Plastic Surgery, Exosome Therapies, Ethical Cosmetics

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/07/10

Dr. Joshua Korman, a Stanford-trained, board-certified plastic surgeon and founder of Korman Plastic Surgery, discusses his background in music, sculpting, fitness, and plastic surgery innovations. He explains the role of exosomes and gene therapy in accelerating healing, ethical considerations in younger patients seeking surgery, and the blurred lines between vanity and necessity. Dr. Korman highlights his Clean Slate Program’s national impact on tattoo removal for gang rehabilitation and emphasizes the importance of education in emerging regenerative technologies. He reflects on patients’ misconceptions, such as overconfidence from online research, and shares insights on passion, judgment, and lifelong learning.

Scott Douglas Jacobsen: All right, today we are here with Dr. Joshua Korman, husband of Dr. Siobhan Korman, a Stanford-trained, board-certified plastic surgeon and founder of Korman Plastic Surgery, with locations across Northern and Central California, including Carmel-by-the-Sea, Los Altos, Mountain View, and San Jose. Recognized for his artistry and expertise, he specializes in advanced facial, breast, body, and male procedures. A Castle Connolly Top Doctor and Newsweek honoree, Dr. Korman also serves as an Adjunct Clinical Professor of Surgery at Stanford University School of Medicine. He holds numerous patents in skin remodeling and tissue expansion and advocates for the positive psychological impacts of surgery. A community leader and founder of the Clean Slate Program, he balances his surgical career with music, sculpting, and outdoor fitness passions. Let us start a little off-topic. What kind of music do you play, why did you get into sculpting, and what outdoor fitness activities do you enjoy?

Dr. Joshua Korman: In the order, you asked, what kind of music is it? I play the piano and the oboe and actively perform in several groups and bands. I was a music major in college. Many of my relatives are musicians. I play different kinds of music — I perform in big bands and small groups. Similarly, the oboe is quite different from the piano, and just as I enjoy a range of instruments, I do not like to be pigeonholed as “just a facial plastic surgeon” or a “body plastic surgeon.”  It is a “yes and” approach to use your words. As for sculpting, I became interested when I was a chief resident. People often say plastic surgeons are artistic, but I don’t think I really appreciated what that meant. There was a visiting sculptor at Stanford, and I arranged for her to run a course for plastic surgeons and trainees. A few of us participated, and at first, the sculptures we made looked a bit like Martha Washington. But eventually, I realized a few important things that are different working in clay than in surgery— for example, always keep the nose up because when you sculpt faces in clay, they naturally tend to look older.

There are little tricks like that. That is the kind of sculpting I do. I enjoy it a lot. As for outdoor fitness, I work out consistently. I ride my bike, lift weights, and run. That is a big part of my life. It is essential to stay healthy. I grew up playing soccer, and I remember during one medical school interview, the interviewer said, “Oh, I see you play sports. Do you like to exercise?” I said, “I guess so,” and he replied, “When I get the urge to exercise, I sit down and wait for it to go away.” But my father, who played soccer at an almost professional level, is now turning 97, and exercise has certainly served him well. So yes, I firmly believe that exercise is a very good thing.

Jacobsen: Have you found any knock-on effect benefits from these side parts of your life in your primary profession?

Korman: I have found side benefits from these things; yes, so, they give me something to talk about and relate with many patients. I never run out of things to discuss with patients and people in general. We live in a world with so many different subworlds within it. Before I got my first dog, I did not know much about dogs. Then you go to a dog show and realize, wow, there is a whole world of people who live for their pets. It’s enlightening to learn about whole other worlds. But at times it also gives me a sense that there are people who might not know what they are talking about, but sound like they do. It makes me realize that there are things I truly know about and others I really don’t  — and that is true for others.

Jacobsen: So passion is not a proxy for knowledge.

Korman: It is not. That is a perfect line. I will have to borrow that.

Jacobsen: TM. So, moving more to the main set of questions, some natural avenues of questioning will follow from this. Regardless, how are gene therapy and exosome-based treatments relevant to plastic surgery now?

Korman: People live longer and are increasingly concerned about their health and appearance. I recently saw a statistic that more than half of babies born to today will live to be 100. Exosomes — let us go back to what exosomes are. Exosomes were discovered in the 1980s, and initially, people thought they were waste products of cells. For something to be classified as a cell, it needs a nucleus and a membrane; exosomes are not cells . So, early researchers thought exosomes were just cellular waste. But then it became clear that they are incredibly powerful signaling devices that cells use to communicate. Inside these little bubbles are a lot of truly remarkable biological materials. They have clever membranes that allow them to easily slip into and out of cells, making them highly effective. Exosomes are very good for reducing inflammation and have significant therapeutic potential. The FDA has not yet approved them for direct injection due to concerns about safety and misuse, but the science is promising. It is not just hype; exosomes are real and potent. I have seen them dramatically improve healing when applied topically, especially after procedures like microneedling. As for gene therapy, it can restore function in cells by changing the genetic material. Only recently have true clinical applications started to emerge. Biohacking is a buzzword that may sound negative, but the concept of improving human lives through genetic modification is moving quickly. 

