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The art and science of plastic surgery are evolving every day, and the last year was particularly progressive. We saw rises in groundbreaking procedures like non-surgical nose jobs and CoolSculpting. Yet, for all of that innovation, the most popular procedures are relative mainstays.

According to the American Society of Plastic Surgeons’ (ASPS) annual report on plastic surgery trends, 17.7 million surgical and minimally-invasive procedures (such as injectables) were performed in the United States in 2018, which is up two percent from the previous year. (Figures from 2019 aren’t yet available.)

Botulinum toxin type A injections—better known by their brand names Botox, Dysport, Xeomin, and, introduced last year, Jeuveau—took the top spot for minimally-invasive treatments. According to the ASPS report, 7.43 million botulinum toxin type A procedures were performed in 2018, which is up five percent from just two years earlier and 845 percent since 2000.

As popular as ever

While Botox is used mainly to treat wrinkles, its enduring popularity can be attributed at least in part to the growing variety of procedures it can be used for, such as the treatment of hyperhidrosis (excessive sweating) and migraines.

That said, this latest wave of popularity appears to have more to do with the decreasing taboos around injectables. More patients are trying botulinum toxin type A for the first time, including more male patients and patients at both ends of the age spectrum. I’ve written a lot here in recent months about “Baby Botox,” which is a treatment that uses smaller doses of botulinum toxin type A as more of a preventative measure in younger patients.

Don’t call it a comeback

Somewhat more surprisingly, breast implants were the number one plastic surgery procedure in 2018, up four percent from 2017 and seven percent from two years earlier, according to the ASPS.

Breast augmentation has been the most popular plastic surgery procedure since 2006 (by a fairly wide margin), and while it seemed inevitable that that momentum would start to wane, implant innovation and advances in surgical techniques appear to have given the procedure new life. Most love the look of breast implants but were afraid of them feeling foreign. However, that concern is dissipating as the implants feel more and more like breast tissue.

As widely performed as both of these procedures are, it’s still critical that you seek out a board-certified plastic surgeon with extensive experience specifically in the procedure. In untrained (and even undertrained) hands, bad outcomes are still a possibility.

Considering how quickly trends develop on social media these days, and influence the plastic surgery landscape in the process, it shouldn’t come as a surprise to hear that cultural forces shape plastic surgery trends. But for all the globalization that’s taken place since the advent of the internet, it turns out that local cultural factors have the most impact on the type of procedure you’re most likely to get.

Every year, the American Society of Plastic Surgeons (ASPS) publishes a report on plastic surgery trends for the past year. Aside from taking a deep dive into which surgeries are performed the most across the country, which injectables are on the rise, and the ways in which plastic surgery is increasing among men, it also explores how your zip code may contribute to your interest in a certain procedure.

More specifically, the ASPS looked at the most popular surgical and minimally invasive procedures and then broke those figures down by region.

Some interesting differences emerged. For instance, about 36% of all breast augmentations were done in the west. And a third of all male breast reductions were performed in the northeast.

Climate plays a role. “In the west, because the weather is better and people are a little more exposed, a lot of women are more aware of what their breasts look like in public,” said Debra Johnson, MD, a past-president of the ASPS. “Western women tend to steer themselves more towards procedures like breast implants, lifts, and reductions to keep themselves feeling comfortable.”

A region’s prevailing industries also appear to be a big influence. For example, looking younger may be more valued in an area like Greater Philadelphia, where there’s a higher percentage of a mobile, white-collar workforce, than it is, say, along the farm belt, where people are generally more inclined to stay at the same job for longer.

Wherever you find your inspiration, be sure to do your homework and find a board-certified plastic surgeon who’s experienced in the procedure you’re considering. 

I’m fond of saying that plastic surgery is equal parts medicine and imagination, that the best doctors among us possess both technical expertise and uncommon artistic ability. And while that idea is certainly not new, it’s taken on a fresh relevance as surgeons are using injectables in lots of innovative ways to sculpt the human face.

With a syringe of hyaluronic acid filler, we can plump lips, alter the shape of a nose, and carve a new jawline. By understanding how Sculptra can spur collagen growth, we can subtly restore lost volume. And with neurotoxins (like Botox and Jeuveau) and deoxycholic acid (Kybella), we can create negative space and streamline the silhouette.

