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Only 10 years ago, much of cosmetic surgery seemed to be about aspiring to look like a supermodel on a magazine cover (their most famous features, at least) or turning back the hands of time in equally dramatic fashion.

The prevailing interest today is in much subtler results. People tend to want to look more like their own filtered photos, and it’s changing plastic surgery and cosmetic procedures in a number of meaningful ways.

For one, subtlety is ruling the day. The goal of most procedures now is that the results not be obvious. Increasingly, patients generally want to leave their inherent face structure intact, complete with their unique family traits, and look, well, more like themselves, but maybe with a few strategic tweaks.

They could take the form of fat-grafting for contouring and fine-tuning, rather than just plumping, or even breast augmentation, but with smaller, more naturally shaped or positioned implants.

They could also include the unorthodox use of filler to resolve slight but irritating facial and body quirks, like to tighten a stretched piercing in an earlobe or on the bridge of the nose during a noninvasive rhinoplasty (also known as a “liquid rhinoplasty”).

Body contouring

Noninvasive fat-reduction procedures, like CoolSculpting, are very much a part of this movement, too. What’s so subtle about shedding fat? These procedures are not intended (nor are they approved to be) weight-loss treatments. But they’ve proven to be very effective for people who are within 10 pounds of their goal weight.

And in the case of CoolSculpting, all it entails is sitting comfortably in a plastic surgeon’s office for a couple of sessions that typically take less than an hour each. Then it takes about three months for the frozen cells to die and be eliminated naturally by the body. And once those cells are gone, new cells aren’t able to take their place, which makes CoolSculpting a fairly permanent solution.

Preventative cosmetic treatments

Larger numbers of patients are also undergoing cosmetic treatments at a younger age as a preventative measure. In a recent survey by the American Academy of Facial Plastic and Reconstructive Surgery, 72% of its members reported an increase in cosmetic surgery or injectables in patients under 30.

While starting at such a young age may seem a little extreme, it is a sensible way to prevent invasive procedures in the long run. Keep in mind, too, that, yes, much of the interest described here is patient-driven. The stigma’s fallen away from plastic surgery, and it’s helped make a lot more people comfortable with the idea of seeking out a minimally-invasive procedure or two.

But the other part of that is that the science has advanced by leaps and bounds over recent years, making such tweaks possible. Little to no downtime, once the exception, is increasingly becoming the standard.

Much has been said—within this blog and elsewhere—about the rise of plastic surgery against the backdrop of new nonsurgical procedures that promise quick results and little to no downtime. As plastic surgery prioritized discretion, the stigma faded and the lunchtime procedure became part of the mainstream vocabulary.

While the noninvasive landscape evolved over the years, that lunch-hour jaunt to the plastic surgeon’s office became even more productive: dark under-eye circles were erased with facial fillers, radiance was restored with gentle fractional lasers, and bulges were frozen away with CoolSculpting.

A strange thing was happening all the while, however: The traditional facelift was experiencing a resurgence. Over 28% more people got facelifts in 2015 than in 1997, five years before the introduction of Botox, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Turns out, that was just the tip of the iceberg.

Is this really about time management?

The emergence of Botox and the other quick shots and no-downtime lasers was thought to spell the beginning of the end for the more invasive plastic surgery. But it seems to have had the reverse effect. Nonsurgical procedures have become an easier access point, allowing a lot of people who were curious to begin with to wade into plastic surgery through the shallow end.

As a result, interest is spiking in all kinds of plastic surgery, according to the ASAPS. In the case of the facelift, it helps that it’s undergone its own makeover in recent years. A rash of advances is enabling surgeons to achieve more natural-looking results while minimizing scarring and downtime.

But the larger trend is being attributed to an appreciable shift, with more and more people seeking long-lasting or permanent procedures, especially millennials. They’re forgoing nonsurgical means and instead investing in mini-face- and necklifts, their thinking being that it’s an easier commitment than returning to their surgeons’ offices every six months.

