Millennials shouldn’t have much to complain about, cosmetically speaking. Prime-of-their-lifers haven’t had to grapple with the cumulative effects of gravity and changing hormones. That’s why, except for nose jobs and breast reductions, cosmetic procedures have chiefly been the domain of the 40-plus crowd. But now, Delaware’s plastic surgeons say that millennials are their fastest growing patient demographic. What they’re getting nipped and tucked is quite surprising.
Labiaplasty is one of the hottest procedures in cosmetic medicine. The procedure isn’t new; for several years, women have undergone labiaplasty to undo the effects of vaginally birthing babies. What is new is that pre-maternal women in their 20s and early 30s are choosing to go under the knife. Asymmetry and excess volume are the most common complaints, explains Dr. Lawrence Chang of Advanced Plastic Surgery Center, which has three locations in Delaware. “There’s definitely a cosmetic factor, but it’s also about irritation and discomfort,” he says.
Dr. Chris Saunders sees the same demand for the procedure at his offices in Wilmington, Newark and Chadds Ford. “Those labia can interfere with sex and exercise, even hygiene.” Saunders is doing an even newer procedure: injecting labia majora with fat so they look plumper.
Whether minora or majora, labiaplasty is a surprisingly quick procedure. “It seems impossible to be wide awake and have that done, but 10 minutes of numbing pain and one shot of local anesthetic and it’s 100 percent painless,” promises Dr. J. Joseph Danyo of Danyo & Gillespie Plastic Surgery in Greenville. Saunders recommends general anesthesia, but no matter the sedation level, the surgery is relatively quick. Recovery is another story. Patients take three to five days off work, they can’t exercise for two to four weeks and there’s an (understandable) kibosh on sex—to allow for full healing, patients should abstain from intercourse for one month
Labiaplasty and buttock enhancements are some of the hottest procedures in cosmetic medicine right now.
Labiaplasty’s cousin is vaginal rejuvenation, which addresses concerns that are more functional than cosmetic. Nonsurgical with no recovery time, vaginal rejuvenation is directed at the muscles that compose women’s pelvic floors. Pregnancy, age and other factors can negatively impact those muscles, leading to urinary incontinence and a wide variety of other issues. There are an equally wide variety of medical devices purporting to treat those issues. What differentiates them is how energy—radiofrequency, ultrasound high-intensity focused electromagnetic technology, etc.—is applied to the pelvic floor muscles to tone them.
“Some are more effective than others and some aren’t safe at all,” Danyo cautions. “It’s important for the consumer to dig into the details of each product and ask questions of their doctor.” A recent FDA advisory warned patients about the inefficacy of vaginal rejuvenation devices and pointed an accusatory finger at manufacturers who overhype their results.
Chang reports satisfied patients, but believes the problem may be that, while the devices may work, they require multiple treatments and results are temporary. “We’re subjecting the vaginal canal to energy that tightens tissue, and patients are generally happy with that. However, they may need further treatments after four to six months.”
That’s not true of surgical body tightening procedures, which continue to be sought by women in their 40s and older. They get tummy tucks and breast lifts, or the combo platter of the “mommy makeover,” which does both surgeries at once. Breast augmentations are also popular, although Delaware surgeons agree that most women are going for smaller, more natural-looking implants than the eye-popping bra busters of years past.
Boobs aren’t the only things getting boosted. Butt augmentations are in high demand at cosmetic surgeons’ practices. Whereas tiny hineys were once the standard, women from 20-50 want the big booties that are bountiful on social media. It’s a national trend borne out in Instagram hashtags and raw numbers. According to the American Society of Plastic Surgeons, approximately 20,300 buttock augmentations were performed in 2017, double the number from five years ago.
“In Delaware, women usually don’t want to be as big as the Kardashians,” Saunders explains, “but they do want full, contoured buttocks.” Roundness is the butt shape most desired. “Women want a thin waist and sometimes big hips,” says Danyo, “but mostly they want their side profile to have curve.”
Accomplishing that isn’t easy. Buttock implants are one option, but many surgeons frown on them, citing the high risk of complications. “It’s a flawed procedure,” Danyo says. “As opposed to breast implants, buttock implants are subjected to the pressure of sitting, sleeping and other daily functions.” That can lead to infections, and implants can become misshapen or even shift.
Danyo’s colleagues agree with his assessment, preferring to augment buttocks with fat grafts. Here’s how it works: first, fat is liposuctioned from the abdomen or thighs. The fat is then processed and injected into buttocks. The whole thing is done in one procedure. Women can go back to desk jobs in 10 days, but full recovery takes two to four weeks. “You have to use booty pillows and other products to keep off your bottom while it heals,” Saunders says. “That’s the hardest part.”
The fat itself isn’t hard, which is why some of it gets reabsorbed into the body, reducing the augmentation’s original look. “But overfilling the area by doing a high-volume injection of fat in the buttock isn’t recommended,” Danyo explains. “We do a low volume of fat into the right places.” Still, the fat can reduce by one-third over six months to a year. That’s not a bad thing, Saunders says, because it looks quite natural. “Some women on TV have almost outrageously shaped buttocks because they’ve had the operation done three or four times, which is not safe.”
