5 new trends in cosmetic surgery

Last week, The American Society for Aesthetic Plastic Surgery (ASAPS) held its annual Scientific Meeting in San Diego. Plastic Surgeons from all over the world with special expertise in Cosmetic Surgery gather to discuss and share the latest developments in the field of Aesthetic Surgery. After attending the meeting, I would like to share with you what I believe are the 5 most interesting and important trends occurring in this field.

1. Breast surgery continues to surge

Breast Augmentation and Breast Lift Surgery, with or without implants, continues to be extremely popular around the world. Placement of the implants over the chest muscle under the breast tissue is regaining popularity. Advantages include decreased recovery time and post-op pain. This technique also provides a modest lift for breasts that are deflated or sagging. However, it is not ideal for women with very small breasts or little breast tissue because the implants can look transparent. The majority of experts perform breast lift surgery with implants (augmentation mastopexy) at one operation, not staged. While there is a slightly higher complication rate, most women prefer to do it all at once. Newer techniques allow achievement of better breast shape and form. Finally, Silicone implants continue to evolve and improve, and recently the newer so called "gummy bear" implants have been approved by the FDA to stay in place for 20 years. Previous generations needed to be replaced every 10 years.

2. The Face; Fill it, Lift it, or both?

Botox and fillers like Hyaluronic Acid have revolutionized facial rejuvenation. This less invasive approach has replaced facelifts in some younger patients. Fat transfer to the face has gained significant popularity because of its longevity and availability. There was a lively debate regarding which filler, fat or injectables, was better. Most agree, the answer lies within the needs of each patient. Facelifts have not been abandoned! They are combined with fat transfer to maximize the result, enhancing cheekbones and rejuvenating the face. However many surgeons argued that facial fillers are effective to a point, and there are too many patients with faces that are over-inflated, creating a bizarre appearance. Most agreed that fillers are effective until they are not, and then facelift is the best option.

3. Variations in Tummytuck surgery

Abdominoplasty or Tummytuck is a fairly standard operation, removal of redundant lower abdominal skin and fat and tightening of the lax abdominal muscles. Plastic surgeons are refining the procedure, further contouring the region with liposuction of the upper abdomen and flanks. Some advocate further liposuction of the mid and lower back to shape the torso and achieve balance. Many recommend tailoring each Tummytuck procedure to match the patients' physical needs and desires. A popular notion for most cosmetic procedures, and I strongly agree.

4. Aggressive body contouring after massive weight loss

Massive weight loss after surgery or diet and exercise is a significant event. Many individuals lose triple digit pounds. Unfortunately, it does not end there. Most of these people are left with an enormous amount of redundant skin that just hangs down and frustrates them because fat is replaced by rolls of skin. They often require a total body makeover, several procedures to remove skin and tighten areas once inhabited by fat. These procedures are combined to hasten the process. Most start with an operation called "Total Body Lift." This is essentially a Tummytuck that extends 360 degrees around the torso to also excise redundant skin of the lower back and lift the buttocks which sag like a punctured balloon. Sagging, deflated breasts are lifted and redundant skin from the arms and legs are also excised. Sometimes facelift is another necessary option to address redundant skin remaining after weight loss in that region. Often times plastic surgeons team up and operate simultaneously to attack several areas at once to lessen OR time. The transformation is often dramatic, but the journey can be arduous.

5. Transgender surgery

Once the elephant in the room, finally an accepted trend. Another somewhat lengthy process, it is becoming a sub-specialty of plastic surgery. Many start the transition with fairly straightforward procedures. Breast augmentation for those transitioning to female, simple mastectomy for those transitioning to male. Genital transition is a much more complicated procedure, however techniques continue to evolve and improve. Evolution of our society with regard to acceptance of this population will hopefully also continue. The joy of being a plastic surgeon is the continued change and evolution of the specialty. Meetings like the one I am describing are crucial to the field because it brings together free thinkers from all over the world to debate, compare and share new techniques. The goal is to continue to refine methods and techniques and improve patient safety.

Robert Tornambe, MD is a New York City Plastic Surgeon and Medical Advisor for Trueself. Certified by the American Board of Plastic Surgery, Dr. Tornambe has been practicing plastic surgery for more than 25 years. He is a fellow of the American College of Surgeons, was featured in NYMAG's "Best Doctors" issue, and was the Chief of Plastic Surgery at NYC's Cabrini Medical Center for 20 years.

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