The Plastic Surgeon Summit

We’re in a plastic surgery “renaissance period.”

Dr. Yannis Alexandrides: It is busier than ever. There’s a remarkable year-on-year demand increase that we see in surgical procedures, especially for the face, but also for the body. This is a trend that we have seen through the pandemic, but it has accelerated the last year.

Dr. Ashkay Sanan: I think plastic surgery is in a renaissance period right now because of people publicly talking about it. Plastic surgery is now part of your wellness armamentarium. People used to flex what gym they went to, that they had a trainer, and now plastic surgery is part of that flex. People love to rock that they had their eyes done or their face and neck done or their body done. It’s just part of the cultural shift that we’re seeing.

Dr. Jason Champagne: This is where social media comes into play, camera phones and Zoom meetings. You see yourself from all these different angles nowadays that maybe you didn’t notice in the past.

Dr. Emily Hu: I find it very generational: Those who grew up in the social media era with a lot of sharing and openness are also very open about telling their friends [about the work they’ve had done].

Sanan: There’s a shift in consumer or patient habits. More people in their late 30s, early 40s, they’re choosing surgery earlier to age gracefully instead of waiting until things are advanced. They’re like, “I’m not going to wait until it drops down further. I just want to be hot in my 40s.”

Dr. John Diaz: It used to be that not everyone had access to a plastic surgeon. That was reserved within the realm of the elite. Well, not anymore. I have celebrities, executives, and business owners come in — but also teachers and waiters. There’s this democratization of attractiveness.

Dr. Paul Afrooz: Patients are very educated these days. They know what they’re looking for, they know what realistic results are, and they have the ability to do a lot of background research and understand who does things at an elite level.

Diaz: When I first moved to LA, if I was at an event and someone heard that I was a plastic surgeon, they would pull me aside later and be like, “Can I ask you a question?” Now, I’ve been at dinner parties where we have 20 people at the table, someone hears I’m a plastic surgeon, and they’re yelling at me across the room: “Hey, I got my breasts done two months ago, and I love them!”

Dr. Paul Nassif: I just had a patient today from a pretty popular reality show who wants me to do their nose and put it on social media. They want to go through the whole experience and show people. They want to educate.

Champagne: I saw a post today from someone who said, “I don’t want to be a gatekeeper. I don’t want to hide the fact that I do things, because it’s not fair to other people to think that this is achievable or this is just how I was born.” It’s a good thing that people are willing to talk about it.

Alexandrides: There is a little bit of pressure on people who are always in front of a lens. You post on Instagram, you are on TikTok, and then you have interviews, and [plastic surgery] is difficult to hide. Even if you want to say, “I look 40, but I’m 60, and I haven’t done anything” — people don’t believe you. There is a certain level of pressure on these people to pretty much explain what happened instead of other people speculating and just creating a whole buzz around it.

Dr. Charles Galanis: People are being more transparent with plastic surgery, but I say that with a caveat — that’s only for certain procedures. Body contouring will be the last frontier of someone being honest. Plenty of people in TV and film would be terrified if someone knew that they had a body contouring, like a lipo contouring procedure. I’ve had patients who’ve been public about what they had done with me — but only 50% of what they had done with me.

Let’s get into it: Why are we talking so much about facelifts this year?

Diaz: Facelifts have absolutely exploded for a few reasons. A lot of women see celebrities and influencers suddenly looking incredible, and they want to know how. Think about Kris Jenner — she had a huge impact when her pictures came out. And now it’s brought awareness to the fact that we have the technology to be able to take a young-looking woman and make her look better with surgery, without making her look fake. That was a real challenge 20 years ago.

Alexandrides: Kris Jenner was a very hot topic the last few months. Definitely a lot of the patients I see here take her as, let’s say, a model on how they want to look, because she looks fresh, but she doesn’t look pulled. She looks younger, and she looks happy, and you cannot see the scars, at least not in these pictures that we see.

Hu: I can’t tell you how many of my patients are like, “Yeah, my mom had a facelift. She was so scary. I’m never doing a facelift.” I mean, that was their response because they see their mom all bruised and scary looking.

Dr. Mark Murphy: Facelifts historically had a stereotypical “plastic surgery” look. Now people have realized, “I can look like myself 15 years ago and not have to look like a circus freak for it.” It’s become very digestible for patients. Social media is a huge driver behind it. Well, that, and the techniques are better.

“The more invasive, the more predictable the result. The less invasive, the less predictable the result.”

So what’s actually new or changing about facelifts?

Dr. Mark Mani: We call it the golden age of facelift surgery. It’s primarily because of the success of the deep plane facelift.

Dr. David Shafer: There’s nothing new about [the deep plane facelift] as a procedure. It’s just very sophisticated marketing that’s being done now, and there are refinements to the procedures. But it’s not some plastic surgeon who’s marketing it now as some magic procedure that he came up with that nobody else does.

Mani: [A version of] the first deep plane lifts was performed in the late 1960s by a surgeon named Tord Skoog in Sweden [though the name came later]. I have his textbook and can show you results that would stand up to the best deep plane surgeons today. It’s not the procedure, it’s the surgeon, and facelift surgery, among all surgeries in plastic surgery, is an art form.

