The Aesthetic Trends I Wish Would Die

I want to start this chapter with a clarification.

I'm not anti-trend. Trends in aesthetics, like trends in fashion, come and go. Some of them eventually settle into the mainstream as legitimate options that work for the right patient. Others fade out as patients realize the look they were chasing has aged badly or never quite delivered what was promised. The flow of trends in this industry isn't inherently good or bad.

What concerns me are trends that cause patients real harm. Permanent changes that they later regret. Procedures done in patients too young to make these decisions. Aesthetic ideals that are chased into surgery and then mourned for the rest of someone's life.

This chapter is my honest list of trends that I'd love to see end, or at least be approached with much more caution than the industry currently treats them. Some of these positions will be unpopular. Some are out of step with what's being heavily marketed right now. But these are the conversations I have with patients in my chair, and these are the regrets I've watched develop over years of practice.

Let me say something else upfront. If you've had any of the procedures I'm about to discuss, this chapter isn't about you. It isn't about judging anyone's choices. It's about looking honestly at how some procedures got popular, what they're costing patients, and where I'd like to see the industry course-correct.

Buccal Fat Removal

This procedure removes the fat pads from the cheeks to create a more sculpted, hollow look in the lower face. It became massively popular in the early 2020s, driven by social media and a particular celebrity aesthetic that was suddenly everywhere.

The problem with buccal fat removal isn't that it doesn't work. It does. The procedure removes fat, the cheeks become more hollow, the cheekbones look more prominent, and patients see the immediate result they wanted.

The problem is what happens over the next ten to twenty years.

The face loses volume naturally as we age. Fat pads thin. Bone density changes. Skin loses elasticity. The youthful fullness in the lower face that buccal fat removal eliminates is the same fullness that helps faces look younger and healthier into the forties, fifties, and beyond.

The twenty-five-year-old who removes her buccal fat to look more sculpted is creating a face that may look beautiful at twenty-five but skeletal at forty-five. By the time she realizes what she traded away, the procedure can't be reversed. The fat is gone. She can fill the area with HA filler indefinitely, paying for filler every year to replace what her own body had naturally. Or she can live with the increasingly hollow look that wasn't a problem when she was twenty-five and is a problem now.

I've talked patients out of this procedure more times than I can count. The ones who proceeded anyway, most of them, are doing fine right now. They'll be doing less fine in fifteen years. The patients I really worry about are the ones who had the procedure in their early twenties, who haven't yet started to see what they lost.

If you're in your fifties and have always carried significant lower face fullness that you don't love, buccal fat removal might be a reasonable conversation to have with a careful surgeon. For most people under forty, my position is don't do this. The face you're creating for today is the face you'll mourn in twenty years.

"Russian" Lips and Other Aggressive Lip Augmentation

Several trends have driven lip filler in directions that concern me. The "Russian lip" technique creates dramatically elevated upper lips through specific filler placement. Other techniques aim for the heart-shaped, extremely projected look that became popular through certain celebrities and influencers.

The result on social media looks dramatic. In real life, it often looks alarming.

A few problems: