It used to be, 40 was ‘over the hill.’ Now, in the age of camera-ready social media, boomers are proudly proclaiming ‘60 is the new 40.
Getting your groove back in later decades is great and something to be celebrated, but it also means that many are in search of anti-aging solutions that will turn back—or at least slow down—the hands of time. In fact, of the 17.7 million cosmetic surgery procedures performed in the U.S. in 2018 (the most recent data available), 23% were performed on those 55 and older, according to the American Society of Plastic Surgeons.
“There is more age discrimination today in our society,” says Dr. James French of the Center for Plastic Surgery in Annandale. “Some people feel they need to look younger for professional reasons. People are getting more comfortable and more aggressive regarding certain procedures, both aesthetic and reconstructive.”
Northern Virginia Magazine asked four expert plastic surgeons to give their takes on the latest youth-focused trends in plastic surgery. Here, we break down what you need to know if you’re thinking of going under the knife.
The Trend: Fat Grafting/Transfer
Local plastic surgeons are increasingly seeing their patients ask for fat grafting (medical term: autologous fat transfer), which begins with adipose fat being withdrawn from one area of the body, via liposuction. Multiple procedures use autologous fat transfer. For more minimally invasive treatments, often facial, the fat is injected to fill in wrinkles, enhance thin lips and plump up sunken skin. Fat transfer is also being used with increasing frequency in more intensive surgeries to enhance the buttocks, often referred to as the Brazilian butt lift.
Pop culture icon Kim Kardashian has made the procedure more popular, notes Dr. French.
For patients desiring breast augmentation and reconstruction, autologous fat transfer may provide an alternative. The procedure can last longer than breast implants, which have an average lifespan of 10 to 20 years, and avoids introducing a foreign object into the body. While fat transfer is not yet a mainstream alternative to implants, it is commonly used as a supplement in breast reconstruction, says Dr. French.
This has become a more popular alternative to traditional augmentation following the identification of an increased risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in patients who have Allergan BIOCELL textured implants. Allergan recalled the implants in 2019.
Autologous fat transfer for breast reconstruction, says Dr. Michael Olding, director of the Cosmetic Surgery Center at The GW Medical Faculty Associates, is “the Tesla of breast reconstruction. It’s a spectacular way of using your own tissue.”
Despite its rising-star status, would-be patients should be aware of the procedure’s potential complications. When fat is removed from the body, the blood supply is cut off, and because blood supply is necessary for fat grafting, the transfer has to be done very quickly. “It’s devastating when the patient is anticipating a beautiful breast, then the blood supply gets cut off and the tissue is lost,” says Dr. French.
But as techniques improve, autologous fat transfer is expected to be used more for breast enhancement and reconstruction. “Can you imagine a world where you could have breast enhancement with almost no risk?” says Dr. Olding.
The Trend: Minimally Invasive or Nonoperative Treatments
Minimally invasive or nonoperative treatments, including fillers and neuromodulators, such as Botox, to repair wrinkles or restore youthful appearance, are also growing in popularity.
One fairly common minimally invasive operation plastic surgeons perform is an eyelid lift, which is among the most requested cosmetic procedures for men, according to data from the American Society of Plastic Surgeons.
Another popular minimally invasive treatment? The vampire facial. Celebrities like Kim Kardashian have shined a spotlight on the scary-sounding facial, which employs platelet-rich plasma therapy. In this procedure, the patient’s own blood is drawn, the platelet-rich plasma separated in a centrifuge and the plasma injected under the patient’s skin. Platelet-rich plasma therapy is also used for hair loss, joint damage and even vaginal rejuvenation, sometimes after childbirth.
While fat grafting is generally not considered nonoperative because fat is harvested by liposuction technique, there are instances in which small amounts can be withdrawn in a medical office under minimal anesthesia. This technique is applicable for minor repairs and adjustments, such as filling in crow’s-feet, in lieu of using artificial fillers.
Laser techniques, used to remove unwanted hair, unsightly marks or reduce appearance of veins, also fall under the heading of nonoperative or minimally invasive.
What is Minimally Invasive Surgery?
The procedure employs special surgical instruments and a viewing scope that helps doctors perform operations via tiny incisions, rather than making large ones. Minimally invasive procedures can reduce recovery time, cause less pain and scarring, and can cost less than more invasive procedures.
The Trend: Body Contouring
At its core, the goal of body contouring is to remove sagginess and bagginess in skin.
“Body contouring is a very broad term and can [comprise] both nonoperative techniques and surgical techniques,” says Dr. Marilyn Nguyen at Virginia Hospital Center.
Nonoperative techniques, she says, include newer technology such as CoolSculpting for fat reduction,
Emsculpt, which helps increase muscle tone, or Kybella, an injectable product used to dissolve fat.
Operative techniques used in body contouring include liposuction, along with other techniques to surgically remove excess skin and fat. The most common, familiar procedure would be abdominoplasty, colloquially known as a tummy tuck. A breast lift also falls under the umbrella of body contouring.
Body contouring has also increasingly become an add-on procedure after obese patients undergo bariatric, or weight-loss, surgery.
“Especially as bariatric surgery procedures increase, skin removal after weight loss in other areas such as arms and thighs (as well as belly) is also something patients might consider,” says Dr. Nguyen.
The Trend: Mommy Makeover
Pregnancy and childbirth can permanently change a person’s body. The abdominal skin and fascia, which Dr. Olding compares to gristle on a steak, stretch with pregnancy, particularly the more babies you have.