Afrooz: A surgeon named Sam Hamra — he just passed, but a wonderful human being, an extraordinary thinker, an extraordinary surgeon — first coined the phrase “deep plane facelift” in a 1990 paper and laid out some building blocks of the procedure. Just like everything else in plastic surgery, we stand on the giants before us.

“The talk of the town is gland removal and facelifts.”

Dr. Michael Stein: There are two main facelift techniques: deep plane and SMAS plication. The deep plane facelift is where you cut the layer under the skin called the SMAS, dissect underneath it, and tighten it in addition to the skin. In the SMAS facelift, instead of cutting and elevating the SMAS, you suture it to itself to tighten it from over top.

Dr. Amir Karam: The majority of surgeons, up until recently, have been doing the traditional SMAS technique, which is more or less horizontally pulling the face sideways, and that was leading to a very unnatural look.

Mani: I was the surgeon who wrote the most-read facelift academic article that convinced other surgeons to do deep plane facelifts. It was an article in Aesthetic Surgery Journal in 2016, where I detailed the specific anatomic reasons that deep plane is better.

Stein: The people who only do deep plane facelifts say they have a more longitudinal result, and vice versa. But the truth is, a good result is a good result. It depends more on the surgeon versus technique. A good facelift is a good facelift.

Sanan: Kris Jenner did not have a deep plane facelift. I just came back from our American Academy of Facial Plastic and Reconstructive Surgery meeting in LA, and we were talking about the technique that was done for Kris Jenner, and you can tell where it falls short of deep plane surgery.

Shafer: It’s a tough world out there for people to navigate, because everyone now is advertising deep plane facelifts. Even docs in Miami who have picked my brain over the past decade, and I’ve told them about deep plane, I see them now advertising and presenting as if they're a long-term expert in deep plane lifting, which in conversations with me years ago, they didn’t know what it was. So it’s wild.

Facelifts aren’t done evolving.

Karam: The consumer is driving surgeons to create better and better results. So there’s been a massive increase in interest for surgeons to level up their strategies surgically and learn new techniques that are not new but new to them.

Afrooz: Even my facelift today is better than my facelift was one year ago. When you hone in on one thing as your career, you’re just constantly looking for ways to improve. It’s the cumulative effect of small subtleties over time and practice that you notice nuanced improvements to your results. One might assume that a deep plane facelift in one surgeon’s hands is the same as it is in another’s, but I’m here to tell you that it’s very much not the same.

Dr. Daniel Gould: There are new layers that we’re adding into the surgery. We’re recognizing the importance of the mid-face and volume position there. I’m recognizing adding fat to the mouth and the areas around the mouth, the chin, because all these areas have been neglected. We are now nailing all the low-hanging fruit: We’re nailing the neck, we’re nailing the face, we’re nailing the temple and the brows. Now it’s time to move forward and continue to innovate and push the limits of what we can really do in facial rejuvenation.

Mani: What I’ve developed is called the scarless lift, and it’s basically a deep plane facelift without a scar in front of the ear, with an endoscope. The endoscopic procedure involves a hidden incision within the hair, a short one behind the ear, and sometimes one under the chin. I still do about 60% open [non-endoscopic], but a good percentage of my facelifts are scarless endoscopic. The results are more beautiful because you don’t have to worry about the scar, and the vectors of lifting are better.

Alexandrides: I don’t think this will be now, “OK, let’s forget about facelifts, let’s move to something else.” What will probably happen is that people will discover intricate little different techniques and say, “You have the facelift that is done like that.” I have patients who ask me very technical questions: How do you design your scar around your ear?

Stein: Facelift surgery has survived the test of time. Every year there are new machines designed to tighten skin, and for some patients with mild laxity, they may see nice results. The truth is though, if you have jowls or droopy skin of the face and neck, the only thing that’s really going to give you the best bang for your buck and directly address your laxity is a facelift.

“I have a patient who wears a burka every time she comes in, and she’s not a Muslim.”

OK, but what should I make of younger people getting facelifts?

Until recently, when you thought of a facelift patient, you’d picture Joan Rivers. But there’s a new demo on the table: “We’re getting girls in their 20s and 30s asking for facial rejuvenation procedures,” Diaz says. “Twenty years ago, it was unheard-of for a woman in her mid-30s to be asking about a facelift. Now it’s common.” Should we be horrified by such intervention at that age? Should we applaud their make-my-own-destiny approach to their beauty? Here are a few perspectives to consider.

1. It’s not really about looking younger.

“Facelifting is not about the right age, it’s about the right set of issues,” says Gould. Any anxieties we have about young people getting facelifts are probably tied up in our perception of facelifts as something people do to look younger.

