Interest in plastic surgery peaked in January 2010, according to search data collected by Google Trends. As of this month, that interest has decreased by a notable 65 percent.
However, despite what that stat suggests, the procedures are currently on an upward trend: There were 17.1 million surgical and minimally-invasive cosmetic procedures performed in the United States in 2016, according to the American Society of Plastic Surgeons, a solid jump from the 15.9 million that took place the year prior.
These numbers reveal plastic surgery hasn’t lost steam. However, the way it’s being pursued and performed is seeing significant change.
A backlash to fillers
“There’s a different feeling when patients come in today,” said Melissa Doft, M.D., a New York–based plastic surgeon. “When [people used to] come in for a face lift, they’d say, ‘Pull me as tight as you possibly can; you know it’s not going to last, so make me look like I’m 40.’ Now they all say, ‘Don’t pull too tight, it’s okay to have a wrinkle.’”
Indeed, the widespread revolt against ageism seen everywhere from runway shows to advertisements seems to be seeping into plastic surgery, too. “Patients are now saying, ‘I don’t want to look 40, it’s okay that I’m 65. I just want to look great at [that age],’” said Doft.
These more understated attempts are reflected in the top minimally-invasive procedures of 2016: botox, fillers, chemical peels, laser hair removal and microdermabrasion. But Doft believes a backlash to these non-surgical procedures — and others, including Ultherapy and Coolsculpting — is underway.
“People are getting frustrated with some of [these] procedures because they don’t have longevity, or they’re not really seeing marked results, despite the fact that they’re still pretty expensive,” she said, adding that the procedures can cost anywhere from $400 to $2,000, despite the fact that no surgery is involved.
She called out fillers, in particular, which can be used for everything from plumping lips to softening facial creases — sometimes in a quick fifteen-minute appointment. “I think the use of fillers can be excellent and can really enhance, but because everyone is doing [them now], there are a lot of bad fillers out there — and a lot of overfilling going on,” said Doft, explaining that some inexperienced practitioners will inject faces with up to six fillers, resulting in a distorted, more masculine-looking face.
A lack of regulation in the industry is to blame here, as not all states require licensing or accreditation where cosmetic surgery is performed. “People who aren’t doctors are calling themselves doctors, and it’s crazy,” said Doft. “That’s not something that’s open to interpretation. You either have a certificate, or you don’t!”
The return of the face lift
This has Doft and her peers championing the more invasive face lift instead. “For the first time in a while, face lift [requests] are up, and I think that’s partly due to the filler backlash,” she said, adding that face lifts, though pricier (averaging at around $7,000), only need to be done every 8-10 years.
Research from the ASPS backs up her claim: After dropping off the list of top-five requested procedures in 2015, face lifts made a comeback in 2016. They’ve also accounted for 17 percent of all plastic surgery–related searches since July, according to Captify, just behind tummy tuck (18 percent) and boob job (22 percent).
“Face lifts look more natural,” said Doft. “I know that’s something only a plastic surgeon would say, but when done properly, they’re less distorting.”
Restoration vs. total alteration
Doft says that, rather than the stereotypical plastic surgery customer — who wants to “look like a porn star” — she typically sees women patients who are instead looking for restoration. “I see a lot of women who have had a few children and feel that their bodies don’t look as great anymore. They’d like to look better in a dress or a bathing suit, just feel more confident,” she said, adding that this desire to not change too much is particularly strong in New York.
Los Angeles, as always, is a different story. While attending a plastic surgery conference in the area earlier this year, Doft noticed that a local surgeon’s presentation on rhinoplasty showed women of varying racial backgrounds with the exact same “Barbie nose.” “That’s not going to fly in New York,” she said. “The girls come into my office and are like ‘I love [my heritage], but my nose could be a little [smaller],’ and they want to maintain some sense of individuality.”
But this hasn’t always been the case in New York, she said. It was once just as common to have women hoping to replicate a celebrity’s visage. “There are definitely still some people who say ‘I want to look like Kylie Jenner,’ but I think more people are like, ‘I’m happy with what I look like. I just want to look a little better.’”
Different generations, different desires
Miss Jenner’s popularity, paired with her infamous lips, continues to drive the younger cohort toward lip injections. Doft says they’re twenty-somethings’ No. 1 request, and the ASPS calls it the second-fastest-growing facial procedure in the U.S., after microdermabrasion.
Prevention is also on their minds, leading them to explore processes like chemical peels and micro-needling, a minimally invasive technique that boosts the skin’s production of collagen and elastin.
As far as more invasive procedures go, breast implants and reductions reign supreme for twenty-somethings, and according to Doft, they have much less shame about it than previous generations. While her older patients will only admit to having work done to their closest confidantes, the younger group “will talk about it to everyone [and] blast it on social media.”
One girl went so far as to throw a “boob-bye” party before her breast reduction, while another wrote a poem for her boyfriend, explaining her decision to get implants. “It’s just a totally different way of relating to it, and I have to imagine it’s due to the advent of social media and people being so comfortable putting themselves out there,” she said.
Another trend Doft has noticed is among her older patients who are still in the workforce. In order to remain competitive at work, many women are feeling pressure to get extra work done.
“I had someone come in and say ‘I’m tired of people asking me when I’m going to retire.’ And several people have said, ‘I don’t want to look like I’m the [from the movie] ‘The Intern,’ or ‘I want to look like I’m the most senior person [at the office], but not that I’m inched out,’” said Doft, noting that it’s particularly common in industries like technology and fashion, where the infusion of youthful candidates highlights any age gap all the more.
The next generation of makeup?
Looking to future trends, Doft believes that fillers will be used more and more, in smaller doses, to replace popular makeup techniques like contouring, which relies on a variety of skin-toned makeup to add definition to the face. She’s begun “contouring” at her own practice, using fillers for definition: She adds some to the cheek to create a “hollow” or shadow, as you would with bronzer, or on each side of the nose bridge to make it appear thinner, as you might with foundation.