John J Corey Plastic Surgery Blog

I think at times there is a misconception that the office of a Plastic Surgeon on any typical day is filled with fragile self-esteemed women who have been “gently” ushered in at the elbow by dominating men with a low set brow. I can tell you that in my almost 20 years of practice, that is not the case. Oh, don’t get me wrong…It does happen. But it is so rare, that I would be shocked if I see more than 2 cases a year of that. But what I do see on any given office day, is confident women who have pretty clear cut goals about what they want and what makes them happy; and what of the men? Oh they’re there… Usually sitting in the chair next to their wives or girlfriends and just being incredibly supportive. What I hear from them is “Hey, this is all about her…”, or “Honey, you know I think you look great right now…” Most of the time, these men would honestly rather go get jet skis or quad runners! Now that’s not to say that when the surgery is done that they don’t appreciate the result because they really seem to. But overall I have seen the far majority of men be very accepting of their partners and are not super critical. Many times, women can be their own worst critic and not the men in their lives.

I have always characterized it this way for my patients.  Most men have explained that they really care more about interaction than appearance. If they can get out there and do activities together, be it biking, beach or pool, have an uncensored environment without dressing in the closet or the dark (two of the more frequent comments when asked) and have a fulfilling sex life, then most men are not bothered in the least by a small cup size, a few extra pounds or the “scourge” of cellulite. And if I do see men being what I think is way too critical, then that raises a huge red flag for me in my practice and I discourage any surgery, or at the very least, have a good one on one conversation with the woman about the concerns I have.

So for most of us men, we’re thrilled just to have a woman we love by our side!

Capsular contracture, commonly referred to as CC is the condition where the scar tissue that forms around implants in all cases, normally thin and soft, becomes thick and firm. The incidence of having some form of this is probably close to 15% but accurate statistics are hard to come by.  This can become so severe that the breast becomes misshapen, distorted and even painful in some cases. One of the first signs of a woman developing this is a firm feeling to the breast that seems different than the other side. It can also be seen as changing shape or size, commonly looking a little bit higher at the top. We think there may be a variety of factors that may contribute to this condition, such as bleeding, implant rupture, too large of an implant, or possibly immobility, but now there seems to also be the idea that there may be micro-contaminants on the surface of the implant that cause a tissue reaction.

Most often what I have seen in my practice is that if a woman is going to develop this, she usually does so in the first 6 months. That is not to say that she cannot develop this later on, but the chances seem less.

My first non-surgical course of action if a woman begins to feel a change is to begin vigorous massage and in many cases this early tightness can be reversed. Medications have been tried but the data is unclear or non-existent as to its effect.

Should the condition progress, the first surgical option is Capsulotomy, where the capsule is opened and multiple cuts are made in order to open the space that holds the implant. The next step is more aggressive. It is called Capsulectomy and instead of cuts being made in the capsule, it is entirely removed. Different implants may be tried and changing the location of the implant to above or below the muscle may help as well. Other options may be to place a tissue “spacer” into the wall of the capsule that is more resistant to contracture. I prefer to use Strattice Acellular Dermal Matrix for this and the success rate seems to be very high.

Having said all of this, there are some women that will continue to have hardening of the capsule no matter what is done and it may only be on one side as well. More needs to be done to fully understand this process that fortunately only happens in the minority of cases.

As plain as the nose on your face! So the saying goes…But Rhinoplasty is still a very sought after operation and one that really can have an impact on your self-image. Most of the time, patients tell me that they have never totally liked their nose and that there may be certain angles in photos that just “bug them”. I almost never (now watch, I’ll get 2 this week!) have people come into my office with pictures cut out of tabloids of noses they have picked (pun intended)…

Rhinoplasty has changed over the years. In the past, surgeons and patients were obsessed in seeing how small they could get a nose to be and we have all seen the resulting overly narrowed and pinched nose. We now know that the nose continues to change over the years and we have to take that into account. It seems now that as surgeons, we are oriented to not only changing the appearance of the nose but keeping in mind the structure and support as well, more than ever before…This may mean the use of grafts of cartilage or fascia, the use of supportive suturing, or the introduction of implants, some of which are absorbable.  So yes, we can make a nose longer and shorter and more narrow or wide, but my goal is to always make sure that it still looks like you, and try and minimize the changes that may occur years down the road. And I take into account ethnic considerations as well. Many patients want to reshape a part of their nose that they don’t like but still retain their overall ethnic features. And remember, if you have already had nasal surgery, each time after that can get a little trickier and you may have more long term swelling than the first time!!!

Dr. Corey recently added Latisse to the many skin care and aesthetic products we now offer at our office and all I have to say is I am officially impressed! It is hands down one of the most reliable treatments we offer to patients. Not only are my eyelashes now fabulous and voluptuous, time and time again patients who also use the product blow me away with their amazing dark, thick, and beautiful long lashes. I think part of its popularity is also the relatively low price tag, $120 for a 2 month supply.

Latisse is the only prescription treatment for eyelash growth that is FDA approved and is only available at doctors' offices, such as Dr. Corey’s. Besides making the lashes longer and fuller, Latisse also makes them darker, which sets it apart from other brands.

Here are some helpful hints to get the most bang for your buck………The brushes that come with it are too thick and can suck up a lot of product so I found it helpful to use a thin makeup brush of some kind or you can thin out the ones provided by cutting some of the outer bristles.

Another tip, I think you can actually use Latisse less frequently then daily and maintain results. I found that once I felt like I achieved a good clinical result I tried every other or every third day for application. Rationing the medication like that can make a single bottle extend for 3-4 months instead of 2 without much diminishing results. A good cosmetic budgeting strategy in these times!

We have found Latisse to be an excellent product with limited side effects when used correctly. One question I get asked frequently is, “Does it change the color of your eye”? Regarding eye color change, when used as a glaucoma medication (different dosage and applied directly into the eye) 3 out of thousands of patients noticed that green or hazel eyes got darker - of particular note none of the three patients thought the change was significant enough to stop using the medication. And this was NOT seen in the Latisse trial. This is not to say that it can't happen - I just think we should be clear on the facts. Latisse is also a prostaglandin analogue similar to the drug bimatoprost used in the treatment of glaucoma.  Because of this another potential side effect includes darkening of eyelid skin which is usually reversible once the drug is stopped.

The fact of the matter is three people this week asked me if I was wearing fake eyelashes!  I have been using Latisse for almost three months. I’m a believer, it’s amazing the difference it makes.