The latest American Society for Aesthetic Plastic Surgery statistics show surgical cosmetic procedures fell slightly from 2013 to 2014, but aesthetic physicians we talked with are bullish on cosmetic surgery’s popularity through 2016. The reality, they say, is that for patients to achieve desired long-term results, they often need cosmetic surgery.
Cosmetic surgery is evolving, they explain. Trending in 2016 is a combination approach — even a multidisciplinary approach — to surgery, using more than just one procedure to achieve desired patient results.
Cambridge, Mass.-based dermatologist Ranella Hirsch, M.D., says it’s really about being able to guide patients on the best ways to achieve their aesthetic goals.
“For some people, that is injectables,” Dr. Hirsch says. “For others, it is surgery plus soft tissue fillers or soft tissue fillers and laser treatments... and for others, it is all of the above. The best work that comes out of my office is with combination therapies. Often, we will team with our facial plastic surgery and plastic surgery colleagues, as well — always with the best outcomes as the goal.”
More than blending disciplines, today’s patients are benefiting from a blending of technologies, according to Boca Raton plastic surgeon Jason Pozner, M.D.
“For example, we add laser resurfacing to almost all our facelifts (fat grafting too),” Dr. Pozner says.
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The Pendulum Swings
Experienced cosmetic surgeons are always amending or improving their techniques, and the best surgical procedures are titratable, according to Boca Raton, Fla., oculoplastic surgeon Steven Fagien, M.D.
This doesn’t necessarily mean surgeons are using watered-down versions of the gold-standard techniques, according to Dr. Fagien. In fact, many surgeons are realizing the demand for minimally invasive and abbreviated procedures hasn’t resulted in better patient options or more satisfied patients, he says.
“Procedures are so over-simplified that the results are either not long lasting or it’s hard to tell if there has been any improvement,” Dr. Fagien says. “I think it’s a real problem. Blepharoplasty… is one example of that, where they’ve dummied down the procedure so much that it doesn’t accomplish what you need to fully rejuvenate the eyelids. The facelift is another with touted alternatives like the thread lift. There’s simply no way currently that a thread can do what (good) surgery can do.”
That’s not to say that surgery is the answer in every situation, he says.
“I think the pendulum has to swing somewhere in the middle,” Dr. Fagien says. “We’ve gone from aggressive surgical procedures back in the 1980s and ‘90s to now, swinging to completely minimally invasive procedures, which don’t always work that well or have any longevity or persistence, to where we have to come back in the middle.”
NEXT: A Middle Ground
A Middle Ground
Maybe the solution is somewhere in the middle. That seems to be the case with body sculpting, according to Beverly Hills, Calif., dermatologic surgeon Jason Emer, M.D.
Body shaping and etching for a fitter look is in high demand, Dr. Emer says.
Especially for men, he says, who want to look more athletic, and that requires a combination of approaches to etch and define the shoulders, abs, chest and calves.
“In the past, liposuction was just for fat removal. If you had a little bit of a flank, people would just suction it out and it would be improved, and patients would be happy,” Dr. Emer says. “Now people look at bodies, and they see the new athletic male. My patients are coming in, and we’re creating lines. We’re doing liposuction and suctioning around the shoulders and chest…. We’re suctioning around the abs to get the shape, and then using the fat to give them more size and definition in their chest, shoulders and calves. [In the end, patients want] a more chiseled, athletic look with defined muscles, sculpted contours and tight skin, as opposed to just fat reduction or mild improvement.”
Women, he says, are opting for more natural, athletic, but still feminine, appearances.
It’s also a growing trend to use fat transfer, which is more natural and safer than implants and other foreign substances, to augment and contour women’s bodies, according to Dr. Emer.
“The future of fat reduction is full body contouring, defining, sculpting and etching using surgical and non-surgical approaches in concert to get the best outcomes," Dr. Emer says. “It’s the same with patients coming in for their faces. They’re looking for wrinkle improvement, volume improvement, lifting — all at once.”
Dr. Emer often follows surgery with external radiofrequency skin tightening, lymphatic massage, hyperbaric oxygen and IV nutrient therapy to achieve optimal results, prevent complications and speed healing.
NEXT: Old School: Real Results
Old School: Real Results
Joe Niamtu, III, D.M.D., an oral and maxillofacial surgeon with a practice limited to cosmetic facial surgery in Richmond, Va., says his focus is on surgery, and he performs several facelifts and blepharoplasties a week, mixed with brow lifts. According to Dr. Niamtu, he uses old-school surgical approaches, including fully ablative techniques, full-coverage laser surgery, facial implants and more.
Patients, he says, often come to his office after spending lots of money on noninvasive procedures at other practices. And they’re disappointed or not satisfied with the results.
“I remain concerned about the over-promotion of results from nonsurgical treatments. Too many times, the patients bear the brunt of the failed treatment, both aesthetically and financially. ‘If it sounds too good to be true, it probably is,’ should be the mantra of both doctors and patients. New technologies that truly produce dramatic results will rise to the top, while others will continue to fall in the pile of other failed and overhyped treatments,” Dr. Niamtu says. “In the meantime, surgery continues to be predictable and the ultimate treatment for conditions of excess skin and fat. It is true that surgery does come with risk and recovery, but, for now, it remains the gold standard for facial rejuvenation.”
That said, Dr. Niamtu admits that there is a portion of his practice that demands nonsurgical treatments, which he offers to patients as long as he thinks there will be a noticeable result.
“After spending hours in the operating room huddled over with loupes and performing precision suturing, it is a welcome break to walk into a room and perform injections. I am not a ‘machine guy’ and really don’t offer a lot of those treatments,” he says.
Dr. Emer is a consultant/luminary and does clinical trials for Syneron/Candela, Venus, Thermi and Valeant.