Craft MD

Youn Stitch Reel

Gynecomastia. Same man, six months apart. Frontal, 45, lateral.

He'd done the work. Lean, training for years. The chest didn't move because it was never fat. It was gland, and gland doesn't answer to a deficit.

This is how I do it. Liposuction first, to take the fat around the gland and feather the edges. Then direct excision of the gland itself through a small incision at the lower edge of the ar**la. Then I stop early. I leave a disc of tissue under the ni**le on purpose, because taking all of it is how you get the crater: a ni**le sitting in a dent, which looks worse than what he walked in with and is much harder to fix. Then Renuvion under the skin. Helium plasma, subdermal, to tighten what lipo loosened. It's the one add-on I've kept.

It's common. Somewhere between a third and two thirds of adult men have palpable breast tissue depending on whose series you read. Most never mention it. The ones who do have usually spent years assuming it was their fault.

Photographs unretouched. Exposure and background matched between sessions. Face cropped by patient request, tattoo kept by patient consent.

Everyone on this app is using this sound to complain about slow walkers at the airport.

I'm not complaining.

He walks slow. I walk behind him. We make our connection 100% of the time, barely.

The calf tattoo says Randy, by the way. So if anyone else is enjoying the view, know that it's spoken for.

We did not buy Lightning Lane.

In my defense, I grew up in Ohio waiting 90 minutes for the Magnum at Cedar Point with no phone and a dad who said "this builds character." I'm simply passing it on.

I didn't set foot in Disneyland until I was an adult. The boys are six. They're already ahead of me and they still think we're trash.

Why I run the Aerolase before microneedling, not after, and why ReyaGel goes on last.

Step 1: Aerolase Neo Elite. Four passes at the setting Aerolase publishes for facial rejuvenation. The 650-microsecond 1064 nm pulse heats the dermis without touching the surface: it coagulates the tiny vessels feeding oil glands and inflamed spots, calms background redness, and gives the dermis a thermal collagen signal (heat-shock proteins, including the one that chaperones collagen). The laser needs clean, dry, product-free skin, so it goes first. You never pass a laser over open channels or heat a topical into them.

Step 2: Microneedling. Mechanical collagen induction, and thousands of channels that stay open for minutes. This is the main engine. The laser makes the field better; the needles build the collagen.

Step 3: ReyaGel. A solubilized extracellular matrix: collagen, elastin, hyaluronic acid, peptides, growth factors, and extracellular vesicles. FDA-cleared topical. Into the channels immediately, while they're open.

Two collagen signals plus the raw materials, one appointment. The Neo adds no epidermal injury, so recovery is the microneedling recovery, and in my patients the redness settles faster with the gel than without it.

What I owe you: the laser parameters come from published rosacea and acne-scar protocols (6 mm spot, four crosshatch passes, endpoint transient redness). The collagen data on the Neo alone is modest; the big numbers you see in ads come from studies that combined it with an erbium laser. The combination evidence for laser plus microneedling is for a different Nd:YAG and a different target. ReyaGel's evidence is case series. Nobody has run this exact three-step stack against needling alone. The theory is sound. The trial doesn't exist yet. When it does, you'll hear it from me either way.

I buy all three. No relationship with Aerolase or ReyaGel.

General education, not individual medical advice. Whether this protocol fits your skin is a conversation with your own provider.

Dr. Andersen did not have surgery. That red line is a marker. He volunteered his abdomen so I could show you how I close incisions now, without a running suture on top.

Step 1: BRIJ-SEAL. A sterile film that seals the incision. No glue, no cyanoacrylate, so none of the glue rashes. Waterproof and breathable. The company's third-party lab testing says it holds as a bacterial barrier for 14 days. You shower in it.

Step 2: Brijjit force-modulating tissue bridges on top. Each one pulls the skin edges toward each other and offloads tension from the incision. Tension is the thing that widens and thickens scars.

What the data actually says:
In finite-element modeling, a suture concentrates about 4,000 mmHg at the skin; a bridge about 20. That is a computer model, published by the device's inventor.
In a randomized trial at UT Southwestern, 34 women having breast reduction got bridges on one breast and standard sutures on the other. T-junction breakdown: 3% with bridges vs 32% with sutures. Scar area 38% smaller at 8 weeks. Small trial, early results, 12-month scar scores still pending.
A 243-patient cohort in breast surgery: significant wounds 1.7% vs 15.2%. Retrospective in part, single surgeon, company leadership on the author list.

So: promising, consistent direction, small numbers, and the people who invented it wrote most of the papers. I read all of that and I still use it, because the downside is low and the tension logic is sound. Bridges get swapped every two weeks for up to eight. Nothing to take out at your first visit.

I buy this. No relationship with the company.

General education, not individual medical advice. Whether this is right for your incision is a conversation with your own surgeon.