Pulling back the curtain on the facelift

As interest in the facelift continues to increase, those inquiring about it are getting younger. Some start as early as their thirties, but it’s generally smarter to wait until your forties, because the surgery’s less extensive than it is at later ages and the results can be easily—and beautifully—maintained with injectables. Not to mention the simple fact that younger bodies heal faster.

Whether this youth movement is responsible for the destigmatization of plastic surgery, or they’re just jumping on board because of it, this much is clear: The occasional nip-tuck is no longer taboo. Behind-the-scenes videos demystifying the surgical process and the unfiltered testimonials on social media have effectively made the process a whole lot less frightening.

With the recent explosion of noninvasive cosmetic treatments, it shouldn’t come as a surprise that demand for noninvasive fat-reduction procedures has become insatiable. Already, there are a dozen noninvasive body-contouring procedures employing several different technologies on the market, and even more are set to launch later this year and in 2020.

One industry analyst projects that noninvasive and minimally-invasive fat reduction procedures will be a $1.1 billion industry by 2022, as patients, increasingly, are prioritizing in-office treatments with minimal downtime over surgical solutions.

While all of this may make non- and minimally-invasive fat-reduction procedures sound like a modern holy grail, the truth is, not all treatments are made equal and not all procedures are right for every issue. With all this sudden interest and growth, body contouring has become an umbrella term for some very different kinds of treatments, including skin tightening, fat reduction, muscle tightening, and cellulite treatments.

Some treatments work for tough-to-reach body parts better than others, while others are more effective for targeted areas. Most treatments also take a couple of months for the results to fully materialize. Taking that under consideration, along with the technology’s rapid evolution, it’s difficult to point to one as the best treatment. But there are a couple that are more effective than the others.

Freezing fat away forever

CoolSculpting was one of the first noninvasive, fat-eliminating treatments to hit the market. The FDA-approved device uses controlled cooling to permanently freeze fat cells that are resistant to diet and exercise in areas like the inner thighs, upper arms, and stomach.

It takes about three months for the frozen cells to die and be eliminated naturally by the body, so a little patience is necessary. But once those cells are gone, new cells aren’t able to take their place, which makes CoolSculpting a fairly permanent solution.

Don’t forget about lipo

For all the leaps in technology, liposuction still reigns supreme when it comes to medical intervention for fat elimination. The same way that the rise of facial fillers has brought the facelift out of the shadows, the growth of non- and minimally-invasive body-contouring procedures has renewed interest in liposuction. And that’s because the former is intended as refinement for those within 10 pounds of their goal weight, not as a weight-loss method.

But liposuction’s done a lot of evolving itself, with improved techniques to reduce bruising and swelling, minimize scarring, and shorten recovery times. It’s not uncommon today for a patient to have liposuction on a specific area, like their thighs, and be back at work the next day. It’s also not a stretch to call liposuction the ultimate minimally-invasive fat reduction procedure.

The best way to find out which body-contouring procedure is the right fit for you is to consult with a board-certified plastic surgeon who can advise you based on a variety of physical and lifestyle factors.

In my last blog post, I discussed a few things you’ll want to consider when trying to figure out whether facial fillers are a good fit for you, including the various roles that the different fillers play and why your bestie’s favorite filler may not be the right choice for you.

Here, I’ll breakdown a few more considerations to round out our facial fillers guide.

Lip augmentation is an individualized treatment

We have the Kardashians to thank for the explosion of interest in lip augmentations. And while they’ve become the ideal for so many women, the truth is, everyone’s lips age a little differently once they hit 30. Consequently, there’s no one-size-fits-all approach to achieving Kim’s luscious lips.

Hyaluronic acid (HA) fillers are the only kind used in the lips because they integrate well. But, from there, the treatment depends on you and your plastic surgeon. Soft, flexible HA fillers are a somewhat conservative approach, but they provide an appreciable volume boost without leaving the lips looking stiff or overdone.

For those interested in simply making their lips look a little more, well, pouty, the injection technique and placement matter as much as the filler. Even a tiny drop placed on the Cupid’s bow can have a meaningful effect.

