There’s been an unprecedented demand for cosmetic procedures across the nation and in Sacramento. Here’s what people are asking for, according to four local physicians.
Big breasts, big butts, big lips. “Bigger is better” has been a cosmetic surgery trend for years, at least in celebrity circles: Think Cardi B’s backside, Dolly Parton’s “twins” or Kylie Jenner’s pout.
But what happens in Hollywood (or Dollywood) doesn’t necessarily happen here. Sacramento is different. Or is it?
Apparently, it is and it isn’t.
“We are lucky that in Sacramento we have more normal people who don’t want to look fake,” says dermatologist Suzanne Kilmer, M.D., founder of Laser & Skin Surgery Center of Northern California (on J Street), who has been de-aging local patients with minimally invasive procedures for 30 years. But while most want to look natural, Kilmer says, there are some—mainly the younger clientele—who look to TikTok and Instagram for inspiration.
“It’s a split group right now,” Kilmer says. “There are the young ones who come in with a picture and say, ‘I want my nose or cheeks to look like that,’” she says. “But the older patients don’t want that at all.”
Serving this schizophrenic demographic can be challenging. But staying on top of trends helps. Just what trends are happening on the local front these days? We asked four experts to weigh in.
1. The Zoom boom. If you cringed every time you faced yourself in the glare of your computer monitor when the “Zoom boom” hit during the pandemic, you are not alone. If the shock factor sent you running to the nearest plastic surgeon, you are also not alone. “During COVID, when everyone was working from home and on the computer, people suddenly became worried about what they looked like in the monitor,” says board-certified plastic surgeon Shahriar Mabourakh, M.D., of Folsom Plastic Surgery. Like many, Mabourakh closed his doors for a short time during the pandemic’s peak. But when he reopened, there was a rush of patients, he says, mainly seeking fast help in the form of nonsurgical treatments. “We started seeing things like Botox and fillers, and by extension lasers, microneedling, radiofrequency, things like that—anything they could do to make themselves look better in front of the computer,” says Mabourakh. But even postpandemic, he says, he continued to see an uptick in business for both nonsurgical and surgical procedures.
This is not just a local trend. Nationwide, more than three-fourths of plastic surgeons who responded to an American Society of Plastic Surgeons survey in 2022 reported an unprecedented demand for cosmetic procedures, post-pandemic.
2. Nonsurgical surge. Not a new trend but a growing one, the popularity of nonsurgical procedures continues to surge. At Laser & Skin Surgery Center, neurotoxins (mainly Botox and Dysport; there’s also a new one, Daxxify) and fillers (such as Juvederm) remain king, says Kilmer. “A lot of times people ask what I do to stay looking natural, and I say toxins and fillers,” she says. Beyond that, Kilmer’s got more than 50 lasers and devices for every imaginable purpose—things like CoolSculpting (a fat buster) and Resonic, which uses high frequency sound waves to combat cellulite.
Combining nonsurgical treatments is also a trend, Kilmer says. “We’re realizing that combinations work so much better than just one thing alone,” she says. For example, Kilmer says, a patient might use Fraxel (a laser) to improve skin tone and texture, a different laser to combat blood vessels and yet another to blast away brown spots, then do Fraxel again over the entire surface “to smooth it all together. And they’ll heal faster from everything if we do it all at once.”
3. No more “one and done.” The days of waiting a lifetime for the “big” surgery—typically a face-lift in one’s 60s—is over. Today’s consumers prefer to get a jump-start on the battle against aging, usually in the form of nonsurgical procedures in their 30s and 40s, so they can stave off a major surgery for a while—or avoid it altogether. “There’s talk now that you don’t wait to do a face-lift; you do preventive things so you don’t have to do a face-lift,” says Kilmer. “I think someday we’re going to look back and say, ‘Can you believe we ever used to do face-lifts?’”
That wouldn’t be a good thing for face-only specialists like Arnold Almonte, D.O., a board certified plastic surgeon who has spent years perfecting the art of the face-lift. But even at his Almonte Center for Facial Cosmetic Surgery in Roseville, he sees plenty of patients who would rather take baby steps than plunge straight into surgery. “I’m seeing a trend of younger patients seeking out facial rejuvenation in the form of nonsurgical treatments,” he says. “They like the way they look and want to keep it, and they don’t want to do anything drastic later on.” At the same time, Almonte says, he’s seeing younger patients wanting facelifts. “Why would a 39- or 41-year-old want that work done? Because they want to maintain that youthful look. If they’re starting to see changes, a little loose skin or excess fat, they want to take care of that now.” In its 2021 statistics, The Aesthetic Society also reported a younger demographic for cosmetic surgeries in the United States: The 36–50 age group had the highest number (41%) of surgeries, followed by those ages 51–70 (31%).
