Public perception of lasers treatments, Botox, and injectable fillers have changed drastically in the last three decades. These procedures are no longer viewed as exclusive to the excessively wealthy and vain. Cosmetic surgery, however, is often viewed in a much different light, and many are still apprehensive about it. Indeed surgery does carry much higher risks, as well as costs. Why might surgery still be the better option for some patients?
Soft Procedures vs. Cosmetic Surgery
Cosmetic treatments generally refer to “soft procedures” such as laser or light-based treatments, Botox, injectable fillers, and sometimes chemical peels or microdermabrasion. These procedures are less invasive than cosmetic surgery, which like medical surgeries, cut into the skin and therefore have unique risks associated with them.
Soft procedures have exploded in popularity by offering three key advantages over surgery:
- Convenience – little or no downtime or recovery
- Lower cost1
- Lower risk
Many of these procedures can be performed during a lunch break, start from a few hundred dollars, and have almost no downtime – where you have to take a day off work or leisurely activity. Many patients also like the more subtle, soft, and “natural” changes that aren’t too aggressive. Today, many patients don’t desire drastic changes that make it clear to a co-worker that they’ve had “work” done but want subtle improvements. For all of these reasons, soft procedures are performed about 10 times as often as true cosmetic surgeries.2
With all of these advantages, who would want to risk cosmetic surgery?
There are many upsides to soft procedures. There are, however, good reasons that patients may still consider surgical procedures. The most common reasons for opting for surgical procedures are:
- Certain improvements are only possible via surgery, such as correcting the malposition of fat pads.
- A longer-lasting improvement in appearance
- A more pronounced improvement in appearance
- In some contexts, surgeries could be more cost-effective
One of the most noticeable changes in aging is volume loss and upper face wrinkles due to muscle overuse – and fillers and Botox treat these problems very effectively. However, these are not the only changes that occur with age. Malposition of the underlying structures such as the fat pads and ligaments also change at a certain age. Even the bone will begin to become resorbed, changing the face’s overall appearance at a more fundamental level. At the surface level, the skin’s protein composition (especially elastin) will change and become loose and wrinkled. In short, there are certain types of changes that can’t be treated with Botox or injectable fillers. Cosmetic surgery can make possible certain types of changes that a soft procedure simply wouldn’t be able to affect.
In this video, plastic surgeon Dr. Bryce Cowan explains some of the changes that occur with age.
Generally, fillers only last 3-12 months as most fillers are viewed as “foreign” and are eventually absorbed into the body after being broken down. Similarly, most other soft procedures have a definite length of time that the change lasts, at which point the retreatment will be necessary. Surgical intervention, by its nature, involves repositioning or manipulating tissue, and therefore creates a longer-lasting change. In some cases, this could be negative – if you don’t like the outcome, unlike a filler, it’s much longer to “wait it out.” Your decisions are weightier, for good or for worse.
More Pronounced Improvement
Cosmetic surgeries generally result in bigger improvements and more noticeable changes. These procedures are much more involved and generally require several hours and often weeks of recovery time. Patients can, therefore, expect more dramatic changes to their appearance. This isn’t what everyone wants, of course – many people prefer soft procedures for just this reason – wanting subtle changes that their coworkers wouldn’t really notice on a conscious level. Depending on the procedure, patients can appear as much as 10 years younger and expect longer-lasting change.
Surgeries Could Be More Cost-Effective
Cosmetic surgery improvements generally last longer. For example, Botox and injectable fillers typically last for 6 to 12 months. A corollary procedure for a filler injection is autologous fat transfer, a surgical procedure in which fat tissue is taken from another part of the body where fat is unwanted (such as the thigh or abdominal) and then injected into where fat volume is missing. With this procedure, the changes are considered semi-permanent as the body does not absorb the fat since it isn’t perceived as a “foreign” body. We can say that in most patients, the effect would last 10 years. While it’s true that injectable fillers cost less, once you take into account the number of re-treatments that will be required to maintain a similar appearance over time, it could very well cost more than a cosmetic surgical procedure that would last longer.4
Cosmetic surgery is definitely not for everyone. It is a much more involved procedure that requires a much higher level of commitment on the patient’s part than a soft procedure like Botox. For the right patient, however, it presents more choices – that may be right for them.
For more information about aging and cosmetic surgery vs. soft procedures, you can view Dr. Bryce Cowan’s video series on The Science of Facial Aging.
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1This isn’t always true in the long run, but soft procedures cost far less than surgical procedures on a per-procedure basis.
3It’s tempting to say “permanent,” but no procedure can actually stop the aging process. Aging is a continuous process, but the effect that a particular treatment has can last longer.
4Another important factor to consider is that while $500 worth of Botox may be sufficient today, it may be insufficient 5 years later when the face has changed due to natural aging. It’s important to remember that no cosmetic procedure, surgical or not, can prevent aging.