Davis

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.