I would not compare it directly to AI, but like AI, it is something everyone is talking about and slowly materializing into real use cases. To clarify, when I refer to biohacking, I’m referring to biohacking strategies that have been proven and scientifically researched. 

 In plastic surgery, we traditionally say we deal with the skin and its contents, but plastic surgery is not solely about the skin. The term “plastic” comes from the Greek word meaning “to “mold or “to shape.” Plastic surgery encompasses reconstructive, aesthetic, cosmetic, and more. A plastic surgeon performed the first successful kidney transplant. Plastic surgery is a vast and dynamic field.

However, to answer your question — how are cellular advances related? It is all about healing. It is about improving healing and delaying the signs of aging. That is how it is most beneficial to plastic surgery.

Jacobsen: If we are looking at timelines, whether you are on the younger side of life or the older side, what would a regular timeline of healing and recovery look like after surgery? And with these therapeutics and treatments, what would be the change or difference?

Korman: It depends on how you look at it. For example, think of laser resurfacing, which is controlled burns to the face or other areas. Usually, if you stay pink and are still healing for two weeks, with advanced therapeutics, that healing can happen in a few days instead of two weeks. It can be very dramatic because the body is programmed to heal open wounds quickly — open wounds can be life-threatening. In terms of surgical results, meaning when you have closed a wound after an operation, these processes can accelerate healing significantly. If it usually takes two weeks, advanced treatments could allow someone to recover much sooner. If you ask how soon someone can return to work — say, after a knee operation, which is orthopedic, not plastic surgery — orthopedics has been injecting different types of materials into joints to improve healing for a long time. In plastic surgery, healing improvements can be pretty dramatic as well. I am not being more specific because it depends on the part of the body and the patient’s age. Older individuals tend to heal more slowly than younger individuals.

Jacobsen: Another question from that is: Is there an upper limit, or an age plus other considerations, that tends to be when plastic surgeons do not perform surgery? What are the conditions for that?

Korman: It is interesting — both on the young and old sides. Have you ever seen the movie Hidden Figures?

Jacobsen: A friend of mine talked about it, but I do not recall the details.

Korman: It is about three women who worked for NASA, who were brilliant mathematicians, and their struggles to be accepted. They accomplished amazing things for NASA. NASA has a major facility here, and I operated on three people — two women and one man — who had worked there, all in their 80s. But you would never know they were in their 80s. These individuals were like G.I. Joe and G.I. Jane — pilots and incredibly active. You would think they were 40. Yes, they had some wrinkles, but how youthful and vibrant they were was shocking. So, chronological age is very different from biological or functional age.

On the younger side, it is interesting now that it used to be thought that facelifts and similar procedures should not be done until patients were in their 50s, 60s, or 70s. But now, many people are seeking surgery before they turn 40 because they want to maintain their youthful appearance, not just regain it later. They want to stay looking like they are in their 30s. It raises interesting ethical questions. I have seen several patients who had surgery in Korea while in their 30s, and they came to me for follow-up or other procedures. There has been coverage of this in outlets like The Wall Street Journal, noting that many people are having cosmetic surgery in their 30s.

Social media plays a role in this trend. People want to stay looking young rather than wait until they look significantly older before pursuing surgery. The best compliment someone can receive after not seeing them for many years is , “You look the same,” rather than, “Oh, you had surgery,” or “What did they have done?” Looking unchanged—just fresh and youthful—is a very positive outcome.

Jacobsen: What about vanity surgeries? People are free — these are not illegal procedures. So, these can be done. Yet, in consultation, do these become part of the conversation regarding the soft skills approach needed for surgery since they are in your office seeking expert advice?

Korman: Several years ago, I gave a talk to Stanford undergraduates titled, Is it Necessity or Vanity? I started by showing them a picture of a baby with a cleft lip. I asked, “Is this necessity or vanity?” They said, “Oh, necessity, of course.” Then I showed them a picture of a mastectomy patient, and again, almost all said, “Necessity.” Nearly all — but not everyone. Then, I showed them a picture of a patient who wanted a facelift to stay competitive in Silicon Valley, maintaining a youthful appearance for professional reasons. Everyone said, “Vanity, for sure.” Then I showed them a picture of a 20-year-old with a cleft lip — a patient from a trip to Vietnam many years ago. Again, they said, “Necessity.”

