The Story of a Free Gynecomastia Case

We met this young patient through his mother, who was also a patient of ours. He had been teased so badly early in his high school years that he had dropped out of sports and withdrawn from many of his peers. We decided that this kind of case deserved pro bono treatment. Dr. Yoho performed gynecomastia surgery. Gynecomastia is more commonly known as "man-boobs" or "moobs". Some males develop breast tissue, typically during puberty. Although this is a pretty common condition, many boys and men who develop it feel self-conscious and isolated.

Boys and men can not only feel as self-conscious as girls and women, young men who develop this condition can even be embarrassed about feeling self-conscious. That very self-consciousness is seen as a weakness in some circles, and we all know how cruel our school peers can be. Many men grow up not wanting to take off their shirts during sports or at the beach. They feel embarrassed around their male peers, and extremely shy around girls or women as well. Even going to the gym can be a source of discomfort, and it's discouraging for these men to discover that no amount of fat-burning exercise can cure their condition.

Gynecomastia surgery is actually fairly simple as far as cosmetic surgeries go, and recoveries are usually relatively quick and uneventful, with excellent results. While nothing in surgery is guaranteed, gynecomastia surgeries have very high satisfaction rates. The process involves liposuction, and sometimes excision of a small amount of breast tissue. Many men are well on their way to surgical recovery within a day.

Post op, he's on his feet and recovering already!

We hope that we have made a difference in this young man's life. We are grateful to him for sharing his story. He agreed to let us publish his interview and photos online, which was very courageous. We hope his story will inspire others as well. While a few people still consider cosmetic surgeries to be for the vain and frivolous, Dr. Yoho has seen many times over what a real difference it makes in people's lives.

Is It Important to Wear a Bra With Your Breast Implants?

I repeatedly emphasize to our patients that good bras are important or the breasts will sag. If they wear the bras and have support all the time, particularly for the first year when the scar is forming around the breast implant, often the breasts will be just as perky five years later as when the breast implant is placed. However, especially if the breast implant is a large one, the patient will have unpleasant, unnatural, and unsightly sagging of the breast. Here’s an example where the patient, in spite of all my admonitions, is wearing a very lightweight bra, at only two months after breast implant surgery. We recommended to her that she consider a heavier bra like the Bali Minimizer bra, and as always we told her to continue on her fish oil and Vitamin E indefinitely in order to keep her breasts soft.

Liposuction For Men - Six-Pack Abs

Did you know that you could have sculpted abdominal muscles from your liposuction procedure? There are new options available that can give you a chance to look your best. Dr. Yoho specializes in removing all the possible fat from this “six-pack” area of the abdomen and also injecting a little bit of fat in each square of your “six-pack.” This fat tends to be retained and creates a bulging muscular look. While the recovery takes a little longer than with ordinary liposuction, the results can be stunning. Additionally, we make a special effort to suction the fat from the creases of your abdominal muscles, thus creating more definition. Feel free to schedule a complimentary consultation about this exciting new procedure.

Advances in Breast Augmentation

Belly button breast augmentation or "TUBA" is one of the innovative techniques in breast augmentation surgery that has rendered obsolete many of the surgeries that leave scars on the breast, such as the through-the-areola approach. While some patients need to be treated by the through-the-areola approach because of odd-shaped breasts or other problems, the TUBA approach can put the implant in through the belly button without any scars anywhere near the breasts.

In experienced hands, this technique works wonders for many patients. It seems to have a lower rate of complications, such as capsular contracture, which is firming of the breasts. This complication accounts for the highest of all of the problem rates in breast augmentation surgery.

Dr. Peter Cheski pioneered and invented this technique, and Dr. Yoho learned his technique right from Dr. Cheski, working closely alongside him in his office over the years. Dr. Cheski was at the point where he could perform one of these surgeries in 10 to 15 minutes with virtually no help outside of a scrub tech and a sedation person who watched the monitor. He performed many tens of thousands of these surgeries over the years, and Dr. Cheski is regarded as one of the pioneers in breast augmentation.

