Primary or Secondary Hyperhidrosis

In some cases, excessive sweating is a symptom of another condition such as menopause, anxiety, heart disease, Parkinson’s disease or cancer.  This form is called secondary hyperhidrosis.  Because the underlying medical problem could be serious, it’s important to consult a physician if you should suddenly develop hyperhidrosis.

The medical encyclopedia of the U.S. National Library of Medicine reveals that 2-3% of the country’s population (male and female) wrestles with primary hyperhidrosis, or excessive sweating, from the armpits, hands and feet that usually begins at puberty.  Yet less than half those who suffer actually consult a doctor for help.

Help is Available

There are several different treatment options for hyperhidrosis.  For most people, a good course of action is to try the least invasive and least expensive choices first, then progress to stronger measures as needed.

• Natural therapies:  Anxiety and emotions often play a role in excess sweating.  For some people, yoga, biofeedback, relaxation techniques or psychotherapy can be of some help.
• Antiperspirants:  For the armpits, a good place to start is with clinical strength deodorant/antiperspirants.  A few are available over the counter, and you can get access to a few more with a doctor’s prescription.
• Iontophoresis:  This is a painless, FDA approved therapy for the hands and feet.  It involves immersing the extremities in a water bath with an electric current passing through it.
• Botox:  The same injectable treatment for dynamic wrinkles of the face can help block nerve stimulation of the sweat glands.  How well the injections work and how long the effects last varies from person to person.
• Sympathectomy:  For some patients who aren’t helped in other ways, surgery to cut the sympathetic nerves to the sweat glands may be the answer.
• “Sweat Lipo”:  Direct removal of some of the sweat glands from the armpit area can be accomplished through a relatively straightforward outpatient procedure.  It’s technically called “suction currettage,” but we refer to it with an easy-to-remember name: “Sweat Lipo.”  We perfected the technique in our practice and designed special instruments for sweat gland removal.

We find that living with hyperhidrosis can pose as many psychological challenges for our patients in New York as gynecomastia does.  If excessive sweating is a problem for you, the good news is that the right treatment or combination can probably alleviate this embarrassing condition.

You can see that there are several different techniques to try, and each one has its advantages and drawbacks.  Therefore, it’s important to consult a physician with experience treating hyperhidrosis with a variety of approaches.

Learn more about hyperhidrosis, liposuction and other topics of interest to men at our website devoted to gynecomastia: www.gynecomastianewyork.com.

Photo by Robert Ennals, available under a Creative Commons attribution license.

In our last post we discussed torsoplasty, or liposuction of the abdomen, a cosmetic procedure our New York gynecomastia patients frequently have at the same time as male breast reduction. If you’ve been thinking about cosmetic surgery—whether it’s gynecomastia surgery, liposuction or something else—don’t feel shy about consulting a board certified plastic surgeon to discuss your choices. We see increasing numbers of men considering fine tuning their looks for a wide variety of reasons.

In fact, our Manhattan patients mirror trends reported by the American Society for Aesthetic Plastic Surgery, an organization that has tracked statistics for many years. According to the ASAPS, the top cosmetic procedure for men is liposuction. Nowadays, more than 35,000 men opt to have liposuction each year, often to banish love handles and other stray bulges in the abdominal area. As we discussed last week, many of our New York gynecomastia patients feel it’s a natural choice to add torsoplasty to male breast reduction surgery.

The second most popular form of plastic surgery for men is rhinoplasty, says the ASAPS. This isn’t surprising when you consider that nose jobs have been performed for decades, and the procedure is chosen to improve function as well as form.

The third most highly ranked procedure for men may surprise you—it’s eyelid lift, or eyelid tuck, known medically as blepharoplasty. Men as well as women have realized that the eyes tend to show signs of aging before most other parts of the body. Blepharoplasty is a relatively simple procedure that can remove sagging skin and puffiness around upper and lower lids and restore a youthful look.

Gynecomastia surgery takes fourth place in the top five cosmetic procedures for men. Interest in the procedure continues to grow, as men learn that surgery is the only option for banishing man boobs and that the procedure is safe and straightforward when performed by a male breast reduction specialist. More than 18,000 men had male breast reduction last year, according to the ASAPS.

Rounding out the top five cosmetic surgery procedures for men is otoplasty, or surgery to pin back protruding ears and/or reduce their size. This surgery can be performed on adults and on children as young as four years old. It’s safe and involves an easy recovery, and it can put an end to painful teasing.

The days when plastic surgery was thought to be for women only are long over. In fact, cosmetic surgery for men continues to show steady growth over the years as men feel more and more comfortable seeking assistance in looking and feeling their best.

