Vaser treatment for gynecomastia is a liposuction machine that contours fat with ultrasonic (sound) energy. This is different from standard liposuction that uses a cannula (tube) attached to a suction machine. Liposuction machines such as Laser, Power Assisted, Ultrasound, among others, are all alternatives to achieve the same endpoint, but Vaser has clearly been revolutionary at the AGC: I have used it in over fifty gynecomastia patients with impressive results, and this coming from someone known to be very critical.
I am familiar with the plastic surgery literature from about twenty years ago that suggested the value of ultrasonic liposuction in treating the denser fatty tissue found in most gynecomastia patients. The implication was that it would reduce the need for open surgery and would make it easier for the surgeon to contour the gynecomastia, compared to standard liposuction. Studies suggested that you could treat gynecomastia patients without having to remove tissue, thus avoiding the small incision around the areola.
I can confirm that Ultrasound is a far better tool than standard liposuction in the treatment of gynecomastia, but it does not mean you don’t have to remove tissue. No energy device can remove the glandular tissue that is found in nearly 80% of patients. It only requires a small incision around the areola to remove this dense tissue responsible for the appearance of full, puffy nipples. What is so special about Vaser liposuction is that it significantly changes how I approach the treatment of gynecomastia, making it more predictable and reliable and less technically challenging.
This is what I have learned from 50 cases performed in two months’ time:
- There is less blood loss than when standard liposuction is used. There is no doubt about this because we can actually see less bloody fat being removed and the patients clearly have far less bruising when I see them in the days after their procedure. The blood loss in all gynecomastia cases is minimal so that’s not the real benefit—clearly less bruising is nice in terms of recovery.
- There is less pain with Vaser. This was obvious early in our series of patients. Compared to the standard liposuction, the Vaser was associated with less pain. Less pain is a good thing for patient comfort.
- Less work for the surgeon. Compared to traditional liposuction (and I have performed several thousand larger volume liposuctions), less work by the surgeon is a good thing. I can attest to the physical abuse I have experienced during my 30 year career doing liposuction. Easier is better.
- Vaser gets through the fibrofatty tissue associated with gynecomastia very effectively. It will not make the gland dissolve, but it does a great job with the most common tissue associated with gynecomastia—the fibrofatty variety that is difficult to remove with standard liposuction. This is the tissue, along with the gland, that I often had to remove with open surgery as standard liposuction alone was not completely effective reducing this tissue compared to Vaser. The pictures with the larger specimens you can see on my website are examples of this tissue removed with open surgery. With Vaser, the specimens I remove are considerably smaller because Vaser widdles away at the firmer tissue.
- The incision when I use Vaser around the areola is smaller because the Vaser system effectively reduces the size of the mass to be removed and it frees up the glandular tissue from the surrounding skin and muscle which allows the glandular mass to essentially “pop out” after effective treatment. This is impressive.
- There are fewer electrosurgery burns at the incision because the cautery isn’t used as much with Vaser. I get “around” the mass with Vaser and not electrocautery dissection will results in few burns of the skin.
- Longer term results are as good as, or better than, previously treated patients with standard suction based systems.
- I can make no comments about the ability of ultrasound treatments (Vaser) to facilitate skin retraction but I can see how this could possibly occur and it certainly doesn’t hurt but the amount of retraction, if any, would be minimal until proven otherwise. There is no “night and day” difference in skin retraction that I can observe. You would not seek this machine out if you have lose skin and believe this will help tighten it. That’s NOT going to happen.
- It’s a game changer in terms of the planning and surgical treatment of gynecomastia. The Vaser effectively reduces the fibrofatty tissue. I can dissect around this tough tissue with the Vaser and this means that I don’t have to use the electrosurgery and lighted retractors to get around this mass. The conduct of the procedure is safer, more predictable compared to open surgery. This is a big deal—a really big deal.
My hat is off to my friends at the Vaser Company who first loaned me the machine so that I could learn from it. I ended up purchasing the machine and I am not beholden to the company by any means. I used it, learned from it, and came away with a game-changing device that I know has revolutionized my treatment of gynecomastia.
The bottom line is, this is a method that is well-tolerated by patients, has minimal inherent complications, reduces risk, and offers consistent reliable results. For an experienced gynecomastia surgeon such as myself, the benefits to my patients may not be as apparent because I am always able to achieve very nice results no matter what surgical tools I use. But it makes a clear difference in reducing the potential for complications and allows me to provide patients with an even higher level of excellent results.