Not many years ago, cosmetic procedures were few and far between and sought out primarily by women. Today, though, women and men seek out procedures, both cosmetic and minimally invasive. There have also been considerable advancements in terms of both the types of procedures available and the materials used in such procedures, as well as in techniques reducing risk and recovery time. In fact, every year seems to bring some sort of improvement or new technique; in some cases, costs are decreasing, which makes procedures available to more people and increases their overall popularity.
Those advancements and other factors have changed the face of cosmetic surgery and procedures and have led to an overall expansion of the industry as well as its appeal to Americans across the board.
Evolving Marketplace
Trends are difficult to identify in terms of popular procedures in Oklahoma.
“I don’t know if there have been any real changes in trends the past year or two,” says Dr. James R. Koehler of Tulsa Surgical Arts. “The only trend I would point out is a higher percentage of men [seeking out cosmetic procedures]. Typically, 90 percent of my patients are women because of the type of practice I do, but I am seeing more men.”
Koehler says breast augmentation and rhinoplasty are the most common procedures sought by younger women.
“When they get into their 30s, women who have had children are getting breast lifts and augmentations and tummy tucks,” he adds. “That hasn’t changed much.”
Dr. Tim Love, an Oklahoma City surgeon, agrees that there has not been much change in terms of popular procedures with women – the most popular revolve around breast, body and facial work – and while new technology has periodically threatened to change the nature of those procedures, they haven’t proven to have the staying power.
“All technology tends to cycle pretty quickly,” says Love. “The biggest challenge is investing in the proper equipment. There’s lots of niche marketing. Something will show up on Good Morning, America, and suddenly it becomes a trend.”
Love can’t say whether or not men today make up a larger percentage of the overall market share, but he says he has noticed an uptick in male interest.
“There are statistics available, and I think as the total number of procedures goes up, there is a little move-up for men,” he says.
Love adds that men tend to seek out hair transplants and “some liposuction.”
“I think non-surgical procedures in major metropolitan areas, where men are generally more interested in their appearance, there’s probably more demand for (them),” he continues. “Guys tend to do things for themselves. Hair replacement, for example, makes them feel good.”
Dr. Angelo Cuzalina of Tulsa Surgical Arts says that for a while, the “mommy makeover” was popular. He explains the term is a reference to “breast and tummy” work.
“Typically, women get stretched from child-bearing effects, and many want to try to get back their appearance from before child birth, and they usually love the results,” Cuzalina says.
Procedures of all types have gained in popularity because of what Cuzalina says is a change in perception of the practices.
“In cosmetic surgery, people aren’t as worried about perception anymore,” he says. “It was once thought of as a rarity, but it’s becoming more commonplace.”
Cuzalina also sees a rise in the number of men undergoing procedures.
“The percentage of men [in the marketplace] was always under 10 percent, and it’s now just over 10 percent. The number of men has slightly increased. However, demand is still dominated by women,” he says.
“The most common procedures sought out by men are liposuction of the belly to address love handles,” Cuzalina continues. “One thing that has slightly increased in demand is for [male breast reduction]. A lot of times, men don’t even like to admit need for it, but it’s an older treatment that has become more popular.”
Cuzalina says that both overall and in terms of Tulsa clientele, the Brazilian Butt Lift is a popular procedure.
“It’s really lipo of the hips, then adding that to the butt,” he says.
The procedure is particularly sought out by women who have had gastric bypass surgery.
“Here in Tulsa, it’s definitely becoming more popular,” Cuzalina says of the Brazilian Butt Lift. “It’s a lot less risky than gluteal implants and more curvy.”
Price sensitivity is also driving an increase in demand for cosmetic procedures. Breast augmentation has notably decreased in price, and Cuzalina cites this as particularly true at Tulsa Surgical Arts. He also notes that procedures cost considerably less in Oklahoma than in major urban areas.
“In New York City, for example, the cost is about three times that of what it is in Oklahoma,” he says. “The industry is lower priced here than in other places.”
Dr. Nicole Patel of the Aesthetic Surgery Institute of America, based in Tulsa, offers a different, if shorter-term, perspective on trends.
“I think what you see is determined a lot by the type of practice you have and the services you offer,” she says. “Breast augmentation and body contouring remain very popular. A new procedure, labiaplasty, is also more in demand. However, I might find that because I am a woman, and women might seek me out for that (reason).”
Patel says that non-surgical facial procedures remain high in demand.
“Anti-aging procedures are also very popular,” Patel adds. “People are looking for not just surgical practices.”
Patel says that her perspective also is affected by the fact that she is a relatively new practitioner.
New And Noteworthy
Given the different types of practices they have and their various areas of expertise, it is little wonder that cosmetic surgeons have different perspectives on what is new, noteworthy and otherwise coming down the pike to bring any major change to the industry and to cosmetic practices overall.
Koehler cites an improved form of breast implant, which is new in terms of technology and has just been approved by the FDA.
Form stable breast implants are “pretty new in the U.S.,” he says. “They are completely solid implants that can’t leak like others. They haven’t yet taken a lot of the market share, perhaps because of cost or that they tend to provide a more conservative look. They are more for a woman who is an A or B cup and who wants to be a C cup. They’re solid, nice implants and very safe. They are nice for certain women, and they suit certain patients.”
Koehler also mentions significant improvement with dermal matrices, which he says have been around for years but have benefitted from recent technology.
Acellular dermal matrix (ADM) has been used as a soft tissue replacement since its introduction in 1994. ADMs are soft tissue matrix grafts created by a process that results in decellularization but leaves the extracellular matrix intact. This matrix provides a scaffold upon and within which the patient’s own cells can repopulate and revascularize the implanted tissue. The introduction of ADM has provided surgeons with alternative means of obtaining sufficient vascularized soft tissue to cover the implant, thereby alleviating some complications.
Most cosmetic surgeons believe that recent advancements and those on the near horizon revolve around better materials – everything from better laser-type devices to sutures that don’t need to be removed because they are absorbed into the body.
However, some point out that procedures tend to come and go, become very popular and then fade away. The result is an ever-changing marketplace that can, at the very least, appear erratic.
“My biggest concern, not to sound negative, is that there are so many technologies,” Love says. “There is about a 24- to 30-month cycle when it comes to new things, and often they don’t deliver or don’t become very popular. In some cases. it’s because the machinery is not cheap, and that makes it impractical for many practitioners.
“There will always be improvements,” Love adds. “But the ratio is like 10:1, with the ‘one’ being the advancement or improvement that actually has the staying power to actually stick around.”
If there is one potential advancement that fosters disparate opinions, it is the application of fat-derived stem cells. These stem cells possess potential in both traditional medicine and in cosmetic applications. However, since they are not derived from fetal material, they would seem to prompt less controversy than previous discussions over stem cells derived from such material.
“Stem cells harvested from fat makes moot the arguments against fetal stem cells,” Love says. “Stem cells in fat peak in a person’s mid-20s. When you do liposuction, those cells go with you, but they aren’t isolated. There has long been evidence that there are applications for these cells, as a facial agent, for example. There are potentially numerous other applications. It’s only a matter of time before new hair can be grown with them. In application today, they are useful for liposuction and grafting facial volume. The most beneficial effects are when I’ve applied them in breast reconstruction after breast cancer.”
Love sees numerous other applications on the horizon in medicine and cosmetic procedures.
“The thing that excited me most is finishing my career and seeing these stem cells help stroke patients and others,” Love says. “There have been a number of studies that show they can also be effective to combat congestive heart failure. We already have these cells, so the case is closed on the [fetal/infant] factor. In our field, the point is that these could have a huge implication when it comes to burn scar victims and people with other serious damage. The potential applications across the board in medicine are impressive. It’s an exciting time.”
