Trends in Cosmetic Procedures

  • By:  Lambros K. Viennas, M.D.

There’s a lot of buzz about beauty these days, especially cosmetic plastic surgery. Today’s women want to look their best, and the demand for cosmetic procedures is on the rise in the U.S. The American Society of Plastic Surgery reported that more than $16 billion dollars was spent on cosmetic plastic surgery in 2016 that included 1.7 million surgical and 15 million minimally invasive procedures. This represents a 3-4 percent increase from 2015 to 2016.

Many women are choosing minimally invasive procedures due to their lower cost, shorter recovery period, and lower risk when compared to surgery. However, not all patients are candidates for minimally invasive procedures alone. Depending on the patient’s cosmetic goals, a treatment plan may include minimally invasive treatment, surgery, or a combination of both.

The American Society of Plastic Surgery Procedural Statistics show that the most commonly performed minimally invasive procedures are botulinum toxin, soft tissue fillers, chemical peels, laser hair removal, and microdermabrasion, which are mainly used for facial rejuvenation. Here’s a look at what these procedures entail.

• Botulinum toxin is used to selectively paralyze facial muscles in order to prevent dynamic facial wrinkles, for instance, when someone is frowning or squinting. Other uses include facial shaping. The eyebrows can be raised or the corners of the mouth can be lifted by paralyzing the opposing facial muscles that depress the brows or the lower lips. Botulinum toxin requires redosing every few months to maintain the results.

• Soft tissue fillers are used for static facial wrinkles. These are the lines that are present without facial animation, and they do not respond to botulinum toxin. Specifically, fillers are injected under the skin and are used to treat the vertical forehead lines, lip lines, and lines along the nasal labial folds located between the cheek and upper lip junction and corners of the mouth. Fillers can also be used for facial shaping. For example, fillers can improve fullness of the cheeks, plump the lips, and treat depressions, such as hollow areas under the lower eyelid.

Most fillers are made from a genetically engineered hyaluronic acid which is naturally found in human tissue. The advantage of these materials is that they have a low risk for allergic reaction and low complication rates, if properly performed. Hyaluronic acid fillers are temporary and have variable longevity ranging from months to two years, depending on the gel type and location that is injected. Although there are many other types of fillers that can be used with good results, permanent synthetic fillers, such as silicone oil, have a very high risk of complications including infection, scarring, and permanent facial deformity, and therefore should be avoided.

• Chemical peels and microdermabrasion procedures are used to improve facial skin tone and texture by removing the outer most layer of epithelium which regenerates and requires maintenance treatment. Depending on the chemical used, their concentration, and the way they are applied, mild chemical peels can create a very superficial skin exfoliation and produce an overall improved appearance, with short recovery and low risk, but the rejuvenation effect may be minimal.

More invasive chemicals and higher concentrations can cause a deeper chemical burn that may result in longer lasting and significant rejuvenating effects, but  are associated with higher risk of complications and a longer healing time. Similarly, microdermabrasion improves skin texture by mechanically removing the outer layer of epithelium with less down time and lower risk. The rejuvenation effects are less compared to the more invasive dermabrasion procedure, which removes deeper layers of epithelium. Dermabrasion may result in significant improvement with longer lasting results, but with longer healing time and higher risks.

• Laser hair removal can effectively reduce hair but typically requires maintenance treatment. The laser light is absorbed by the dark pigment of the hair that generates heat and destroys the hair follicle, thereby, inhibiting hair growth. The lighter the skin, the darker the hair, and the more coarse the hair, the better the results, and the lower the risk. However, patients with darker skin color have an increased risk of sustaining a burn due to the absorption of the laser light by the pigmented skin; therefore, adjustments to the laser energy must be made to prevent this problem.

The ideal rejuvenation treatment should be safe, affordable, have a short recovery period, and should achieve a long lasting, predictable and excellent result. Many of the minimally invasive procedures have limited indications for rejuvenation and cosmetic enhancement. As new technologies and products evolve, minimally invasive treatments may replace surgical procedures in the future. 

Dr. Lambros Viennas serves as Chief of the Division of Plastic Surgery at the Eastern Virginia Medical School. His clinical interests include all facets of cosmetic surgery including facial rejuvenation, breast enhancement, and body contouring.

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