My Teen Wants What????

You may have read an article recently referencing recommendations made by the American College of Obstetricians and Gynecologists (ACOG) regarding "plastic and cosmetic surgery on teens".  Most of the articles make a point of patients undergoing breast augmentation or labiaplasty.

Before everyone gets excited about teens undergoing cosmetic surgery, lets look at actual data:

The plastic surgery procedures, by the numbers, include ear surgery, nose surgery, and breast surgery.  

• Most ear surgeries are otoplasties, for prominent ears, which patients often are teased relentlessly about.  
• Rhinoplasty certainly has a cosmetic component, but also has a functional, breathing component.
• Breast surgery is a mixed bag.  8,000 breast augmentations were performed on 13-19 year olds in 2014 (there are no further breakdowns by age, but presumably most are 18-19 years old).  Breast reduction is tracked much less accurately, but around 5,000 reductions were performed on 13-19 year olds in 2014.
• Labiaplasty is not tracked by the American Society of Aesthetic Plastic Surgeons, but numbers are estimated to be miniscule.

Are teens bombarded with images through media and the Internet with ideal, likely unobtainable body images?  Absolutely.  Does this lead some of them to develop unhealthy images and expectations of themselves (Body Dysmorphic Disorder)?  Sure.  

When I am faced with a teenager who is requesting a procedure, it is always a difficult issue.  Each patient is an individual with a different set of problems.  For instance, the American Society of Plastic Surgeons recommends that breast surgery be delayed until a patient is 18.  However, I have had several patients in the 15-16 year old range requesting breast reduction that are very mature, have insight and understanding of their problem, and are constantly reminded of their problem by their pain, inability to find appropriate clothing, and unwanted attention.  If they and their parents understand the risks of surgery, as well as the additional risks of that surgery in someone that young, age shouldn't be an absolute.  Likewise, the majority of teens who undergo labiaplasty (a procedure I do not perform), are patients that have functional pain from their problem.  Similar to breast reduction, these patients can have the same problems - pain, difficulty with clothing, and unwanted attention in the locker room.  

The bottom line is that much of the recent press is sensationalizing a problem that is present, but not nearly to the levels that they would have you believe.

Pucker up!

Thanks to the likes of Kylie Jenner and the dawn of selfie culture, lips are having a moment: According to new data from the American Society of Plastic Surgeons, lip augmentation is the second-fastest-growing facial procedure in the country, coming in right after facial dermabrasion or resurfacing treatments.

In 2015, lip implants saw double-digit growth in all regions nationwide, which equated to 27,449 total procedures and a 48 percent rise since 2000. Lip injections have also shot up in numbers, a part of the more than 9 million such procedures patients sought out in the past year.

As far as cosmetic-surgery procedures go, many patients think lips seem like a small (but substantial) place to start — and it’s not just because they’re seeking a trendy pout.  Often times, it is to replace volume lost with aging, or to restore some balance to the face.

Lip implants are typically made from a soft, pliable silicone and offer more flexibility and more options than previous incarnations. Song says patients generally recover quickly from the procedure, and unlike with injections, you don’t have to go back for multiple visits.

Is this a fad, or are more full lips here to stay?  Only time will tell.  Right now, there are temporary fillers and silicone implants which meet almost everyone's desires.

Plastic Surgery Trends 2015

The statistics are in for 2015!  As expected, the overall number of cosmetic surgeries has risen, as the acceptability of procedures becomes higher.  Several surprising issues came out of 2015's numbers though:

• Facelift fell out of the "top 5", and has been replaced by abdominoplasty
• Buttock procedures have increased, both implants and "Brazilian Butt Lifts"
• There has been an increase in males seeking procedures

Let's briefly look at each of these.  

I don't think it is particularly surprising that we are seeing a decrease in the number of facelifts.  We are starting to see the effects of people who have been doing Botox and fillers for a number of years, and in effect are doing some "preventative maintenance" rather than waiting until they need a much larger procedure.  Also, the rise of abdominoplasty has likely come about with the popularity and advertising of "mommy makeovers" for women post-pregnancy.

Buttock procedures increasing is an interesting phenomenon.  In many South American countries, the desired body type is smaller breasts and a fuller butt.  In fact, historically, large numbers of patients in those countries undergo breast reduction (to reduce their breasts to a B or small C cup) and butt augmentation.  In the United States, we historically have found larger breasts desirable.  This trend does not show any sign of slowing, since we can see that augmentation leads the list of cosmetic procedures.  Although buttock procedures are on the rise, time will tell if this is a fad (led by certain celebrities - Kim K and such), or whether we really are seeing a change in aesthetic goals.

Finally, we are seeing an increase in male patients on several fronts.  This has ranged from in increase in gynecomastia surgery (male breast reduction) to injectables, with "Brotox parties".  In my own practice, I have definitely seen an uptick in male patients, though this is still a female dominated portion of most practices.

Vampire Breast Lift - Gimmick, or for real?

The "vampire breast lift" has gotten a fair amount of press recently, particularly since it was included in Oscar nominees' "swag bag".  Let's take a few moments and look at this.

What is it?  The vampire breast lift involves taking a patient's blood, spinning it in a centrifuge to create platelet rich plasma (PRP), and injecting that solution into the breast to stimulate growth of breast tissue.

Does it work?  We really don't know.  PRP is used in some orthopedic procedures, but is not FDA approved for this indication.  As far as I can tell, there is no data, and have been no peer reviewed journal articles about it  Most surgeons think it probably works as a soft tissue filler rather than a stimulant for breast growth, and we know that soft tissue fillers aren't a great idea, since they can cause problems with mammograms and palpability of the breast tissues.

Who is doing it?  As far as I can tell, the only proponent of this procedure is an ER physician who is doing cosmetic surgery on the side.  There does not appear to be any board certified plastic surgeon considering this procedure.

Conclusion:  It appears that it doesn't work, that there is no data on safety, and that it may cause harm in the long run.  As with many things in cosmetic surgery, this appears to be one which is long on hype but short on results.