“When people say, ‘Hey, should we be doing facelifts on people in their 40s?’ Well, the truth is, should we be doing breast lifts on people in their 40s?” Gould continues. “We’re perfectly OK with augmenting your breasts or changing your nose in your 20s. Why is that not age related? It is because: I want to look better in my 20s and 30s. Same thing with the face. It used to be that a facelift just removed wrinkles, and it’s like, well, if you don’t have any wrinkles, you don’t need to remove anything. But nowadays, a facelift is so much more than that. A facelift is about beauty — and we can make people look better.”

“Age is not the reason you do a facelift on someone. It’s their anatomy, how they look in real life, how they look in their photos,” agrees Sanan. His youngest deep plane facelift and neck lift patient was a 32-year-old who was “dealt a very crappy genetic hand,” he says. The patient hated her double chin and thought she looked a decade older. “She was like, ‘I can’t even date. People don’t take my age seriously. Guys don’t believe me when I tell them.’ Within two years of her having her surgery, she was engaged and married and sent me a really nice message like, ‘This really changed my life.’”

Sanan’s youngest-ever neck-lift patient was just 22. Long insecure about her side profile, she made a deal with her parents: If she finished college, they’d pay for the procedure.

2. There’s a case for doing them earlier in life.

“Honestly, there is a sweet spot with doing [a facelift],” Hu says. “Think of a home remodel: If you wait until the house is falling apart, well, if you do the siding, it’s going to be really obvious. But if you update the siding by painting when it’s just starting to crack here or there, it’s still a big job, but it’s not as dramatic a difference, and it just looks like you’re maintaining your house nicely.”

Construction metaphors abound on this point. “Like any building project, the quality of the materials plays a big role in the final outcome,” says Afrooz. “And when you’re younger, that elastin and collagen content within the tissues is much more favorable for having a result that’s going to be durable and have much more longevity than, say, someone in their 60s and 70s.”

3. But you have to be a good candidate.

“It’s rare to have a 30-something actually need a facelift,” Karam says. “At least at our practice, we turn them away left and right.”

“I’m going to say no” to a 20-something wanting a facelift, Nassif says. “The reason is that I haven’t seen or met any 25-year-old whose skin elasticity is so poor that they need an actual incision around the ear. The ones that I’ve seen in their 20s have horrible scars, and their life is pretty much ruined because you really can’t fix them until later, when they have loose skin in their 40s. The young ladies that I’ve seen that have done it — it’s just a mistake. Now, I have seen people in their late 30s who already have problems with elasticity, possibly due to a genetic family history. So, the earliest time for a facelift? Maybe late 30s. But on average, we’re starting in the 40s, especially with these short-scar mini deep plane facelifts and neck lifts.”

Dr. Gould: Reset facelift, lower face and neck deep plane, endoscopic temple lift, structural fat grafting, nanofat grafting, upper and lower blepharoplasty with fat repositioning, and Co2 laser

Facelift talk dominated 2025. What will we be talking about next year?

The new nose job. The rhinoplasty has come a long way. “Historically, you had to use a hammer and a chisel in order to take someone’s bump off or narrow their bones,” Sanan says. But the ultrasonic piezo rhinoplasty is like “trading in your hammer for a paintbrush,” he says. The procedure/technology has been around for about a decade. “You’re literally sculpting the nasal bones, and you don’t have to break them anymore,” he says. “My patients have very low pain after the rhinoplasty, to the point they’re just taking Tylenol and their bruising is significantly less.”

There’s also the “preservation rhinoplasty,” which, to use another house metaphor, is like “adjusting the appearance of the roof by dealing with the ground floor,” Afrooz says. Instead of tackling a bump head-on, “you take out parts of the ground floor in order to lower the roof rather than working on the roof itself.”

Dr. Paul Afrooz: Primary rhinoplasty

Shorter foreheads. “We used to do brow lifts all the time, but for women who have longer or bigger foreheads, it’s not a great option,” says Dr. Diana Ponsky. “The surgery that’s becoming popular is forehead shortening, or hairline lowering. Both of those give you a softening of the forehead area, a look of rejuvenation, because it can lift your brows slightly, or restore the height of your brows as well as bring your hairline down a little bit more.”

Next-gen fat transfer. As an alternative to filler, it’s been around for a while, but it’s getting a closer look amid the facelift boom (and is often executed in tandem with other procedures). At the American Academy of Facial Plastic and Reconstructive Surgery annual meeting in September, “what was emphasized by many was the importance of fat transfer in getting that next-level result with these already very advanced surgeons,” says Dr. Raj Dedia. Fat transfer is also more sophisticated than it used to be: Once the fat is harvested, doctors can “make the particles that we’re injecting various sizes,” says Dedia. “You can have these smoother, smaller clumps of fat. So if you’re going under the eye, where the skin is thinner, you could have a smoother fat that you deliver there.”

“The recognition that volume to the face adds a lot of value” will be a big topic in 2026, says Dr. Oren Tepper. “Twenty years ago, if you told somebody you’re going to inject or add volume in their face, they’d say ‘No way.’ Now people appreciate that volume in the right places can be pretty impactful. There’s a technique I do called the boomerang lift, which is adding fat to the junction of the cheek and the eyelids. People love that.”

