 Good morning everyone. I hope everyone had a great weekend. We're starting to date. Dr. Saul here in Beverly Hills. I want to congratulate all the LA fans on the Lakers. We finally brought back the championship home where it belongs. Go Lakers. Our final gentleman here has gynecomastia. In this case, his gynecomastia, we have to do with scars because there's a lot of excess skin. True gynecomastia. For this gynecomastia, I have to make a scar down here. There's a lot of skin and tissue to remove. The areola is far from where it needs to be. And to get adequate supply, it's going to be difficult. So we're going to do a free nipple graft where we take out the nipple areola and then paste it back on here as a skin graft. This is going to be a very nice case. We're going to make him nice and flat. Here he is from the side. You can see I'm going all the way extending it, all the way lateral to take all the extra tissue. And on this side also, you can see how lateral we're going to go. All this tissue will be removed and pulled down. It's going to be an exciting case. We usually have the gynecomastias are a little different. Every patient has their own surgery. Not everyone gets their same surgery. That's why I need to see you before we can tell you what you need. So we're going to get started on this case. It's going to be a great case. Stay tuned. With this case, it's a special case for gynecomastia. We're doing a free nipple graft. So we use the cookie cutter to size up his nipple areola. And this is going to be put on like a skin graft. I'm taking my time. You guys might be wondering why I'm going so slowly. I'm trying to get this as thin as possible because we want this as a graft and it needs to be thin. So I'm trying to start it out thin to begin with. Good job. Let's get it very thin. So you guys can see his areola nipple is out. It's going to be placed here after we do the case. So it's a decision. It's going to start immediately and come laterally all the way to his axilla, close to his axilla right there. Look at how thick he is here. He's about an inch and a half thick. And I've gone up almost to his clavicle. We want this to be thin. So I raised everything, left the fascia on. Fascia is the covering of the fat here. Look at that. That's almost as thick as when we do a tummy tuck. That's about an inch and a half of that. We're taking off. This is his pectoralis major down here. You see that fasciculating right there? The fasciculation means when the muscle is twitching. Look at that. That's the muscle twitching. There's a band of the muscle here. We're going to make him as thin as possible. He wants to be very thin up here. So now we're cutting the excess skin as we marked it. You see the marking right there? We follow our markings. We always measure twice to cut once. There it goes. Beautiful. Well, look at the thickness that you have. This is where the areola was. You can see the white stuff, that's the gland. So you can see he had a big gland also. That's the breast butt, breast gland, or whatever you want to call it. So this is what we're attempting to do. We're going to pull him all the way down and excise the tissue, and the scar is going to land right in his groove right here. We did a minor alteration. We brought our line down just ever so slightly. And here we go for the lateral aspect as we rotate. So here we are cutting the flap on this side on the left, and this is the excess skin. We have it all nicely marked, getting out good amount of skin. The impressive part about this is how thick it is. Let's see. This is about inch and a half in thickness, I think in some places maybe more, but an inch and a half thickness. So in order for the graft to take, we make some slices, pie crust incisions in the graft so fluid doesn't collect under it and push our graft up. Then we're putting these Vaseline Gauze in there, and then we're going to put some sterile cotton balls, which we have sterilized with water to put weight on the graft so it'll stay down and it won't get lifted. Little gizmo here we created with the Vaseline Gauze and sutures puts pressure on the nipple graft so it adheres to the deep dermis layer and it pushes and squeezes all the fluid that would gather under it out.