By Jane Kollmer
The current rise in popularity of plastic and cosmetic surgeries among Americans is well documented in the media—as is the pandemic’s part in driving many of the current trends in plastic and cosmetic surgery. There are, however, additional factors driving the rise in popularity of these procedures, including social media, population demographics (specifically, an aging population), and a societal shift toward more acceptance of cosmetic procedures. Overall, the unprecedented increase in volume means plastic surgeons are seeing more requests for consultations and procedures from a wide range of people for a variety of reasons.
There is no denying that the pandemic has caused a lot of people to undergo the knife, especially people who might have not done so otherwise.
“All of the uncertainty from the pandemic caused many people to adopt a ‘now or never’ mentality, so they’re wanting to seize the moment, bite the bullet, and finally transform themselves to reach their goals,” says Norman Rowe, MD, owner of Rowe Plastic Surgery in New York City.
The Zoom Boom Trend
The pandemic and the initial lockdown meant a lot more people were working from home, not attending any events, and staring at themselves on video conference calls for hours on end. Staying home caused people to consider plastic surgery as a more attainable goal.
“Patients now have more down time and cash on hand to finally get procedures they’ve been dreaming about their whole lives,” said Rowe. “These include hair restoration and ear pinning procedures for men and rhinoplasties and breast reductions, augmentation, or lifts for women.”
Being online so frequently created the “Zoom Boom,” influencing an uptick in procedures that impact peoples’ appearance in the virtual realm, such as Botox, fillers, and laser skin resurfacing. The latest data from the American Academy of Facial Plastic and Reconstructive Surgery reported that 79% of facial plastic surgeons identified patients seeking procedures for an improved appearance on video conferencing as a rising trend, compared to only 16% the previous year.
Additionally, the total number of surgical and non-surgical facial plastic surgery treatments is up dramatically: Facial plastic surgeons performed an average of 600 more procedures than they did in 2020, a 40% surge, according to the new data.
Pandemic makes recovery easier and more discreet
Not only was the pandemic a good time for many people to improve their aesthetic, but being home and wearing a mask have made it easier and more discreet to recover from surgery at home.
“For example, a lot of the moms that weren’t taking their kids to school in person anymore and were able to work from home created the perfect storm for interest in plastic surgery,” says Alex Zuriarrain, MD, FACS, owner of Zuri Plastic Surgery in South Miami, Fla. “I think this was pent-up interest. They’ve always wanted to, but they couldn’t find the time to do it or the necessary time off to recover.”
Heading to 2022, restrictions loosened amid widespread vaccination and most activities slowly began resuming. With more people going back to work in person and having more face-to-face social interactions, there was skyrocketing demand for cosmetic enhancements.
“I am seeing more people who have worked virtually for the past 2 years and now are going back to work who don’t want to surprise their colleagues,” Rowe says. “They want liposuction, facial rejuvenation, Botox, and fillers.”
Weight gain, in particular, has been a concern post-lockdown for mostly everyone. The return to more fitted professional clothes has fueled interest in body contouring, liposuction, tummy tucks, and breast augmentation.
Mommy makeovers still extremely popular
Another demographic seeking plastic surgery in large numbers is mothers in their early to late 30s who are looking to restore the shape and appearance of their bodies after childbearing. These so-called “mommy makeovers” typically involve some combination of procedures done at the same time to enhance the breasts, tummy, butt, and labia. Each mommy makeover is customized to a woman’s individual needs, lifestyle, and anatomy.
“They are still extremely popular,” says Zuriarrain. “I do more of those than anything else.”
Although he tells his patients he will not be able to get them back to their 21-year-old body, he assures them they can look really good for their age. He says most women are really happy with their transformation.
Breast implant removal surge continues
The surge of surgeries in 2020 also included the removal or replacement of breast implants, a trend that has been happening for the past 5 years. Reasons could vary, but some patients who have had implants for more than 10 years simply don’t want them anymore or want to switch to a different type of implant. For others, their choice for explant surgery could be motivated by concerns over breast implant illness or breast implant-associated anaplastic large cell lymphoma (BIA ALCL). Zuriarrain says he does a lot of en bloc capsulectomies in his practice.
Breast implant illness has become a hot-button issue in the plastic surgery arena.
“The problem is it’s a nonspecific disease process,” says Zuriarrain. “Right now, all we’re going by is anecdotal evidence as to whether or not taking out the implant makes a difference in symptom relief.”
He explains that the American Society of Aesthetic Plastic Surgeons and the American Society of Plastic Surgeons are running academic studies to collect long-term data. Regardless, patients are talking about the illness on social media and many of them are sharing their experiences and advice, so it’s likely that breast implant removal will continue to be a popular request.
Edmond Ritter, MD, chief of reconstructive and plastic surgery at Westchester Medical Center in Valhalla, N.Y., notices that there has been a trend away from textured breast implants because of the correlation with BIA ALCL. While the condition is rare, there is enough concern that patients are opting to have their implants removed.
Ritter says, “There’s still an occasional patient who you might use a textured implant with certain indications.”
