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If you’ve ever consulted a plastic surgeon about smoothing your fine lines with injectables, you were probably presented with one or two options—three, at most—because that was the number of FDA-approved neurotoxins on the market.

That changed this year with the approval of Jeuveau for the treatment of moderate to severe glabellar lines, or “frown lines,” as they’re more widely known. You may be thinking, What’s the big deal?

Well, Jeuveau, which is structurally similar to Botox, is the first new brand of neurotoxin to come to the US market in almost 10 years, and that’s pretty remarkable when you consider the demand for neurotoxin injections. In 2018, nearly 7.5 million Botox, Dysport, Xeomin injections were administered in the United States, according to the American Society of Plastic Surgeons (ASPS), making it the most popular minimally-invasive procedure at a time when interest in every kind of facial filler is exploding.

So, any new option is bound to generate lots of buzz.

Even more, the demographic that’s growing the fastest is the under-30 age bracket. Neurotoxin injectable procedures have increased 28% among 20- to 29-year-olds since 2010, according to the ASPS.

Evolus, the California-based company that manufactures Jeuveau, is responding to that budding demand by positioning itself as a self-described “performance beauty” company, rather than a traditional drug maker.

As a quick refresher on how injectable neurotoxins work, they smooth wrinkles by temporarily paralyzing the underlying facial muscles, which sounds much scarier than it actually is. The technical name for these formulas—which you may recognize from the endless stream of online, TV, and magazine ads—is botulinum toxin type A.

While Jeuveau is only approved, for the time being, to treat the appearance of frown lines in adults, it had a higher satisfaction rate than Botox in a recent head-to-head, blind trial.

Curious about what Jeuveau could do for you? Davis Cosmetic Surgery is the exclusive Jeuveau provider for the Delaware Valley, including South Jersey and Philadelphia. Schedule a consultation with board-certified plastic surgeon Dr. Steven Davis to find out whether you’re a candidate for the treatment.

Breast reduction surgery tends to be the most gratifying type of surgery a plastic surgeon performs, professionally and emotionally. It also consistently ranks high in patient satisfaction studies.

There’s an immediate sense of liberation for women who’ve felt like they’ve been held hostage by the size of their breasts. It’s limited their lives and kept them from doing a lot of the activities many other women enjoy.

Women who undergo breast reduction surgery are often seeking relief from physical symptoms caused by the excessive weight of large breasts, such as shoulder, neck, and back pain. They can also have permanent marks on their shoulders caused by their bra straps grinding into their skin day after day.

Those who’ve experienced dramatic weight loss are also candidates for the surgery. Having lost the volume in their chest, their breasts may be stretched out and sagging, which can result in chafing and rashes underneath.

So, what exactly does breast reduction surgery entail?

It’s an outpatient procedure that’s performed under general anesthesia, and it typically takes between three to five hours, depending on the breast size. During the surgery, excess breast tissue is removed to achieve the patient’s desired breast size. For many women, that’s between a C and a D cup.

Immediately following the surgery, the patient is dressed in a snug surgical bra to help support the breasts and take some of the weight off the incisions. It’s not essential to the healing process, but most women feel more comfortable with the extra support from the bra for the first two weeks after the surgery. After that point, the surgeon will recommend wearing a sports bra for another two to four weeks.

The surgeon may also recommend lifting the breast into a normal shape during the course of the surgery, since much of the breast tissue has been removed. Often, for patients with large breasts, the nipples point downward, or they’re below the breast fold. Which means the surgeon isn’t only removing excess skin and breast tissue, they’re also repositioning the nipples higher on the breast mount.

Breast reduction is considered a two-for-one surgery because it addresses both functional and aesthetic concerns.

Keep in mind, with all breast surgeries, slight asymmetry is generally accepted as the rule. While your breasts may look similar, they’re not exactly alike. After surgery, it’s common to sit there and stare, and that’s when subtle asymmetries can become apparent. But almost everyone naturally has some asymmetry.

And, what’s the recovery like?

Even with the compression bra, the swelling will take about four to six weeks to go down, and it’ll take three months for the final results to fully manifest. That said, while patients will need to avoid strenuous activity, including exercise, for a couple of months, most can get back to their normal life within a few days to a week or two.

And, perhaps most importantly, relief from the pain associated with the excess weight is almost immediate, even with the expected post-operative soreness.

Unlike most plastic surgery, breast reduction surgery, in whole or in part, is eligible for insurance coverage as long as certain criteria is met, like the presence of back or neck pain, shoulder-strap grooving, and the amount of breast tissue that’s going to be removed needs to be significant. So, seek out a board-certified plastic surgeon you’re not only comfortable with but who’s also willing to advocate on your behalf with your insurance provider.

