This month, I've decided to share some questions from my e-mail. There seems to be a lot of misconceptions dealing with the things that plastic surgery can accomplish. Perhaps this will help dispel some of them.

Q. Can liposuction alone cure gynecomastia?

A. Gynecomastia consists of varying amounts of excess fatty and glandular tissue. If there is only fatty tissue, a condition more properly called pseudo-gynecomastia or false gynecomastia, liposuction alone will offer the improvement. Despite the claims of some, liposuction will not accurately remove the glandular tissue. Either it will create a hole for the glandular tissue to temporarily drop into, or it will chip away at the edges. To contour properly, the majority of the glandular tissue has to be removed by direct vision, leaving behind the right amount to prevent collapse of the nipple or anchoring to the muscle. This leads to the next question.

Q. Why can't you take out all the glandular tissue so there is never a recurrence?

A. If all the glandular tissue is removed, the raw surface of the skin beneath the nipple would scar down to the surface of the muscle, creating a crater. Even if this were not evident when you were standing still, you would see it when you flexed. In some people, this temporarily occurs even when the right amount of glandular tissue is left behind. If the glandular tissue were totally removed, this would be permanent.

Q. I know there are pectoral implants, calf implants and even buttock implants. Can I get biceps, triceps, deltoid and abdominal implants?

A. Currently available implants can best be called static implants. They are space fillers. They go either behind the pectoral or gluteal muscle, or under the gastrocnemius fascia. Their main purpose is to push out the existing muscles and as such no change in the shape of the implant is necessary.

Biceps and triceps radically change shape will flexion. Implants in those areas would have to be dynamic and change contour as well. At present there is no implant material or design that can accomplish this. The attempts at placing implants in these areas have looked ridiculous. Abdominal implants in the shape of both cigar shaped inserts and a full muscle contour mat have been attempted. Again, we have a situation where the implant may look acceptable with the person standing perfectly still. Once there is twisting of the trunk, it looks very unnatural.

Q. What shape should I be in to get liposuction? Should I be at my heaviest or my thinnest?

A. Liposuction is there to eliminate those areas resistant to diet and exercise. The best time to have liposuction is when all is looking as you want it with the exception of those problem areas. The surgery can then bring everything into balance. This is especially helpful when trying to maintain upper body mass and have six-pack abs. To get defined, most people have to sacrifice some mass. With the use of liposuction, both can be attained.