Dallas Fort Worth Plastic Surgeon Dr. David Azouz discusses Cosmetic Areolar Reduction

Nipple Areola Reconstruction/Reduction

The areola and nipples can often be disproportionate to the breast or chest.  Both men and women can suffer from abnormally large or small nipple/areolar size.  This can worsen asymmetry or can cause difficulties with tight fitting clothing. 

Some of the common causes of nipple-areolar size discrepancies are size changes to the breast such as pregnancy, breastfeeding, and gynecomastia. Genetics can also be a factor in nipple-areola disproportion. Fortunately, all of these concerns can be resolved through a relatively simple procedure called nipple or areola reconstruction.

Nipple Reduction or Areolar Reduction: What are the Common Reasons?

The most common reason for men to desire nipple/areola reduction is because they have underlying gynecomastia.  In women the most common reason to desire nipple/areola reduction is because they have enlarged or sagging breasts and thus they are in need of a breast lift or breast reduction. 

Some patients are left with a small or a flat nipple areola after surgery.  Dr. Azouz is able to help many patients who have had plastic surgery performed elsewhere and seek more symmetry with a revision procedure.  Dr. Azouz frequently performs revision male breast reduction or revision breast lift. 

Areola Reconstruction Surgery: Who Can Benefit?

Nipple reconstruction surgery changes the shape and reduces the size of the areola. Areola surgery can be done by itself or in conjunction with a breast reduce or breast lift. Nipple puffiness can be reduced in patients who have disproportionate areola and nipples due to post breast-feeding and men with “puffy nipples” who are suffering from male breast. Other candidates include individuals who would like their inverted nipples reconstructed. Inverted nipples may result from scarring or genetic factors.

Areola Reconstruction Procedure?

In a typical areola reduction surgery, the first step is making an incision around the areola, followed by removing the excess tissue and skin. By making the incision around the areola the scar is well hidden along the border of the areola/nipple. When repairing inverted nipples the incision is also hidden. After making a small incision the scar tissue or other connective tissue holding the inverted nipple in place is removed.

Nipple/Areola Reconstruction Recovery Time

Most patients report that nipple reduction is not painful and are able to do light activities such as computer work, and leisure walks within days. Intense physical activity such as lifting heavy weights should be avoided during the initial healing process. With that being said, Dr. Azouz monitors each patient on their individual healing process with follow up appointments and will advise you when you can slowly return to your daily activities and strenuous exercises.

Areola/Nipple Reduction Surgery: Frequently Asked Questions

Nipple reduction surgery is considered permanent. In men the nipple areola can increase or decrease by a small amount with weight changes and it is not uncommon for the nipple to still function normally after surgery.  However, results are generally permanent, dramatic and aesthetically pleasing. The statifiation rate with nipple reduction surgery is extremely high.

Can I Make My Nipples Smaller Without Surgery?

Surgery is the gold standard to anatomically change the shape, size and prominence of the nipple areolar complex.  Medical weight loss and hormonal treatments are typically not the best method of reshaping the nipple areola.

Is Nipple Reduction Surgery an Outpatient Surgery?

Yes, nipple reduction is performed as an outpatient surgery meaning you go home the same day after surgery.  Similarly Dr. Azouz performs the vast majority of plastic surgery procedures as outpatient surgery including: breast lift, male breast reduction, areolar reconstruction and breast augmentation.  

How Long is the Recovery for Nipple Reduction?

The recovery for nipple reduction is generally quite quick.  Most patients do not report significant swelling or pain. Dallas plastic surgeon Dr.  David Azouz, performs plastic surgery with enhanced recovery. Patients can generally go back to activities including heavy exercise, powerlifting, gymnastics, and contact sports within five to six weeks after their plastic surgery.

Can You Fix an Inverted Nipple Without Surgery?

Inverted nipples are generally repaired surgically.   Inverted nipples are common and can affect approximately 5-10% of men and women.  Nipples can be permanently inverted or temporarily inverted.  Nipple retractors, extractors, shells, and cups are generally associated with temporary and modest results.  Nipple piercing is an option for stabilizing and preventing nipple inversion.  Nipple piercings can eventually be removed once the nipples heal in an everted position. Dr. Azouz is generally able to preserve the milk ducts for patients who undergo nipple reconstruction so they may still breastfeed.

