The Men in My Waiting Room Are Not Here for Their Wives Anymore

Black and white photograph of a man seen from behind at a tall window, fastening the cuff of a dark shirt, in hard directional light. Illustrative image, not a patient. Commentary by Frank Agullo, MD, FACS.

The men in my waiting room used to be there for their wives. They held the purse and read the magazines.

Now they have their own appointment. And they have a list.

“In my practice, the most common procedure I perform in men is gynecomastia surgery. That is number one. Number two is liposuction, which usually involves the abdomen and the lower back, but sometimes it is extended to the neck, upper back, lateral chest and even the breast itself. Number three is eyelid surgery. Number four is rhinoplasty, which is very common in younger men.”

Then the one that is new.

“Last but not least, facelifts and neck lifts have become more and more common in men, especially with the GLP-1s. The face loses fat fast, and it is one of the most noticeable changes as a patient is losing their weight. They also look older from the loss of volume.”

Chest, waist, eyes, nose, face. I have written the gynecomastia story already, including the price, so this is about the other four, and about what changes in my hands when the patient is a man.

Nobody asks that question, and it is the interesting one.

“Although the techniques and the surgeries are pretty much the same in men and women, there are some specific changes. Most men want to appear more masculine, so the procedures are modified to achieve this desire.”

Start with the brow. “When we do facelifts, we do not like to raise the brow as much. In men, it should pretty much line up with the superior orbital rim.” A few millimeters too high and a man does not look rested. He looks startled, for good.

Then the hair, or the lack of it. “We also have to modify where the incisions lie so that they can be easily hidden, depending on whether the patient has lost hair in the scalp, including at the sideburn and temple.” A woman’s facelift scar disappears into a hairline. A man’s has to be planned around the hairline he will have at sixty.

The nose. “Male rhinoplasty is usually a more masculine, closed rhinoplasty aiming for a straight dorsum, the Roman style. We want to avoid the curved dorsum and the more projected, refined tip.” Nobody wants a pretty nose on a man. They want a straight one.

The waist. “In liposuction, it is more likely that we will perform etching to show off the abdominal muscles and the six-pack during liposuction. Sometimes we add fat grafting to the pectoralis major muscle to increase the size of the muscle itself, or even the biceps. For this we can use the patient’s own fat or alloClae.”

And the part men never think to ask about. “When we do buttock fat grafting in men, we usually skip fat grafting to the hips, because we want to avoid a feminine curvature and instead project the gluteus maximus muscle.”

People assume I spend the male consult talking men out of things. I do not.

“I don’t think I’ve actually encountered many situations where I have to talk somebody out of a procedure. Oftentimes they don’t come in wanting a specific procedure, they come in with a problem and a consultation on how we can fix it.”

The under-eye bag is the classic. He asks for a blepharoplasty. “Many think it is just a blepharoplasty, but I use the blepharoplasty approach to remove the fat bags, I use fat injections into the tear trough, and I use Morpheus8 microneedling with radiofrequency to tighten the skin. Sometimes I even use AccuTite to tighten the skin, avoiding an incision that can give you a visible scar, or even an ectropion.”

He came in with a procedure. He leaves with a plan.

And the wave behind all of it is the pen. “I think the GLP-1s are actually increasing the amount of demand we see in the office for consultations. The first thing patients notice is the deflation on the face.” Then the body catches up. “The patient feels better and is healthier, but the body, with the loose skin, is not showing that externally. So many men are coming in for gynecomastia and tummy tucks.”

“Men are getting healthier, slimmer, and ready for their bodies to match the way they feel.”

The prices for every one of these are published, and the full ranked list with what I do differently is on the male plastic surgery hub. The one procedure I left out of this post has its own.

Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful

Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

A Thorn in My Side Since I Was Eleven: A Gynecomastia Consult, Nearly Verbatim

Black and white editorial photograph for gynecomastia commentary by Dr. Frank Agullo, MD, FACS.

He came in on a Friday morning between a painter and a car negotiation. He had been almost two ninety back in 2017. He was down about a hundred pounds and going to the gym two or three times a week. And the chest had not moved.

I am publishing this consult nearly as it happened, identifiers removed, because men ask me these exact questions and almost nobody answers them out loud.

Him: This has been a thorn in my side since I was about 11 or 12 years old.