4. Facial fat grafting. When face-lifts do happen, the “windblown” look of yesteryear is out, says Luke Boone, M.D., a board-eligible plastic surgeon at Ideal Plastic Surgery in Sacramento. “More of a natural look is absolutely the current trend,” he says. One way of helping to achieve that, says Boone, is with facial fat grafting. “A face-lift used to be just sort of pulling everything back, but now we’re focusing on tightening the deep structures of the face and re-volumizing with facial fat grafting, then resurfacing with lasers or chemical peels,” he says. Fat grafting not only adds a youthful fullness to an aging face, says Boone, but has the advantage of being more long-lasting than fillers. Fat grafting is popularly used for other body parts, too, he says—especially the booty.
5. Snatched—in more ways than one. Yes, snatched jawlines are a thing. (We’ll get to that in a minute). But the trend Boone sees most at Ideal Plastic Surgery, he says, is a different kind of snatched: the Brazilian Butt Lift, aka BBL. “The snatched waist with a big booty— that’s a request we get a lot,” Boone says. Not every patient is a candidate for the hourglass-on-steroids look; it depends on anatomy. But for those who are, the procedure involves taking fat from other parts of the body and transferring it safely to the buttocks, says Boone. The word “safely” is key: A 2017 report from The Aesthetic Surgery Education and Research Foundation suggests a significantly higher mortality rate for gluteal fat grafting than any other aesthetic procedure.
“The most detrimental outcome for a gluteal fat transfer would be a pulmonary fat embolism,” says Boone. But such outcomes, he says, are “exceedingly rare” in the hands of an experienced surgeon practicing current standards of care.
Also on the “snatched” list of trends: jawlines. As a surgeon specializing in faces (and necks), Almonte can speak to this trend. “‘Snatched’ is that sharp jawline and neckline that’s being increasingly requested,” he says. To create that look, Almonte performs what he calls the “ALift,” his signature lower face and neck lift, starting with incisions that start in the temple, go down in front of ears around the earlobes, and back behind the ears. A third incision goes under the chin, where fat is liposuctioned away. By lifting and trimming the skin, removing fat and tightening the muscle under the skin known as the SMAS, says Almonte, you’ll be snatched—and likely stay that way for 10 to 12 years.
6. Fox eyes. In the category of “who knew?,” fox eyes are also trending, says Almonte. “I’m not necessarily a fan,” he says. “But if you were to put your fingers around your temples and pull your skin up and back, it creates a slanted, tight look. People are requesting that.” Be warned, however: You won’t find it on Almonte’s list of services. “If I do a temporal lift or brow lift and it turns out to look like that, great,” he says. “But I’m not going to do a procedure just to create that look specifically.”
7. Lip lifts. One procedure Almonte will do—and does with increasing frequency—is a lip lift. “They’ve become hugely popular,” he says. As we get older, he explains, the distance from the corner of the nose to the top of the lip lengthens, creating a droopy, aging look. By making an incision under the nose, removing a little skin and closing the gap with stiches, the upper lip is lifted. “The purpose is not to make your lip bigger, but to show more of it,” Almonte says.
8. Implant removal. In a bit of role reversal, an increasing number of patients are requesting breast implant removal, says Mabourakh. “More and more are coming to have them removed, especially the over-50 crowd,” he says. “They’ve read about problems implants have caused, and they just want them out.” Rupture, systemic symptoms and even anaplastic large cell lymphoma are among the risks associated with breast implants. But the vast majority will not experience any serious complications, according to the American Society of Plastic Surgeons—and the number of women getting breast augmentation still far outpaces the number who are doing the opposite.
9. No drains, big gain. Tummy tucks (abdominoplasties) have long been one of the most popular cosmetic surgeries and also one of the most arduous, with yucky drains and a lot of pain. But that’s changed recently—and for the better—with a new no-drain version that’s gaining ground, says Mabourakh. “With a traditional abdominoplasty, the drains are uncomfortable and stay in for a couple of weeks,” he says. The new procedure, which uses progressive tension sutures instead of drains, offers several advantages over the old-school approach, according to Mabourakh: shorter and easier recovery, less risk of complications and better results. (Yes, an even flatter tummy.)
10. Sacramento: A destination? We’ve saved the best for last: Sacramento, we’re told, is now a cosmetic surgery destination. Why? “Well,” jokes Almonte, “there’s this little thing called the internet.” There’s also a little thing called money: Surgery is generally less expensive here than, say, LA or San Francisco. “We’re like Beverly Hills north, but at a fraction of the cost,” says Almonte. Other experts interviewed for this story noted similar trends, with patients coming from as close by as Modesto and Mexico (a big one) and as far away as India and New Zealand. Beverly Hills north, indeed.
ON THE NATIONAL FRONT
Top 5 surgical procedures:
Abdominoplasty (tummy tuck)
Mastopexy (breast lift)
Top 5 non-surgical procedures:
Skin treatment (chemical peels, hydrofacials, etc.)
Skin treatment (combination lasers)
Source: Aesthetic Plastic Surgery National Databank Statistics, 2020–2021, theaestheticsociety.org