Can a Nipple Reduction be performed at the same time as gynecomastia surgery?

Yes Dr. Azouz frequently performs gynecomastia surgery concurrently with nipple and areola reduction surgery.

Can flat nipples stick out more?

Yes, flat nipples can protrude more with inverted nipple surgery performed by Dallas plastic surgeon Dr. David Azouz.  

Schedule a Consultation

If you’re interested in areola reconstruction, schedule a consultation with Dr. Azouz at Azouz Plastic and Cosmetic Surgery in Dallas, TX. Call (972) 702-8888 or request an appointment online.

Gynecomastia: Benefits of Male Breast Reduction

Gynecomastia, or enlarged breast tissue in men, can be caused by several factors ranging from genetic conditions to the use of certain drugs. Regardless of the condition’s cause, men dealing with gynecomastia frequently suffer from reduced self-esteem and wish for flattened, masculine chest contours. Male breast reduction, also known as gynecomastia surgery, is a procedure designed to decrease the size of the breasts and create a more masculine-appearing chest. Gynecomastia is more common than you might think, and male breast reduction has many benefits for the patients who choose this procedure.

Improved Male Chest Contours

In addition to reducing the size of the breasts, a male breast reduction can improve the contours of your chest overall. As a well-regarded gynecomastia surgeon, Dr. Azouz understands that in addition to removing excess tissue, the chest contours can be reshaped for a better result. This gives you a natural-looking, enhanced masculine appearance.

Reduced Breast Size for Overdeveloped Breasts

In men, the breasts can become overdeveloped for a variety of reasons. This includes a hormonal imbalance, which can be genetic or taking certain medications. When these are the cause of your gynecomastia, no amount of dieting or weight loss is likely to improve the appearance of your chest. Male breast reduction is the best way to permanently reduce the size of the breasts.

Reduced Excess Fat in Male Breasts

In some cases, the appearance of male breasts may be due simply to stubborn excess fat. This appearance can persist even if you are keeping up with a healthy lifestyle. Male breast reduction can help to reduce this excess fat, giving you the masculine appearance you’re looking for.

Reduced Excess Glandular Tissue in Male Breasts

Liposuction alone is often not enough to address gynecomastia, as excess glandular tissue may also be to blame for the enlarged breasts. In these cases, Dr. Azouz can carefully and effectively reduce this excess tissue using advanced surgical techniques.

Improved Confidence and Self Esteem

For male breast reduction patients, improved self-esteem is one of the major benefits of the surgery. Gynecomastia is typically not a health concern, but the condition can be a source of embarrassment and self-consciousness for many. Male breast reduction can help restore self-confidence.

Cost of Male Breast Reduction

The cost of gynecomastia procedure depends on many factors and can only be evaluated after a consultation with Dr. Azouz. If you would like more specific details regarding all the fees involved in a cosmetic surgery procedure, contact the office of Dr. Azouz today and his helpful office staff will be able to assist you.

Combination Procedures

Liposuction is a very common procedure to combine with male breast reduction surgery. Liposuction assists in the removal of breast tissue and can be used on other areas of the upper body like the flanks, abdomen, and hips.

Male pectoral implants can be combined with male breast reduction as well. Implants are commonly used for patients with Poland Syndrome and for those with significant asymmetry in their chests.

Schedule a Consultation

To learn more about gynecomastia surgery, schedule a consultation with Dr. Azouz. Call our Dallas, Texas plastic surgery center at (972) 702-8888 or request an appointment online.

Men’s Plastic Surgery in Dallas: Dr. Azouz reviews and explains why more men are seeking plastic surgery than ever.

Plastic surgery for men is becoming increasingly popular.  As times have changed, more males are having cosmetic plastic surgery and investing in their faces, chest, and bodies.

Men’s cosmetic surgery has expanded in both the volume and public interest.  Plastic surgery in men is incredibly popular today and blepharoplasty (eyelid surgery), gynecomastia surgery (male breast reduction), placement of pectoral implants and abdominal liposuction are some of the most popular procedures among male plastic surgery patients.

One thing is clear the taboos are over:

          Men want their bodies and face to look the best that they can.

The many options for plastic surgery procedures can be enlightening for men and can help boost confidence and encourage a better self-image. Let’s review examples of male plastic surgery and cosmetic surgery for more men.

