What will shape cosmetic medicine in 2018? We asked industry leaders to weigh in with what they think will drive aesthetic medicine’s evolution this year.
Jeffrey E. Janis, M.D., president of the American Society of Plastic Surgeons (ASPS)
Fat grafting safety, multimodal pain management and nerve decompression for migraine headaches will make big impacts on plastic surgery in 2018, according to Dr. Janis, who is professor of plastic surgery, neurosurgery, neurology and surgery at Ohio State University Wexner Medical Center, Columbus, Ohio.
Fat Grafting Made Safer
“Fat grafting to correct reconstructive deformities or augment cosmetic surgery results is a growing part of everyone’s practice. What’s going to be new this year is technical refinements on how to make fat grafting as safe as possible,” Dr. Janis says. “I think that’s going to be a major issue, especially with regards to fat grafting to the buttock or what’s otherwise known as the Brazilian Butt Lift. There are going to be scientific recommendations that are going to be made this year that are going to be beneficial for anyone who performs this procedure.”
Multimodal Pain Management
“I think we’re all aware of the opioid epidemic that has really ravaged the county. The question is: How can we apply procedure-specific multimodal pain management strategies to our patients and our practices?” Dr. Janis says. “I think that, as we all become more aware of alternative strategies to curtail opioid use in helping to treat acute postoperative pain in our patients, we will be able to provide safer, more effective pain control to our postsurgical patients.”
“There are 35 million Americans who suffer from migraine headaches. It’s actually more common than asthma and diabetes combined,” Dr. Janis says. “…plastic surgeons can help treat these patients by doing nerve decompression of nerves in the head and neck [in appropriate candidates for the procedure]. We have published results behind it and are continuing to come out with additional scientific evidence to support this procedure. This year, I think you’re going to see this become more main stage because we have position statements about to come out from the American Society of Plastic Surgeons that basically define indications and provide scientific evidence to support its safety and efficacy.”
Predictions From the AAFPRS
William H. Truswell, M.D., president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
Facial plastic surgeons predict filler refinements and injectable rhinoplasty will be among the top 2018 trends, according to a recent AAFPRS press release.
Stem Cells for Filler Longevity?
More flexible fillers that respond when the face animates, refinements in the use of stem cell injections and increased use of volumizers for facial rejuvenation could make important strides in 2018, according to Dr. Truswell.
“Embryonic stem cells are pluripotent cells — that is, they can turn into different cell types,” Dr. Truswell says. “Stem cells exist in the adult human in fat and bone marrow. These are multipotent stem cells. They have the ability to turn into bone, cartilage, muscle and fat.
Adipose-derived stromal cells (ASCs) are similar to stem cells in fat and are being scrutinized for use in aesthetic surgery, notably fat grafting.”
Fat grafting is used to add volume to the lips and other areas of the face that would benefit from increased volume, but fat grafting’s permanency is debated in the literature, Dr. Truswell points out. The hope is that enriching fat grafts with adipose-derived stromal cells will increase fat retention.
ASCs are also being studied as a means to rejuvenate aging skin, as well as in areas beyond cosmetic surgery. But stem cell use remains under investigation and not all claims are legitimate, Dr. Truswell says.
“Some companies tout plant stem cell uses for collagen rejuvenation. This false cross-species therapy simply does not work,” he says. “This is a very complicated subject…. There are many claims of success but still ‘let the buyer beware’ is sage advice.”
Nonsurgical rhinoplasty has become more popular because it can be performed in minutes and results in a fraction of the downtime, bruising and swelling associated with traditional rhinoplasty. The trend will continue in 2018, according to Dr. Truswell.
Injectable rhinoplasty is a method of altering the shape of all or part of the nose with an injectable hyaluronic acid filler, he says.
“This technique is commonly used to fill or lift dips, camouflage irregularities, elevate the nasal tip and so on,” Dr. Truswell says. “The technique is fairly straight forward. The material is injected slowly with careful observation. It should be done by a skilled injector, as should all facial injections.”
While effective in the right patient, nonsurgical rhinoplasty doesn’t address every nasal deformity. The approach won’t alleviate nasal obstructions or straighten crooked noses, he says.
Prejuvenation, Selfies & Millennial Men
The AAFPRS also predicts rising popularity for “prejuvenation,” the concept that younger patients have age-prevention cosmetic procedures — from skincare and injectables to laser and light therapies.
Social media selfies will continue to fuel patient demand. More than 40% of AAFPRS members noted in the AAFPRS member survey in 2016 that patients were requesting facial plastic surgery to look better on social media.
The New Year will feature a greater focus on transgender/feminization procedures at academic centers.
Millennial men will continue to want to maintain. A survey by the AAFPRS, found that nearly a third of men surveyed said they are "extremely likely" to consider a surgical or nonsurgical cosmetic procedure. Of those men, 58% were between 25 and 34 years old while 34% were 18 to 24 years old.
Breasts, Botox & Eyes
In a recent press release, ASAPS-member plastic surgeons from across the country have made several predictions for what they think will make big waves in 2018:
Laser-Assisted Breast Reduction & Lift
Grant Stevens, M.D., believes that an outpatient breast reduction and lift procedure he pioneered, called Laser Bra, will be trending, given that small breasts are in.
The Laser Bra differs from a traditional breast lift, in which a portion of excess skin is removed and discarded from each breast. Using the Laser Bra technique, Dr. Stevens keeps this skin, treating it with a CO2 laser and placing it inside the breast to provide additional support from the breast to the chest wall. The resulting “internal bra” lifts the breasts and creates cleavage. There are no drains or external sutures that need to be removed after the Laser Bra procedure, according to a 2010 press release from Dr. Stevens’ Marina Del Rey, Calif., practice.
ASAPS President Clyde H. Ishii, M.D., a Honolulu-based plastic surgeon, tells The Aesthetic Channel that many women seeking breast augmentation want a more natural look — specifically, to avoid the obvious augmented breast look. And many large-breasted women are seeking breast reductions at earlier ages — not waiting until their 50s and 60s to do it.
“The popularity of an active lifestyle probably contributes to this trend,” Dr. Ishii says.
Troy, Mich., plastic surgeon Anthony Youn, M.D., says 2018 might be the year Botox (Allergan) is dethroned by a better-than-Botox product.
“I predict there will a product better than Botox released in the next year. Although Botox is still the top cosmetic treatment in the world, there are similar products in the pipeline that will likely come out in 2018. Once they do, watch out — we may have a new king of the cosmetics on our hands!”
Prettier Private Parts
Labiaplasty procedures increased 23% in 2016 and demand among women was even higher in 2017, according to ASAPS. The stigma is fading and more women are looking to increase confidence and comfort for their private parts, according to New York City-based plastic surgeon Tracy Pfeifer, M.D., M.S.
Filler-Fueled Eye Rejuvenation
This year, doctors will increasingly use fillers to restore volume in the upper and lower eyelids, says Dr. Pfeifer.
“Noninvasive treatments are very popular and this includes treatments to the periorbital area,” Dr. Ishii says. “Soft tissue fillers can mask many signs of aging in this area, since volume loss is a part of the aging process. There is less margin for error in this area, so patients must seek treatment from qualified practitioners.”