We’re always happy to field any question about male breast reduction our New York patients want to ask.  We’re especially pleased to share good news when someone inquires about re-contouring the abdomen along with reducing man boobs: we can combine gynecomastia surgery with liposuction in most cases. Liposuction around the midsection is called torsoplasty – it includes the entire abdomen and the love handles.  Our patients are delighted to find out that we consider it a natural fit with many male breast reduction procedures.

If you have gynecomastia, you probably already know that no amount of exercise and no special diet can make your moobs go away.  And certainly there are no magic pills, supplements or creams that work, other than to reduce the size of your wallet.  The same can often be said about the fat deposits that cause love handles and tummy “pooches.”  These pockets of fat can be quite resistant to diet and exercise, and a little liposuction can do wonders for streamlining the male shape. In fact, we often tell our gynecomastia surgery patients that the combination of male breast reduction with torsoplasty can take a physique “from good to great.”

On that note, it’s important to mention that torsoplasty is not a weight loss strategy. Just like liposuction for thighs, arms, neck or anywhere else, the technique is effective for removing localized fat deposits and resculpting, not for eliminating pounds.

When we discuss combination surgery with patients seeking male breast reduction in New York, the topic of safety inevitably comes up, as it should.  Two of the most important factors influencing patient safety in any kind of surgery are the type of anesthesia used and time under anesthesia.  When we combine torsoplasty with gynecomastia surgery, we use twilight or intravenous anesthesia for nearly all our patients—not general anesthesia.  Our patients sleep gently, wake up quickly and suffer no anesthesia “hangover” or nausea.  In addition, liposuction for the midsection adds only 60-90 minutes time to gynecomastia surgery.  Most patients are “under the knife” no more than about two and a half hours.

Combination surgery has been thoroughly researched by many plastic surgeons and found to be generally quite safe, even for more complex combinations performed under general anesthesia such as female breast surgery and abdominoplasty—the classic “mommy makeover.”  The shorter surgery time and lighter twilight sedation we use for our patients add up to increased safety and comfort.

If you’re in pretty good shape, you’re at or near your ideal body weight and you have relatively supple and elastic skin, you should be a good candidate for combination gynecomastia-torsoplasty surgery.  Just be sure to seek out a board certified plastic surgeon experienced in this procedure, ask for evidence in the form of before and after gynecomastia photos and check references.  You can start by checking with the American Society of Plastic Surgeons for some choices.

Photo by florbelas, available under a Creative Commons attribution license.

Although we specialize in helping men feel content with their physiques with procedures like gynecomastia surgery, liposuction, torsoplasty and even nipple reduction, we don’t do areola reduction. Let me explain.

One reason we don’t perform areola reduction is that it’s too risky. If you cut a doughnut shape from around the edge of the areola, you’re essentially disconnecting an important part of the blood supply. This means there’s a very real possibility of loss of sensation. If you need to remove some tissue from beneath the nipple/areola complex as well, as most gynecomastia patients require, you will cut off most of the rest of the blood supply. In this case, the entire nipple can easily die.

If you do decide to remove a doughnut of skin from the areola to reduce its size, you then have to suture a larger diameter circle to a circle that’s much smaller. This results in a series of small pleats or puckers of skin that take time to iron out, and may not ever lie fully flat. This kind of wound is under tension as it heals, so some plastic surgeons use a permanent circular stitch to hold the incision together and prevent wide scars. Patients often complain that they can feel these sutures and find them annoying.

But the primary reason we don’t perform areola reduction is that our New York gynecomastia patients don’t need it. We often use a balloon analogy to explain. If you inflate a balloon and draw a dark circle on it, then let the air out, the circle shrinks. Right? That’s a good way to visualize what gynecomastia surgery does for areola size. As you remove the tissue that caused the man boobs and re-contour the chest, the areolas shrink. In fact, in all our years performing gynecomastia surgery in New York, we have never seen overly large areolas on a man without gynecomastia.

After male breast reduction, our patients are usually quite satisfied with the look of their chest—including the areolas. Still think you need areola reduction? Make an appointment with a highly experienced male breast reduction surgeon and see what he or she thinks.

For men, nipple reduction can be performed in conjunction with gynecomastia surgery or as a standalone procedure. When performed on its own, treatment is pretty straightforward, usually requiring less than an hour and just local anesthesia. We can reduce the diameter of the nipple, the projection from the chest wall or both. Small, dissolving sutures are placed to close the tiny incisions, and that’s about it.