Facial Fillers are full of possibility

When you think facial fillers, lips and wrinkles probably come rushing to mind. But they’re capable of so much more, like: elevating sunken scars, brightening hollowed-out under-eyes, and sharpening jawlines. They can also add more substance to bony hands.

More structural fillers, like Radiesse, Juvéderm Ultra, Restylane Lyft, are typically used in the hands and jawline. While a more fluid HA filler can lift the skin up and away from the underlying blood vessels, alleviating discoloration and hollowing under the eyes.

The acrylic-based Bellafill is the only filler technically approved by the FDA for treating acne scars, but plastic surgeons generally prefer to use reversible HA fillers instead because the injection placement can be tricky.

That said, facial fillers, on their own, aren’t miracle workers. They can help lift sagging skin to a degree, but a filler’s not going to have the same effect as a facelift. They’re also not going to be able to make deeply etched lines disappear. That’ll require a combination of procedures that may include filler, Botox, and laser resurfacing.

A tweak can make a big difference

It’s also a misconception that you need to be plagued by a specific problem before you can consider facial fillers. Just wanting to look a little different is enough. A plastic surgeon can refresh your look by placing tiny drops of filler in a few strategic locations. Allow your doctor to suggest a tweak that you never considered.

Injecting the temples is a great example. Almost no one asks for it, but it’s almost universally loved once it’s done.

The foundation of the “Mommy Makeover” is a combination of a tummy tuck and breast surgery. But within that framework, there are lots of variations: the mini-tuck, full tuck, skin-only tuck (lax, stretch-marked skin is cut away, but the abdominal muscles are not repaired); and for breasts, there’s the lift, reduction, augmentation, or a hybrid therein.

A flood of interest, coupled with advances in plastic surgery techniques, has broadened the definition even further to include liposuction, fat and filler injections, and vaginal rejuvenation.

The fact that many new moms are millennials is believed to be one of the main driving forces behind the mommy makeover’s recent surge in popularity—and the larger de-stigmatization of plastic surgery. They tend to be more accepting of it than any other generation. According to RealSelf, an online plastic surgery library of sorts, the primary demographic researching mommy makeovers is 25- to 34-year-olds.

Millennials are also likely to be more open about their treatments, whether that means discussing them among friends or posting photos of themselves throughout the process on their social media feeds. Surgeons, too, have begun to pull back the curtain a bit, discretely posting procedures-in-progress and before-and-after photos with savvy hashtags. Together, they’ve helped popularize and demystify the various elements of the mommy makeover.

Mommy Makeover; Less discomfort

It’s not all a result of good timing and better promotion, though. Recent surgical advances are playing a big part as well by enhancing the safety of the operations and minimizing the recovery.

One of the most meaningful innovations is the use of long-acting numbing agents, which are injected into the surgical site and block much of the pain for up to three days following the procedure. Less discomfort during the recovery means less reliance on opioids and fewer side effects from those drugs. It also gets patients on their feet faster, which shrinks the risk of blood clots.

Surgical drains have long been a standard feature of tummy tucks. When the procedure’s done, there’s a large space that needs to be collapsed, and the tissue has to grow together. Drains help fluid from pooling and slowing this process. But they can be quite intrusive.

However, a new technique is increasingly making drains unnecessary. By using progressive tension sutures, which are special internal sutures that reduce potential fluid build-up, or incorporating tissue glues and compression garments, plastic surgeons are able to provide drain-free tummy tucks.

Alternative approaches

Plastic surgeons are also exploring new ways to tweak the protocol, including performing non-invasive fat-reduction treatments, like CoolSculpting, in the months leading up to the mommy makeover. That eliminates the need for liposuction, a more invasive procedure, at the time of the surgery, which shortens the operating time and the healing time.

The mommy makeover is becoming more comprehensive—and, perhaps, more attractive—because the surgery and recovery are becoming more efficient and less demanding.

