Abstract Background Higher grades of gynecomastia with marked skin excess, enlarged nipple–areola complex (NAC), and a feminine chest shape poses certain unique challenges. In order to achieve outcomes similar to the lower grades, management of excess skin and enlarged NAC is critical. Surgical removal of excess skin produces visible scars while repositioning of NAC with a free nipple graft leads to loss of sensation. Objectives To compare the skin tightening or “chest lift” and reduction in NAC area achieved with a combination treatment of RF energy and PAL to those treated with PAL alone in higher grades of gynecomastia. Methods A retrospective comparative analysis of 118 patients with gynecomastia grade 2b and 3 (59 in each group) who underwent primary surgery was done. Gynecomastia grade 1 and 2a, secondary surgery, and unilateral gynecomastia were excluded. Preoperative measurements included SN-NAC (Sternal notch to NAC) distance on each side, IND (Inter-nipple distance), and area of each NAC. Post-operative measurements were repeated at 6 months and 1 year. Results SN-NAC and IN distance decreased significantly in patients treated with combination of RF energy and PAL (p<0.05). There was also a significant decrease in the NAC area with reduced secondary deformities of skin/NAC in these patients (p<0.05). Conclusions The addition of RF energy to PAL achieves a quicker and more effective “chest lift” as compared to PAL alone to produce a more masculine chest. The skin tightening and reduction in the areas of NAC can obviate the need for secondary correctional procedures and its associated abnormal wound healing.