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Cosmetic surgery year in review: What's next?

Article-Cosmetic surgery year in review: What's next?

Looking back on 2014, plastic and cosmetic surgeons report buttock augmentation and neck rejuvenation were among the “hottest” procedures. It was also a year the industry saw some highly promoted fat and skin tightening devices lose their sizzle. What's in store for 2015? From a predicted uptick in procedures for men to natural and noninvasive solutions, this is what your peers have to say.

Bottoms Up!

Dr. SingerWomen’s growing desires for butt augmentation stem from a global influence, says plastic surgeon Robert Singer, M.D., of La Jolla, Calif.

“We’re seeing some of the trends that existed in South America and, because of multiculturalism, we’re seeing an increase of patients who want to do something in their buttock areas,” says Dr. Singer, former president of the American Society for Aesthetic Plastic Surgery (ASAPS). “The Brazilian butt lift with fat injections is a procedure that significantly increased.”

Dr. Singer says the procedure is especially attractive to people in states such as California and Florida, where women tend to spend a lot of time outdoors, in skimpy clothing, and where the Latin influence is high. But the increased popularity is by no means limited to the sunny states. Buttock augmentation went from a b-list cosmetic procedure to one with the most significant increase in the ASAPS 2013 statistics. In 2013, 11,527 buttock augmentations were performed — a 58 percent increase from 2012.

The boost in buttock augmentation’s popularity has come with well-publicized disasters in Asia, Central and South Americas and here, in the U.S., no thanks to inexperienced and untrained providers using inappropriate materials, including illegal or excess filler. Most U.S. plastic surgeons prefer to do the procedure using fat injections, according to Dr. Singer.

More Mommy Makeovers

Mommy makeovers mean different things to different patients and surgeons. But the basic goal is the same and restoring the pre-pregnancy body to its post-pregnancy state is a popular one, according to Dr. Singer.

The plastic surgeon says the media has driven a greater awareness about cosmetic options for new moms who fret about what pregnancy has done to their bodies. Mommy makeovers usually include a tummy tuck to tighten the overstretched and uncooperative muscles, breast work and might also include liposuction in select areas, he says.

Dr. SchlessingerAlong the lines of a mommy makeover, dermatologist and cosmetic surgeon Joel Schlessinger, M.D., who practices in Omaha, Neb., says he is doing more of the UltraShape (Syneron-Candela).

A past president of the American Society of Cosmetic Dermatology, Dr. Schlessinger tells Cosmetic Surgery Times that he loves that he can do fat reduction on an entire abdomen in one 45-minute session. Other perks: there are fewer consumables and the procedure isn’t painful.

Neck and Neck

Popularity is soaring for fat removal in the neck and jowl areas. That’s why New York City plastic surgeon Sharon Giese, M.D., focuses on those areas of the face in her signature Natural Lift by Dr. Sharon.

Dr. Giese“The core part of that [procedure] is internal ultrasound to the jowls and neck fat, then removing the neck fat,” Dr. Giese says.

In Pursuit of Youthful Lips

Lip enhancement has always been popular among aging patients, Dr. Singer says. What’s changing is patients are more likely to describe what they don’t want. They don’t want the unnatural lip augmentations they’re seeing in celebrity magazines and reality shows, he says.

To achieve a more natural, youthful lip, Dr. Singer uses either fat or fillers, like Restylane (Galderma) or Juvéderm (Allergan). In both cases, the key is to use the fat or filler judiciously.

Volume: Lost and Found

Consumers are more aware that volume loss associated with aging is a problem. As a result, more patients want to enhance their facial features with volume, according to Dr. Singer.

Dr. Singer says he uses fat or a combination of fillers to address facial volume loss. The key is not to overdo the filling.  

“… one of the more popular new treatments is Voluma (Juvéderm) for the cheek areas,” Dr. Singer says.

Dr. WoodwardJulie Woodward, M.D., associate professor of ophthalmology and dermatology at Duke Medical Center, tells Cosmetic Surgery Times that the combined use of structural fillers with higher viscosity, including Voluma, Radiesse and Perlane, for mid-face rejuvenation has been a top pick among her patients around Durham, N.C.