“By the time you have a second or third, things are stretched out,” he explains. “You can work out as much as you want; that’s never changing.”
A host of surgical options comprise the “mommy makeover,” including abdominoplasty, breast augmentation and lift to replace volume and buoyancy lost during breastfeeding, and liposuction. Autologous fat transfer can be employed, using the fat removed during liposuction to enhance the breasts or buttocks.
“(Mommy makeovers) are great,” says Dr. Olding. “The patients who have them are so excited; it’s another phase of their lives.”
And it’s not just women whose bodies can be affected by babies. Dr. Olding says he is seeing more men seeking the equivalent to the mommy makeover, dubbed the “daddy do-over,” which might include fillers around the eyes, liposuction to remove stubborn fat or body contouring.
“Men don’t get pregnant but they do get older, and most married men put on weight when they get older,” he says.
What is CoolSculpting?
CoolSculpting is a brand of fat-freezing technology that can kill fat cells, resulting in a reduction of up to 25% of fat in treated areas. A muscle toner such as EmSculpt can stimulate contractions and help build muscle more quickly, while Kybella is marketed as the “double-chin treatment,” an injection of synthetic deoxycholic acid under the chin to help break down and absorb fat.
In the News: Gender Affirmation Surgery
Perhaps the biggest hot topic in the world of plastic and reconstructive surgery right now is gender affirmation, or gender confirmation, surgery, formerly known as gender reassignment surgery.
“It is becoming more prevalent as laws and society change,” says Dr. Nguyen, who noted that she herself does not perform “bottom” or genital-related gender confirmation surgery.
The American Society of Plastic Surgeons reported more than 3,200 transmasculine and transfeminine surgeries performed in 2016, a 19% increase from the previous year, and a 15.32% increase between 2017 and 2018, with a total of 9,576 gender confirmation surgeries reported in 2018.
“It is a reflection of how far we’ve come in how we recognize that there are people who do not feel comfortable with their own [assigned-at-birth] gender,” says Dr. Olding. “It’s an amazing thing that’s happening. People are more accepting of other people and the variations that occur in life. Gender affirming surgery is a wonderful thing, but gender issues in the United States are still problematic for many people. But thank God for young people, because young people aren’t set in their ways like old people.”
Despite young people perhaps being more open about gender identity, gender-related surgeries remain an intensely debated topic in the medical community.
“If you have a 14-year-old who believes they’re born the wrong gender, adolescent brains don’t function as adult brains,” says Dr. Albert Oh, a craniofacial surgeon and pediatric plastic surgeon at Children’s National Hospital. “How do you know they should have reassignment surgery?”
Many major health insurance providers will typically not provide coverage for adolescent gender affirmation surgery, though certain procedures, such as mastectomy in female-to-male patients, may be considered on a case-by-case basis.
The American Academy of Pediatrics states: “Although current protocols typically reserve surgical interventions for adults, they are occasionally pursued during adolescence on a case-by-case basis, considering the necessity and benefit to the adolescent’s overall health and often including multidisciplinary input from medical, mental health and surgical providers, as well as from the adolescent and family.”
At present, Dr. Oh says, gender confirmation surgery for minors is not being actively considered at Children’s National, but he says he can “see it becoming a point of discussion.”
“It’s a growing topic in the general plastic surgery community,” says Dr. Oh.
Future Trends: What’s on the Horizon
As plastic surgery techniques progress, doctors say it’s likely there will be both new treatments introduced and improvements to existing treatments.
“We are refining some techniques and technology we have, and getting better and better at that,” says Dr. French. “There’s no question that techniques are getting better.”
He cites the DIEP (deep inferior epigastric artery perforator) flap used in breast reconstruction, as an example. In this procedure, excess skin and tissue, but not muscle, is removed from the lower abdomen, where there is typically excess fat, and used to recreate the breast.
“It’s much better than flaps that have been used in the past,” he notes. “Surgeons are getting a better result with that flap in most cases.”
Under the umbrella of minimally invasive treatments, Dr. Olding sees longer-acting botulinum toxins and neuromodulators, such as Botox and Dysport, on the horizon, while Dr. French anticipates an increase in J-plasma, which uses helium gas and radiofrequency to tighten skin.
Doctors will also continue to look at existing matters like lymphedema, abnormal buildup of lymph fluid that causes painful swelling in the extremities.
“It’s an old problem that people are looking at new ways to try to address,” says Dr. French.
Plastic surgeons have also been instrumental in helping move forward regenerative medicine therapies, like burn care, nerve regeneration and stem cell therapy.
“In the real experimental world, people are excited about stem cell research,” says Dr. Oh.
“People are taking stem cells from fat and using them to develop other cells.”
Hand and face transplantation fall under the umbrella of regenerative medicine and an “area of excitement,” says Dr. Oh, is pediatric facial transplantation.
“This is for people who have really horrible facial deformities that don’t respond to typical procedures,” he says. “It’s approved but very controversial.”
The controversy stems from high risk of rejection (pediatric patients would have to take anti-rejection medications their whole life), the associated risk of certain cancers like leukemia or lymphoma, and identity and psychological issues.
From improved approaches to common problems to revolutionary reconstructions, there is plenty to look forward to in the plastic surgery world. However, Dr. Olding advises cautious optimism.
“So many trends are driven by media and by the people promoting them,” he says. “People need to be circumspect. It seems like every 10 years there’s a new trend. Everyone jumps on the latest and the greatest. I say, ‘See me in five years,’ because it’s unlikely to still be there.”