Subtraction by addition

Nonsurgical rhinoplasty, or the “liquid nose job,” as it’s more widely known, is often held up as the most impressive example of shape-shifting with hyaluronic acid fillers. Augmenting the nose renders it bigger, not smaller. Yet, by creating a highlight down the center and a delicate point at the tip, the nose appears smaller and proportionate.

Lip augmentation is a similar illusion. It’s easy to think that more volume equals plump, pouty lips. But a much more natural-looking result requires a deft hand because it has more to do with subtly changing the structure, building the height of the top and bottom lips with hyaluronic acid filler and perhaps perking up the Cupid’s box with a strategically placed neurotoxin.

Each of these changes can be measured in millimeters. But take in the whole picture and you’ll see that the difference is in the details.

Subtle rarely means simple

Increasingly, certain fillers are also being used as a framework for the face. As we age, we lose fat in some prominent places. To help restore those contours, filler is placed more deeply under the skin, often right up against the bone. The technique has the effect of restoring the foundation without leaving the face looking overstuffed.

With experience, surgeons can now also enhance the highly individual variations of the face, judiciously placing robust hyaluronic acid gels or longer-lasting Radiesse at key points. By redefining angles and contours, rather than erasing them, as once was standard, the change is subtle, but undeniable.

Subtle is a term that features prominently in plastic surgery consultations these days. Few among us are looking for wholesale changes. We simply want to look like the best version of ourselves. But from a surgeon’s perspective, the smaller the alteration, the greater the degree of difficulty. Which is to say that we’ve arrived at this point not by chance but by evolution.

If the waiting room at your plastic surgeon’s office seemed especially busy last month, that wasn’t your imagination. The first week in January—and, really, the entire month—is thought to be the busiest time of the year for cosmetic treatments, according to a new article in Allure magazine.

There’s no overstating the strength of the January “makeover” mentality. Whether you’re hitting the gym on a more regular basis or addressing deepening fine lines, declaring it in the form of a New Year’s resolution makes it go down a little easier.

But practical reasons also played a role in the bump, the article says. “December often means travel, kids home from school, and encounters with friends and family you haven’t seen all year, or in other words, not the ideal time to book an appointment” with your plastic surgeon. With several weeks of winter still in front of us, now is also an ideal time for many to schedule procedures that tend to be more extensive and require lengthier recovery times.

If you’re interested in getting in on the action—no resolution required—these are some of the procedures that are in the most demand at the moment, according to Allure.

Peels, lasers, and facials

Chemical peels and most laser-resurfacing procedures require that patients stay out of the sun for a week or two after the treatment. That’s a lot to ask in the spring in summer. In the dead of winter, not so much. Each treatment, in its own way, treats fine lines, reduces the appearance of pores, enhances firmness and elasticity, and improves skin tone and texture.

Injectables

Anymore, there’s no time of year that isn’t a good fit for Botox or a filler, but they’re an especially safe play when the forecast looks like 50 shades of gray. Sure, the “New Year, New You” pressure is undeniable. But, at the end of the day, this is about doing something good for yourself. And if that something is able to remedy a long-running concern in a half-hour or less, all the better.

Body contouring

Not everyone starts working out in January, even though it may seem that way. If you’ve been faithfully exercising all the while but just haven’t seen the progress you expected, now may be the time to finally consider aggressive, alternative ways of combatting those stubborn fat pockets. CoolSculpting is an FDA-approved body-contouring treatment that freezes and kills fat cells in targeted areas, like the thighs, upper arms, and lower back. These cosmetic treatments take under an hour, and there’s no downtime.

What did you gift your significant other for Valentine’s Day: flowers, chocolates, a decadent dinner? How about plastic surgery?

A growing trend called “beauty matching” began to emerge a couple years back. It has two different interpretations. In the majority of instances, it refers to couples who book cosmetic procedures—fillers, Botox, CoolSculpting—together prior to a big event or simply to share the experience with each other.

When you think about it, beauty matching is not the stretch it may seem to be at first glance. Couples tend to be like-minded people who have similar priorities. Why wouldn’t that extend to how they go about improving their appearance?

Sometimes, a partner is inspired by the other’s rejuvenation and books their own version. As one person is learning about a given procedure, they’re likely also discussing it with their partner. A treatment then becomes a mutual exchange of ideas.