Facial fillers have become the driving force in plastic surgery’s most recent popularity surge. Hyaluronic acid (HA) fillers, like Restylane and Juvéderm; neurotoxins, like Botox and Jeuveau (newtox); and fat-melting Kybella have worked their way into the mainstream vocabulary and changed the face of cosmetic surgery, angling it more toward minimally-invasive procedures that yield natural-looking results.

And practitioners of all kinds—with varying degrees of training and experience—are capitalizing on the demand. As breezy as our attitude’s become about filler injections, the ability of the injector still matters.

Facial fillers are generally very safe and effective when injected by a board-certified plastic surgeon who has an intimate knowledge of the human anatomy. But that’s really just our starting point. Before you dip a toe in the rejuvenating waters of facial fillers, there are a few other things you should know.

What’s in a name?

While the term facial fillers is thrown around pretty nonchalantly by beauty sites, it’s actually an umbrella term that encompasses a nuanced range of injectables. For starters, the majority are made of HA, a safe sugar found naturally in the human body, while a few are made from other materials.

Radiesse contains the mineral calcium hydroxyapatite, which is found in our bones and teeth. Sculptra uses poly-L-lactic acid, the same biodegradable component that’s used in absorbable stitches. Bellafill suspends non-biodegradable acrylic beads in cow-derived collagen and is far longer lasting—it’s considered safe and effective for up to five years—than most other facial fillers.

HA fillers act kind of like place holders, substituting for depleted collagen and fat. But these others are known as biostimulatory fillers. Basically, their primary purpose is to spark the growth of your own collagen for longer-lasting fullness and lift. (HAs have also been shown to increase collagen and elastin production over time, but to a lesser extent.)

And even within the HA fillers, there’s a lot of diversity. The gels vary by density, viscosity (or flow), elasticity, lift-ability (or stiffness), and longevity. These traits determine their roles. Robust fillers like Restylane Lyft and Juvéderm Voluma can help restore volume and projection to the cheeks while lifting the lower face. While lighter HAs, like Juvéderm Voluma, are a more appropriate fit for the small lines that can appear across the upper lip.

Depending on the formula, some will break down faster or swell up more. These are all things that will factor into your plastic surgeon’s consideration when selecting the right filler for you and your features.

Facial fillers aren’t blanket treatments

Chances are, you were turned on to facial fillers by a post about a celebrity or maybe even a close friend who was more than happy to brag about her treatment. While there’s no harm in that, of course, it’s important that you enter your consultation with a plastic surgeon with an open mind.

Facial fillers really are an individualized treatment. Your friend may look great with Juvéderm Volbella in her lips, but it’s not a given that it’s appropriate for your needs, goals, and anatomy, too.

Not to mention, plastic surgery is as much an art as it is a science. In other words, you could consult with a handful of doctors, and each one would likely suggest a different solution—because there’s always more than one. Choose a plastic surgeon based on their education, experience, and aesthetic. And then trust in their ability.

Botox treatments (and the like) were the most popular cosmetic procedure performed in 2018. But that’s been a recurring headline for the last few years. The nearly 7.5 million treatments represented a 3% jump over 2017 and an astounding 845% increase since 2000, according to the American Society of Plastic Surgeons.

Plastic surgery has become far less stigmatized over that span, and minimally-invasive procedures, like Botox injections, have grown the most dramatically as a result of the accessibility and interest that followed. Today, Botox is not only an effective means to minimize the early signs of aging, it’s also become popular as a preventative measure.

When should I start Botox treatments? It’s not unusual for a plastic surgeon to suggest the mid-twenties. We develop wrinkles because, as skin loses its elasticity with age, it can’t effectively bounce back from the countless facial expressions we make every day. Botox relaxes the facial muscles and prevents them from constricting and wrinkling the overlying skin.

Say you furrow your brow when you read from a screen. We’re essentially retraining your face to no longer do that and, in turn, lowering the chances that you’ll develop those dreaded wrinkles between your eyebrows. So, the earlier you begin getting Botox, the better, in most cases.