Many of us become aware of our pores at some point during the waning years of our childhood, when we stumble upon our mothers’ makeup mirrors.

It can be a traumatizing sight after hardly giving your skin any thought up to that point in your life. Ever since, you understand, deep down, that they’re a part of you that no one else can see unless they’re standing an inch or two from your face, but some days, it’s much easier to imagine them as the little craters they appeared to be in that magnifying mirror.

Now comes the almost-too-good-to-be-true news that hyaluronic acid fillers could be used to drastically reduce the appearance of large pores.

The results are clear

The study that produced the viral headline was published in the Journal of Cosmetic Dermatology. Researchers at Capital Medical University in Beijing injected the faces of 42 patients with intradermal low molecular weight hyaluronic acid two to five times, leaving either a one or a one-and-a-half month timespan between each treatment.

In follow-ups, the researchers noticed a significant difference in the appearance of large pores from the injections. They weren’t the only ones. The participants did, too. Their satisfaction rate was an incredible 92.8%.

Too much of a good thing?

Collagen is the structural foundation for our skin. As such, it helps to hold our pores in place and maintain their shape. As we age, our bodies produce less collagen, which allows the pores to become more pronounced. (To be more specific, from age 20, the dermis layer of the skin produces 1% less collagen each year.) A number of external factors, like sun damage, only enhance that process.

Hyaluronic acid injections have been shown to lead to an increase in collagen production. As one prominent dermatologist said in response to the study, “If collagen is the frame of our mattress, then hyaluronic acid is the stuffing. Replacing lost volume with injected hyaluronic acid can also minimize the appearance of pores by re-inflating the skin, like re-stuffing the deflated cushion.”

It is worth noting that the amount of filler the researchers injected per treatment was a lot. And while the participants had few visible pores, injecting fillers at that amount and frequency could lead to an unnatural, overfilled look that no one wants.

In that vein, it’s always a good idea to consult a board-certified plastic surgeon who has extensive experience administering facial fillers and ask many questions beforehand so you know exactly what to expect.

In 2016, the first year that the American Society for Aesthetic Plastic Surgery tracked facial fat grafting, it ranked among the top 10 cosmetic surgical procedures performed that year. Why is it in such high demand? Let’s take a closer look.

What to expect

A fat transfer to the face, also known as a facial fat grafting, is probably a lot like how you’re imagining it. A very small amount of fat is removed, with a needle, from another site on the body, typically the abdomen or thighs. It’s then “cleaned” so that only whole, undamaged fat cells are used. Those cells are then injected into the targeted areas, most commonly the lips, the folds that extend from the nose to the corners of the mouth, the under-eye areas, and the cheeks.

It has the same rejuvenating effect as hyaluronic acid fillers, but it’s considered even safer because it’s using your own fat, which eliminates the risk of an allergic reaction.

And, just like with facial fillers, the downtime is minimal. You may experience some mild bruising and swelling following the procedure, but both should go away, for the most part, within a couple of days.

Fat grafting or facial fillers?

Know that there’s no wrong answer to that question. Both are effective means of adding volume to the face and reducing wrinkles. So, your decision will come down, mostly, to your personal preference.

If you’re primarily concerned with restoring fullness to your face, particularly around your eyes, cheeks, and jawline, fat grafting may be a more appropriate option for you because the resulting fullness tends to last longer than it does with facial fillers. Think years rather than months.

It’s believed that fat-grafting’s effectiveness is due to a stem-cell response within the skin, but that idea has yet to be proven.

If you’re more concerned with reducing and even temporarily eliminating wrinkles, facial fillers may be a better fit. They’re comprised of biocompatible substances, such as hyaluronic acid, poly-L-lactic acid, and calcium hydroxylapatite, which, when injected into the face, add volume, improve contouring, and fill in even the deepest wrinkles by stimulating collagen production.

How quickly the results become apparent depends on the filler. Some results are gradual, others are immediate. All fillers, though, are temporary. The effects generally last between a few months and a year. In turn, a treatment is typically less expensive than fat grafting.

A dangerous trend only seems to be gaining momentum: DIY injectables. Even though it’s illegal to sell hyaluronic acid fillers online, a growing number of consumers are ignoring the legal and physical risks, with many going so far as to inject themselves.

People buying facial fillers online and self-injecting is nothing new, but the growing availability of counterfeit fillers for purchase online coupled with social media tutorials that make it look easy to inject them yourself appears to be fueling interest.

Not all is what it seems

Almost as prevalent online are horror stories of the countless ways self-injection could go wrong when you lack the medical knowledge. A woman injects her lips with what she was told was Juvéderm—it arrived in a Juvéderm box, at least—only to later learn it was a counterfeit filler adulterated with silicone that she needed to have surgically removed.

A man consulted with a dermatologist after a filler he bought online and injected into his under-eye area looked lumpy and uneven. Even more, he also started having some sort of allergic reaction to it.

Another woman developed bumps on her lips from filler injected by a friend who offers such treatments out of her basement. An antidote was injected, but it wasn’t able to dissolve it, most likely because it was silicone.

If you think you need to scavenge through the recesses of the internet to find these products, you’re going to be surprised to hear that it’s so much easier than that. In fact, they’re becoming more prevalent on Amazon, even though Amazon maintains strict counterfeit policies. Amazon also prohibits the sale of dermal fillers. One search, however, yields plenty of hits.

A lot of these counterfeit injectables feature familiar brand names , like Juvéderm and Restylane. There are also no-name generic fillers, often listed simply as “hyaluronic acid filler,” which can be bought for under $100 on Amazon.

Some are legal products that have been stolen from unsuspecting licensed specialists’ offices, but the vast majority are believed to have been illegally re-imported from Asia and Eastern Europe.

Extraordinary dangers

One of the biggest risks of buying DIY Injectables online, counterfeit or legitimate but illegally available, is that you can never truly know what you’re getting. The packaging may look authentic but without the FDA’s stamp of approval, anything could be inside, including, but not limited to, adulterated ingredients, like silicone, and unsterile ingredients that can cause an allergic reaction or severe infection, which can lead to loss of tissue and scarring.

Even if the product is legitimate, injecting it on your own or having someone who’s unqualified do it for you carries incredible risk, including blindness and permanent disfigurement. As easy as those YouTube tutorials make it seem, injecting filler and Botox is very complex and requires intensive knowledge of the anatomy and physiology. Certified specialists train for years to learn how to inject effectively and safely.

While it may seem like a less-expensive way to get the change you’re after, the result of injecting yourself with a filler you’ve bought online can be life-changing and irreversible.

As many as 10 to 20 percent of women have inverted nipples—those that retract inward rather than protrude outward—according to one widely-accepted estimate, though there’s no way of knowing for sure.

It’s a congenital condition that usually occurs when breast tissue adheres tightly to the base of the nipple, enough to prevent it from sticking out. If you’ve had them from birth, inverted nipples are usually harmless, though they can complicate breastfeeding. If they developed later in life, it’s worth having them checked out. They can be a sign of a medical condition, like breast cancer.

Either way, if your inverted nipples are a constant source of insecurity for you, know that they can be de-inverted with plastic surgery. In fact, nipple procedures have risen sharply in popularity over the last few years, mostly as a result of a growing awareness that such a procedure exists. While more of them are being done than ever before, the increase isn’t necessarily disproportionate to a rise in plastic surgery in general.

As various before-and-after photos flood social media, it seems to be fostering a growing awareness of our bodies, which, in turn, is stirring a desire to improve our appearance, nipples included.

What to expect

As far as what the procedure entails, basically, the abnormally tight connections to the nipple are divided and the nipple is sewn onto itself. It’s a fairly straightforward surgery, though those with fairly large nipples may also need to undergo nipple procedures at a later time. Generally, it’s not recommended that the two procedures be done at the same time.

You should also be aware that your nipples may be more visible under your clothing—which is probably something you’re not used to dealing with.

A less invasive option

Sometimes a small fat graft or a filler, like Juvéderm Voluma or Radiesse, is injected under the nipple to help support the release and prevent the tissue from reattaching and contracting again. The injection procedure costs a fraction of the surgery, though the results are temporary, while the surgery’s are permanent.

Keep in mind, this injection procedure is different from the budding trend where hyaluronic acid fillers are being injected into nipples to increase their volume.

Use of injectable fillers is increasing year over year. And it’s not just the number of fillers that’s growing, but the number of places that patients are starting to request them, too: lips, ear lobes, hands, under eyes, pores, cellulite dimples, and, now, nipples.

For the most part, the industry has come out against nipple fillers. It’s not an FDA-approved use of hyaluronic acid fillers. Even more, it could increase the risk of nipple or breast infections and interfere with breastfeeding. All for a procedure that may be very painful and, best-case scenario, yield results that last only three to six months.

Before Anna Faris got breast implants more than a decade ago, at age 30, the actress needed to come to terms with her staunch stance against plastic surgery. To that point, she had been very public in her belief that it was an anti-feminist practice.