Recovery involves a bit of soreness for a few days. Patients can usually resume most activities immediately, but we advise them to avoid strenuous exercise for at least two weeks after surgery. Scars should be nearly invisible after nipple reduction and complications are rare. Occasionally a patient will report reduced sensation in one or both nipples after healing.

One thing to be clear about is that nipple surgery does not change the look of the areola, the pigmented circle of skin surrounding the nipple. We find in most cases enlarged areolas result from excess breast tissue, or gynecomastia. Our New York patients with this condition most often need male breast reduction surgery rather than a procedure to reduce the size of their areolas. Once the excess tissues have been removed, the chest skin and the areola itself will shrink in diameter – right on the operating table. It is like letting air out of a balloon. (We’ll discuss areolar reduction in a future post.)

Whatever your concern about your chest may be, talk to your plastic surgeon candidly. He or she will evaluate your entire chest and make a recommendation about the best way to achieve the change you’re hoping for.

If you’d like to consult us about gynecomastia, large nipples or any other aesthetic issue, just contact us online or give us a call at (212) 570-6080 and we’ll arrange an appointment. We often work with out of town patients, as well as men seeking treatment for gynecomastia from New Jersey, Long Island, Westchester, Connecticut and surrounding states.

The common misconception:

Many people have the idea that liposuction is a weight loss procedure. Actually, liposuction goes best when you are at, or near, your normal weight. The point of liposuction is not to reduce your weight but to remove bulges that may show through  clothing.

Liposuction is often done in connection with gynecomastia surgery. In most guys, there is some fatty tissue over the main chest muscle, the Pectoralis  major. That can be liposuctioned with good results but the dense, fibrous tissue lying under the nipple must be surgically excised.

Liposuction is also used in another procedure that men like, the Torsoplasty. Once many guys have a flat chest, they eyeball the rest of their torso more critically and decide the flabby stomach and love handles should also go.

(Check out some Torsoplasty and gynecomastia before and after pictures for yourself.)

Liposuction is done on those locations, big time. But only where the fat is what we doctors know as superficial, that is, lying just under the skin.

If you have a rotund pot or beer belly, that fat is too deep down around your internal organs for liposuction and you must remove that on your own – with serious workouts and a reasonable, low calorie diet.

Women most often request liposuction of:

• Thigh bulges
• Love handles
• Flabby upper arms

Now for the news I mentioned: For the first time, the International Society of Aesthetic Plastic Surgery (ISAPS) has compiled the numbers and types of cosmetic plastic surgeries done worldwide in 2009.

The most popular procedure in the world? You got it, liposuction! It accounts for18.8 percent of all plastic surgery done globally but is second in America. (Breast augmentation is in first place here.)

The world’s most popular procedures two through five are:

• Breast augmentation – 17%
• Upper or lower eyelift – 13.5%
• Nose jobs – 9.4%
• Tummy tuck – 7.3%

Here’s another statistic you might find interesting.

The top 5 nations for performing large numbers of plastic surgery procedures are:

1. United States
2. China
3. Brazil
4. India
5. Mexico.

Here is my interview on WCBS-TV’s “The Early Show”. Go to: http://www.cbsnews.com/stories/2010/08/09/earlyshow/health/main6756741.shtml

But it seems like the words of a mere plastic surgeon with 25 years experience treating gynecomastia doesn’t count for much, judging by the tons of advertising that feature a quick and cheap — but worthless — fix.

Some are real knee slappers!

I heard from some patients who were told that acupressure removes gynecomastia.

Acupressure  — a blending of “acupuncture” and “pressure” — is a complementary medical technique using pressure put on the acupuncture points by the hand, elbow, or with various devices.

Sorry, guys; it just does not work. Ditto turmeric and flax seeds.

(I was delighted to see that the turmeric and flax seed commercials for  curing gynecomastia were in the right section. The companion ad was “The Truth about the Nevada Triangle.”)

All the herbal cure ads alone would fill several box cars. I notice such products are always billed as safe and “natural”. We may have encountered an oxymoron here because, while snake bites are also 100 percent natural, they are far from safe.

I’m not naming the  products due to the lawyers lurking around the corner and because:

• It would take all day to create such a list and require more space than the Internet offers.

• I would love the opportunity to debate herbal manufacturers on the science of their claims but, that would also take far too much time away from my patients who need actual treatment for their condition.

So let’s just go with the basic, ultimate consumer-beware statement: no pill or herb removes true gynecomastia. Surgery is the only treatment.

