Response to: Comment to: "Correction of Gynecomastia with Combination of Ultrasonic Liposuction (VASER) and Gland...

In response to the Letter to the Editor commenting on our published article, "Correction of Gynecomastia with Combination of Ultrasonic Liposuction (VASER) and Gland Excision through a Minimal Scar Incision: A Multi-Center Experience," we appreciate the opportunity to further clarify our technique, rationale, and outcomes. The concerns raised relate to incision size and placement, the effectiveness of our method in advanced Grade III gynecomastia, and the duration of follow-up. First, we respectfully disagree with the suggestion that 1.5 cm incisions at the nipple-areolar complex are necessarily superior [1]. Our technique employs 3-4 mm lateral periareolar incisions, which heal well and are barely perceptible in most cases, especially compared to larger scars which may cause indentations, pigmentation, or prolonged healing. Furthermore, small additional lateral chest incisions (2-3 mm) are used only to address lateral adiposity or axillary rolls-not for gland removal. This strategy avoids excessive scarring and has been well received by patients prioritizing fast recovery and minimal invasiveness. Second, while we agree that severe gynecomastia with extreme skin laxity may occasionally require skin excision, this is clearly acknowledged in our discussion and limitation sections. VASER-assisted liposuction promotes notable skin contraction, reducing the need for secondary skin excision in most cases. We do not advocate this method as a replacement for excisional surgery in all high-grade cases, but rather as a highly effective and reproducible technique with good outcomes, even in many Grade III presentations [2]. Third, our published study includes many challenging cases treated without quilting sutures or electrocautery, further minimizing trauma, edema, and scar-related complications. Lastly, the mean follow-up period of 9.4 months (range 1-36 months) is explicitly mentioned, and we also recommend future studies with longer follow-up, as noted in our limitations [2]. In conclusion, we maintain that our technique offers a minimally invasive yet comprehensive solution for gynecomastia correction, supported by consistent aesthetic results and high patient satisfaction.Level of Evidence V Expert opinion based on clinical experience and descriptive studies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .