Foresight is 20/20: Innovations for the Year 2020 and Beyond

The Future of Plastic Surgery

As we approach the year 2020, many of us look into the mirror and ask not only “how fast time flies by”, but how fast we change in appearance. Actually, the physical signs of aging happen very slowly, significant changes happen perhaps over a decade. What we perceive is a sudden premonitory sign that has always been there but we suddenly notice. It’s like buying a car and suddenly noticing everyone else has your car. The cars were there; you are now just noticing them for the first time.

And so it is with the signs of aging. Once we notice it, it takes a life of its own as our mind becomes more and more focused on it. The good news is that there are a whole cadre of professionals who are also focused on aging, measuring it, slowing it down, and even reversing it!

Let’s start with the top emerging trends in anti-aging for 2020

Natural Body enhancement

It is clear that with the latest advances in fat grafting, your body’s worse nightmare is turning into “liquid gold”. Over the past decade, plastic surgeons have taken the century old procedure of fat grafting and applied high tech scientific protocols to better understand how to make fat live in another body part while looking like it always belonged there. The procedure involves harvest of fat usually form the abdomen, flanks, or thighs, followed by processing of the fat to small allequots and finally injecting it into the appropriate recipient site. There are three main areas that fat seems best suited for transfer:

Face: Less is More

Another exciting trend that is bound to increase next year is the application of fat to the face. There has been great emerging literature in plastic surgery that shows that a significant amount of our facial aging is actually attributed to differential loss of fat in our mid and lower face. In response to this knowledge, we have been incorporating fat grafts to almost all the facial surgeries that we do as part of the concept of doing many small maneuvers that bring harmony to the face while minimizing “the operated look”.  In light of the recent overzealous fat grafting procedures on some celebrities, there has been hesitation by much of the public to accept this procedure but recent advances have shown that it is much more prudent to apply small amounts of fat at a time. Another emerging trend is fat banking that will allow your fat to be preserved so that you can get small amounts of fat over time as a quick office procedure that would not require anesthesia and soon to replace other injectables.

Buttocks: More is More

Given the enduring popularity of celebrities like Jennifer Lopez and Kim Kardashian, this brings up another body part that is increasing popular for fat grafting around the world, the buttocks. In a procedure also known as the “Brazilian butt lift” the plastic surgeon takes large amounts of fat form other body parts (anywhere from 1-5 litres or over one gallon) and applies the fat particles to various carefully selected parts of the buttocks in order to shape and lift it into submission. What is remarkable about the procedure is that by reshaping the mid section of the torso, our patients are able to fit into completely new set of evening gowns and outfits that were not available to them because of their body shape.

Breast: More or less

Fat is now used as a means of providing improved contours to breasts after mastectomy and breast cancer reconstruction.  There is a plethora of evidence that shows that fat can actually improve the appearance and contours of the breast even in the setting of radiation exposure. This is great news which has led many plastic surgeons to start a careful study to see whether fat can also be used to augment the breast. Given the fact that over 3 million women have breast implants and over 300,000 breast augmentations were performed in the United States alone last year, this is a really exciting emerging trend that will allow our patients to finally get what they have wished for: “remove the fat from where I don’t want it and put it where God should have put it”.

Remote breast expansion

But what about women who have no fat to spare. There is also great emerging technology to help them as well. We performed a clinical trial with a new device called Airxpander which allows forinflation of the breast implants via a remote controlled device. The device does not need a battery as it operates with an electromagnetic trigger that allows a small amount of air to be released into the implant at will in order to increase the size fo the implant. Others are working on acellular fat matrix that allows integration of new fat cells into your own tissues via a natural process in order to add or contour misshapen body parts.

Customized breast enhancement with naturabra

The era of large breast implants has come to an end as more women opt for a more natural and lifted appearance.  Many patients will be exchanging their current implants for ones that are more proportional to the rest of their body while combining it with a lift. The Naturabra procedure which allows the breast to be lifted while using the body’s own tissue to provide an internal bra support that can also accommodate an implant. This means that a smaller implant can now produce fullness and cleavage or the implant can be replaced by patient’s own fat (Naturashape) combined with the Naturabra procedure.