Male Plastic Surgery for the Face:

Blepharoplasty, male eyelid surgery to rejuvenate the eyelids.

This facial cosmetic surgery for men is one of the most requested procedures. It involves the removal of excess skin on the upper eyelid and the removal of the eye bags that appear under the eyelids. 

The main benefit of eyelid surgery is that on the one hand, it eliminates the feeling of “looking tired”, can improve vision and can provide a younger look.  Dallas plastic surgeon Dr. David Azouz performs the surgery in such a way that there is no perceptible scar.

The key to eyelid surgery in men is to avoid feminizing the eyelid.

Board-certified plastic surgeon Dr. David Azouz focuses on providing men a natural and masculine look with eyelid surgery (blepharoplasty).  Another benefit of eyelid surgery is that it can improve the symmetry of the face and remove dark circles under the eyelids.  Some patients can have improvements in their vision if the skin is blocking light reaching the eye.


Neck lifts are another of the most requested cosmetic surgeries for men.

A neck lift or inferior rhytidectomy is incredibly popular in both young and older men. Both younger men and older men seek to remove their double chin through neck liposuction and desire a stronger jawline via a chin implant.  Increasing the strength of the jawline and removing the double chin can provide an overall more masculine look and a slimmer appearance.

Neck Liposuction can provide a slimmer and more masculine appearance.

Older men often desire a traditional neck lift, whereby Dr. Azouz removes excess skin and jowling of the neck.  Dr. Azouz utilizes a hidden incision around the hairline of the patient’s ears while not altering the hair of the beard or sideburns.   Dr. Azouz conceals the incisions around the back of the ear, which hides scarring.

Dr. Azouz uses advanced liposuction techniques in neck lift and facelift patients.  Removing platysmal bands can also be performed in either a neck lift or a facelift.

Men’s plastic surgery: rhinoplasty (nose job), a classic of cosmetic surgery.

Rhinoplasty can provide dramatic results by remodeling the nose to provide a more cosmetic and symmetric appearance.  A nose that is in harmony with the rest of the face can provide a more aesthetic look.  Rhinoplasty is used to remove a prominent nasal hump, refine the tip of the nose and can correct asymmetry.

Cosmetic rhinoplasty can also be combined with functional rhinoplasty to improve breathing. With functional rhinoplasty, Dr. Azouz can straighten the nasal septum and reduce the nasal turbinates.  These techniques can improve airflow through the nose, can improve a man’s sense of smell and can even reduce the incidence of sinusitis.

The fact is that more and more men are seeking rhinoplasty for both functional and cosmetic improvements.

Male Plastic Surgery for the Chest:

Eliminating male breast tissue with men’s cosmetic surgery: gynecomastia and liposuction.

Gynecomastia in men is incredibly common and can be attributed to many medications, hormones, steroids, and marijuana use.

Liposuction and removal of gynecomastia (male breast reduction) is the best surgical solution for patients who have an increase in breast tissue who want a flatter, more sculpted chest or are bothered by prominent or puffy nipples. Gynecomastia surgery is well tolerated and is performed under local anesthesia and sedation on an outpatient basis.

Most men choose to remove gynecomastia and then work out to build up the pectoral muscles.  Male pectoral implants are commonly used for patients with Poland syndrome or for those who have significant chest asymmetry. 

Dr. Azouz performs liposuction and removal of gynecomastia with quick recovery, without drains and with camouflaged incisions.

Male Plastic Surgery for the Body:

Liposuction for men is used to eliminate the accumulated fat in certain areas of the body that is stubborn and hard to lose with workouts. The most frequent areas treated are the abdomen, hips, and flanks. In men, it is common to find this accumulation of fat in the abdomen and iliac rolls as compared to the leg.  Liposuction is associated with quick recovery and is performed with local anesthesia and sedation.

Tummy tucks and lower body lifts are common for men who have lost significant weight or have had bariatric surgery in the past.  A tummy tuck can be used to remove excess skin, stretch marks and scarring.  Many men choose to perform a tummy tuck at the same time they have their rectus diastasis or hernia repair performed.  A tummy tuck can be combined with male breast reduction (gynecomastia) surgery or with liposuction. Are you a man considering having cosmetic surgery? The cost of male plastic surgery is affordable for most patients and financing options are available.  Insurance can sometimes play a role if male plastic surgery is deemed medically necessary.  Tell board-certified Dallas plastic surgeon Dr. David Azouz or get in touch with us at 972-702-8888 if you have any questions!

