The Procedures Experts Want You To Reconsider This Year

Aesthetics trends come and go at a rate that can be hard to keep up with (don't worry, we’ve got you covered on what to expect in 2022). While there are no signs of interest in perennial favorites like Botox and fillers slowing down now or, really, ever, there are some newer modalities – especially in the non-surgical space – that are rising up the ranks. So, what are these treatments and what do their emergence mean for your next trip to the dermatologist or plastic surgeon? We asked top aesthetic providers to weigh in on what procedures are worth investing in this year.

What’s Trending – and Why?

We don’t need to tell you that the COVID-19 pandemic dramatically changed the way we lived, worked, and socialized in 2020 and 2021. More time at home and more time dissecting our faces on Zoom, led many who had been contemplating surgery to finally opt to go under the knife (a new report shows a 40 percent increase in facial plastic surgery last year). After all, you could recover discreetly without missing a beat. And, if you did venture out, there was plenty that could be concealed behind a face covering.

But, as we increasingly return to in-person living, working, and gathering, the pendulum is swinging back the other way. “My patients are most interested in the non-invasive procedures – what they can do that is a quick treatment, with little downtime, that still delivers results,” says Bruce Katz, MD, board certified dermatologist and founder of JUVA Skin and Laser Center in New York City. The same is true on the West Coast. “I’m also seeing fewer patients interested in facelifts and eyelid surgeries,” says Neda Mehr, MD, a board certified dermatologist and founder of Pure Dermatology Cosmetic and Hair Center in Newport Beach, CA. “Instead, they’re opting for minimal-downtime procedures that can achieve desirable results without the risks of surgery.”

But it’s not just surgical versus non-surgical. Even among minimally invasive procedures, there are other factors at play. Chief among them? Pain. “Some of the older non-invasive treatments, like Ultherapy®, are declining in popularity,” says Stafford Broumand, MD, a board certified plastic and reconstructive surgeon and founder of 740 Park Plastic Surgery in NYC. “We have treatments that render better outcomes with less pain available now.” Dr. Mehr agrees. “I have seen a huge shift in my practice away from painful procedures like Ultherapy® to the less invasive procedures like Thermage®,” she notes.

And then there is the very important topic of side effects and complications. No matter the level of invasiveness, no procedure is without risk. Last year, Linda Evangelista opened up about her experience with paradoxical adipose hyperplasia (PAH) after a series of cryolipolysis (read: CoolSculpting®) treatments. Since then, Dr. Broumand says the fat-freezing treatment has become a less popular request among patients. “It has also declined due to a rare side effect and negative press on the treatment,” he shares.

Popular Procedure Swaps

Now that we’ve covered what’s driving patients and providers alike to opt for some of these newer, non-surgical and less invasive alternatives, it’s time to talk about exactly what some of these updated treatment protocols involve. Here are five our experts are most excited about:

1. New Uses For Neuromodulators

While it’s important to talk about neurotoxin safety and how necessary it is to visit a highly skilled provider, interest in the wrinkle-reducing injectables is higher than ever. “We are seeing more filler and Botox® in our practice, as patients are interested in non-invasive quick fixes to correct their facial asymmetry,” Dr. Mehr shares. For some, this may be the first time they are seeking treatment. “Since they see themselves on Zoom all day long, [they] are noticing a lot of discrepancies that may not have bothered them before,” she adds.

One such area is the nose. Dr. Mehr performs what she calls a “non-surgical nose lift” using strategic placement of neuromodulators. “We use Botox® on the nasal ala (nostrils), the upper sides of the nasal wall, the nasal dorsum area (between the eyes), and the columella (base of the nose) to relax the muscle so it lifts the tip of the nose,” she explains. This can act as a minimally invasive alternative to rejuvenation rhinoplasty.

And that’s not all. Dr. Mehr and her team are also using botulinum toxin type A injections to treat patients with androgenetic alopecia or genetic forms of hair loss. “For patients with androgenetic alopecia, histopathology specimens show that the blood vessels are in the deeper muscular plane,” she explains. “When you soften or relax those muscles with [neuromodulators], the diameter of the blood vessels increases.” Treatment requires 150 units, and, for that reason, Dr. Mehr says she usually chooses Dysport®, Jeuveau®, or Xeomin® (rather than Botox®). “When you use beyond 100 units of Botox®, people can start to develop antibodies to it, and it becomes less effective over time,” she notes. “The science is the same: If it’s a neurotoxin, it relaxes muscles.”

When it comes to results, she says patients will start to notice an increase in the diameter of the hair follicles after about three months. By six months, there is increased hair growth. “The treatment frequency is every six months,” Dr. Mehr shears. “And ideal candidates are those with temporal thinning and vertex scalp thinning.”