“Using this in combination with subcision with cannulas has excellent results. This use of … cannulas to subcise the zygomatic cutaneous ligament, as well as perioral muscle insertions, is working very well in my practice,” according to Dr. Woodward.

Fat Grafting for Breasts

Along the lines of building volume, Dr. Giese says 2014 brought an upswing in fat grafting for the breasts.

“I think results show that fat grafting can help with shape,” she says. “I like to do it when I’m doing the breast lift, if the woman wants just a little more fullness in the medial quadrant of the breast.”

More Payment Options

Having another competitor in patient financing helped fuel business in 2014, according to Dr. Schlessinger.

“We carry Alphaeon Credit now, instead of just Care Credit. [We] have seen many situations where folks were turned down with Care Credit, but Alphaeon worked for them,” says Dr. Schlessinger. “Additionally, the terms are a bit kinder and gentler to the patients if they miss a payment or two.”  

Moving Beyond the Hype

Some areas that are losing their luster among patients and their surgeons include nonsurgical approaches for removing fat, treating cellulite and tightening skin, according to Dr. Singer.

“There are always things that are hyped as new and best that fall by the wayside because they prove not to be efficacious, are not better than what’s out there or, even worse, have a greater complication rate,” he says.

Dr. Giese finds results from noninvasive fat melting questionable.

“I think people are excited about noninvasive fat melting, but it doesn’t achieve the same results as liposuction,” Dr. Giese says.

According to Dr. Schlessinger his practice saw a significant decrease in Zeltiq in 2014. The competition with medspas made offering Coolsculpting fruitless.

Some of the same goes for nonsurgical skin tightening and nonsurgical replacements for facelifts, according to Dr. Singer.

“Nothing lives up to the facelift,” Dr. Singer says.

Cosmetic surgeons might get some improvement with nonsurgical treatments claiming to lift and tighten, but the results often fall short of the hype and patients’ expectations, according to Dr. Singer.

Dr. Giese says she has been part of an anti-technology trend. Dr. Giese has been using “old-school” microneedling for wrinkles, acne scars, lip lines and crows’ feet.

“That has become increasingly popular because I think some people are getting away from some of the lasers for the expense and the pain. I think you can accomplish the same with microneedling as you can with the Fraxel laser,” she says.

Falling by the Wayside

Intense pulsed light (IPL) use fell in 2014 for Dr. Woodward. Why? The competition, she says.  

“It is still a very good procedure, but the state of N.C. allows one to exist on nearly every street corner, so I tend to leave that to aestheticians to do,” she states. 

Looking forward: 2015

The hope of a better economy could spur patients to get those procedures they’ve been putting off for financial reasons, according to Dr. Singer.

In fact, “I’m already seeing that,” he says.  

Many of those are patients who have tried noninvasive and nonsurgical treatments, but aren’t able to maintain or achieve the results they want are coming in for surgery, Dr. Singer says.

Remember the Neck

Remember that trend to make necks more youthful? That should continue, according to Dr. Singer. Something to watch: Kythera Biopharmaceuticals is working on getting approval for what might be the first-in-class submental contouring injectable drug. ATX-101, a synthetic version of deoxycholic acid, a molecule in the body that helps breakdown dietary fat, is in late-stage clinical trials.

Men Want More 

Men used to focus on liposuction to treat male breasts, but Dr. Singer says he is starting to see more men for liposuction of the flank area. That’s a trend particularly on the West Coast, where people tend to be fitness focused and there’s just so much diet and exercise do to reduce the flank area.

“The other thing is we’re seeing more men come in for fillers and Botox (‘Brotox,’ as it’s called),” he says.

Natural and Noninvasive

Cosmetic surgeons can count on two things. Patients want natural results while having to endure as little as possible. In general, patients will max out on what they can do minimally or noninvasively before they opt for a major procedure, like a facelift, Dr. Giese says. 

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