However, I explained that while I repaired the cleft lip when he returned a week later to have his stitches removed, he had been kicked out by his family. As a beggar, he had been a source of income for the family, but once his cleft lip was repaired, he could no longer fill that role. So, the question of what is considered necessity versus vanity is not as simple as it seems. We are all judgmental and think we know the answer, but often, we do not.

Jacobsen: What are the promising applications of aesthetic and reconstructive procedures in the current period?

Korman: There are up-and-coming developments. Face transplants are now being performed, which is remarkable. You might wonder, “Who would do that?” It is for individuals who have been severely disfigured. To undergo a transplant, you must take immunosuppressive drugs — unless you have an identical twin, which is rare. Otherwise, the transplant would be rejected. Face transplantation has begun, and so have hand and limb transplants, which are significant advancements. Robotic microsurgery is also on the horizon.

In aesthetic surgery, healing topicals such as exosomes are advancing rapidly and have great potential. There is a growing focus on combination approaches—everyone, understandably, wants the least invasive, longest-lasting, most cost-effective, and best results possible.

There are an increasing number of minimally invasive and non-invasive procedures, but it is also important to help patients understand what truly works for their specific situation. For example, I perform deep plane facelifts, but sometimes, I modify them with short-incision techniques or combine surgical and non-surgical treatments depending on the patient’s needs.

Globally, the trend is toward combining techniques from different areas that you would not necessarily expect to work together. I also invented a medical device currently in clinical trials that aims to shorten breast reconstruction with tissue expanders from three months to one week—innovations like that.

Plastic surgeons have always been at the forefront of developing new technologies and devices, and that tradition continues strongly today.

Jacobsen: How long until gene-editing tools or exosome delivery systems become mainstream plastic surgery protocols?

Korman: Well, regarding exosomes and the mainstream — the FDA has not yet approved exosomes. Therefore, you cannot use on-labels widely yet. Do you know the difference between on-label and off-label products?

Jacobsen: When it has gone through its complete phase trial process with the FDA, or…?

Korman: No, not exactly. When the FDA has approved something — let us say a pill for asthma — and the FDA has approved it specifically for asthma, that is called on-label use. If someone realizes that the same pill is also effective for treating something else, even before the FDA officially approves it for that new use, doctors can legally prescribe it for the other condition — but that is called off-label use. So, it has been approved, but for a different primary purpose. Exosomes have not yet been approved for anything in terms of injections, and that is what everybody is waiting for. The FDA wants to be cautious, and understandably so. Many companies are lining up, preparing for that moment. The day the FDA approves exosomes for injection or injectable treatments will be a significant moment for the field.

Gene editing tools, CRISPR, and so on are exciting areas. I see gene editing as more relevant in cases like children born with congenital anomalies, where genes can correct defects before or shortly after birth. That is exciting, but it is not happening today or tomorrow in routine practice. Gene editing is still far from being standard in our field. Exosome therapies are much closer to clinical use.

Jacobsen: What are the responsibilities of plastic surgeons in educating patients about emerging regenerative technologies?

Korman: It is essential to be good doctors first and foremost. That is the best guiding principle. Hyping treatments that are not yet proven or not appropriate. At the same time, doctors need to be well-versed in what is available and emerging to offer patients the best advice and options. It might sound old-fashioned to say that surgeons must strive to be good doctors, but it is true. With exosomes, for example, many companies are making big claims. While the technology is real and promising, we must be cautious. Until the FDA approves exosomes for specific treatments, there are limits to what can responsibly be offered to patients. Doctors must stay educated and act responsibly with new technologies.

Jacobsen: More young patients are seeking facial procedures. What are the ethical lines in these procedures? We touched on that earlier when discussing the vanity versus necessity assessment.

Korman: Yes, yes. Well, the point is that it is a question of whether people want to look the same but refreshed and better or whether they want to look dramatically different. When people want to have their noses fixed, they may want to look different because they do not like what they see now. There have been many stories, movies, and articles about people who want to look dramatically different. Again, it is essential to be smart and to educate patients. Plastic surgeons can operate on ears but not on what is between the ears.

Jacobsen: You founded the Clean Slate Program to remove gang-related tattoos. What lessons can be drawn from aesthetic transformation and psychological healing?

Korman: That was an exciting project, and I am proud of it because I started it over 30 years ago. It follows the idea of “give a man a fish, and he eats for a day; teach a man to fish, and he eats for a lifetime.” The program is still active today, even though many participating doctors do not even know how it started — and that is okay.