Please come in for a look to see whether this procedure is appropriate for you. We love its results, but you must be evaluated before having the procedure.

Sculpting a Six-Pack

Did you know that there are new liposuction techniques that can get you more definition of your abdominal muscles than ever before? These new techniques include special aggressive suction of the fat in between the muscles, which can be done with ordinary liposuction or with other types of liposuction machines. Dr. Yoho’s belief is these new machines don’t yield any significant advantage. However, the real news is that a tiny bit of fat injected into the muscles of the abdominal area makes for greater definition and a much better result. This has to be done carefully and with experience, to ensure that the muscle squares are enhanced and improved. It helps to have good muscle tone before the procedure, but you don’t have to be slender. The liposuction itself can do that.

All About The Total Makeover

Robert Yoho, MD playing with his daughter

Generally, facial procedures are done “all in one.” In other words, facelifts, eyelids, cheek implants, chin implants, noses, and laser resurfacing are often performed at the same time. This has been the traditional approach and is felt to be reasonable by the medical community. 

 However, the “total body makeover” where all this facial work is done and then breasts and liposuction are all performed together we think represents an extreme risk. One of the problems with this involves anesthesia time, which increases the problems with blood clotting and other medical issues related to the anesthesia. Surgeries over a couple of hours to us seem relatively unreasonable, although sometimes our facial surgery or breast lift will extend three hours or a little more.

So beware of the “total makeover.” We think that it’s easier for you and makes more sense to approach these things stepwise, thus getting to know the quality of your surgeon and the quality of the results bit by bit.

The Insanity of the Modern Tummy Tuck

Trinidad beach scene-by Dr. Yoho. Nothing to do with tummy tucks.

I am concerned about the fact that the Los Angeles tummy tuck has become synonymous with plastic and cosmetic surgery in some contexts. The fact is that this operation is not indicated in most cases. A tummy tuck or abdominoplasty is a major surgery which has a fatality rate of one in 3,000, according to the best medical literature we have. Older studies had a fatality or death rate of one in 625 surgeries. The patient is cut all the way from hip to hip. The fat and skin is separated from the muscle. The muscle is usually tightened, and a large portion of skin and excess fat is removed and then the patient endures a recovery which can last for many months.

Modern liposuction can accomplish many of these goals and for most patients it is the preferred alternative, even for very overweight patients. Recovery from liposuction is very modest compared to a tummy tuck. The death rate for liposuction may be as low as one in 50,000. Although after a liposuction with a large patient, some saggy irregular skin is to be expected, the skin shrinks to a much greater degree than most people would expect. It’s not like cutting and pasting a paper bag. The skin is the magic organ of the body, and just like after a pregnancy, after a liposuction the skin shrinks a great deal. Particularly helpful in this regard is the irritation that is produced by the liposuction process itself. This irritation or injury process accelerates and helps the shrinkage of the skin.

Nothing is perfect. Liposuction can produce irregularities, and just like abdominoplasty, major complications can occur. However, let the reader imagine the number of hospitalizations, major blood losses, and blood clots to the lungs and legs that occur with tummy tucks versus liposuction. It’s a ratio of ten to one or greater with the much safer procedure being liposuction.

Large-volume liposuction, or removal of more than five liters of fat, has become a standard and much safer procedure for the modern surgeon and the contemporary patient. We believe that this can be accomplished safely and efficiently in our hands, using our techniques, with a very modest risk. These surgeries result in very gratifying results, and if extra skin remains after the procedure and the patient is willing to have a secondary touch-up procedure, this can be removed much more easily than when the patient presents with all the fat to begin with. In other words, a second relatively inexpensive surgery can make a result with a smaller scar and less risk of major problems after a liposuction than trying to do it all at once. Particularly risky is the practice of doing a large liposuction and cutting skin out at the same time. This procedure can result in areas of skin death or problems of other kinds, including infection or sometimes other problems.

