July 12, 2018
In a culture where trends have moved toward ultra-magical skin cremes with anti-aging properties, or diets loaded with the nutrients and healthy fats that make skin glow, how popular is facial plastic surgery compared to 20 years ago?
That is, the days of Joan Rivers or Cher relatively often surfacing looking just a tad different than they did the week before.
Here, Ryan Heffelfinger, director of the Division of Facial Plastic and Reconstructive Surgery at Jefferson University Hospital, explains how plastic surgery has changed since the '90s--and how a selfie generation is changing the demographic.
Is facial plastic surgery as common as it once was? Say, in the '90s?
Facial plastic surgery is much more common than it was in the 1990s for many reasons. Techniques and technology have improved. Surgery is no longer a hush-hush topic nowadays; the phrases “anti-aging,” and “you look good for your age” are taboo. The tables are turning on what it means to look and feel great, with a focus on health, vitality and empowerment. We are seeing more educated consumers who are focused on taking control of the aging process. This patient population is knowledgeable about hi-tech skincare and sun prevention and are starting with facial injectables before they turn 30. No matter the treatment, a natural-looking outcome is paramount for patients.
What is the most common plastic surgery on the face?
As it has been for the past decade, the most common non-surgical procedure is botulinum toxin injection. These are done to treat wrinkles of the upper face and forehead. This is a simple, office-based procedure that takes minutes to perform. The results last three to five months. The most common surgical procedures we perform at Jefferson Facial Plastic Surgery are rhinoplasties and facelifts. Rhinoplasty is performed to change the shape of the nose, facelifts to reverse sagging skin, fat, and muscle in the face.
Would a doctor consider an injection, like Botox, plastic surgery?
I commonly hear… “Why is it called plastic surgery?” This is a great question, especially when considering that modern procedures having nothing to do with the synthetic polymer that Americans know as plastic. The origin of the word "plastic" comes from the Greek “plastikos," which means to mold or shape something. In that sense, injecting Botox or fillers in the face indeed does change the shape or appearance of the face.
The terms plastic surgery and cosmetic surgery are often used interchangeably to describe the same thing. Strictly speaking, the term surgery suggests that the skin is being cut. I would not consider an injection a surgery. Therefore, botox or filler injections are more accurately referred to as minimally invasive cosmetic procedures.
• The most common procedure, still? The nose job.
• The ideal candidate for a facelift is someone who's younger and has elastic skin.
• Desire for a more flattering selfie is one reason doctors have patients come in.
• Plastic surgery has recently trended toward preserving features already there, rather than trying to do overhauls.
• In general, plastic surgery is safer than it's ever been, with shorter recovery times.
How does facial plastic surgery compare to other types? Are breast augmentations more popular than a facelift, for example?
This is a difficult question to answer, because there is no central database or required reporting of cosmetic procedures. A handful of plastic surgery societies survey their members, including the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), the world’s largest association of facial plastic surgeons. I reviewed survey results from four major plastic surgery groups. To briefly summarize, breast augmentation is the most common procedure reported by general plastic surgeons, while facial plastic surgeons tend to do more rhinoplasties and facelifts. The overall most common procedure appears to be the good-old nose job (rhinoplasty).
Are cosmetic plastic surgeries more or less expensive than they might've been 20 years ago?
There is a wide variety in what plastic surgeons charge. Price depends on geographic location, the experience of the surgeon, the rent and overhead of the office--you are paying for that Picasso in the waiting room--and a host of other factors. I believe that the ultra-expensive plastic surgeons prey on the consumers thinking that they can buy a perfect result. This is simply not true. That said, I think that if you look at inflation-adjusted costs, cosmetic surgery is probably more affordable than it was 20 years ago. Most patients that have facelifts in my practice are blue-collar people: teachers, politicians, stay-at-home moms, business owners. In fact, the average income for a facelift patient is less than six figures.
An exception to the affordability rule is that the newest technology often comes with premium price, and it is often not even proven to work. Remember the “vampire facelift," or “thread-lifts?" People paid a lot for them when they were the newest and greatest. That was certainly a waste of their money.
What are the advancements in plastic surgery on the face as of the last five to 10 years or so?
