Author: Maureen Brouse


The Ideal Implant: for Breast Augmentation


There are many options in choosing breast implants for breast augmentation. A new option has recently been added to the mix; the Ideal Implant.

Breast implants can be filled with saline (salt water) or silicone gel filled. The saline implants are filled at the time of surgery and the silicone gel implants come prefilled. The outside can be smooth or have varying degrees of roughness or texturing. The implants can be partially filled, completely filled or overfilled. They can have different width to height rations or different types and degrees of projection. The gel can be very soft, medium or firm.  The implants can be completely round or have a shape with various dimensions of height, width and projection.

Each implant has its pros and cons.

The two largest general categories for implants are saline filled and silicone gel filled. The silicone gel implants tend to be softer and more natural but can have silent ruptures. A rupture is when the implant breaks but you really can’t tell that it is broken just by looking at or feeling the implant. This has led to the FDA recommendation to perform MRI scans three years after placing the implants and every two years thereafter. The MRI scan is the best noninvasive way to determine if the implant is broken. These scans are usually not covered by insurance.  It is also recommended that if there is a ruptured implant that it be replaced. Replacement of a ruptured silicone gel implant requires removal of the scar tissue around the implant at the same time. This is done to remove as much of the free silicone gel as possible.

If a saline implant breaks it will deflate. It is very evident when that has occurred. No MRI scans are needed. If they do have to be replaced it is a much less invasive and simpler procedure when compared to the silicone gel implants. Saline implants do have the downside of being less natural in the way they look and feel. They look rounder and feel firmer. There may also be more rippling of the saline implant when compared to the silicone gel implant.

There is now a new implant that combines some of the pros and eliminates some of the negatives of silicone gel and saline implants. It is called the Ideal implant. It is a saline implant that looks, feels and acts like a silicone gel implant but does not require MRI follow up. Just like saline implants it will deflate visibly if ruptured and is easily replaced. It is also adjustable when initially placed. Just like silicone gel implants it is softer and more natural in look and feel.

The Ideal implant is priced about the same as a silicone gel implant and carries similar warranties. The incision tends to be smaller than that for a silicone gel implant because it is filled with the salt water after it is in place, unlike the silicone gel implant that is prefilled.

This new type of implant was developed by plastic surgeons and appears to offer a suitable alternative to the old style saline implants and the silicone gel filled implants. A complete discussion with a plastic surgeon certified by the American Board of Plastic Surgery with extensive experience in breast augmentation can help you decide what type of implant is right for you.

by Dr. John Stratis

Am I Too Old For Plastic Surgery?

You’re never too old for self confidence!

Many people will not consider a cosmetic plastic surgery procedure because they think they are too old.  This question really can be broken down into two aspects; health and attitude.


A very important consideration in undergoing plastic surgery is a person’s health regardless of their age. We have treated many men and women who were in their seventies and eighties for cosmetic procedures who were quite healthy. Alternatively, we have discouraged the pursuit of cosmetic surgical procedures in patients who were not healthy enough to undergo them. We offer less invasive procedures for these patients when appropriate.

We decide jointly (the physician and the patient) what is most appropriate for any particular patient but never put the patient’s health in jeopardy. We will often obtain the medical opinion of their family doctor, internist or cardiologist to assess their health status and their ability to successfully undergo a procedure.


Your attitude is also a very important factor in deciding to have a cosmetic procedure performed.  People are living longer and maintaining healthier lifestyles than in the past. They tend to persist in work and physical activities rather than be arbitrarily slowed by the accumulation of years. They have a young attitude and want their bodies and faces to match the youthful way they feel. These people seek out the benefits that plastic surgery has to offer.

If you feel old, regardless of your age, and feel that old people should look and act their age you may not have the attitude to even consider a cosmetic procedure.  In order to appreciate the benefits of having a cosmetic procedure that may make you look better and feel better, you truly need the proper attitude. When asked how he stays so active and healthy at the age of 87 Clint Eastwood said, “Just don’t let the old man in!”

That’s the attitude!

Recovering From Plastic Surgery

Dr. Stratis checking on patient in recovery.

Recovery after any plastic surgery procedure depends on what the procedure was, what you are recovering to do and what your plastic surgeon wants you to do. Generally speaking most physical activities will depend on the discomfort level of the patient. Most, if not all of us, will not do things that cause us pain. It is a very common and understandable mechanism to keep us safe. As our discomfort level decreases our activity will increase. There are some circumstances where patients will be encouraged to do certain activities after surgery that causes them pain but are overall beneficial to recovery. Getting out of bed the day of a hip replacement is one such activity. It hurts but is very beneficial to a fast recovery.