Various work-out programs are also often put forth as a way to remove gynecomastia in teens and young men.  One program that advertises, “Lose Man Boobs Now” offers lots of sympathy and even starts to cover some of the same ground we’ve walked by telling how teens and men hide their condition. (Read our post on how some guys conceal their man boobs.)

One online Chinese herbal store (http://hnmrc.net) located in London, England, offers nine herbs which taken individually and in various combinations will allegedly cure gynecomastia.

The proof?  “11 total cases observed; 11 Fully recovered”.

But that’s all the site tells you about the cases. Let’s at least hope those nine herbs are also natural!

A Better Size

You may already know me through this blog as a plastic surgery specialist who removes large male breasts through gynecomastia surgery.

But I also reduce the size of extremely large female breasts – and watch as the patients soon enjoy the medical benefits of the procedure.

It’s also a pleasure to know that, more times than not, health insurance will kick in and cover most of the procedure.

You must be wondering, though. Why cover it for women but not for men?

The list of health woes for a woman whose extremely heavy breasts may hang down to her belly button is pretty long, including:

• Back troubles
• Neck pain
• Shoulder discomfort
• Frequent infections of the skin beneath the breasts
• Breast pain

Insurance companies usually cover the procedure because eve they realize they will not have to expend funds to treat all those aches and pains in the future. Untreated, the condition can even lead to skeletal deformities.

However, the procedure for getting approval has become ever more demanding. (Read more about obtaining breast reduction coverage.)

Insurance coverage for a man or teen is much more difficult because the damage caused by overly large breasts is “only” psychological, and not physical. For a male, the procedure is usually considered cosmetic surgery.

Many times, a woman candidate for the procedure shows up in my office asking about breast reduction surgery and I immediately see that the weight of her bra straps has created notches in her shoulder blades. Surgery creates breasts that are smaller, lighter, firmer, balanced and lifted.

Many such women have tried losing weight, thinking the breasts will slim down, too.  Sometimes, they also try physical therapy and seek treatment for their various pains.

But the only real, lasting solution is surgery to reduce the size and weight of the breasts. Between the lines, I see many patients who enjoy moving their breasts from resting on their stomachs to  a position higher up on their chests where most womens’ breasts sit.

It makes daily life easier, too. With very large, or especially in gigantomastia cases, teen girls suffer extremely cruel remarks and behaviors from men and boys. After surgery, clothes fit better and exercise no longer causes breasts to flap around.

The trade-off for female breast reduction is long scars on the breast.

Of course, like all scars, they lighten and fade over time and are hidden by bras, swim wear and most tops.

Surgical markings are where an open rhinoplasty begins

You may know me here mostly for gynecomastia surgery but I also do many other plastic surgery procedures.

One of my favorite and most frequently performed plastic surgery procedures is the “nose job” or rhinoplasty. Because a human nose is so small and intricate, with many interconnecting tissues, it is something like working on a living watch.

One of the first questions patients ask is about open and closed rhinoplasties. (Most of what we do is the closed).  I always explain that it is like a car repair:  lift the hood and repair the engine (open rhinoplasty) versus remove the front grill and repair the engine through a smaller opening (closed rhinoplasty).

When a cosmetic plastic surgeon starts a rhinoplasty procedure, there are two approaches. Those are:

• The open, or external, approach

Feel the tiny strip of skin that keeps your nostrils apart and note how small the area is. One finger tip can cover the place where surgeons start. An incision is made there and then the skin is lifted up and back to reveal the architecture of the nose.

• The closed technique

In this choice, the surgeon operates through the nostrils, without pulling back the skin of the nose. Some surgeons favor this approach although it requires extra training and is more demanding due to the small tolerances in the nose.

Also known as the endonasal approach, it offers some advantages, including allowing the surgeon to immediately visualize what the final result is going to look like.

When using the open technique, however, the nose skin must first be pulled back into place over the framework of the nose to get a concept what the nose’s outcome will be.

Another upside to the closed procedure: it heals faster. If the skin over the nose is lifted, the lymphatic drainage system is interrupted. That also causes more swelling.

Or, if the surgeon is not getting the results desired during a close procedure, he or she may go ahead and open the nose up for better visibility.  This is often done if there are severe distortions or asymmetries of the tip structures or if it is revision, or secondary, operation.

The thing is, if the surgeon starts with an open approach, he can’t go back to a closed and enjoy its particular benefits.

Which is best?

If you like the quicker healing of the closed approach, do the next logical thing and look at the surgeon’s before and after rhinoplasty pictures to make sure all the noses you see look natural, fitting and flatter the owners’ faces.

(Read more about a  rhinoplasty from Dr. Jacobs.)