Almost 18 million people underwent surgical and minimally invasive cosmetic procedures in the United States in 2018, according to the American Society of Plastic Surgeons.

That’s nearly a quarter of a million more procedures than in 2017, and a trend that’s been rising the past five years.

Dr. Phillip Khan, a board-certified plastic surgeon at Novant Health Coastal Plastic Surgery in Southport, North Carolina, tackled questions about the latest popular trends in plastic surgery, including breast implants and Botox.

Dr. Phillip Khan
Dr. Phillip Khan

Q: What would you say to women concerned with the U.S. Food & Drug Administration’s latest identification of a possible association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)?

A: I would suggest that they look for good educational resource sites for background on this, such as the American Society of Plastic Surgeons and the website of the U.S. Food & Drug Administration, which provide good insight into concerns and common questions that women have. At the same time, I would ask them also to really seek out their plastic surgeon, who should be certified by the American Board of Plastic Surgery. Women’s questions with breast implant-associated large cell lymphoma are `Am I an immediate risk? Is there a problem? Do I need to have my implants removed immediately?’

Current recommendations are that women, without having any types of symptoms that would indicate a concern for something such as this, do not need to have their implants removed.

The most important thing is that these women get evaluated by a board-certified plastic surgeon. Indicators for concern are breast pain, swelling of one breast as opposed to the other, or changes in how the implants look with time.

The important point is that there are prospective trials now, and many studies that have been following this in order to track these devices and ensure their safety. At the present time, breast augmentation is a safe procedure.

Q: There is a trend of younger patients getting Botox to prevent lines and wrinkles before they happen. Are there any health concerns for women in their 20s or 30s regarding using Botox?

A: Their concerns or questions are no different than any other portions of the population. Things of concern are whether someone is breastfeeding, whether someone has an allergy to any type of medication like the Botox itself, or if they have any type of muscle diseases.

The main concern is that they need to go to a board-certified physician, experienced in the aesthetics of the face, both surgical and non-surgical, that has been trained in injecting.

Q: Can you help consumers understand the importance in selecting a board-certified plastic surgeon to do these procedures (Botox and fillers)?

A: I think it's very important to select someone that's board certified in plastic surgery or someone that's directed by them in terms of getting injectables and fillers, because we have a strict background and training for this. Not only do we understand the aesthetics of skin as well as the muscle structures that go into facial expression, we know the safety profiles of each medicine and are vetted in this very significantly. The fear comes in providers that may be certified in a medical specialty, not trained in surgical and non-surgical facial aesthetics that are performing injectables in settings inside or outside of the office. Many things can come about that lead to less desirable results for the patient, as well as patient safety. Things such as Botox parties may provide instances of undue peer pressure on patients who may not desire fillers or injectables. 

With this, one must be careful in events in which alcohol is served, as well.  But the most important thing is going to a board-certified provider that understands how facial tissue drapes, how facial muscles work, how the anatomy in the face works to give them the best results, and more importantly than anything else, provide patient safety and proper questioning so that they get the best results.

Q: There are recent reports of a woman whose lips swelled four times the normal size following a normal injection at a Botox party. What do you say to consumers who participate or are thinking about participating in Botox parties? And are there any concerns they should consider?

A: I would put up a veil of caution. I think things that are important to consider are the peer pressure itself from the consumer, of whether they really think that they want to have the Botox or not. I think another avenue of concern is to really think about the people that are doing the injection itself.

Have they been properly trained, not only in the technique, not only in the anatomy, but in the safety profiles of the medicines? The third aspect of it are the medicines themselves. Where are they coming from? Is it from a reliable source and has the person that's actually doing the injection had the proper training for this? The goal of this is to avoid things such as a poor outcome, infection, or even more devastating complications for patients.

 There's a strict vetting process that goes about that we have in an office-based setting that provides an advantage. The large Botox party situation does not have, in many instances, that capability in terms of a dedicated history and physical, a dedicated allergy profile, a dedicated medication list, which are all important. Is a patient breastfeeding? Are they allergic to certain types of proteins? Are they someone who is taking a certain medicine that may potentiate the effects of Botox or the filler itself?

 We want to avoid things such as a poor result, or things such as infection. Going to someone who is certified in this, which can be something that's not necessarily correlated with a Botox party, is something that's very important.

Breast augmentation was the most common type of cosmetic surgery (313, 735 procedures) in 2018, according to the American Society of Plastic Surgeons.

Q: Are you seeing any trends of explant surgeries (implant removal) as women get older? What recommendations do you have for someone who is considering this as an option to remove an implant from when they were young?

A: I think that we have seen trends in terms of explanting or removing breast implants that women have gotten in the past. Typically women have been told and they hear that every 10 years you need to have the implants removed or exchanged for another breast implant. Technically that comes about from the fact that with time, changes can occur naturally with the body, or, although rare, with the implant itself that can change the effect with time. The trends haven't really changed in terms of any type of a complication with an implant. It hasn't changed in terms of any type of changes to the implant.

What we have seen is more of a change in women that just would like to have their implants removed. The important thing to understand is that implant removal is something that will understandably give a woman a different breast appearance.

Things change with time in terms of a woman's natural body as well as how breast tissue can respond to gravity, and women that have had implants removed have many options. One is to have her implants removed and have new implants placed. Should they go about the route of just having their implants removed, it's important to understand that they will have a volume loss. They may have changes with things such as a droopy breast or changes in position of their breast with time.

There are options which are very exciting which are available for them. Something such as a basic breast lift or a breast lift with placement of new breast implants. Something such as autologous fat grafting, where their own fat is liposuctioned from their body, processed, and injected into the breast tissue to recreate or enhance their breast contour. This is a similar technique that we are using in breast reconstruction as well.

The importance of women that just want to have the breast implants removed is absolutely understandable and normal. They need to be informed that they may have some volume loss with time and may have an effect that is undesirable to them in terms of how their breast appearance looks. But the great thing is that we have options to bring that back and that's what makes plastic surgery so exciting.

Novant Health Coastal Plastic Surgery offers reconstructive and cosmetic procedures to deliver the results you desire.