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This is a 63-year-old resident of New Hampshire who presented to the San Francisco office at Union Square for evaluation for gynecomastia. He developed his gynecomastia at a young age, but over the years it has become progressively worse. He is 5 feet 10 inches tall and weighs 155 pounds. He never takes off his shirt due to the extreme amount of embarrassment. He underwent gland excision with a superior incisional lift and liposuction of his chest. He had 6 centimeters of tissue removed and sent to Pathology from his right side and 6 centimeters from his left side. He had 150 cc of fat liposuctioned from each side. His surgical procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the overall improvement in his chest contour. This is a very complicated case. Due to his age being 63 years old, his skin is loose with less elasticity and contractility as well as sun damage to the area. This is, overall, a good outcome that can be improved by further peri-areolar lift for tightening of his skin.