SURVEY SAYS

Here's Why Plastic Surgeons Are Turning Away More Young Patients Than Ever Before

A new survey of plastic surgeons reveals a major influx of younger clientele seeking cosmetic procedures.

February 15, 2022

Closeup of female surgeon's hand over equipment

The more things change, the more they stay the same. That's a theory that no one likely would have thought could be applicable to the world of aesthetics, but here we are. As the coronavirus continues to evolve and cultural restrictions loosen and snap-tight again, so do the treatments and trends in the elective aesthetics universe.

Much has already been written about the early pandemic plastic surgery boom, but what's been less clear — until now — is how plastic surgery fared in 2021. And as we collectively settled into pandemic life, got vaccinations, and dared to dip a toe back into pre-pandemic life, plastic surgery has changed, too. The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) just released the results of its 2021 member survey, outlining new insights and theories about how the ongoing ebb and flow of the pandemic has impacted the industry and its patients. We asked five leading facial plastic surgeons for their insights on the report's key takeaways.

When the COVID-19 virus spikes, so do consultations

In the summer of 2021, Washington, D.C.-based facial plastic surgeon, Michael Somenek, M.D.,'s practice saw patient consultations and surgeries returning to a stable, steady rate as vaccinations became widespread. But once the Omicron wave hit, all bets were off.

"We definitely saw a peak in consultations and surgeries again," he says. "People thought they were going to go back to their offices in the new year and then the return was postponed again, so patients who didn’t take advantage of the downtime in 2020 were taking advantage in 2021."

Consultations are more essential than ever

One growing trend at Dr. Liotta’s office is a surprising one: saying no. "I've been turning away more and more young patients than I ever have," she says. She believes the higher percentage of patients seeking a procedure that they are not a candidate for is typically due to unrealistic expectations, leading her to dedicate more time to her consultations to ensure surgeon-patient alignment.

"I spend 45 minutes with every single consult because that expectation setting and communicating what is realistic is so important and has gotten so mixed up over the last few years," she says. "And I think that’s because of TikTok [and] Instagram."

Patients are taking recovery more seriously

One of the constants for many of us throughout the pandemic has been working from home, which has supercharged safer patient recoveries. "There hasn’t been a need to push recovery timelines to rush back into the office like there was before," says Mary Lynn Moran, M.D., a Tennessee-based board-certified plastic surgeon and past president of AAFPRS.

She notes that before COVID, patients were always looking for recovery shortcuts to get back to work faster. "I think patients are taking the time to really see these procedures as a self-care moment."

"Tweakments" are over

Just a few years ago, "tweakments" or a series of small, subtle facial enhancements, were all the rage in the aesthetics world, but now, "that’s very much over," says Dr. Liotta, adding that surgery offers patients more predictable and stable results over time.

Patients are also willing to swap longer-term benefits for a bit of downtime, even for non-invasive procedures, "if that means a more substantive result," says Dr. Moran, who says she's performing far more CO2 laser resurfacing treatments than before, which comes with a few days of downtime. "They're more willing to have some downtime if it means an actual long-lasting result that is not going to require a bunch of little tiny treatments that may or may not work."

Filler fatigue is leading to a rise in niche surgeries

"In pre-Covid times, there was a little bit of joy that went along with your Botox and filler maintenance — that sense of taking care of yourself," says facial plastic surgeon, Dara Liotta, M.D., who practices in New York City.

Now, many patients aren't interested in continuous injectable upkeep, nor do they want to run the risk of an overfilled area due to repeat injections. Instead, they are turning to more permanent solutions, like the increasingly popular lip lift and brow lift procedures.

"I have patients coming in to get their lips dissolved to come back to a baseline, which [looks] like crinkled raisins to them after being inflated for so many years, and then they get their lip-lift," says Dr. Somenek, who believes this procedure will continue to be popular well into 2022. "That gives them a little bit more of a long-term option. Their lip is going to continue to age and probably deflate but in a much slower manner."

Brow lifts, on the other hand, can be either surgical or noninvasive and can delay the need for an upper- or lower-eyelid surgery. "It's going to give you that little peak to the brow, and you'll be set for a while before you [might[ need a blepharoplasty," explains Dr. Somenek.

Preventative and proactive procedures are soaring

As plastic surgery becomes more social media, patients, in turn, have become savvier and done their homework on potential procedures before they even step into their consult, according to Dr. Moran. This increased knowledge and awareness, especially for millennials, is attracting younger patients for procedures usually reserved for someone a decade or two older.