Do people still care about looking “natural”?

Yes — in almost all of our interviews, plastic surgeons emphasized that patients come to them wanting to look like enhanced, refreshed versions of themselves. “If you look, everywhere it’s natural, natural, natural, natural results,” says Champagne. “There have been those practices or patients who want to look overdone, and I’m feeling more confident that we turned the corner on that.”

But to achieve a “natural” look, sometimes more is more. “Minimally invasive is over. People are like, ‘If I’m going to do this, do it right,’” says Dr. Ryan Neinstein. “You look more natural when you have bigger, more extensive operations. The body starts looking weird when you piecemeal it. It looks a lot better when you take it all apart and put it all back together in harmony. When someone has these minimally invasive operations, they look like someone’s operated on a part of their body.” For that reason, “mini” tummy tucks are off the menu at his practice: “If you had a mini tuck, you can see it from across the room.”

“There’s really not much in this world where, in 45 minutes, you can reverse the clock 10 years.”

Still, exact tastes vary geographically…

“In LA, the aesthetic has historically been about being noticed, whereas New York has always been about understatement,” says Diaz. “Having said that, I find that LA now is being pulled toward the New York aesthetic. It may have to do with the fact that there’s so many people moving here from New York, but I think it’s really influenced by social media. There’s this exchange of ideas, a sharing of values and aesthetics.”

It varies by practice, but in Florida, “bigger is still better,” says Dr. Norman Rowe. “Many women come in with photos of well-known celebrities, people like Ivanka Trump, Melania Trump, or Kristi Noem as visual references. What they’re drawn to are the highly defined, ‘done’ features those women are known for.” The goal is hardly to look untouched: “In New York, patients want to look like they woke up flawless. In Florida, they want everyone to know they invested in it. There, plastic surgery isn’t a secret, it’s a status symbol. Think of it as the Birkin bag of beauty.”

What about discretion?

For all the increased openness about plastic surgery in our culture, most people still want going under the knife to be kept under wraps. Here, two doctors share stories of the lengths patients go to protect their privacy.

Mani: My office has a back entrance, and we are lucky to have a ramp directly to the parking garage, so that patients literally will have their driver pull them up in their Escalade or whatever to the third floor, and we walk them over. I have a patient who wears a burka every time she comes in, and she’s not a Muslim, you know, but she does it to disguise herself, even for follow-up visits. I’ve had a lot of celebrity patients who will just walk in with their face uncovered, but they will have their bodyguard with them. A lot of my patients have bodyguards. They’re out by the operating room and things like that.

“Plastic surgery isn’t a secret, it’s a status symbol. Think of it as the Birkin bag of beauty.”

Neinstein: I operate on a lot of people who are in the public eye, and there’s no possible way for us to give them anonymity during normal business hours. It’s a lot of after-hours stuff, where I can reduce the odds that you’re going to see any other human that’s not my staff, who are under strict NDAs and don’t mess around. We can get you when the doorman’s not in the building and there’s no one in the elevators. If you do surgery on a Saturday or a Sunday, no one’s in the building. I don’t think about it as a burden. You could be like, “Oh, man, I worked all week.” Or you could be like, “Thank God I got to operate every day this week, and on Sunday I get to do one of the most famous people in the world. That’s awesome.”

I’ve seen hoodies and sunglasses. I’ve seen wigs, literally Hollywood makeup disguises. We’ve seen someone get off the elevator and then half an hour later, after they’re done taking off their makeup, it’s like you don’t even know who they are. But the No. 1 thing they do is scale down their entourage. Anyone walking down the street surrounded by six people, you’re going to be like, “Who the heck is that?”

I have a partnership with the Plaza Hotel and the Ritz [for recovery packages]. All of our patients go through the back entrance, up the service elevator, into the room. No one’s the wiser. When you book surgery with me, we take care of all the coordination: We like certain rooms. I have an after-care nursing team. We have a private chef. We have our own wheelchairs that we’ve designed for that hotel, for those elevators. At the Plaza, they have a 24-7 person dedicated to just my patients — that’s how many people stay there from us.

Where did we land on fillers?

It’s true that people are more cautious about relying on filler as a be-all, end-all treatment. “In the past year or so, there’s been a huge shift in decreasing the volume of injectables,” says Maggie Hartz, lead injector at Contōr Studio in New York. “When I first started injecting in 2021, the companies were telling us everybody needs a syringe of filler per decade — so people in their 30s need three syringes — and they needed them every six to 12 months forever.” For some patients, the number of syringes they got was a kind of flex on social media. Now, among industry colleagues, “all of us talk about how we can achieve results with the least amount of intervention.”

“We are seeing an uptick in people requesting surgical procedures for rejuvenating the face, as opposed to a filler-based option,” says Dr. Catherine Chang. While the messaging in the media around filler can often be black-and-white, when used judiciously, our panel agreed that it can be a useful solution. “For the really fine lines around the mouth, filler is a great option, as surgery is not going to fix that,” she says. “So I think we have to be really careful and understand when you can use filler and then when filler becomes too much.”