That gets to the heart of the buttock augmentation controversy: safety. While considered safer than surgical implants, fat injections can be rife with complications. The buttocks are filled with blood vessels, explains Chang. Injecting fat in the wrong place, or too deeply, can place it in one those blood vessels. “Fat can travel to the heart or lungs and that can kill patients,” he explains. “The fatality rate is high—irresponsibility high—for these procedures because many unqualified doctors are doing them.”
Buttock augmentations aren’t getting a bum rap. There’s real danger here. In August 2018, the American Society of Plastic Surgeons and a cohort of professional associations from around the world formed the Task Force for Safety in Gluteal Fat Grafting. The goal is to create and enforce universal safety standards for the procedures.
Rounder behinds aren’t the only beauty standard birthed by social media. Selfie culture is driving the demand for using Botox and hyaluronic fillers to perfect faces and erase signs of aging. Women who are 40 and older have been doing that for some time, but Delaware’s cosmetic doctors say that, in this category too, millennials are the fastest growing patient population.
As with most things contributing to the demise of American culture, it started with the Kardashians. Although she’s technically a Jenner, it was on “Keeping Up with The Kardashians” that Kylie, youngest sister to Kim et al, launched her million-dollar cosmetics line. It began with her lipstick-and-liner Lip Kits that Jenner promoted with her perfectly pouty mouth. Later, she admitted that her lips were medically enhanced with hyaluronic fillers.
That sent young women flocking to cosmetic doctors seeking filler for their own lips. “Kylie set it off,” reports Chang. “Even if they don’t watch that TV show, women see pictures on Instagram and Snapchat. Social media is shaping the demand and type of procedures wanted.”
Selfie culture makes people hyper-focused on their faces.
Snapchat body dysmorphia is the trendy name for what’s caused, in large part, by photography filters that shrink chins and noses and make brows higher. The finished photos are engineered to make facial bone structure look universally pleasing—and now people want to look that IRL—that’s “in real life,” for those not text-ese conversant.
That’s why, although wrinkle-fighting and line filling seems unnecessary for people in their 20s, Chang says that Millennials are becoming connoisseurs of fillers, Botox and other things that change their appearance. Selfie culture makes people hyper-focused on their faces, he says. “When you hit your late 20s, you will see a few small expression lines,” Chang explains. “The moment they see that, they don’t want to look like their mothers or aunts.”
The fillers are about plumpness. “Lips and cheeks look better plumper because that denotes youth,” Saunders says. “If you look at a young woman, her face is plump and tight, almost fat. But it’s not fat, it’s youth. That’s why injectables are so popular.”
Millennials aren’t the only ones seeking syringes full of youth. Gen Xers and baby boomers are some of the largest patrons of facial rejuvenation, says Dr. Paul Sabini. Women go to his Newark office seeking fillers, Botox and microneedling as well as eyelid and neck procedures. But it’s men in their 50s and 60s who represent a fast-growing patient population. “I’ve started to see more male patients in the past year and a half,” he reports. “They want to stay fresh and not look tired, but they don’t want surgery.”
Christina Buckley has seen a similar influx of male patients at Wilmington’s MagnifaSkin MedSpa, which she co-owns with Dr. Tony Cucuzzella. “Botox, Dysport, fillers, PRP for hair restoration,” Buckley lists as the procedures most in-demand among men looking to combat crow’s feet, forehead wrinkles, sagging jowls, under eye hollows and balding. “We have plenty of male patients coming in… but they don’t want anyone to know that they’re coming in.”
Men in their 50s and 60s are a fast-growing patient population for facial rejuvenation procedures.//Fotolia-Monkey Business
They are also coming in for injections of Kybella, which promised to eliminate fat under chins. But enthusiasm has fizzled for the once-hyped product. It does work, Danyo says, but only after multiple injections spaced several weeks apart. “If you’re a surgeon, you can do a better, more efficient job with a 20-minute procedure in the office with local anesthesia where you remove the fat, not try to melt it with Kybella,” he explains. “Brabella”—using Kybella to eliminate fat rolls generated by bra straps—gets the same skepticism from Danyo. “It’s far easier and more efficient to do liposuction on patients’ backs,” he says.
Liposuction is still a go-to, but fat-blasting, love-handle-reducing procedures like Cool Sculpting, Venus Freeze and mesotherapy are popular among men, as are skin tightening devices like BodyTite and FaceTite. Chang uses them to perform incisionless lifts of faces, necks, thighs, arms in men and women. “You will not get the equivalent result as with surgery,” Chang cautions, “but you can get 30-40 percent of the result and people will take that over the long recovery of surgery.”
Given the cost of these procedures, results are important. All in all, the cosmetic professionals say that patients don’t view nips, tucks, lifts and injections as indulgences, but as investments in their well being. “The most common thing I hear is that people feel their outsides don’t match their insides,” Buckley explains. “If you eat right, exercise and feel good, you want to look good on the outside and reduce the uncontrollable signs of aging.” As for Millennials, who don’t yet have signs of aging, Buckley contends that, as with makeup and hair color, there’s nothing wrong with young people using cosmetic procedures to enhance their appearances. “To me, it’s all about self-esteem,” she says. “If it makes you feel good about yourself, go for it.”