Patel says it might be some time before these particular types of stem cells are ready to introduce into numerous applications.
“Stem cell technology is quite something,” she says. “The technology is evolving. We’re learning more all of the time, but I think it will still be a while. I think this is particularly true in medicine. Because the cosmetic surgery world has many patients that pay cash, the technology might actually advance faster in the cosmetic world than in medicine.”
Koehler has a more conservative view of fat-derived stem cells than some of his colleagues in the industry.
“As it stands right now, the technology is not far enough along to use it,” Koehler says. “It shows great promise on the horizon. There are people out there marketing stem-cell facelifts, but they aren’t really using stem cells. It’s just fat-grafting. A lot of research on stem cells is being done in other countries. It may be very positive in the future, but it’s maybe 10 years off from being common. Even if they perfect procedures in the next four years, it would take another four years or so to go through the approval process in the United States.”
Making The Choice
It isn’t just that there are more procedures and new technologies in the cosmetic procedures world today, there are also more practitioners, both medical doctors and aestheticians – and they offer their services both in the United States and abroad.
While most cosmetic surgeons report that very little of their work is repairing damage done by other practitioners with one designation or another, cosmetic surgeons also believe that, with the right training and in the right environment, some minimally-invasive procedures can be safely administered by non-M.D.s.
“Aestheticians are only able to do certain procedures, and as long as they are doing those procedures for which they are trained, that’s okay – such as laser hair removal and such,” says Koehler. “There are things they cannot do. There are clinics out there in which nurses might be injecting Botox and other fillers, but for some minor procedures, it’s generally safe. I haven’t seen any disasters from fillers being done in med-spa environments.
“Actually where you run into problems is physicians doing cosmetic procedures even if they are not experts in the field,” Koehler continues. “Any medical doctor, for example, can do liposuction, but they might have had only a weekend training session in it.”
Cuzalina points out that the ease of access to some procedures might well cross the line of appropriateness and safety.
“I’ve heard of Botox parties, but how would one know if there is anyone there licensed to do that?” he asks. “Someone would have to be crazy to do that. If it sounds too good to be true, it probably is.”
Love says that various practitioners are trained for non-surgical procedures.
“You’ve got all of these levels of experience,” he says.
Each physician agrees that the potentially most precarious decision is a “cosmetic” vacation overseas, where procedure prices can be much lower and where procedures not approved in the United States can be purchased. There are distinct concerns about that, despite the fact that just because a doctor is overseas doesn’t mean he isn’t competent and capable.
Patel says her practice does see patients who had gone abroad for procedures.
“Hey, there are good physicians all over the world,” she says. “The biggest problem is what happens if there are complications? Who takes care of you? Are you going to fly back to the country where you had the work done? Here, doctors might be afraid to take on the liability risk for someone else’s work overseas. You should have procedures done near where you live, so that follow-up and any complications can be addressed by the initial surgeon.”
Other physicians agree that having work done near one’s home is an important factor in deciding on whom to seek out for procedures.
Domestically, there are certain words of advice each surgeon has to offer. Visit facilities, inquire about experience and expertise, ask to see before and after photos of prior patients who had the procedure you’re seeking done by the practitioner, ask about hospital privileges and where procedures take place and even ask to speak to previous patients about their experiences. Surgeons of repute should have no problem addressing these concerns and questions.
You’ll also want to deal with a surgeon who is open and honest about potential risks and complications. Finally, something more esoteric to consider: Chemistry is important when it comes to a patient’s relationship with his or her doctor. Does that chemistry exist? Do you feel comfortable with the doctor, the staff, the environment? All are the primary factors one should take into consideration when making a decision, according to each surgeon interviewed.
Taking these considerations in mind and being an educated consumer can greatly enhance any cosmetic procedure one might seek.
“Life’s too short to be unhappy,” Love says.