One other thing to keep in mind: the way filler can affect future procedures. “We go into surgery with people 10 years after their last filler treatment, and we see that the filler is still there,” Dedia says. “If I’m doing a rhinoplasty, or if I’m doing a lower eyelid surgery, where I’m trying to contour something that’s really subtle, having filler in there can make my job very unpredictable. It’s hard to know how that’s going to affect how everything settles down, so I do dissolve it.”

What’s the best bang for my buck?

Skin care. Doctors couldn’t emphasize this enough. “There are people who think surgery is the best thing for them because it’s the most invasive, but that’s not the case,” says Alexandrides. “You need to have a certain appearance before surgery becomes a good option. So by having a good skin-care regimen, you can avoid surgery, you can delay surgery.” While tools like occasional laser resurfacing and red-light therapy came up as steps to consider, it was practically unanimous among the experts that nothing beats a daily routine with SPF. “Active sun protection is so important,” says Karam. “Because one day when you do get that facelift, and you have lovely skin, you’re going to look a thousand times better than if your skin’s beat up.”

Blephs. “Upper eyelid blepharoplasties are very high ROI,” says Dedia, who points to the straightforwardness of the surgery, the low downtime, and the quick results and patient satisfaction. “Most of my patients will say they can go back to work within a day.” Not everyone is a candidate, of course, but multiple surgeons say they expect its popularity to grow: Because the eye area can be one of the first places to show signs of aging, the procedure has the potential to make a big difference. “You’ll look like you’ve been getting 10 hours of sleep overnight,” Sanan says. “There’s really not much in this world where, in 45 minutes, you can reverse the clock 10 years.”

Neck Botox. “Game-changer — huge,” says Hu. “Yeah, it’s nice to take care of the crow’s feet, but a lot of people are like, ‘I don’t mind my crow’s feet.’ And then with the forehead, they’re like, ‘Oh, I wear bangs.’ But I have not met one person who doesn’t have concerns about their neck.” She mentions a patient of hers who’s had a few face- and neck lifts in her lifetime and started getting neck Botox relatively recently: “We did it, and her before-and-afters are amazing.”

Dr. Paul Afrooz: Deep plane lower face and neck lift, upper blepharoplasty, deep resurfacing laser

OK, then, what’s the worst?

Thread lifts. The surgeons we spoke to were united in their loathing of thread procedures. “You are literally asking a barbed suture to lift up sagging skin and muscle,” says Sanan. “Among plastic surgeons, it’s like a WTF procedure. Why would you even consider that if you have any idea of how plastic surgery works? Thread lifts do not make any sense. It’s a waste of money, and it’s just very painful for the patient.”

“Nonsurgical” or “liquid” facelifts. This is the practice of basically injecting your way out of sagging skin. “All that stuff has definitely been [trending] downward,” says Karam. “First of all, it doesn’t actually lift anything, and then people end up just looking heavy along the lower face and really wide on the upper face. It just ends up looking strange.”

“We’re not in the witness protection program. We’re not trying to make you look like a different person and change your passport.”

Chin liposuction. Hardly anybody is a good candidate for it in Gould’s estimation. “There’s this portion of patients, maybe 1%, that have fat between the skin and the deep layer that if you liposuction it out, it looks a little better,” he says. “But they get a lot of scar tissue. It doesn’t always look great. And later in life, if they need a facelift, you’re missing the fat — that’s the best fat that disguises the connection between the muscle and the skin.” All things considered: “I’d rather do a neck lift on most patients.”

Shortcuts in general. “The more invasive, the more predictable the result. The less invasive, the less predictable the result, and likely the less traumatic,” says Galanis. “If you want something dramatic and you think a noninvasive is going to get you there, nine out of 10 times, it’s not going to be the case. But for some people, it's a reasonable bridge to stave off surgery, or if you want to exhaust your options before.”

Are boobs the new butts?

Not exactly — breast surgeries have long been the queen of plastic procedures. “The two most common procedures year in, year out in the United States are liposuction and breast augmentation,” says Galanis. “It’s probably not even close relative to other procedures.”

And just as Kris Jenner comes up in practically every conversation about facelifts, the Jenner family is also shaping our collective breast preferences. “There’s this tendency now to be more subtle. Twenty years ago, I would have patients reference Pamela Anderson, and now I’m getting Kendall Jenner,” says Diaz. “I’ve seen breast sizes decrease, and the average patient is asking for a smaller-size implant.”

Kylie Jenner’s recent Instagram disclosure about her own breast augmentation — “445cc, silicone, moderate profile, half under the muscle,” courtesy of Dr. Garth Fisher, M.D. — has had its own ramifications on the field. “Implants can either go above the muscle or below the muscle, depending on what works best for the patient’s anatomy,” says Stein. “But patients are coming and requesting, ‘I only want over the muscle’ or under the muscle. Then Kylie Jenner posted, and more people came saying, ‘I want half under the muscle, half over, like Kylie.’ There are Instagram trends, and there’s doing what’s right for the patient. As a plastic surgeon, you just have to do what’s right for them.”