At the time, and still today, many people could not get jobs because of tattoos, especially gang-related tattoos. That is how the program began. People make mistakes at any age, but many had extremely challenging childhoods. The program has been beneficial.

When I launched it, I insisted that if it was going to succeed, people needed to know about it. It was originally coordinated through the Mayor’s Office in San Jose. I believed you could not just do it quietly; it had to be prominent and well-known to reach the people who most needed it. Now, if you look up tattoo removal programs or “Clean Slate” online, you will find programs connected to the University of San Diego and elsewhere. It is interesting — because although some claim it started there, it did not. Still, that does not matter. I am very proud of it, even though it has long outgrown me.

The ethical takeaway is that it is about helping people — providing real, effacacious assistance that can change lives.

Jacobsen: How far has it spread outside of the mislabeling of where it originated? How many programs have developed from it?

Korman: All over the country — a lot. A lot. At the time, it was early days for lasers that were effective at removing tattoos without burning the skin. That is how it started: figuring out how to do it safely. Lasers are expensive, so part of the challenge was finding ways to get lasers donated by companies and similar initiatives. As technology improved, more and more people and programs started doing this kind of work.

Jacobsen: So, how does that work, in short, in terms of tattoo removal?

Korman: In a tattoo, ink is placed below the skin. The body is always trying to get rid of it — it recognizes the ink as a foreign material, which is why some tattoos fade over time and some look better. Professional tattoo artists are truly skilled, and that quality affects how tattoos appear over time.

Laser removal works by breaking up ink particles. Blast the ink into smaller fragments, and the body’s lymphatic system clears the debris over time. That is how the body gets rid of it.

We used to joke that if you performed a lymph node biopsy on someone who had multiple tattoo removals, you might find remnants like “Susie” or “Jimmy” — names with lines through them — embedded in the lymph nodes. But that is, in technical terms, how tattoos are removed.

Jacobsen: How should other medical professionals approach launching community-based aesthetic programs, particularly when considering long-term social impact?

Korman: First, the basic principle is “do no harm.” You need to make sure that what you are doing is truly beneficial to the people you want to help.

Then, it is critical to ensure you have all the necessary pieces in place: community support, a reliable funding source, and medical infrastructure to back the program. You do not want to launch a program that runs out of resources halfway through. Having political support from local leaders and organizations is also helpful, providing additional legitimacy and access to resources.

There are already many excellent programs — for example, initiatives supporting victims of domestic violence or children from underserved communities. Fortunately, health insurance coverage for children in the United States is relatively widespread, but programs like this can still make an enormous difference.

Jacobsen: What are common misconceptions prospective patients have when they come to you that come up during consultation?

Korman: A common misconception is that I want to operate on them. I want to do the right thing for each individual, but I do not want to operate on someone if it is inappropriate. Another misconception is that patients often think they already know the right solution. Many come in having done a lot of research online—what I sometimes call “Google University,” “InternetU,” or, today, even “ChatGPT” research.

Jacobsen: Wikipedia Polytechnic.

Korman: Yes. So, that is part of it — there are misconceptions. Sometimes, patients think that healing and recovery will take an extremely long time, but that is not necessarily the case. As a profession, we have worked hard to reduce recovery times significantly. That is one misconception.

Another common misconception is about how long the results of a procedure will last. Perhaps the biggest issue patients have is fear — fear of surgery, especially when it is elective and not medically necessary. It is a significant emotional hurdle.

I grew up in a small town where no one had plastic surgery at the time. But the point is, if something bothers you for many hours or days, it is worth exploring solutions—whether it is surgery, a new car, or something else meaningful to you.

I do this work because so many patients tell me afterward that it has improved their lives, and that is worth a lot.

Jacobsen: Final question: what are your favorite quotes? They can relate to fitness, music, sculpting, or plastic surgery.

Korman: These are my favurite quotes. I mentioned earlier the one about the ears — “Plastic surgeons can operate on ears, but not on what is between the ears.”

Another quote I like is that “you do not know what you do not know,” and then there are things “you do not even know you do not know.” That concept appeared in The Big Short, although it was misattributed to Mark Twain — it was not actually from him.

I have so many favorite quotes:

Plastic surgeons can operate on ears, not what’s between the ears.

You can be so open minded that your brains fall out.

You should guzzle water and sip wine, not the other way around.

Jacobsen: Thank you for your expertise and your time, Josh. It was nice to meet you.

Korman: Nice to meet you, too. Thanks a lot. Bye.

Links: 

Website: https://www.kormanmd.com/about/dr-korman/

Instagram: https://www.instagram.com/kormanplasticsurgery/

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