Plastic Surgeon Dr. David Azouz Answers Frequently Asked Questions on Neck Lifts/Face Lifts

Who Can Benefit From a Neck lift Procedure?

A Neck lift is a common plastic surgery procedure performed by Dr. Azouz as day surgery and is often associated with little pain afterward. Aging contributes to skin and soft tissue laxity. Over time, the body stops producing high levels of collagen and hyaluronic acid, which leads to loose skin, wrinkles, jowls, and many other signs of aging. Patients who desire a more youthful and contoured neck can meet with Dr. Azouz at Azouz Plastic and Cosmetic Surgery in Dallas, Texas. Dr. Azouz performs neck lifts for patients with these concerns and can help improve the side-effects of an aging neck and face.

        Have you been thinking about getting a neck lift but are unsure if you are a candidate?

The best way to determine candidacy for a lower rhytidectomy is to speak with Dr. Azouz. The best candidates for a neck lift are those healthy, do not smoke, and have realistic expectations for the procedure. A neck lift can treat various concerns with your face and neck you may have due to naturally aging skin.

What Can Neck Lift Surgery Treat?

  • Loose neck skin
  • Creppy neck skin
  • An obtuse cervico mental angle
  • Excess fat under the chin
  • Jowls
  • Muscle banding in the neck
  • Excess fat and skin relaxation in the neck

How does a neck lift compare to non-surgical procedures?

The neck starts to show visible aging signs prior to other areas of the body. To help combat this, a neck lift, or lower rhytidectomy, is performed to restore a youthful appearance. During a lower rhytidectomy, excess fat and/or skin is removed on the lower face, chin, and neck. The suspensory layers of the face are tightened and lifted to a more youthful position.  This has the advantage of contouring the jawline and neck for a more distinguished profile.

Non-surgical options do not physically remove excess skin and fat.  Generally, non-surgical procedures must be repeated numerous times in order to yield an appreciable result.  A neck lift is definitive and most patients will undergo only one in their lifetime.

What is it like to have a neck lift in Dallas?

The neck lift journey involves three main parts including the consultation, the surgery, and the recovery.


During a consultation, Dr. Azouz will walk you through what to expect for your lower rhytidectomy procedure.  Dr. Azouz will take a medical history and perform a physical examination.  Dr. Azouz also points out the aesthetic anatomy of the face through a physical examination.  Dr. Azouz is able to demonstrate on your neck what to expect after surgery.   Dr. Azouz is also able to discuss combination surgery for patients who would like to combine their neck lift with blepharoplasty (eyelid surgery), laser resurfacing, facelift, rhinoplasty or otoplasty.


Dr. Azouz most commonly performs neck lift surgery with local anesthesia and sedation. Dr. Azouz uses this technique so you are comfortable while minimizing the risks associated with general anesthesia.  This also allows Dr. Azouz to monitor and protect the muscles of facial animation.  Patients can be deepened or lightened to their desired level of comfort with anesthesia.  The vast majority of patients do not remember their operation due to the specific medications that are utilized during cosmetic procedures.  Dr. Azouz works with anesthesiologists and certified nurses and anesthetists who are experts in delivering an optimal surgical experience.  Side effects such as pain and nausea are minimized by Dr. Azouz’s local and regional blocks, his specialized dressings and the long-lasting anesthesia drugs that are provided by the anesthesia provider.


Dr. Azouz provides prescriptions for medications that will treat pain and nausea after a neck lift.  Patients do not usually describe significant pain after a neck lift and there are many patients who do not take any opioid pain pills after surgery.  Dr. Azouz personally follows his patients in the office after surgery with frequent appointments.  Dr. Azouz removes stitches at different appointments and will notify patients when they begin their skincare, sunscreen and makeup regimens.  Neck lift incisions are hidden behind the ears and under your chin.  Most patients are able to return to desk work a few days after surgery.  Dr. Azouz does not recommend any heavy activity such as scuba diving, sky diving, cross-fit, heavyweight training and marathon running for at least four to six weeks after surgery.