“Kylie being transparent about her breast augmentation led to people asking about it,” says Tepper (who notes that the most common surgical request he gets is for a breast augmentation “that doesn’t look too augmented”). “But it also was an opportunity to educate people that someone’s implant size is not necessarily the right fit or appropriate match for you.”

Are BBLs out, though?

Surgical interest in bigger butts via the infamous BBL — aka Brazilian Butt Lift, in which liposuctioned fat is added to one’s rear — certainly isn’t what it used to be. “The craze for BBLs is on the declining end. Definitely the buzz that facelift has right now is the buzz that BBLs had maybe five years ago,” says Shafer. “We’re still doing a lot of them, but it’s patient specific.”

“My staff are not allowed to use that word or an acronym, because BBLs become synonymous with these cheap Miami chop shops that cause a lot of patient problems,” says Dr. Rian Maercks. Most of the butt-enhancing work he does these days is lateral posterior flank liposuction — taking fat out from around the backside of our waist to bring the shape of the butt into focus. “If you study fine art, the space around things a lot of times is what we’re looking at,” he says. “The space a vase carves out in the space around it is almost more important than the vase itself. The same is really true with the gluteal aesthetics.” (And when he does plump the butt, “I’m putting in a couple of hundred cc’s of fat, not a couple of thousand,” he says. “I’ve never done a BBL that would catch your eye as a butt that’s sticking out more than a natural butt.”)

The next big thing in bodywork is not for the faint of heart. “So, there’s a new product that came out called Renuva,” says Shafer, “which, it sounds gross when you first hear about it, but it’s cadaver fat that’s been treated so you can put it into other people’s bodies.” Hold your skepticism: As a nonfacial, high-volume filler alternative, “it really works,” he adds. “We do one area like their breast, and then they come back like, ‘Can I get this in my butt, too? Can I get it in my hip dip?’”

The new tummy tuck — and other ways GLP-1s are affecting the business

“Right now, the biggest driver of most cosmetic procedures is probably weight loss,” says Gould. “That has been growing for the last two or three years because of the amount of people that are losing weight with GLP-1 inhibitors.” And as the stigma around GLP-1 use shifts, that likely won’t slow down. “I would say about 50% of my patients are [on GLP-1s],” says Diaz. “They’re on it strictly for weight loss or maintenance, and all ages — from 20s to 50s and 60s, women and men. There’s no other medication I can think of that is that widespread. There’s nothing like it.”

Doctors say these weight-loss drugs are growing their business in a few ways. When someone loses a lot of weight quickly, they often end up with extra loose skin, and the skin itself becomes less elastic. You’ve probably heard the nicknames for this sudden laxity: “Ozempic face, Ozempic butt, Ozempic breasts even,” says Shafer. “Everything starts to sag.” So you’ve got more patients looking to lift and tighten those features, and patients more open to surgical intervention in general. As Shafer puts it: “Patients are, on the GLP-1s, looking better, feeling better, and now they’re [asking], ‘What else is available to me?’”

“We are now nailing all the low-hanging fruit: We’re nailing the neck, we’re nailing the face, we’re nailing the temple and the brows.”

Weight loss is growing the market for more invasive procedures, too. GLP-1s alone have given the tummy tuck business a makeover, according to Stein. His typical abdominoplasty patient used to be a mom who’s had a couple of kids; for them, most tummy tucks involved a hip-to-hip incision. Now, he’s seeing a lot more patients between 20 and 40 who have not been pregnant and, as a result of weight loss, have laxity not just in the front of their bodies, but along their side and into their lower back. “These patients are a better candidate for a circumferential tummy tuck, where the scar doesn’t just go hip to hip but goes all the way around to address all areas of skin laxity,” he says. “The nature of my practice has changed from almost exclusively traditional tummy tucks to more circumferential tummy tucks.”

One underdiscussed aspect of GLP-1s and plastic surgery? Their impact on pre- and post-op care. “With GLP-1s, typically we need to have [patients] come off of it before surgery since it slows down the gut, so then they’re at higher risk of having problems during surgery with anesthesia,” says Hu. “And then they have to stay off the medication after surgery, because they need really good nutrition to heal.” (Because GLP-1s can quiet “food noise,” she adds, “we already know that there’s an issue with protein, of not having enough of it with the GLP-1s.”)

At the very least, this can add a wrinkle to expectations about before-and-after transformations. “I find that it is hard with people who are used to their GLP-1s and lose the weight to then come off of it for surgery sometimes,” Hu adds. “And then they’re really stressed about not being on it afterwards.”

4 reasons a surgeon might turn you down.

A huge aspect of being a plastic surgeon? Knowing when to say no. When evaluating patients, doctors take a full picture of your health and assess your motivations — multiple surgeons even joked that part of their job is playing psychiatrist. Outside of failing to meet general screening criteria, here are some of their red flags.

You’re too obsessed with celebrity references.

