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:

The proportions violate natural lip anatomy. Beautiful lips have specific ratios. Typically the lower lip is slightly fuller than the upper, the lips have natural definition at the borders, the central tubercle creates subtle dimension, and the lips have natural softness when at rest. The dramatic upper-lip-forward look violates several of these principles at once.

The work doesn't age well. Lips that have been aggressively filled don't return to their natural shape easily when filler is dissolved. The skin can become stretched, the proportions altered, and the lips can take years to return to anything resembling their original state.

Lip filler migration becomes more likely with overfilled lips. The classic "filler mustache" above the upper lip is a sign of overfilled lips that have allowed product to drift outside the lip border.

If you want lip enhancement, work with a conservative injector who does small amounts at a time, who respects natural lip proportions, and who can tell you when enough is enough. The before-and-after that looks like "you, with slightly more lip" is what you want. The before-and-after that makes you look like a different person is the warning sign.

"Fox Eyes" and Other Westernized Beauty Standards Imposed Through Procedures

I'm choosing my words carefully here.

A few years ago, fox eye procedures became popular. The look involved lifting the outer corner of the eye through threads, blepharoplasty, or other techniques to create an elongated, lifted appearance.

The look originated by mimicking features common in Asian eye anatomy. Then it was popularized by mostly white celebrities and influencers, who got procedures to create this look on their own faces.

There's something deeply uncomfortable about a beauty trend where one group of people gets surgery to look like another group of people, while members of that other group have historically faced pressure to alter their natural features in the opposite direction.

This isn't unique to fox eyes. Beauty trends in aesthetics frequently involve patients being pushed toward features that originate in cultures other than their own, treated as objects of admiration when they appear on certain faces and as flaws when they appear on others.

My position: be careful about procedures that significantly alter features in ways that don't fit your face's natural structure. Your face has its own beauty. The aesthetic you bring to the world includes the eye shape, lip shape, nose shape, and overall proportions that are yours. Tweaking and refining is reasonable. Erasing what makes you you, to chase someone else's features, is rarely going to make you happier in the long run.

The "Snatched" Jawline Trend

The dramatically sharp, contoured jawline that became an aesthetic ideal in recent years.

In some patients, particularly men or patients with naturally strong jaw structure, this look can be achieved through tasteful filler and looks great.

In others, particularly women with naturally softer lower face proportions, the pursuit of an extremely sharp jawline through filler can create a masculinized lower face that doesn't match the rest of their features. The combination of filler-enhanced jawline with soft cheeks, full lips, and feminine eye area can look uncanny rather than beautiful.

The amount of filler required to create the dramatic jawline look on someone without naturally strong structure is significant. Three, four, sometimes more syringes in the lower face alone. That's a major investment, with potential for migration and overfilling concerns.

My suggestion: subtle jaw definition through targeted filler can be lovely for patients who'd benefit from it. Pursuing a dramatically sharp jawline that fights against your natural facial proportions usually doesn't end well.

Aggressive Tear Trough Filler

The under-eye area is one of the trickiest places in aesthetics. The skin is thin. The tissue is delicate. The risk of visible product, migration, lumps, and the Tyndall effect (bluish discoloration from filler placed too superficially) is real. The vascular anatomy in this area also makes vascular events more dangerous when they occur near the eye.

For some patients with mild hollowing of the tear trough, careful conservative filler placement can be transformative. For other patients, especially those with significant under-eye bags or fat pseudoherniation, filler is the wrong intervention entirely and surgical blepharoplasty would be more appropriate.

The trend I want to call out is the casual treatment of tear trough filler as something every patient should consider, sometimes performed by injectors without specific training in this delicate area.

Tear trough filler done well is a precise, conservative procedure performed by injectors with significant specific experience. Tear trough filler done badly leaves patients with persistent puffiness, visible product under the eyes, and dark circles that look worse than before treatment.

If you're considering tear trough filler, see a provider who does many of them, who's honest about whether you're a candidate, and who is conservative with placement.

"Baby Botox" Done Too Young

I touched on this in the Botox chapter but want to revisit it here as a trend.