Frequently Asked Facelift Questions

How is a neck lift different than a facelift?

A Neck lift only addresses the lower portion of the face including the neck and jowls.  Young patients who have loose skin and fatty tissue under the chin are more commonly candidates for a neck lift.  Older patients who would like the benefit of midface rejuvenation are better candidates for facelifts.  Dr. Azouz generally combines a neck lift with all facelift procedures.  Some patients simply require neck liposuction which has the additional benefit of skin tightening and minimal incisions.

How can you tell the difference between platysma bands and loose skin?

Platysma bands are actually strips of muscles of the neck which become prominent with aging.  This is due to a combination of soft tissue and skin laxity as well as decreased muscle tone.  Dr. Azouz will be able to diagnose and treat platysmal banding after an in-office history and physical examination.

Is Botox enough for neckbands or is a platysmaplasty better?

Neuromodulators such as botox and Dysport generally only will last for 2-4 months.  This means that patients will have to have their platysma bands treated with injections several times a year for as many years as the plastysma bands bother them.  With a neck lift or facelift Dr. Azouz treats platysma bands directly by a platymaplasty, direct platysma band excision and by resuspending the skin and soft tissues of the face.

What causes premature aging?

The overwhelmingly greatest cause of premature aging is genetics.  People often notice that they look more and more like their aging parents as they age.  There are modifiable causes of aging as well but these do not contribute to aging as much as genetics.  Modifiable causes of aging include sun exposure, smoking, diet, skincare, and stress.

How can I reduce premature aging and maintain the results of my neck lift or facelift?

  1. Sun protection is one of the best ways to prevent premature aging. Wearing hats, avoiding the sun at the hottest parts of the day and applying sunscreen frequently is critical.  New broad-spectrum sunscreens protect from multiple damaging rays including UVA/UVB, infrared and blue rays.
  2. Smoking causes significant damage to nearly all parts of the body. The skin and soft tissues of the face and neck are damaged and can not recover as well in smokers.  Smoking can also cause discoloration of the teeth and gums.  Quitting smoking can not only lead to a longer life but also to the ability to better rebuild collagen and heal.
  3. Eating healthy is another way to better prevent early aging. A healthy diet rich in fruits and vegetables provides the skin with a healthy glow, better texture, tone and can even contribute to better skin elasticity.  Alcohol, fried, salty and sugary foods do not provide the face with the nutrients to build healthy and youthful collagen.
  4. Daily skincare programs with retinA, hydroquinone, vitamin c and moisturizers can strengthen, smoothe and tighten the skin. Azouz customizes skincare regimens to his patients after performing a skin exam and history.
  5. Daily stress is difficult to avoid but patients who provide self-care with exercise, meditation, familial support, and yoga can better distress to lower their stress hormones such as cortisol and adrenaline. Even very young patients in their 20s and 30s can become aged looking after experiencing periods of significant stress.

Cost of a Neck Lift

There is no one cost for a neck lift procedure. It varies based on many factors. Dr. Azouz will give you an estimated cost for your neck lift during your consultation.  Insurance companies deem facelifts and neck lifts to be cosmetic surgery and therefore non-covered procedures.  If you have any questions regarding the cost of a neck lift, feel free to contact our Dallas office at 972-702-8888.

Talk to Plastic Surgeon Dr. Azouz

If you are unhappy with your neck/jawline area due to loose, sagging skin then talk to Dr. Azouz. He can create your customized neck lift procedure to help you look years younger. To get started, contact our Dallas office today by phone or by filling out an online form.

Combination Plastic Surgery: Face, Breast, and Body

What cosmetic procedures can be combined and why would that be beneficial?

Combining plastic surgery procedures is extremely popular and involves a plastic surgeon performing multiple plastic or cosmetic surgeries in one day.  This is a great option for patients who have many different concerns they would like to address. Dr. David Azouz is a board-certified plastic and reconstructive surgeon in Dallas, TX who performs many combination procedures to help his patients reach their goals in a safe, efficient, and effective manner. Dr. Azouz is highly experienced and offers patients the benefits of a natural-appearing look with minimal scarring from his combination procedures. The most well-known combination procedure is the mommy makeover, but there are many procedures that can be combined. Facelifts, tummy tucks, liposuction, and breast surgeries are all popular surgeries that can be done together.