During the past 10 years, rhinoplasty surgery has trended toward using structural techniques that use cartilage to reconstruct shape, bolster anatomic components, expand the airway and establish appropriate aesthetic contour. This is in contrast to older techniques that relied on cartilage resection, created ski-slope noses, and left patients unable to breathe. Several new technological devices have evolved in recent years. At Jefferson, we have pioneered the ultrasonic bone aspirator to perform precise osteotomies and contouring of the nasal bones. Digital imaging has become an increasingly important element of rhinoplasty planning and has become an essential component of the preoperative consultation.
Advancements in facelift procedures have been largely driven by the demands and desires of patients. Twenty years ago, the surgeon who did the tightest facelift was considered the best. Not so today, as significant advances are helping surgeons achieve far more natural-looking results while minimizing scarring and downtime. That's even piquing the curiosity of younger patients who've experienced the limitations of nonsurgical tools—namely, their inability to transform the lower face and neck in a meaningful way. In fact, recent scientific studies have confirmed that younger patients with more elastic skin reap the benefits of better and longer results after a facelift.
A major trend in recent years is the combination of facelift operations with autologous fat transfer, which also addresses the volume loss that occurs with aging. Many surgeons will combine this with skin treatments, including laser resurfacing of the skin.
All surgeries come with risk, but are cosmetic surgeries generally safer than they've ever been?
I absolutely think that cosmetic surgery is safer than ever, as long as you choose your doctor and location wisely. Anesthesia in a certified environment by a board certified provider is absolutely safe. Additionally, with advanced techniques we are using at Jefferson, we see less nausea and faster recovery than we did even five years ago.
Fifteen years ago, a nose procedure could put someone in the hospital for two to three days. Today, it takes just a few hours.
Is there a procedure from the '90s that doesn't get performed anymore?
In general, aggressive procedures that drastically change the face are out, while preservation of anatomy and volume is in. A procedure that is definitely a thing of the past is the full-face carbon dioxide laser ablation that leaves the face a different color than the rest of the body. The recovery for this used to take up to six months, which patients just do not tolerate nowadays. The fractional lasers have taken over as the gold standard for skin resurfacing, which treats sun damage including dark spots, wrinkles and poor tone and texture of the skin.
In your experience, what are the motivating factors people have when they come in seeking plastic surgery on their face?
While every patient has different reasons for desiring plastic surgery, the following are some of the most typical:
• Genetics: Perhaps a patient inherited the genes for a crooked nose or abnormally large ears that have made him or her feel self-conscious for years. Plastic surgery can make these features blend in better.
• Anti-aging: Skin care creams and eating a healthy diet only keep the signs of aging away for so long. A plastic surgery procedure such as a facelift can smooth out wrinkles and neck skin sag.
• Sun damage: In previous generations, people didn’t know as much about how the sun damages skin as they do know. That means many people have problems such as age spots, sagging skin, and unwanted freckling. A facelift or chemical peel procedure are two common plastic surgery procedures to correct these problems.
• Scars: A scar on the face or another visible part of the body can have a devastating effect on self-esteem. This is true whether the scar is from acne, some type of assault or accident or as the result of surgery. Examples of possible plastic surgery fixes include dermal fillers, laser skin resurfacing and microdermabrasion.
• Career advancement: Some careers, particularly those in the performing arts or with constant public contact, require a more youthful and attractive appearance than others.
This would be a good place to mention the influence of the “selfie." These glamour shots are certainly here to stay and seem to be driving a lot of new plastic surgery inquiries—and even decision-making, for better or worse. In last year’s annual survey by the American Academy of Facial Plastic and Reconstructive Surgery, more than half of doctors saw patients who admitted to wanting to look better in selfies. But beyond just showing off a new facelift or rhinoplasty, it seems people are taking to the selfie on Instagram, Facebook and other social media forums to find a sense of solidarity. Prospective patients might surf for a flattering facelift that they’d like to replicate or to find other people who have undergone a procedure they’re considering.
Anything to add? Anything you think people should know?
The fountain of youth does not exist, so you need to decide how to age gracefully: the smart way or the uninformed way. A new study commissioned by the AAFPRS and conducted by Kelton Research shows that the majority of people look for an experienced, certified facial plastic surgeon over generalists when it comes to facial plastic surgery.