“If you bring in pictures of celebrities, you’re probably not going to get in the door,” Murphy says with a laugh. “If you’re trying to look like somebody else, that’s a different area of medicine that I don’t practice.” (Photos of your younger self, however, are more than welcome.) Mani puts it this way: “As a colleague of mine once said: We’re not in the witness protection program. We’re not trying to make you look like a different person and change your passport.”

Fortunately, patients have cooled on this habit. With rhinoplasties, “we used to have patients come in with what we call ‘inspiration pictures’ of celebrities that they want to look like, but their facial dimensions and things like that are different,” Ponsky says. “So nowadays, everyone’s embracing a little bit of individuality. They’re aware that, hey, if I am a big-boned person with thick skin, I can’t have Bella Hadid’s or Ariana Grande’s teeny tiny nose.”

You’re looking for a problem (or perfection).

We’re all our harshest critics, sure, but doctors are on the lookout for extreme nitpicking. “Something that comes to mind is patients showing me photos of themselves on their phone at a horrible angle — you could be Angelina Jolie in her 20s, and if you take a photo of her in that angle, she’s going to look terrible,” Afrooz says. “Or if they struggle to show me what it is they’re talking about,” he adds. “We all have facial asymmetries. That’s just part of who we are.”

Gould has a unique way of screening patients with unrealistic expectations: “I say things like, ‘A really good facelift only fixes 70% of your issues,’” he says.

You’re going too far outside of social norms.

The most outlandish requests usually involve genitalia. “Oh, I’ve had everything. I’ve had people ask for two penises, all kinds of variations of gender stuff. I’ve had people ask for genitalia on places where genitalia don’t belong,” says Maercks. (Shafer also recalls a patient who wanted to “split their penis down the middle.”)

But not every request has to be so extreme to still be out of bounds. “Patients tell me, ‘I want to be as tight as a snare drum on my face,’ and I am just not comfortable with that,” Afrooz says. “The next thing you know, that patient’s walking around saying, ‘Yeah, Dr. Afrooz did my facelift!’ My reputation is everything.”

You’re young and don’t need it — or don’t understand.

“I actually struggle sometimes with younger patients right now. Younger patients are really self-critical,” says Hartz. She encounters overeager college students asking for filler where they have no volume loss and preventative Botox where it wouldn’t make a difference. One young patient “wanted me to inject her with filler, and if she didn’t like it, she was like, ‘Can we just dissolve it the same day?’” Hartz recalls. “And I was like, ‘We’re not trying on lip gloss here.’ That shows me you don’t have an understanding of what we’re doing.”

One mom brought her clearly uncomfortable 16-year-old in hoping to get her some Botox. “I gave them the money back for the consult,” Hartz says. “I was like, ‘Sorry, I don’t really feel like she’s consenting to this.’”

Dr. Paul Afrooz: Deep plane face and neck lift, temporal brow lift

The 5 kinds of nightmare patients

The DIY-er. “They don’t follow your post-op protocols. They’re going to be back playing tennis in two weeks,” says Sanan. Some patients even take out their stitches themselves. “I had a patient I did a lip lift on, and she emailed the office being like, ‘I don’t have to come in for my follow-up appointment. I took my stitches out on my own at home,’” he says. “I was flabbergasted. If I paid all this money for a plastic surgeon to do this high-quality work, I want my scar to be as best as possible.”

The grudge-holder. “They come in and have complained about Dr. A, Injector B, Nurse C. They have all these complaints — and you’re looking at them, and they look just fine,” says Shafer. “I’ll tell them no, because I know I’m just going to be Dr. E that they’re complaining about.”

The Klarna patient. When Maercks was a resident, a craniofacial surgeon once warned him to never let a patient get plastic surgery on a financing plan. “Because the fact is, they will have a monthly reminder of why they should hate you,” he says, paraphrasing the advice. “If a patient oversteps their financial boundaries, they’ll never be happy.” Instead, “they’ll make up a migrating complaint and a reason why they should be refunded. Those are the most difficult patients. There’s no winning. They’ll throw 10 complaints at you at the same time.”

The know-it-all. This patient “comes in demanding a certain procedure, or a certain treatment, or a certain brand of something because they’ve been on social media,” Shafer says. But it can be hard to trust what they’ve been looking at — pictures might be heavily filtered or doctored. “I do like to partner with the patients, and I do like their input on things, but if they come in thinking they know more than me about these things, that’s a nightmare.”

Plastic surgeons are generally allergic to trends anyway — just look at buccal fat removal. “People don’t really do that anymore,” says Gould. “It just doesn’t make sense to go and chop it out of young people’s faces, in my opinion.”

The doesn’t-know-enough. “Patients are more informed in many ways, but it’s also overload — it’s like going to the Cheesecake Factory,” says Diaz. “Let’s say I have a young patient asking for breast implants. That’s great, but when I start talking about the shapes and profiles, they are like, ‘I don’t know what I want. You decide.’” As a surgeon, “you can’t make someone happy if they don’t know what’s going to make them happy.”

What do plastic surgeons talk about with one another?