Benefits of Combination Plastic Surgeries

There are many different benefits that come from performing two or more surgeries simultaneously. Mainly, it cuts down on the need for multiple surgery days which allows a patient one recovery. Additionally, combining procedures often cuts down on the cost of surgery and anesthesia.

Candidates for Combination Plastic and Cosmetic Surgery

The best candidates for combination surgery:

  • Require moderate improvement of the areas to be treated
  • Are in good overall health
  • Are non-smokers
  • Have realistic expectations

Dr. Azouz recommends that patients with areas that require significant skin and soft tissue resection stage their procedures rather than have them done on the same day.  The right combination of procedures can achieve the results a patient desires and this is best achieved through expressing your goals with Dr. Azouz.  Dr. Azouz is committed to performing plastic and cosmetic surgery as safely and efficiently as possible.

Combining Plastic Surgery with other non-plastic surgery procedures

Patients often desire to combine cosmetic and plastic surgery operations with other types of surgery including:

  • Hysterectomy
  • Removal of gallbladder
  • Functional rhinoplasty
  • Hernia repair

Dr. Azouz is able to coordinate performing cosmetic surgery with other noncosmetic surgeries with a variety of different surgeons.  Often Dr. Azouz will work with an OBGYN to perform a hysterectomy and tummy tuck together.  Hernia repairs are often performed at the same time as a panniculectomy (tummy tuck).

Recovery Time

One of the main questions Dr. Azouz is asked during his consultations with patients is how much recovery time they will need for their procedure. If a patient has multiple concerns and requires multiple procedures, this adds to time spent recovering from surgery. With a combination procedure, you get one recovery time.  A mommy makeover may involve a drain-less abdominoplasty or mini-tummy tuck, liposuction, and breast augmentation in the same day.   Men often desire liposuction of the abdomen to be done concurrently with liposuction and removal of gynecomastia of the chest.  The recovery time for each procedure is about four to six weeks until a patient can return to heavy exercise. Instead of having to heal for four to six weeks to or three different times, patients can get surgeries done on the same day so that they only go through one recovery.

How soon can you have cosmetic surgery after massive weight loss surgery (gastric bypass)?

Gastric bypass induces weight loss by both restrictive and absorptive methods.   This means that a patient will eat less food and less food will be absorbed through the patient’s digestive tract.  Patients will generally have their weight fluctuate for six months after surgery.  Dr. Azouz typically recommends having a stable weight for six months prior to surgery as well.  Patients who have had bariatric surgery (gastric sleeve or bypass) are typically excellent candidates for post-bariatric body contouring.  Combination procedures are often possible and include a variety of cosmetic surgeries of the body, breast, and face.

Possible combination surgery after bariatric procedures include:

Mommy makeover

Body lift with liposuction

Tummy tuck with liposuction

Facelift with eyelid surgery (blepharoplasty)

Breast lift with breast augmentation

Liposuction and removal of gynecomastia

Cost and Recovery

Along with the cut down on recovery time, combination procedures also cut down the cost. The cost of each individual procedure varies greatly. You have to add in the surgical facility, anesthesia, and medical devices to the total cost. By getting multiple procedures done in one surgery, this cuts down on the time spent in the operating room and anesthesia costs being repeated. Dr. Azouz will give you an estimated cost of your unique combination procedure during your in-person consultation.

Popular Combination Plastic Surgeries

To help his patients save on recovery time and cost, Dr. Azouz performs many of his procedures in combination with others. Due to the drain-less technique accompanying his procedures, patients can enjoy a less complex healing period. One of his most popular procedures is the Drainless abdominoplasty. Other popular combination procedures are:

  • Mommy Makeover (breast and abdomen)
  • Liposuction and Removal of gynecomastia
  • Liposuction and Abdominoplasty
  • Breast Lift and Reduction
  • Rhinoplasty and Eyelid surgery (blepharoplasty)
  • Facelift and Eyelid surgery
  • Mini Abdominoplasty and liposuction
  • Tummy tuck and labiaplasty

Schedule a Consultation

If you have multiple body concerns that you would like to address, then talk to Dr. Azouz about combination procedures. These are excellent options to get your ideal look in a quick, effective manner. You can request a consultation with our online form or give us a call at 972-702-8888.