There are some specific activities that we ask patients to avoid with certain procedures. Most facial procedures require that the patient keeps their heads elevated and not bend with the head down. Breast lift patients should not engage in activities that stretch the arms outward and upward for three weeks. Tummy tuck patients for three to six weeks should not engage in activities that would require a sudden contraction of the muscles as might happen with a jerking lift of moderate to heavy weights. Each procedure will have these types of restrictions.

I have my patients do what they feel comfortable doing. They can drive when they feel in control of the car and are not taking narcotic pain medications when driving. They can also return to work based on their judgement. Patients know how they feel and they also know what it takes to do their particular job. When the two match they can return to work. I always monitor the level of recovery to make certain that the patient is within the norm of where they should be during their recovery.

Also every plastic surgeon will have their own protocols for activity after surgery based on their own experience.

How Do You Get Rid Of Excess Fat?

When there is fat under the skin, there are four general ways to reduce it.

1. Diet and Exercise. These are two things that we can all do on our own, and is the least expensive way to reduce fat. It’s simple, but not easy. Many of us require professional help with diet and exercise; even then we sometimes thwart our own efforts.

2. Noninvasive. There are also noninvasive techniques for fat reduction; CoolSculpting and SculpSure. Both are FDA-approved for fat reduction, but CoolSculpting freezes the fat cells while SculpSure heats them up with laser energy. Both are permanent in the reduction (although you still can accumulate more if you consume more than you expend), and both can reduce up to 25% of the fat that is treated. While CoolSculpting treatments take 60 minutes per treated area, SculpSure treatment time is substantially less at 25 minutes per treatment. There is no anesthesia, no downtime, and no incisions for either procedure. Some patients may have some discomfort during or after the procedure, and on rare occasion CoolSculpting can result in more fat accumulation. If this is the case, the company will pay for liposuction of the area if that happens. This does not happen with SculpSure. Both of these techniques vary by individual and do not remove as much fat at one time as liposuction can.

3. Liposuction. This is a minimally invasive procedure that can remove fat from under the skin. It does require some type of anesthesia and very small incisions. There will be some discomfort after the procedure, as well as some temporary bruising and swelling. There is no medical downtime, and you are allowed to do whatever you feel comfortable doing after the procedure. Very often this procedure is performed in the office under local anesthesia.

4. Tummy Tuck. The final way of removing the fat is to surgically remove the fat and the skin together with a tummy tuck procedure. This does require general anesthesia and is performed on an outpatient basis. There is more scarring, discomfort, and recovery protocol, but very often will give the best results of the four mentioned options, simply because it takes care of the excess fat, skin, and repairs the muscle layer (if necessary).

The choice depends on a number of factors and will be discussed specifically during your consultation.

What Is A Facial Plastic Surgeon?

Facial plastic surgeons begin their post-medical school training in the highly competitive specialty of Otolaryngology and Head and Neck Surgery, more commonly known as an Ear, Nose and Throat (ENT) physician.  A field with diverse opportunity, it attracts the best and brightest the medical field has to offer.  Their residency consists of a year of general surgery and an additional 4 years of head and neck surgery.  When most of us think of an ENT, we picture them inserting toddler’s tubes or removing tonsils, but this specialty is so much more.  One day they are doing microvascular surgery on various areas of the head and neck, another they may be an endoscopic surgeon working on the sinuses and throat.

A facial plastic surgeon continues their education with an additional year of Fellowship focused on Facial Plastic and Reconstructive Surgery.  This highly specialized focus was initially developed during World War I and II to try to correct the wounds of war casualities.  There are only some 40 Fellowships offered in the whole country. That’s right, Dr. Gayner was one of 40 surgeons in the country to be chosen for this very selective Fellowship. Today it has evolved into a field treating patients ranging from reconstructive surgery to purely cosmetic Facial Plastic Surgery.

Here at Stratis Gayner Plastic Surgery we choose to focus on the cosmetic concerns of our patients.  Whether your nose has a bump or you’re fretting about the signs of aging, there is nothing more important to Dr. Gayner than providing someone that sense of confidence they are seeking.

Dr. Gayner in consultation.

Cosmetic plastic surgery is one of the most dynamic fields in medicine today. The innovation of new procedures and products are announced virtually every week. The inception of Stratis Gayner Plastic Surgery in 2007 brought a unique practice to Central Pennsylvania with Dr. Gayner, a board-certified facial plastic surgeon partnering with Dr. John Stratis, a board certified plastic surgeon.  One to focus on the face and one to focus on the body.  With each physician dedicated to their specific area of expertise they can stay current on the latest developments and provide unparalleled expertise to their patients.

We look forward to seeing what we can do for you!


Contact our office for more information.
(717) 728-1700

My Touch MD

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Meet the Surgeons Dr. John Stratis and Dr. Scott Gayner.