Sculpting the thin face

Similarly, for those of you that do not have fat to transfer to the face, there is a whole array of products that stand ready to provide just the right amount of fullness to the right part of the face. You may have head of the liquid face lift which is a misnomer since the face is not lifted or repositioned at all. A more appropriate term would be facial filling since your doctor can expertly apply material found in the dermal component of the skin called hyaluronic acid to strategically depleted areas. There is a whole array of new fillers form the family of Juviderm and Restylane thatcontinue the tradition of finding a niche on your face where small wrinkles and lines still hide. You will also see in increase in the use of Sculptra and Radiesse which actually works by stimulating collagen and has a natural volumizing effect with results are gradual, but lasting over two years.  As with any fillers, it is the artistic eye of the physician that will determine the beauty of the results and remember “less is more” in the face and lips.


Combination surgery will continue to increase as more patients undergo massive weight loss and will require to address multiple areas fo their body such as arms, thighs, abdomen, breasts, and even neck and back excess skin. With the upcoming positive change in the economy, this trend will also among mothers who seeking mommy makeoverwith breast lift, breast implants, a tummy tuckand liposuction, all performed at the same time. Recent polls revealed that many women who undergo these procedures report a boost in self-confidence, attractiveness and satisfaction with their sex life. Another recent study showed that the posture of many women who opt for this surgery also changes as they are not looking to hide their abdomen any more. Also the tightening of the core muscles allows for better positioning of the abdomen against the antagonist back muscles, while raising the breast on the chest allows for less tension and weight on the neck and shoulder area.

Non-Invasive Fat and cellulite Reduction

In asking our patients why they would not opt for surgery we always hear the same two fears: Anesthesia and scars. In order to address these two concerns, there is a slew of new products that will dispose of your fat using new and unusual technologies. Ultra-Shape uses ultrasound energy to reduce fat while CoolSculptinguses cold plates to literally freeze the subcutaneous fat with minimal to no discomfort and zero downtime. Another emerging technology is Celafina which cuts the internal cords that pull and create the cellulite while heating the skin to help firm it form within. Our procedure, Lasercision accomplishes the same goals while adding fat as a cushion layer to help prevent scar bands form forming again.  There need to be further long term studies on many of these products so as always it is wise to solicit the opinion of at least two physicians before proceeding with any treatment.

Muscle Induction

The latest trend in body contouring is Emsculpt which utilizes electrical activity to stimulate your own muscles to bulk up without any physical activity. Of course expect to have lots of maintenance treatments just like going ot the gym. Not to be outdone, Allergan is introducing Cooltone which uses high frequency electromagnetic energy to contour the soft tissues and tighten muscles and skin.

Scalp and Scar modulation

There is not a day that goes by without hearing about another possible cure for bald head and bad scars. Unfortunately there is no cure for bad scars other than redoing them once they have been matured. There is now a clinical trial of a number of scar enhancing drugs that can actually change the scarring response at the molecular level. Ever since the discovery that human fetuses do not form scars, there has been much activity to mimic this condition at a molecular level. This is great news for plastic surgeons since they can apply these medications at the time of the surgery to help prevent the scars in the first place. We currently use Collagen Induction therapy with updated deep microneedling techniques coupled with Platelet Rich Fibrin (PRF)  from your own blood which helps boost the recovery response of your skin and healing. PRF is now our most popular therapy for hair loss since it uses your stem cells to boost hair growth in a quick one hour lunch time procedure.

Migraine Surgery

Another fascinating trend that impacts women in the years to come is the emergence of field of migraine surgery.  With over 35 million Americans affected and one in every five women suffering from migraine attacks, there is now a potential cure for this debilitating disease. First pioneered in Cleveland and adopted by our team in 2010, this surgery evolved from understanding the improvements in migraine patients after cosmetic facial surgery. A series of small incisions are made to decompress the nerves that are under pressure and cause headaches. There is now over an 80 percent chance of improvement for a subset of patients with chronic migraines as this procedure will emerge as a potential cure for migraine in the years to come.


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