“I was always a negative-A cup, so when I was 30, I was getting a divorce, I had just finished House Bunny, and I’d sold another movie. All of these new things were happening to me, so I got my breasts done,” Faris, now 43, said in a recent cover story Women’s Health magazine. “I never, ever thought I’d do something like that. I always thought plastic surgery was caving in to ‘the man,” you know? But it came down to a really simple thing: I wanted to fill out a bikini. What would that feel like?”

Faris said she never had any regrets about her decision to go through with breast augmentation. But that doesn’t mean she’s not still surprised by her decision. “I kept thinking, Am I betraying my own gender by doing this?” she said. Faris knows now that she wasn’t. “I wish that we were more supportive of each other,” she said. “I think that people should be able to do whatever they want, whether it’s getting braces, bleaching their hair, getting extensions, getting a boob job, getting vaginal surgery, or getting a nose job.”

The decision

Breast augmentation has become the most popular cosmetic surgical procedure performed over the last decade, according to the American Society of Plastic Surgeons. In 2018 alone, nearly 314,000 procedures were done, a 4% increase over the previous year and a 48% increase over 2000.

Before the surgery, you’ll consult with a board-certified plastic surgeon. (It’s a good idea to schedule consultations with multiple surgeons. And be prepared to continue looking if you don’t feel completely comfortable with any of them.) At the consultation, you’ll describe the size and shape you’re going for, and the surgeon will make their recommendations pertaining to implant type, positioning of the implant in relation to the muscle, and incision location.

There are two types of implants to consider, saline and silicone. But even after you pick the type of implant, there’s still the shape and size to consider. There are actually 3 different shapes of silicone implants: smooth round, textured round, and textured anatomical teardrop. The round implants give breasts a fuller look, while smooth implants feel softer.

Perhaps the most critical piece of this process is good communication between you and your surgeon. The surgeon needs to fully understand your desires and expectations, while you need to commit to fulfilling your role as the patient.

The recovery

The surgery itself is typically done as an outpatient procedure and takes a little over an hour. A long-acting anesthetic is often administered. It’ll make you feel virtually pain-free for 72 hours. You’ll spend about an hour in post-operation recovery before being sent home. Once the anesthetic wears off, most patients describe feeling chest tightness or soreness, not pain.

And most can return to work in 3 to 5 days, though you’ll need to avoid heavy lifting and upper-body exercise for two weeks. Often, patients feel so good after a week, we need to slow them down so that their body can fully heal.

Even if you only occasionally glance at Instagram (Is that even possible?), you probably know who Megan Markle is. What you may not realize is how profound an impact she’s having on women’s appearances.

Ever since her marriage to Prince Harry two years ago, scores of women around the world have become increasingly obsessed with every little detail of her wardrobe, hair, and even her nose.

Plastic surgeons have been reporting that Megan Markle’s nose is now one of the most popular celebrity-inspired requests they get from their patients, dethroning reality TV royalty, Kim Kardashian and Kylie Jenner.

What is it, exactly, about Markle’s nose that’s earned it a place in the modern-day pantheon of idolized physical features? Ironically, it seems to be the fact that it’s hardly perfect. Pull up a profile photo of her. You should be able to notice a very slight hump on the bridge of her nose that’s almost undetectable when you’re looking at her straight on.

It’s not just her nose. Patients are also asking for her prominent cheekbones and beautifully-contoured jawline.

This isn’t the first time the royals have influenced plastic surgery trends. As recently as 2011, there was a flood of interest in butt lifts after Pippa’s rear—a smaller, more athletic version of the Kardashian butt—famously stole the show at Kate Middleton and Prince William’s wedding.

The interest in Megan Markle’s nose / features appears to be following a larger trend, where both men and women are seeking out procedures that simply enhance, rather than transform, their own natural features. Many a beauty writer has noted that what makes Markle’s features so covetable is their approachability.

As she continues to champion a number of causes, including female empowerment, gender equality, animal rights, and the arts, that sentiment’s only likely to grow.

Plastic surgery’s most-requested celebrity features

Curious about what other famous faces (and assorted body parts) are in high demand? RealSelf, the online cosmetic treatment marketplace, recently released its data on the subject, collected from thousands of plastic surgeons. Here are some highlights, along with the procedures they’ve popularized:

• Kim Kardashian’s butt

Procedure: Brazilian butt lift

• Beyonce’s butt
• Jennifer Lawrence’s nose

Procedure: Rhinoplasty

• Kate Middleton’s nose and smile

Procedures: Rhinoplasty, braces/dental implants

• Madonna’s complexion

Procedure: Fillers (face and hands)