Me: “The problem is that we have a considerable amount of sagging. If I just did lipo, obviously you remove the volume, but it would still be sagging. So I don’t think you want that.”

Me: “Unfortunately, the trade off is the only way to do it is really with a scar. So I would have to put a scar right underneath the fold. And it would go to about here. And with that, I would be able to remove the tissue and the fat and the breast tissue, and then we would use the nipple. I would take it off completely, and then put it back on like a graft. Because I don’t think even with the tightening lasers, I don’t think it’s going to spring back. Especially this side.”

Him: How flat will it be?

Me: “It’ll be completely flat.”

Me: “And that’s why I recommend doing the lipo on the sides, because otherwise it’s going to look like you have a side breast. Because you won’t have anything here.”

The tummy tuck came with it

He had already been told he was a candidate. He was.

Me: “So you are a good candidate for a tummy tuck. The incision goes here. It will remove some of the fat on the mons and it’ll also lift it up. And the scar is going to go to where the fold ends. So it’s going to go to about right here where this fold ends.”

Me: “With that, we’ll be able to remove pretty much all the skin from here down. And then I’ll use this skin, and that’s the one we’re going to pull down. Look at your muscles. If there’s any separation, we’ll put them back together. But you’ll have a nice, tight, flat abdomen.”

Him: Does it make sense to do everything all together?

Me: “Yes. Because really the chest is not going to add any recovery. So you have that advantage of just that one recovery, and you’re done. Number one, it’s safe because we’re still under six hours, which is most important. And then it becomes a little less expensive, because the first hour of surgery is the most expensive.”

Me: “If we did it together, the surgery would be about four and a half to five hours, general anesthesia. It is in and out. You can go home the same day.”

Recovery, and the two drains

Me: “Recovery wise, you’re looking at about two weeks, mostly from the tummy, to get back to normal activity, driving, things like that. And then six weeks where you can go back to exercise, lifting, pretty much back to normal without any restrictions.”

Me: “We would have drains, both in the chest, one on each side. Those are going to come out pretty quick, four to seven days. Then the tummy, those can take a little longer. It could be seven to fourteen days.”

Me: “You’ll have your garments. I do recommend doing lymphatic massages. We have a tech here. And it helps get the swelling down a lot quicker, especially in the areas of liposuction. It helps avoid the fibrosis and bumpiness.”

The question men do not think to ask

Him: The only thing recovery wise I was concerned with, I have three dogs.

Me: “Do you have somebody to help you at home?”

Him: No.

Me: “So then is somebody going to bring you to the surgery?”

Him: I’d probably come by myself.

Me: “So then I would keep you overnight, because we can’t send you home like that. And then in the morning, we do have a service that can take you back home. My nurse will visit you the day after you stay overnight, to help you shower and how to take care of the drains and go over all the instructions again. You can extend those visits, or there’s also a third party we work with a lot that can keep coming in to check on you, and even help you with food and transportation.”

Me: “You would probably want to board your dogs for at least a while.”

Then, because it was true: “We had a male patient that had a facelift and we didn’t find out until after the surgery that he had 25 cats. So he would come to his post op and he would have scratches, and we were like, no. No.”

Why he was there at all

Him: I’ll go to the gym, but then I get really discouraged. I get to a certain point, like, oh, this is good. And then it’s not going to tighten.

Me: “We can take care of that for you.”

My exam note from that morning: bilateral gynecomastia, no dominant masses, ptosis worse on the right, right breast bigger than the left, a lot of excess skin and subcutaneous tissue in the lateral chest, abdomen, upper back and lower back, an abdominal pannus continuing laterally, and some degree of rectus diastasis.

The takeaway

Gynecomastia is not a weight problem and the gym does not fix it. If the skin has been stretched for twenty years, or stretched by a hundred pounds and then emptied, it will not recoil, and no laser changes that. On a chest with real sagging, the honest answer is a scar under the fold, and often a nipple graft. On a firm chest with fatty fullness, liposuction with skin tightening can be enough.

I am a double board-certified plastic surgeon, certified by both the American Board of Plastic Surgery and the American Board of Surgery, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.

Ready to Talk?

If your chest has bothered you since you were a teenager, you have already waited long enough. Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.

#StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.