"We're seeing a significant shift to earlier surgical intervention and non-surgical improvement of skin texture," says Corey S. Maas, M.D., a San Francisco-based board-certified facial plastic surgeon and AAFPRS president.

One region where this preventative dynamic is especially strong is the eye area. It's become such a significant component of early intervention that Dr. Somenek believes eye lifts have the potential to topple the long-standing rhinoplasty as the number one facial procedure.

Energy-based treatments remain popular

"Radio frequency, year after year, remains one of the main energy-based treatments to non-surgically improve the quality of the skin," confirms Dr. Somenek, thanks to the treatment's status as a cure-all for nearly every skin concern. RF devices, which use thermal energy to treat the skin, can be used on both the face and body. "It treats such a wide variety of conditions, from your acne scarring to just doing something for the maintenance of your skin, giving a little improvement to the texture, and evening out the tone," he says.

Technology is keeping up with aesthetic demand

Researchers and tech whizzes are certainly not sleeping on the aesthetics industry, given its projected value of $30 billion by 2029. "It's keeping a pretty good pace, and technology is something that changes quickly," says Dr. Moran. "It's good for everyone because it really holds surgeons accountable for making sure they’re offering the best and safest devices to their patients."

What's more, a slew of new products, devices, and indications from the U.S. Food and Drug Administration (FDA) continue to launch with striking regularity, says Dr. Maas. "Real advances were made in the science of aesthetics over these last couple years," he says, which triggered a wave of new interest from patients in the latest and greatest noninvasive options.

Social media continues to influence in positive and negative ways

Many of the surgeons interviewed for this story have mixed feelings about social media's influence on plastic surgery. "As much as I like to go back and forth with how much I hate social media, there is a component of it that does improve the patient’s comfort level because they’ve seen what a good result is," says Dr. Somenek.

And we can't deny how it’s made education and awareness so accessible, says Dr. Liotta, before giving into her opposing point of view. "It's made patients be a little unrealistic about the process, what to expect, and what is a good result," she says, adding that she thinks more young people are unhappy with their results because they weren't great candidates to begin with, or their expectations weren’t properly managed.

"I think that's sort of the dirty side of social media: the demand for perfection has been squeezed so much, both in the eyes of patients but also us as surgeons, that there's no room for error," she says.

Similarly, Dr. Moran cites comparison as the thief of joy, especially when it comes to aesthetics. "I think some patients see examples of people who look perfect and they do compare themselves, whether it's filtered or not," she says. "Young people aren't as able to discern, 'Hey, wait, that's maybe that's not reality.'"

Surgeons' education has gone digital, too

Continuing education and refining surgical techniques doesn't stop simply because of a pandemic— like all other industries, plastic surgeons have improvised to keep on keeping on.

"Our organization has gone to a virtual platform, and the number of opportunities to learn online has grown exponentially. A lot of sharing came out of that too," says Dr. Moran. She's aware of dozens of surgeon-founded groups within AAFPRS, which surgeons use to swap stories, both positive and negative, and share tips and techniques.

"We've really started communicating in ways that we never did before, which is good for everybody," she says. "Our ability to access the safest, the latest, the greatest, firsthand from other colleagues is benefiting everyone, and it's happened at this exponential pace."

More men are seeking surgical intervention

"We absolutely are seeing more and more men coming in for all types of procedures," says Dr. Somenek, who says he's seen more men for neck-lifts in the past six months than he ever has before.

And they aren't interested in non-invasive treatments —they want to go straight to surgery. "Men, almost universally, will choose liposuction over [noninvasive] Kybella because they are not interested in seeing me every month for three to four treatments," says Dr. Somenek, whose male patients most commonly request submental liposuction around the jawline.

The takeaway

Plastic surgery and aesthetics can really tell you a lot about a culture and an economy, says Dr. Somenek, and the results of the AAFPRS showed just that. According to the report, an estimated 1.4 million surgical and non-surgical procedures were performed in the past year.

What's more, plastic surgeons estimated taking on an average of 600 more procedures than they did in 2020. And this 40 percent increase from the number of procedures they performed in 2020, Dr. Maas believes, is conservative. "Overall, I think this report is a very reflective and reasonable assessment of what's been going on across the country," agrees Dr. Moran.