Cosmetic Procedures: You Woke Up Like This

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This feature was written by Studio MSP writers. While some of our advertisers were sourced, no advertiser paid to be included.

The “Instagram Face,” as coined by The New Yorker’s Jia Tolentino in 2019, is characterized by unnaturally luminous skin, cheekbones cut like the shoulder pads of the ’80s, and doe eyes topped with a swoop of inky lashes. It’s become its own beauty ideal, thanks to our always-online, filter-obsessed culture. But if the local scene is any indication, we may be hitting the “more is more” peak. Patients are communicating that they merely want to look more awake without meddling with their unique identities. 

Dr. Edward Szachowicz of Facial Plastic Surgery calls this movement “prejuvenation,” creating a look that essentially says, with a self-assured flick of the hair, I just rolled out of bed, and I didn’t even have to try to look this good. It’s an effortless aesthetic that gives off the vibe you were light-years ahead of your peers—you were that unicorn that ardently applied SPF in your teens, never went a night without removing your makeup, and established an elaborate five-step skin care routine in your early 20s. “Patients often want to know if their results will be natural,” says Dr. Garrett Griffin of Midwest Facial Plastic Surgery. “The way I answer this is to point out that we are in the Midwest…not Beverly Hills. We know patients don’t want anyone to know they had plastic surgery.” 

And with today’s comprehensive menu of noninvasive services, there’s something out there for every physical hang-up.

In: Laser Light Therapy

Out: Total Facial Resurfacing

The lines at local cosmetic surgery offices are lighting up with callers looking for laser skin rejuvenation, a leading solution for slowing down the degradation of collagen and elasticity. The light-based energy mechanisms trigger the body’s natural healing responses, which, in turn, liberate skin from complexion-dulling cells. 

“We have what’s called the Forever Young BBL [broadband light]—it’s been scientifically proven to slow the aging process of the skin, and what that involves is a procedure where we do a laser light therapy three to four times a year,” says Szachowicz. “It’s not really intrusive, and during those treatments, there’s just a little bit of redness for 30 minutes or so, and the laser treatment is like a cleanup. [Think of] a person who got too much sun on vacation and got too much pigmentation; we use that laser to get all of that off.” 

While the laser largely targets discoloration—like freckles, sunspots, and rosacea—wrought by time and chronic sun exposure, it can also target unwanted hair, reduce acne, and improve the appearance of small veins. The results are instant and can last up to 10 years.

Forever Young BBL was pioneered by Dr. Patrick Bitter Jr., who took a biopsy of skin from behind his ear and found that the enzymes responsible for breaking down the skin were down-regulated. “And [the light-based energy] up-regulated the enzymes that make new collagen, so he said, ‘How long does that last?’ Turns out, it lasted around 90 days and then started to reverse and go back to the way it was,” explains Szachowicz. The Stanford doc then corralled together a small cadre of people younger than 50, performed the treatment on them three to four times a year for 11 years, and found that those people looked better than they had a decade earlier. “All of his research was clinically proven, which is why I tell people: Take your skin to the gym!” says Szachowicz

“It’s not really intrusive…the laser treatment is like a cleanup.” – Dr. Edward Szachowicz / Facial Plastic Surgery

Dr. Jane Lisko, board-certified dermatologist and Mohs micrographic surgeon at Associated Skin Care Specialists, says laser therapy is increasingly popular among all age groups due to its minimally invasive nature—and she doesn’t see that slowing down anytime soon. Laser Genesis, a non-ablative procedure that targets heat into the skin’s outermost layer, is one of the most requested laser treatments at her practice right now.

“Laser Genesis kills the bacteria that promotes acne, while it also helps with red and brown discoloration,” she says. It’s hailed as being gentle enough for all skin types and tones, with little to no downtime following treatment. 

But lasers and “gentleness” didn’t always go hand in hand—for a long time, laser treatment options on the market were narrow, costly, and usually too abrasive, particularly for darker skin tones and sensitive skin types. Dr. Bryan Rolfes, triple board-certified facial plastic and cosmetic surgeon of Pinnacle Dermatology, says that in the not-so-long-ago past, chemical peels and lasers would remove the entire outer layer of the skin—penetrating both the epidermis and the dermis. “The results were dramatic, but the patient would end up with a somewhat unnatural appearance called ‘porcelain skin,’” he says. “In most cases, modern skin resurfacing is done with a laser and is fractional—only removing a portion of the top layer.”

Shining a light

Landing on the right laser therapy for your specific skin concerns can feel a bit like navigating the cereal aisle. To help guide patients to the right one, Facial Plastic Surgery boasts a VISIA Skin Analysis camera, which sets patients’ images against a database of 250,000 faces, generating comparisons on age, gender, and skin type. “The report details UV damage, wrinkles, pigment, et cetera, and the choice of laser is based on the individual patient’s needs,” says Szachowicz.

In: Lip Lifts

Out: Duck Bills

Fillers continue to be the gold standard for plumping up slackened areas of soft tissue (e.g., the lips, eyes, and cheeks), but some patients are choosing to augment their lips for the long term. And while getting a procedure done with permanent results may sound intimidating, lip lifts have proven to be a happy medium for those seeking definition and the appearance of a full pucker—without having to commit to repeated injections. 

“Lip lifts, which started on the West Coast, is where we take out the extra length between a person’s nose and upper lip to give them a whole balance of their face,” says Szachowicz. “The reason that this procedure is important is because it’s showing that more younger people are opting for facial surgery.” There isn’t a one-size-fits-all lip lift: The most common types include the subnasal bullhorn lift, the central lip lift, the corner lip lift, and the Italian lip lift. The differences lie in the shapes, sizes, and locations of incisions and the ways in which those incisions are closed. Rolfes says he performs several lip lifts a week and that the results have been overwhelmingly positive. 

The lip flip is another common enhancement—albeit a temporary one, says Lisko. It’s a treatment that involves administering incremental amounts of Botox to give off a natural but perceptible external rotation and lift of the upper lip, with results lasting up to four months. “A lip flip is a little less noticeable than filler, and for some patients, this is all that is needed,” she says. For others, the lip flip is a gateway to other lip treatments. 

“The overcorrected ‘duck bill’ lip, popularized in Hollywood and such shows as The Real Housewives, is definitely out,” she says. “While many practitioners try to cash in on the allure of cosmetic procedures, board-certified dermatologists or plastic surgeons are trained in aesthetics and cosmetic procedures. There are no bargains in cosmetic procedures, so the adage of ‘caveat emptor’ holds true.”

Dental Diversity

“Natural—not fake—is paramount in cosmetic dentistry. Some people want just perfect-looking teeth; others want subtle nuances or slight imperfections built into their smile…. Not all patients are good candidates for traditional veneers.  Some patients require more traditional crowns to block out darker or mispositioned teeth. Creating a natural, perfect smile can be just the thing people need to boost their self-confidence. Looking and feeling good is worth everything.” 

—Thomas Morgan, DDS, FAGD, of Morgan Family Dental

+ Pro (Needle) Tip

As we age, the distance from the nose to the lip grows longer, the lip rotates downward, and the lip loses its shape and volume. Rolfes says lip filler can restore that lost volume and some of the Cupid’s bow shape, and if the distance from your nose to your lip is short, it can look natural. He cautions that patients with long lips and little to no “tooth show” may not be good candidates for filler, however. “If you have a short upper lip, you can add a lot of volume and it can still look good,” he says. “That’s why Kim Kardashian’s lips look good on her—but if you put the same volume on someone else with a longer lip, it would look ridiculous.”

In: Looking Snatched

Out: Looking Vacant

Chin augmentation can be a surgical or nonsurgical procedure, depending on the strength of the chin and how it relates to the neighboring framework of your face. “Chins are in! Over the past two years, people have been coming in wanting that contour,” says Szachowicz. “And we’re much more clever with contouring the chin than we’ve ever been.” 

Achieving a sculpted profile used to strictly require surgical implants, but as technologies improve, dermal fillers are becoming markedly targeted and varied, like the new FDA-approved Juvéderm Volux, an injectable designed to improve loss of jawline definition. “We hear the word snatched all the time,” he says, referencing the slang term for having a tight and slim mandibular angle, and results are just getting better and better now that we “understand what a feminine or masculine chin or jawline looks like.” 

Jen McBeain, owner and certified injector of Elegantly Ageless, says that as we age, we lose midface volume, causing our skin to fall down and then forward, “and that’s where we see marionette lines and nasolabial folds. So, without dramatic measures—like getting a chin implant—that’s where dermal fillers come in.” She tells patients and injectors alike to not fill directly into the problem lines themselves. “Chase after what’s causing the lines,” she says. “Go to the midface first, and fill in where the volume has been lost because that will tighten the skin.”

“The patient that is likely to benefit the most from buccal fat pad removal has disproportionately full cheeks—the rest of their face is not full, just the mid-cheek. If someone has a full face overall, their cheek fullness is likely more due to a thicker fat layer under the skin, not just the fat pad.” – Dr. Bryan Rolfes / Pinnacle Dermatology

Masseter Botox, she adds, is another great, nonsurgical way to create a narrower lower face. “Especially if you’re someone who’s a mouth clencher,” says McBeain, “that [masseter] muscle will only get stronger and look bigger, so Botox can help prevent a patient from clenching down, which will slim the face and make the jawline look less square. It’s kind of a two-in-one: It gives patients relief of the tension of clenching their teeth but also relaxes that muscle and gives a slimming effect.” 

Buccal fat removal has been having its moment in the sun on social media—feeds flicker with a carousel of before-and-after pics of celebs and everyday people with former cherubic faces looking suddenly hollowed out. It’s a good look for some, yet somewhat of a startling one for others—enough to make one wonder if apple cheeks have suddenly fallen out of fashion. (Spoiler alert: They haven’t.) 

