Plastic surgery down but not out

The 2008 statistics were released this week from the American Society for Aesthetic Plastic Surgery (ASAPS), which represents board-certified plastic surgeons who devote most of their practice to aesthetic (cosmetic) surgery. It’s an annual ritual and the numbers are dissected every which way to see what they imply about trends in plastic surgery and society as a whole. The statistics also measure nonsurgical cosmetic procedures.
So what’s the big news this year? Surgical procedures overall were down for the first time, by about 15% overall, which isn’t any great surprise given the economic climate. What few expected though was that breast augmentation is now the number one surgical procedure, overtaking liposuction, which has held the number one spot since ASAPS first started collecting the data 12 years ago. One likely explanation for the rise of breast augmentation (more than 350,000 cases last year) relates to the FDA clearance of silicone implants a little over 2 years ago. Since they give more natural results for many women, there may have been a sort of pent-up demand, and some women unhappy with their saline implants may have been changing to silicone. In a broader sense though, there is just more comfort now that silicone is in fact safe and people just tired of hearing otherwise when the science gave the implants a clean bill of health years ago.
There is a bigger message in the statistics if you look back over the past few years. Even though plastic surgery has more than doubled since the turn of the millennium, nonsurgical procedures such as Botox and dermal fillers have increased some 750%. The rise of cosmetic medicine, and the inevitable decline of more invasive procedures will be the theme in coming years. Of course there is a long way to go before nonsurgical procedures can truly compete in terms of results, but there are compelling benefits if they can. For now, it is one big happy family since the medical procedures for the most part do what surgery can’t and vice-versa, but watch for big changes down the road.

Botox and mood: It's a good thing

Billy Crystal had a character he played on Saturday Night Live back in the day who used to say "If you look good, you feel good darling" or something like that. Turns out, it's true, and even something like Botox can help according to a study just out in the Journal of Cosmetic Dermatology. Doctors at the University of Cardiff, in the U.K., evaluated mood in 25 subjects who received Botox to the worry lines between the eyebrows. The patients showed significantly less negative mood by standard measures, as compared to a control group. Specifically, subjects were less irritable, depressed, and anxious. This has actually been studied before and these results confirm those earlier findings.
There is more to this than might appear at first glance. The authors of this study point out that facial muscles are not just involved in expressing emotion, they are involved in the experience of emotion as well. The muscles between the eyebrows (called "corrugators") convey concern, anger, and worry. By relaxing them with Botox, the experience of these emotions seems to be lessened through a sort of biofeedback loop. An interesting question is whether this is also related to the effect of Botox in lessening the frequency and severity of migraine headaches for a large number of people. In any case, there is something to smile about.

patterns

It's funny how things seem to appear in groups. this week we had one day that had several mother-daughter consults together, the next was everyone from Alaska, and we seem to have gone through more Botox in the last week than the whole previous month. Surgery this week is mostly tummy tucks (abdominoplasty), while next week seems to be facelift week. We certainly don't plan things this way but that's the way it often works out.
The mother-daughter thing is not what many assume; it is simply a matter of mutual support. Mothers may feel that it is time to do something for themselves after raising a family, while daughters are often dealing with the more recent changes from childbearing. Sometimes there are issues that the daughter was born with such as asymmetrical breasts, and the young woman is now old enough to consider correction. Those who may criticise and say that we would all be better off learning to accept our flaws should walk a mile in their shoes first. We are not dealing with vanity here.
I am tempted to interpret the surge in Botox and fillers (Restylane, Juvederm, Evolence) as a sign that the economy is improving, though there are few other signs offering such encouragement. In at least one or two cases, it is people competing with younger professionals in a more tenuous employment market. Perhaps other people are just getting tired of hearing about all the gloom and doom and just wanting to get on with their lives.