This is a 26-year-old male from San Francisco, California, who lost about 80 pounds and he presents for gynecomastia grade 4 with laxity of tissue. He presents for a two stage procedure. His first stage is excision of glandular and fatty tissue and his second stage is a periareolar lift. He was seen postoperatively after the entire procedure was performed over a period of approximately a year. His photographs are seen approximately a year and a half after surgery. The patients with skin laxity are some of the most complex surgeries in gynecomastia treatment. His overall goal was to try to achieve minimal incisions externally and to achieve a flatter chest.