation starts to return and the nerves begin to regenerate the patient may feel pins and needles which are referred to as dysesthesia/paresthesia. This is a normal condition during the healing process.
After about three weeks into your recovery, gentle massage may help to reduce hypersensitivity, but this should be done only under the direction of your surgeon.
