Dr. Jacobs is occasionally presented with skin contour problems requiring revision gynecomastia surgery. These include lines or creases of the areola, lax skin, wrinkling, etc. Revision surgery for these problems will require surgical detachment of the skin and then an evaluation of the underlying problem. For example, a crease across an areola may be just a small area of insufficient support of the underlying tissues. This can be treated with either a fat graft or an operation to lift up the areola and suture the underlying defect closed so that the nipple now lies on a smooth bed. Sometimes a large amount of skin detachment will allow for uniform tightening of the skin, which will help with lax skin or wrinkling.
Sometimes the skin itself has lost its ability to self-tighten, either through a prior severe overweight condition, the natural aging process, smoking or as a consequence of prolonged sun exposure over many years. In these situations, care must be taken to preserve a certain amount of underlying fat in order to support the skin. This is where the artistry and experience of the initial surgeon must be excellent. When a small amount of skin laxity presents itself, fat grafting can be an appropriate answer. However, if there is a large amount of skin laxity present, then some type of skin tightening procedure, carefully individualized, may be required. This, of course, will require additional permanent scars in order to tighten the skin.