The other interpretation is more literal: couples who get procedures in tandem so that they can look like each other.

The benefits of beauty matching

Let’s be clear: Beauty matching needs to be a mutual decision to share the experience. Getting procedures with your partner is completely normal, even practical. Being able to offer your significant other emotional support during their recovery is a big advantage.

Having another perspective during the consultation is another plus. With so many ways to treat a given issue these days, having someone there who knows you so intimately can sometimes make it all that much easier to arrive at a decision.

So, beauty matching can be very rewarding and valuable. What it shouldn’t be is pressuring your partner, or feeling pressured, into something. Even if your partner really wants it for you, you want to do it for your own reasons.

It’s also not about getting procedures with the intent to look like each other.

How to go about it

As to what types of procedures can be matched, they’re typically aging procedures—couples are often relatively similar in age and tend to have common concerns about their appearance—but, technically, just about anything could be done together.

Generally, the procedures revolve around big life events—Botox before a wedding or liposuction before a milestone anniversary party—which is very often the case for individuals, too.

Regardless of the procedure, the key with beauty matching is communication. Before you schedule a consultation with a board-certified plastic surgeon, make sure that you and your partner are on the same page about what each of you wants from the experience. This is the rare instance in your relationship where compromise isn’t a solution.

In my previous post (part one of this two-part series), we started our deep dive into the tummy tuck by exploring a few basic points: what the surgery’s meant to accomplish, what it entails, and what the recovery’s like.

Here, we’ll get into how to determine if a tummy tuck is right for you and, in the process, compare it to a couple of other popular body-contouring procedures, liposuction and CoolSculpting.

Is it right for you?

Tummy tucks are most commonly performed on women in their 40s and 50s, after they’ve finished having children. The reason for that can be traced to the two differentiating factors of the surgery: the muscle repair and skin removal. (Getting pregnant after a tummy tuck will stretch out the rectus muscles and the skin, essentially undoing the entire process.)

If you’re someone who has concerns about excess fat around your midsection, but not muscle separation or loose skin, or if you’re planning on having children, doctors generally won’t recommend a tummy tuck. In those instances, liposuction or a non-invasive body-contouring procedure, like CoolSculpting, may be a more appropriate choice.

Identifying which procedure is right for you can be tricky; each fills a different role. To help with that decision, seek out a board-certified plastic surgeon who’s experienced in all three forms of body contouring and try to be as clear as you can be in communicating what bothers you about your body and what your expectations are for the procedure.

How it compares

As I mentioned in my last post, a big part of the reason the tummy tuck has increased in popularity in recent years is because comparable noninvasive procedures can’t yet achieve the same results.

CoolSculpting works by freezing fat cells to kill them off, which is effective for dealing with trouble spots that no amount of diet or exercise ever seems to affect—a noninvasive procedure can usually reduce superficial fat by 25%, on average. But it won’t do anything to address the loose skin or underlying muscle separation the tummy tuck targets.

Liposuction can remove significantly more fat than noninvasive body contouring, but that’s the extent of its capabilities. In other words, it won’t tighten loose muscles, nor will it remedy loose skin.

For those for whom a tummy tuck is the most appropriate treatment, it’s still considered to be, among plastic surgeons, the gold standard of body contouring when it comes to results. Aside from the reasons mentioned up to this point, a tummy tuck, unlike many noninvasive procedures, likely won’t need to be refreshed after a few years. The results are considered fairly long-lasting—and, very often, nothing short of dramatic.

Even with the increasing popularity of noninvasive plastic surgery procedures, invasive plastic surgery remains on the rise.

Part of the reason may be because injectables, effective as they are, don’t offer the same level of results as a traditional surgical procedure, like a tummy tuck, which is still very prevalent—more than 130,000 were done in 2018, an increase over the prior year, according to the American Society of Plastic Surgeons—despite the immense growth of body-contouring procedures like CoolSculpting.

So, we’ll be taking a deep dive into the tummy tuck over the next two blogs and breaking down everything you need to know about it, including whether a noninvasive option can give you the results you’re after.

What to expect

A tummy tuck, also known as abdominoplasty, serves two purposes: It removes excess skin and reduces the separation between the abdominal muscles. As a bonus, it also gets rid of excess fat (more on that later).