But I prefer to gauge a starting point by need rather than age because there are a couple more pressing factors that need to be considered, including the amount of sun you’ve been exposed to over your lifetime and your skin tone.

Caucasian women who’ve protected themselves fairly well can usually hold off until 35 or 40. For women with darker skin tones, it’s more like 40 or 45.

The benefit of a little wiggle room

The next natural question is, how far apart should you space your follow-up botox treatments?

The effects of Botox generally begin to wear off after three or four months, but that can vary from person to person. And, ideally, you don’t want to wait until the effects have completely worn off, around six months. What that really means is that the targeted muscle has regained its strength.

You’ll have a better long-term result if you schedule your follow-ups before you reach that point, because Botox has a cumulative effect. With each round of injections, the targeted muscle becomes progressively weaker and eventually atrophies. As that happens, it’ll also allow you to space your treatments a little further apart each time.

Consistency is what matters most

Another reason not to set your Google calendar reminder for three-month intervals is that there are a few other variables at play, too. For one, if you’re very physically active, you may need to schedule your follow-ups a bit sooner.

Also, some muscles, like the one behind those dueling wrinkles between your eyebrows, are stronger than others. So they’re going to require more frequent treatments. So, too, will wrinkles that are relatively fully formed.

Whatever schedule you settle on with your plastic surgeon, commit to it. Much as you may like the initial results of a Botox treatment, they’ll get even better over time—as long as you remain attentive to your follow-ups.

Textured breast implants made by Allergan that have been linked to a rare cancer are being recalled in the United States by the Food and Drug Administration (FDA).

According to The New York Times, 573 cases and 33 deaths from the cancer have been reported worldwide, with 481 of the cases clearly attributed to the Allergan Biocell implants. Of the 33 deaths, the FDA said the type of implant was known in 13 cases, and in 12 of those the maker was Allergan.

While the Allergan breast implant recall is newsworthy, the cancer is rare, considering that millions of women have breast implants. Breast augmentation is perennially the most popular cosmetic surgery performed in the United States. In 2018, more than 313,000 procedures were performed, a 4% increase over 2017, according to the American Society of Plastic Surgeons.

The anaplastic large-cell lymphoma is a rare cancer of the immune system. It is usually found within the fibrous scar capsule near the implant or in the fluid surrounding the implant, according to the FDA. It is not in the breast tissue itself, and it is not breast cancer. Researchers have not been able to explain the link between the Allergan Biocell implants and the rare cancer, according to The New York Times.

However, in most cases, removing the implant and the scar tissue around it cures the cancer. But if it is not detected early, it can spread.

Do I need to do anything?

The main symptoms of the lymphoma are usually swelling and fluid accumulation around the implant. There may also be some tenderness, which shouldn’t be confused for post-surgery soreness. The latter is normal.

If you’re experiencing any of these symptoms, see your plastic surgeon. If that’s not practical, consult another plastic surgeon near you. Either way, your doctor will likely recommend an ultrasound or MRI.

If you have Allergan Biocell implants, but no symptoms, you don’t need to have them removed, the FDA says. The recall means that doctors and hospitals should not implant any more of them and should return any in their inventory to Allergan.

Allergan Biocell Implants? What if I don’t know which kind of implants I have?

The contents of the implant, silicone or saline, are not a factor in the lymphoma, the FDA says. The shell, which can be either smooth or textured, is the key. Textured implants, which have a slightly roughened surface that adheres to breast tissue and helps hold the implant in place, have been singled out as the cause.

It’s important to note, however, that the recall only affects the Allergan Biocell textured implants, not all textured implants. The Allergan Biocell implants carry a risk that is about six times that of other textured implants sold in the United States, according to the FDA. Allergan’s textured implants account for only about 5% of the implants used in the United States, according to The New York Times.

If you’re not sure what kind of implants you have, consult your plastic surgeon. Again, if that’s not practical, see a plastic surgeon near you. Even if they can’t tell you the type, they’ll conduct a physical exam to see if you’re having any issues with your implants.