My firm belief is that liposuction under general anesthesia, particularly large-volume liposuction under general anesthesia, is connected with a much higher risk. My technique involves sedation and local anesthetic combined with two operating professionals who remove the fat rapidly and expose the patient to a much shorter operating time and less medication.

So if your surgeon recommends a tummy tuck, shop this around and be sure this is what you want. Look at pictures online and see Los Angeles cosmetic surgery website in particular to see if there is another part to this story that you haven’t heard.

 Be careful out there.

______________________


Robert Yoho, M.D.

Cosmetic Surgery Procedures After Pregnancy

Question:
What kind of cosmetic procedures are best for me after a pregnancy?

Answer:
Everyone is an individual and must be evaluated in person; however, many women have deflated and saggy breasts after breastfeeding. Breast augmentation for Fresno-area women can restore the original contours or even create a contour that the patient enjoyed during her breastfeeding days. Many times, no cutting is necessary on the skin of the breast, and the implant can be inserted through the bellybutton without cutting the surface breast tissue to any significant degree or disturbing the nerves to the breast.

Most implants are inserted under the pectoralis muscle. They do well because there is a natural drainage of any slight bleeding into the fat of the abdomen rather than the blood staying in the area around the implant. This bruising on the abdomen rather that around the implant helps decrease the chance of scarring around the implant (capsular contracture). This scarring around the implant can make an implant quite firm and sometimes even painful, but a qualified surgeon will be able to explain what techniques he or she will use to minimize this risk.
For more information, please visit my Los Angeles cosmetic surgery website

Another common procedure performed after pregnancy is liposuction. This procedure is very helpful for women who have exercised enough and have had good enough muscle tone of their abdomen. Skin sagging that occurred after the baby was born can often be improved with liposuction alone if it is not too extreme. The liposuction disrupts the skin tissues underneath the surface, which causes them to contract. As surgeons know, skin contraction occurs in every direction for several weeks after any injury and sometimes for longer. In the case of liposuction the damage is minimal and internal, and the skin is allowed to contract back towards the muscle wall. In the best case, smooth, tighter, natural-looking skin can be produced by liposuction alone.

For those women whose muscle walls do not recover from the stretch of having that extra 20 to 30 pounds of baby and baby support system, muscle wall tightening can be performed. The “ Los Angeles tummy tuck” consists of making an incision from hip to hip and then making a passageway right next to the muscle all the way up to the ribs. In this passageway, the muscle wall is sewn to itself in a sort of pleating process which tightens the muscle. Then the skin is pulled down, extra skin is trimmed away, a new bellybutton is shaped, and the skin is sewn along the lower abdomen. Unfortunately, this method does produce long scars. Also, unless great care is exercised, some of the belly buttons are not very natural-looking. However, a qualified Fresno area cosmetic surgeon should be able to create a result that looks and feels natural.

Another way to tighten the muscle wall - if the skin is not tremendously loose - is to do it through the bellybutton. In this method, a bit of liposuction might be performed on the front of the abdomen, and then a little circular cut is made around the bellybutton. After this, passageways are made in the midline above and below the bellybutton and again the muscle covering is stitched to itself with permanent sutures. This procedure cannot tighten the skin, but the skin often will shrink fairly well later on if the muscle wall is tightened. This avoids the long scar of the tummy tuck, but again care must be taken with the bellybutton or unnatural bellybuttons with scarring right on the surface can result.

Please visit my liposuction Los Angeles website for before and after photos and information about these and other cosmetic surgery procedures.

Common Cosmetic Surgery Questions

Question:
What procedures are new in Los Angeles / Fresno area cosmetic surgery?

Answer:
Two procedures are now gaining popularity and we will have to wait and see just how popular they become. The first is revision of the bellybutton as a sole procedure. This can be done by removing a little bit of skin around the belly button and then carefully stitching inside the bellybutton in order to hide the scar. This produces tightening. It is an excellent procedure as a stand-alone bellybutton improvement surgery, or can be done after a Los Angeles liposuction or tummy tuck procedure.