A tummy tuck, in fact, is the only way to get rid of loose, sagging skin that can result from significant weight loss or pregnancy. Our skin is very much like elastic, and once it gets stretched to a certain point, it’s never going to return to its original state.

As for the muscle separation, we’re all born with it, though it increases with age, certain lifestyle factors, and, certainly, pregnancy. Once these muscles spread, the only way to bring them back together is through surgery. A tummy tuck brings the muscle edges together, acting like an internal corset.

A surgeon will make an incision across your bikini line, and through that incision, remove skin and tighten your abdominal muscles. Once the muscles are stitched together, the surgeon will pull the skin tight and remove any excess. (Yes, your belly button will shift down in the process, but don’t worry about that. The surgeon will make a new hole for it.)

Before finishing, the surgeon will place drains in your stomach to remove any excess fluid that accumulates as you heal. They’ll be removed after about a week.

Mini vs. full

Both the extent of the surgery and the recovery will depend on the type of tummy tuck, a “mini” or a full. The main difference between the two is the length of the incision and, thus, the amount of skin that can be removed. A mini runs from inner thigh to inner thigh, while a full spans the stomach from hip to hip. Another difference: The surgeon usually only stitches up the lower half of the abdominal muscles in a mini.

You’ll be under anesthesia for two-and-a-half to four hours, but tummy tucks are technically outpatient procedures, so you’ll be able to go home after spending a couple hours in the recovery room. But once you get home, you’ll need to be patient with your recovery. It could be a few days before you feel comfortable sitting or standing fully upright.

Plan to take a couple weeks off from work. You should be back to your normal activities—which will now include ample posing in front of a mirror—within five weeks.

In a survey of 2,000 people about their New Year’s resolutions, these were the three most popular goals:

1. Diet or eat healthier (71%)

2. Exercise more (65%)

3. Lose weight (54%)

Body image clearly weighs heavily on the minds of a lot of us. While there’s no discounting the numerous positive effects of eating a nutritious diet and exercising regularly, it’s those first few steps that are potentially the most empowering.

As many as 60% of us admit to making New Year’s resolutions, yet only about 8% of us are successful in achieving them. In fact, right around now is when most are abandoning them. Which means that if you can find your way through this stretch, you’ll likely gain all the momentum you’ll need to enact some meaningful change in your life.

To that end, imagine how uplifting it would be know that you had a little extra support where you need it most. While you’re working up a sweat at the gym and eating more consciously, all the while something else is whittling down that stubborn pocket of fat around your thighs or bra strap that always manages to discourage you. And all you need to do to reap that benefit is spend an hour or so in a board-certified plastic surgeon’s office.

Why CoolSculpting is different

Body contouring is one of plastic surgery’s fastest-growing segments. For years, the only real solution for getting rid of excess fat was liposuction. Effective as it is, it’s surgery, which means there’s going to be some discomfort and a recovery period. By contrast, CoolSculpting, which quickly emerged as one of the most effective forms of the new generation of body-contouring technology, is noninvasive and it requires no downtime.

CoolSculpting employs a technique that was developed by scientists at Harvard where body fat is frozen through controlled cooling. Over the course of the 12 weeks after the treatment, the frozen (now dead) fat cells are shed naturally by the body, resulting in an up to 25% reduction of fat in the treated area.

It works because fat cells freeze at a higher temperature than other types of cells. Even more, once those fat cells are destroyed, they’re gone for good. So, if you do gain some weight down the road, it’ll distribute evenly and not just return to the places you targeted.

All you need is an hour

CoolSculpting has been used to help reduce body fat on the abdomen, flanks, upper back/bra area, upper arms, and inner and outer thighs.

The treatment takes about an hour, and it’s done right in the plastic surgeon’s office. The device will feel cold for the first few minutes after it’s activated. But after that, you shouldn’t feel much of anything. And once you leave the office, you’ll be able to get right back to your day. There’s no downtime at all.

You’ll likely begin to notice a difference after about a month. If your surgeon recommends a second treatment, you can schedule it as early as eight weeks after your initial treatment.

You know what’s 12 weeks away? Spring. Sunshine. Warmer weather. It’s also the point at which you can take a deep breath and tell yourself you made it. It’s no longer a New Year’s resolution. It’s your life now.