During buccal fat removal, the part of the fat pad that is removed is in the middle of the cheek, just in front of the masseter muscle, says Rolfes. The procedure is quick and safe and can typically be performed in the office with just a little numbing medicine. He assures patients that they won’t be walking out of there with the “heroin chic” face made famous by the supermodels of the ’90s.  

“The patient that is likely to benefit the most from buccal fat pad removal has disproportionately full cheeks—the rest of their face is not full, just the mid-cheek,” he says. “If someone has a full face overall, their cheek fullness is likely more due to a thicker fat layer under the skin, not just the fat pad.” 

Szachowicz agrees that the procedure isn’t for everybody. “Some people are abusing buccal fat removal, taking too much out to achieve this vacant look,” he says. “But for people with general heaviness [in their face], it makes a really big difference.” It all comes down to having too much volume and not enough space to contain it.

Botox Vs. Dysport: Which is On Point?

“All botulinum type A neurotoxins have the same mechanism of action, which prevents the muscles from contracting that can cause permanent fine lines and wrinkles over time. At Elegantly Ageless, I offer both Dysport and Botox Cosmetic but [personally] prefer Dysport. Due to its higher active ingredient, it can kick in quicker and last longer than others on the market. I also feel it’s more natural looking, which is directly dependent on the dosing amounts per person. 

“In my opinion, the new neurotoxins entering the market don’t offer anything new to make me change my prescribing habits. We know in the aesthetic industry that neurotoxins are still the gateway into other aesthetic treatments, so it is definitely the most scheduled and rescheduled treatment.” – Jen McBeain / Elegantly Ageless

In: Body Contouring

Out: Obvious Augmentation

Looking to regain tone after baby? Eliminate stubborn fat on an otherwise toned booty? There’s a cold applicator for that. And you don’t even have to go under the knife for it. CoolTone is a noninvasive treatment that uses magnetic muscle stimulation to recruit muscle cells to contract (think: the equivalent of doing 2,000 sit-ups in 30 minutes). And Lisko says it’s one of her favorite procedures to facilitate—since it’s a regularly scheduled treatment, she gets to build long-lasting relationships with her patients.

“There are really two ideal patient types for this treatment,” she says. “The first type is a patient who is in good shape but has some targeted goal areas to improve muscle tone on the abdomen, anterior thighs, or buttocks. CoolTone causes involuntary contractions, which strengthen the muscle fibers in the treated area, leading to a stronger, firmer, and more toned appearance.” The second patient type is focused on strengthening a targeted muscle group to alleviate strain on an opposing area. 

“For someone with stubborn fat cells that won’t resolve with diet and exercise, CoolSculpting can help.”– Dr. Jane Lisko / Associated Skin Care Specialists

“For example, the treatment of abdominal muscles with CoolTone can dramatically improve back pain. Treatment of the gluteal muscles is especially helpful for cyclists and runners to treat and prevent iliotibial band syndrome.” For the majority of patients, six to eight treatments are performed over a two-week period. After that, maintenance can be achieved with one to two treatments per month. Results are durable with consistent treatment, she says, as is the case with physical fitness requiring consistent physical activity. 

CoolSculpting is another body-slimming procedure, but it’s more suited to general fat reduction—it’s designed to freeze fat cells and eliminate them. “For someone with stubborn fat cells that won’t resolve with diet and exercise, CoolSculpting can help,” says Lisko. She says CoolTone and CoolSculpting are complementary treatments, where the combination of fat reduction with muscle toning can go on to create a sculpted, contoured physique. 

Speaking of chasing after your best angles, breast augmentation continues to be one of the most sought-after cosmetic surgeries, but the actual implants themselves are decreasing in size. 

Unnatural breast augmentation is on its way out, says Rolfes. “Oversized implants, saline implants, and placing the implants on top of the muscle are all in steep decline. A typical modern breast augmentation employs an implant size, type, and placement that will give a long-lasting and natural result.”

The Changing Pulse of Fillers

Dr. Lynda Kauls of Market Street Dermatology says fillers are no longer used to just, well, fill. The injection techniques and formulations employed have evolved in a couple of chief ways over the past few years. “Certain fillers that have been around a long time were used to stimulate the growth of collagen, which improved the thickness and texture of the skin,” she says. “We call these biostimulatory fillers, and we have expanded the areas where we use them and the technique to provide optimal results.” The newest hyaluronic acid products create subtle differences in the characteristic of the filler, such as elasticity and longevity, allowing dermatologists and cosmetic surgeons to more precisely address certain issues or locations, like improving the architecture of the lip without increasing the fullness.

“There has been a significantly improved understanding of the anatomical compartments and ligaments that move and shift as we age,” says Kauls. “This has changed the techniques that we use and the locations we inject to address the whole face—not just a line or a wrinkle.”

This article originally appeared in the March 2023 issue of Mpls.St.Paul Magazine.

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