2. Facial Rejuvenation – Sans Surgery

At the end of the day, nothing can fully compare to the lifting powers of a surgical facelift – but combining the forces of new skin tightening treatments with biostimulatory injectables can have a seriously rejuvenating effect. For starters, our experts all extoll the virtues of radiofrequency (RF) for firming the skin. Dr. Broumand likes Morpheus8 because it marries the benefits of RF with microneedling, while Dr. Mehr is a fan of Thermage®. “[It] addresses visible signs of aging in just minutes and can be used on the face or body,” she explains. “There is little to no downtime, so my patients can return to their regular activities almost immediately.”

These energy-based skin tightening procedures can be used alone or coupled up as part of a larger, multimodal treatment plan. “Instead of complete facelifts, patients are opting for filler to define certain areas, like the jawline,” Dr. Mehr says. “Over time, as collagen depletes, the face begins to look more ‘boney,’ and placing filler in these areas can help patients achieve a younger-looking appearance.” She often uses Radiesse® because the calcium hydroxylapatite (CAHA)-based injectable stimulates collagen production.

3. Lunchtime Lasers

Lasers are pretty multifunctional in terms of the aesthetic concerns they can treat, and there are classes of them that won’t require you to hide out for an extended period of time. If you’re looking to treat facial redness (including rosacea), Dr. Mehr recommends the Excel® V laser. For pigmentation and pore size, consider Clear + Brilliant®. “Each of these has little to no downtime, so patients are able to get back to their Zoom meetings the next morning looking more refreshed,” she says.

RevLite®, meanwhile, is a non-ablative Q-switched laser that can be used to treat pigmentation and uneven skin tone. “Before RevLite® came out to treat brown spots, we used cryotherapy – or liquid nitrogen – to remove the lesions,” Dr. Katz shares. “You would apply liquid nitrogen to a swab and apply it to the brown spot, and then the liquid nitrogen would destroy the extra pigment, leaving skin more even-toned.”

As he explains, the RevLite® procedure is “much more efficient” and allows for “more precise” results. “You can do both cheeks with RevLite® in less than five minutes and see great results, whereas you’d only be finished with a portion of a cheek using cryotherapy in the same time,” he says. After treatment, expect your dark spots to turn from brown to white and exfoliate away over the course of a few days.

4. A Neck Lift Alternative

The concept of ‘tech neck’ took on a whole new meaning during the pandemic, with people examining their neck and jawline in a whole new way on video calls. Even so, many are not interested in or ready to go under the knife. “A lot of patients don’t want surgery, so they either walked away without treatment or eventually came back for surgery,” Dr. Katz explains. “Now, we can offer those patients something easy and accessible to address their neck concerns.”

What is that “easy and accessible” option you may ask? Enter MyEllevate®. The minimally invasive treatment involves percutaneous suture suspension to treat the platysma bands in the neck to tighten skin. “Prior to MyEllevate®, there wasn’t anything available to treat neck bands and sagging skin in that area,” he says. “The only option was surgery – either neck surgery or a lower facelift.”

Performed under local anesthesia, surgical sutures are inserted via a lighted needle underneath the skin. A series of needle puncture sites are the only wounds, and there is about a week of recovery time. Depending on the patient, MyEllevate® can be paired with energy-based tightening procedures (as discussed above) and/or submental liposuction.

5. Lesion Removal

A blend of medical and cosmetic dermatology, Dr. Katz has been using CellFX® – a new technology that delivers nano-second pulses of electrical energy – to remove benign lesions and growths (think: moles, flesh-colored bumps, warts, and even acne). “Prior to using CellFX® to remove benign lesions, we would do electrodesiccation, which is where an electric current is delivered via a needle-shaped electrode to superheat the skin and essentially ‘burn off’ the lesions,” he explains.

The pulses alter the cells in the treatment zone, resulting in a gradual clearing of the cells that caused the lesion without damaging healthy collagen or nearby tissue. “CellFX® is more efficient and less invasive,” Dr. Katz shares. “It not only targets the lesion on the skin’s surface, but treats the cause of the lesion at the cellular level, while leaving the surrounding skin tissue unharmed.”

The Takeaway

Regardless of what the trend reports may say, the right treatment for you is the one that delivers the best results for your aesthetic concern(s) in the most safe and effective way. With that said, it can be helpful to know how technology and techniques have evolved because, in some cases, it means that quicker, easier, and less invasive alternatives exist. Consulting with a board certified dermatologist or plastic surgeon is the best way to learn exactly what you’re options are.