Mani: In the past, it was more competitive. There’s a good group of five of us that travel around the world teaching facelifts, and we cooperate. The [deep plane] anatomy is complicated, so it really requires us teaching it to these younger surgeons, both in live surgery — like I’m about to do in Istanbul, I’m doing it in Brazil and New York — and also in cadaver courses. So we talk about the anatomy, and we talk about the aesthetics. We also have a good time. We meet each other in exotic places and just have a blast.

Sanan: We’ll look at each other’s result and say: How did you get this result? How did the neck get so tight there? You’re talking to other colleagues [as if] you’re all Michelin star chefs and you have all the same ingredients. But it’s like: How come my recipe came out this way versus yours came out this way? What are you doing? What’s the secret sauce?

Nassif: The talk of the town is gland removal and facelifts. A submandibular gland removal — pros and cons, to do or not to do. Someone with a very thick neck has these glands that are hanging down, and when you’re doing their neck lift, that’s a discussion. We have a camp of doctors saying, “Don’t touch those glands because of the risk of dry mouth or complications.” Then there is the other camp that says, “If you want to have that snatched neck, you need to reduce the submandibular glands.”

“There’s this democratization of attractiveness.”

Shafer: We all like to talk about our crazy patients: “Did you hear about this patient that came in?” There are some patients that go from office to office, so everybody knows about them.

Maercks: How hard it is to run the business aspect and manage staff. Those are the big challenges. Otherwise, I absolutely love what I do. But it’s always tough to run a good team that follows what I want in the patient experience.

Diaz: Being a plastic surgeon now requires that I’m a part-time CEO. I spend the same, if not more, time running the enterprise of being a plastic surgeon as I do actually taking care of patients, talking to patients, and operating. Being a plastic surgeon now is like working two very intense jobs.

Galanis: The best surgeons in the world, the ones I respect the most, don’t think they know everything and have the humility and respect for the profession to say, “Hey, I have this interesting case. Does this plan seem right to you guys? Am I missing something?” It’s a lot of ribbing each other, too. I think I’m very fortunate to have a group of guys that keep each other humble. No one is allowed to get too arrogant around this group, I’ll tell you that.

Chang: We always talk about either interesting cases — while keeping the name and patient confidential — or any complicated or unusual cases. There’s a very select group of two or three, and we do the majority, I would say, of high-profile cases in the country. It's always really fun to just talk about what was the challenging case, why, and then we learn from each other. And then, of course, sometimes we’ll talk about what’s trending online, and either how off base it is or how actually it’s on point — but usually they tend to not be quite accurate.

Dr. Yannis Alexandrides: Deep plane facelift

Let’s end on an uplifting note. What’s the best part of the job?

Diaz: My happy place is with patients. If I could sit with patients and operate, I’d be happy as a clam.

Hu: I have a lot of fun with them. I love meeting them and hearing what their story is, and then being able to present a solution or plan that makes sense to them. I have one patient I took care of this week, and 10 years ago, she said, “I saw you do your breast surgery at this other hospital. Now I work at your hospital, and I just want you to know, when I do my breast surgery, you’re doing it.” And we just did it! We were both so excited.

Neinstein: One of the things I know my patients say [to their girlfriends], which makes me feel so grateful, is: “You have to go to my plastic surgeon.” Mine. They feel like they’re part of your team. This is not a technology-driven field, this is a customer-service, face-to-face field. They love when I come see them in their hotel room every morning. We could do follow-ups with an AI app — no chance. All of our surgical patients get swag: They get a friendship bracelet — it stacks perfectly with their Cartier bracelet — and we have a Barbie-pink sweatshirt that says “Neinstein or Nowhere.” Walk around New York, you’ll see ’em all over the place. That’s amazing. It’s fun. They feel like they’re part of something. They’re not just on the conveyor belt. They feel special.

Stein: Making people happy is pretty incredible. They start looking good, and they start feeling good. They do more things socially, they buy new clothes, and they feel good. They go out more, and they better their relationship with their significant other. The surgery is a catalyst for a lot of life changes. It’s the best to see a patient after a couple of years after surgery, and they’re thriving, all because of your surgery.

Galanis: I had a patient from Hawaii come in for a mommy makeover. I think it was seven months post-op when I saw her. She started telling me a story and got tearful when she was telling it. I don’t get emotional in front of patients very often, and this one caught me off guard. She’s Polynesian, and all of their family’s events were on the water. She told me she was just at her daughter’s event, and her daughter came running up to her and grabbed her leg and said, ‘Mommy, you come to all my events now!’ She didn’t even realize she wasn’t going to a lot of her daughter’s events because they were in the water and she had to wear a bathing suit and didn’t want to go. Sometimes, when we do something for ourselves to let ourselves feel our best, we are there and present for people that we care most about in our lives. It was just such a beautiful illustration of how this is not a self-loathing surgery — these are actually self-loving surgeries.

Reporting by Nolan Feeney, Chloe Joe, Megan LaCreta, Alyssa Lapid, Rachel Lapidos, Samantha Leach, Alexis Morillo, Carolyn Steber, and Emma Stout. Some interviews have been lightly edited and condensed for clarity.