Two World-Renowned NYC Plastic Surgeons Answer Your Questions

Imagine standing across from two world-renowned plastic surgeons who’ve spent decades perfecting their craft, giving you straight answers about the procedures you’ve been secretly googling.

That’s what happened during my Instagram live with my brother, Dr. Evan Garfein (Chief of Plastic Surgery at Montefiore Medical Center in NYC) and his partner, Dr. Oren Tepper, both founders of Greenwich Street Aesthetics in NYC. Once we went live, my inbox exploded with your questions, and I realized that having access to surgeons of this caliber is a true gift.

You’ve asked for more from them, and I am happy to oblige. This week, it’s Dr. Evan Garfein’s turn. (Dr. Tepper will weigh in next week.)

Here are your latest questions:

If you’re over 50 and considering a breast reduction, should you get a lift at the same time?

A breast reduction can be a great operation for women both under and over 50. In fact, in most cases, a breast lift is actually built into the reduction procedure (both for function and aesthetics).

Why? During a breast reduction, excess tissue and skin are removed to alleviate symptoms like neck and back pain or skin irritation. But simply removing volume without lifting the breast would leave an unshapely or sagging result. That’s why the tissue that remains is almost always reshaped and lifted to sit higher on the chest wall, restoring a more youthful, proportionate contour.

A good candidate for both is someone:

• With large, heavy breasts that cause physical discomfort, skin rashes under the breasts, postural issues, or limitations in physical activity, especially if sagging or asymmetry is present.
• Non-smokers in stable health and at a consistent weight.

Combining the two procedures creates a result that’s both medically relieving and aesthetically natural, which can dramatically improve quality of life. And in nearly all cases, the nipple is raised as part of a reduction (leaving ‘lollipop scars’).  

How likely is it that my insurance will cover a panniculectomy?

A panniculectomy is a surgical procedure that removes excess skin and fat hanging over the lower abdomen, usually after dramatic weight loss or pregnancy. This overhanging tissue (known as a pannus) can cause skin irritation, hygiene issues, back pain, and even restrict mobility.

That’s where a panniculectomy comes in. Unlike a tummy tuck, which tightens abdominal muscles and contours the waistline, a panniculectomy is more medically focused and often deemed reconstructive rather than cosmetic.

The best candidates are individuals who are:

• At or near their goal weight and have maintained that weight for at least six months.
• Are experiencing physical discomfort or health complications from the excess skin.

As for insurance? While it’s hard to predict what a given insurance company will cover for a given patient, in the majority of cases, removing excess skin and fat of the abdomen is NOT covered.  

Why? Because insurance companies tend not to cover weight loss after pregnancy, by diet and exercise, or even after the use of GLP-1 agonists.  

However, if a patient has had bariatric surgery for obesity (or other weight loss surgeries), body contouring procedures like panniculectomy are often covered.

^{Dr. Evan Garfein is a board-certified plastic surgeon specializing in cosmetic and reconstructive surgery. He is the Chief of the Division of Plastic and Reconstructive Surgery at Montefiore Medical Center and is dedicated to surgical education and training as Professor of Plastic Surgery at Albert Einstein College of Medicine. He is a pioneer in 3D surgical innovation, including virtual reality and the use of patient-specific 3D printed models that have revolutionized patient care in the field.}

^{Dr. Garfein’s passion for aesthetic and reconstructive surgery has made him an internationally recognized leader in the field. He has authored over fifty peer-reviewed articles and book chapters in both aesthetic and reconstructive plastic surgery. Dr. Garfein completed his plastic surgery residency at the Harvard Combined Plastic Surgery Residency Program, where he served as chief resident at the Massachusetts General Hospital, Children’s Hospital Boston, and the Brigham and Women’s Hospital.}

^{Follow him on instagram at @drevangarfein and reach his private office Greenwich Street Aesthetics, NYC  at 212-245-2499.}

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