The second set of procedures, which are becoming more common are nipple revision procedures for women.

• Some women have large, droopy nipples, but these can be revised surgically at my Los Angeles / Fresno area cosmetic surgery practice. In my opinion, the best way to revise these is to carefully remove a cuff of skin from the base of the nipple. This pulls the nipple up and makes it perkier while still preserving nipple sensation.
  
  Older methods such as cutting off the top of the nipple can often produce attractive results, but have more chance of significant problems and of course entail a much longer healing process.


• Inverted or "sucked-in"nipples can bother women for a lifetime. The revision can be done by pulling the nipple tissues outward after the area has been injected with local anesthetic. After the nipple is pulled outward, a small incision is made in the side of the nipple and the fibrous bands, which held the nipple down toward the inside of the breast are cut, and the incision is stitched. After this, no special care is needed. Bruising is typical immediately after surgery, but this should go away within 1 to 3 weeks. This procedure be performed at the same time as a Fresno-area breast augmentation cosmetic surgery and greatly enhances the results for those women who have inverted nipples.

For more information on nipple and belly button cosmetic surgery, please visit www.dryoho.com.



Question:
What Fresno cosmetic surgery procedures may be "wrong" for most patients?

Answer:

• Thigh lifts are often problematic, and generally unacceptable for younger patients. This procedure causes scarring, and sometimes the scar will pull in unnatural fashion on the area around the private parts of a woman. Additionally, the scar tends to migrate or move down the leg as the tissues mature. While there are ways to help prevent or correct each of these problems, overall this is not generally a good procedure in younger women.
  
  Typical exceptions include individuals who have lost massive amounts of weight. At my cosmetic surgery practice near Fresno I offer liposuction in this area, and in many cases the skin will shrink adequately afterward. In an older woman with exceedingly loose skin, occasionally a thigh lift is an acceptable alternative, but only if the patient understands the potential problems.
  
  Additionally, thigh-lifts place the scar in a moist area that is somewhat difficult to keep clean, so infections are probably more frequent in this area than for other types of surgery in other areas. When an infection happens, the scars become even more spread than is ordinarily the case with case with body surgery. For all these reasons, thigh-lifts are not popular with the cosmetic surgery community and not all surgeons perform these procedures.


• Another procedure that is performed by only a few is artificial pectoral implants in males (in the breast area). There are some hard silicone implants that are designed for placement underneath the muscle to simulate a body builder’s chest, but these implants sometimes are mobile, and you can often feel the edges of them, creating a very unnatural result. While it may be possible that someone somewhere is doing a good quality pectoral implant and getting results that are acceptable, I do not know of any.


• Calf implants are another procedure that is not performed very often and that, in my opinion has unacceptable healing times and a questionable risk-to-benefit ratio. The hard plastic implant (polymerized silicone) is placed through a slit in the back of the knee into the area underneath the muscles of the calf. The patients have to walk around on their tiptoes for weeks to months in order to get the muscle tissue to stretch out around the implant, and this is very uncomfortable. The incision is not insignificant in this area and frequently will spread, producing a scar that may often be unacceptable.

So remember, when you are thinking about cosmetic surgery, you do not have to get "everything on the menu" - just as when you go to a good restaurant, you should not try to eat everything that is there. There are procedures that are appropriate for your particular body and those that are not, and you should consult with your surgeon about what is most reasonable.

For more information, read "Doctor, What Else Do I Need?"
If you are considering cosmetic surgery and live in the Los Angeles / Pasadena area, please visit www.dryoho.com for before and after photos and procedural information.



Question:
What kinds of cosmetic surgery procedures produce the most lawsuits against surgeons?

