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Cosmetic surgery decline?

In every year, there is less aesthetic surgery which is conducted. This may be partly to do with the economic climate where a patient may not want to spend their money on plastic surgery, but in my opinion, it is due to the alternatives to surgery that are now available.
This decline has certainly been noted by plastic surgeons based on records in 2014. And from my own and my colleagues’ practices, I have noticed that less invasive type surgeries are done. We tend to keep our surgeries to what is simple, efficient with low complication or do alternative aesthetic treatments with a filler or a combination of fillers with Botox, laser or Ultherapy, etc.
In February 2017, BAAPS (British Association of Aesthetic Plastic Surgeons) published figures, showing that there was a reduction in the number of cosmetic surgeries by Plastic Surgeons in the UK, including face lifts, breast implants, etc.
Oculoplastic surgeons who are ophthalmologists specialising in eyelid surgery were not counted in that particular survey. However, we have also noticed this reduction particularly for an endoscopic brow lift, direct brow lift, and lateral brow lift. We also see much fewer cheek lifts, and we are doing fewer lower lid blepharoplasties.
One of the obvious reasons for this reduction in Oculoplastic Surgery is that we can get quite a good brow lift by using botulinum toxin selective injection – placing very carefully the lateral orbicular at the edge of the lateral end of the brow. This helps to negate the downward pulling of the eyebrow by the strong orbicular muscle and allow the eyebrow lifting muscle called frontalis to just gently lift and open up the brows.
In the lower lids, we recognise that where there may be a little bit of fat prolapse, the use of filler is often indicated rather than surgery. If the eyeball is rather protruding about the cheek (where the cheek is said to be in a negative vector), we can fill in using Restylane, Juvederm or other similar hyaluronic acid gels into the tear trough and upper cheek, to help correct the negative vector and the hollowing below the eyes.
We do TearFill at Clinica London, which is Restylane with Lidocaine via cannula into the tear troughs and upper cheek. The surgical cheek lifts and cheek implants of the 1990’s to 2010 era are no longer done. I certainly have not seen cheek lifts or implants in the UK by oculoplastic surgeons since about 2007 – 2008. Cheek surgery has been largely replaced by injecting either autologous harvested fat, fat pearls or by filler into the cheeks.
Remember that filler is an injectable medical device.
Fat is autologous, meaning that it has been harvested from your own body and then re-injected into a different place as small particles. Both fat and filler give good results in the mid and upper cheek area. The fillers that are used in the cheek can be Restylane, Perlane or Juvederm Voluma by cannula or needle.
Lastly, one of the main reasons that plastic surgery numbers are less is with regard to the changes in attitude from the public: people prefer subtle, natural changes on faces, which help to lift, rejuvenate and gently tighten rather than having the over-filled, over-lifted, or over-tightened look that was much known in the 1990s and early 2000s. Besides, social media has also played a role, and it influenced people to look natural and do complementary anti-ageing and aesthetic treatments such as Botox, light fillers, deep fillers and better skin care. People want to feel pampered and manage their ageing “gracefully” without major eyelid, eyebrow and facial surgery.
The doctors and the public are becoming less gung-ho, and we are all aiming for a natural, youthful, rejuvenated look where people will just say afterwards “you look very well”, “have you been on holiday?”, “how come you look so young and fresh, tell me your secret”. Our attitudes are embracing lighter anti-ageing treatments, good healthy diets, exercise.
This is disappointing that other people wondering or asking “what on earth have you had done?” or they say: “have you seen Mr or Mrs Smith / Jones / Patel / Chang / Khan / Zubovsky, he or she looks so overdone, I think she must have had a facelift because it looks so tight, it makes her look older”.


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