Rise in DIEP flap procedure
In terms of breast reconstruction, Ritter says surgeons are getting away from the pedicle TRAM flap procedure, which has been the gold standard for a long time, and moving toward the DIEP free flap procedure.
“Over the last 10 years this has grown in popularity and is being done at academic and community hospitals,” he says.
An aging population is embracing cosmetic procedures
Cosmetic plastic surgery of the face is much more prominent than it was 30 or 40 years ago, according to Ritter. “With our aging population, it has become more and more important to women—and increasingly men—how they look,” he says. “As they age, they still want to be competitive for jobs so they’re seeking out cosmetic surgical care of the face, including rhinoplasty, eyelid surgery, fillers, Botox, and facelifts.”
Each surgeon has their own preference over which facelift technique gets the best results, but one that has grown more popular is the deep plane facelift, which involves lifting the face using all of the layers simultaneously—the skin, the subcutaneous fat, and the facial musculature as one unit. “It is much deeper than we used to go,” says Zuriarrain.
Many informed patients request this procedure by name. Proponents of this technique feel it is better for tightening the neck and jawline and improving the cheeks while providing a more natural appearance.
Surgeons will often use additional maneuvers and adjunctive procedures to optimize the results. Ritter adds that most people getting facelifts will get fat grafted into the face. “The reason they do this is because aging creates a loss of volume in certain areas,” he says.
In addition to facelifts, many patients are also choosing to undergo cosmetic rejuvenation of the hands.
“So many people have taken really good care of their faces but their hands give away their age,” says Ritter. “By grafting fat from another location, we can make the hand look more youthful and disguise the protruding veins.”
Brazilian butt lift still in high demand
Gluteal fat grafting, or the Brazilian butt lift (BBL), as it’s more popularly called, is a procedure that continues to be in high demand. In 2020, more than 40,000 were performed, according to the Aesthetic Society. Yet, the procedure has come under intense scrutiny in the media and the medical community after a survey showed that the death rate was as high as one in 3,000, which is a very high mortality rate for a cosmetic procedure.
A multi-society task force came together to investigate and found that the fatal outcomes were because of a high rate of surgical complications, the most serious being fat inadvertently injected into a blood vessel in the buttock. The fat can then travel to the heart or lungs, causing an embolism.
Surgeons have learned to minimize risk by avoiding the muscle itself and placing fat only above the muscle layer. In some cases, ultrasound devices have become important in allowing the surgeon to see the exact anatomy and ensure the cannula is not near blood vessels. As a result, the BBL has become a much safer procedure, on par with a tummy tuck.
Zuriarrain, who has been using wireless ultrasound for BBL procedures for the past 3 years, says, “For the most part, it’s logical that if you can see what you’re doing, you should have a higher degree of safety versus injecting fat in a blind technique.”
Social media is normalizing plastic surgery
Throughout the pandemic, many people logged countless hours scrolling through their social media feeds on platforms, such as Facebook, Twitter, Instagram, YouTube, and TikTok. These behaviors exposed more people to plastic surgery trends through social media.
The plastic surgery boom has been in large part driven by women in the 18- to 22-year-old demographic, who use Instagram and other social media channels to promote their image and lifestyle. It is increasingly common for these “influencers” to undergo plastic surgery and change their physical appearance in order to attract large followings in the hopes of landing sponsorships and other career opportunities, such as modeling and reality TV deals.
The demand for breast augmentation, lip fillers, Brazilian butt lifts, and high-definition liposuction has become normalized among this crowd. The ubiquitous influence of young stars and celebrities like the Kardashians and their propensity to display their seemingly perfect bodies has taken out some of the stigma around cosmetic enhancements.
In addition to providing inspiration, social media is also a source for many patients to get information about procedures, which can sometimes do more harm than good, especially if the information isn’t coming from reliable experts, such as board-certified surgeons. Consultations play an important role in setting the record straight.
“Patients bring me photos of how they want to look,” says Zuriarrain. “I have to let them know what the realistic expectations are. I have to be very straightforward and honest with them. I don’t like to provide fantasies.”
Telemedicine adoption on the rise
The pandemic has also spurred more surgeries because of how easy it is to conduct consultations virtually. A 2020 survey by the American Society of Plastic Surgeons showed that 64% of its doctors had seen an increase in their virtual consultations since the start of COVID-19.
“We’re able to meet, vet, and approve people for surgery faster than ever before,” says Rowe. “When that’s combined with the widespread normalization of plastic surgery, the emergence of the Zoom Boom and the ‘now or never’ mentality caused by the pandemic, the volume of plastic surgery patients has increased dramatically.”
For both Rowe and Zuriarrain, their practices are currently scheduling surgeries 6 months out.
“Our whole culture has changed with the pandemic and plastic surgery is one element of that issue,” Ritter says. “Rather than to impose our idea of human beauty and how they should look, we have gotten better at listening to our patients, and as a result, are becoming a more empathetic profession overall.” PSP
Jane Kollmer is a contributing writer for Plastic Surgery Practice.