Answer:
The answer to this question reflects several factors. First, it can reflect the kind of patients and the perfectionism of the patients who are interested in each procedure. Second, it may represent the difficulty of performing a given procedure well. Third, it may reflect the complication rate of the procedure. If the procedure has many complications, possibly there might be more lawsuits.

• The number-one litigation or lawsuit risk for the cosmetic surgeon is nose surgery. This procedure represents less than 10% of the cosmetic surgery cases performed and about 1/3 of the lawsuits. Nose-improvement surgery is highly specialized and complex and probably should be performed by surgeons with ear, nose, and throat (facial plastic) background or maxillofacial background only, unless the cosmetic surgeon takes a lot of time to learn the procedure “hands-on” from a reputable training facility.
  
  The standard joke among cosmetic surgeons is that you should pay the first 100 patients for performing their nose surgery and after that, the patients can pay you. Nose surgery’s healing process is different than any other >Fresno area cosmetic surgery, and it may take a full year for the final result to be seen. A nose that might look good at 3 months might not look good in a year. Experience is everything, or almost everything. An experienced nose surgeon who has the artistic feel for whether what he is doing can produce beautiful changes and a nose that does not look “done.” There is nothing worse than a bad nose job and problems are so obvious right in the middle of a person’s face.
  
  Liposuction cosmetic surgery in Fresno, on the other hand, has relatively few lawsuits, only about 3% of the total lawsuits against cosmetic surgeons, although it must be about 1/3 to 1/2 of all the surgeries done. However, the problems with liposuction when they occur, are sometimes severe and might require hospitalization.


• Breast reconstruction, especially when an implant is placed at the same time, requires a great deal of experience, and nipple loss is a possibility with some of the surgeries. This is obviously problematic. These cases have a disproportionately higher litigation rate. Ordinary breast augmentation, however, has one of the highest satisfaction rates in cosmetic surgery and has some problems, but no more than the average cosmetic surgery.

The most important message to take home from all this is if you want your nose done, get it with the most experienced surgeon, and choose your surgeon wisely in any case. Look at this plastic surgeon qualifications checklist for further information about how to choose your surgeon.



Question:
I have dark skin. How can cosmetic surgery help my scars?

Answer:
At my Fresno area cosmetic surgery office I see many patients with dark skin: Filipinos, Hispanics, African Americans and others. These skin types do not do well with aggressive peeling procedures because these can lighten or darken the skin, sometimes for lengthy periods or even permanently. However, with special treatment, this skin types can respond beautifully to our skin care programs.

The first step in treatment of a person with irregular pigment problems of their face is generally to use bleaching agents. We often include Retin-A® for better penetration to lighten their entire complexion. After a month or so of this, frequently, light treatments with slightly destructive methods such as electrical burning may be indicated for problem areas. Then, the patient might be instructed to use the bleaching and penetrating agents some more or they may be allowed to back off and use only a mild treatment regimen and allow their pigment to return to the skin.

Acne scars and wrinkles are particularly difficult to treat in these skin types. The peeling procedures and the deeper laser procedures are just not appropriate for darker skins because of pigment change. The good news is that wrinkles are not usually as much of a problem as in light complexions where the sun exposure has to some extent aged the skin. Darker skins are just protected better from the sun because of the natural pigment.

We can effectively treat dark skinned patients who have even darker areas due to their acne. Acne can be treated with a variety of prescription and over-the-counter medications and there is a cure for it called Accutane®, which generally results in long-term improvement or complete cure of acne.

After these treatments are used, the bleaching creams and the smoothing creams can be employed to produce a complexion that is even and attractive. For some patients in Fresno, more intensive cosmetic surgery may be appropriate, but in general a carefully chosen regimen of laser resurfacing and/or other nonsurgical skin treatments is sufficient. The ultimate goal for complexion treatments of any kind is to produce a smooth even-colored look without the color irregularities that are present with some kinds of skin growths and/or skin irritations such as acne. We will individualize our approach to your skin type by evaluating you carefully and using our best judgment about what would help the most.