There's nothing wrong with smaller doses of Botox in select younger patients with specific concerns. The "baby Botox" approach uses less product, treats more carefully, and aims for subtle softening rather than full muscle paralysis.

What concerns me is the cultural shift toward treating Botox as something all young women should be doing prophylactically. Twenty-three year olds with no visible lines getting Botox because they've been told they should "prevent" wrinkles.

The marketing has done a beautiful job of selling preventative Botox to women who don't yet need it and who may not benefit from starting so early. The financial cost over decades is enormous. The cumulative effect of decades of repeated injections is incompletely studied. And the message it sends to young women, that their natural face needs medical intervention to be acceptable, is a message I'd rather not see normalized.

If you're under twenty-five and have visible static lines (the ones that persist when your face is at rest), you might be a candidate for Botox. If you don't have visible static lines, you probably aren't, and the marketing that's telling you otherwise has commercial reasons that aren't aligned with what's best for you.

The Pursuit of "Instagram Face"

This deserves its own section because it underlies many of the trends I've described.

A specific aesthetic emerged in the late 2010s and exploded through filters and social media. Extremely high cheekbones, elongated almond eyes, dramatically full lips, a tiny snatched nose, a sculpted jawline, glass-smooth skin without expression lines. It's an aesthetic that exists primarily in filtered images and that requires significant intervention to approximate in real life.

Patients started bringing photos of this aesthetic to consultations. Sometimes the photos were of celebrities. More often they were of influencers, or even of themselves with heavy filters applied.

The look isn't achievable through normal aesthetic work. To approximate it requires aggressive filler in multiple areas, often multiple procedures stacked together, often performed on patients who don't quite have the underlying anatomy to support it.

The result, when it appears in real life, is the uncanny look I described earlier. Recognizably altered. Recognizably "having had work done." Recognizable not as a refreshed version of the patient but as a version of a current beauty trend that will date itself in a decade.

What concerns me about Instagram face isn't the aesthetic itself, though I personally find it unappealing. What concerns me is that patients are pursuing it without understanding that they're getting a trend, not a timeless improvement. The patient who got Instagram face in 2020 looks like a 2020 patient now. The patient who builds Instagram face today will look like a 2026 patient in 2030.

When I have patients bring me Instagram face reference photos, I have a conversation about what they're really asking for and whether there's a deeper aesthetic goal underneath the surface reference. Sometimes they want overall refreshing, and we can find a path that doesn't involve chasing the trend. Sometimes they really do want to look like the reference photos. In those cases, I often recommend they think carefully, perhaps see other providers, and not rush into procedures that will be hard to undo.

Aggressive Anti-Aging in the Twenties

A broader trend that worries me is the increasing aestheticization of normal twenty-something faces.

Patients in their early twenties are being marketed aggressive prevention, ongoing maintenance, and corrective procedures for concerns they don't really have yet. The skincare industry, the aesthetics industry, and social media combine to convince young people that their normal faces are problematic and need intervention.

A twenty-three-year-old who's not sleeping enough, eating poorly, and stressed out, who shows up at a clinic asking about Botox, fillers, and lasers for the "aging" she's perceiving, might actually need: more sleep, better stress management, basic skincare, and a frank conversation about what she's actually seeing in the mirror versus what filters and her own anxiety have made her see.

A twenty-three-year-old whose face is normal for her age and whose insecurity is being driven by social media exposure might benefit more from time off social media than from procedures.

If you're young and considering aesthetic procedures, I'd encourage some self-reflection. What are you actually trying to fix? Is it really there, or is it something you've been told to worry about? Are you happier when you spend less time on filtered content? Is there a less invasive path forward?

You have decades of face ahead of you. You can always do procedures later. Doing them now, before you really need them, costs more in money and in the cumulative effects of years of intervention. The pressure to start early is largely commercial. Resist it where you can.

Permanent Makeup Done Aggressively

Microblading, lip blushing, and other permanent makeup procedures have legitimate uses for some patients. Done conservatively, with good color matching and careful placement, they can be lovely.

Done aggressively, they create issues that follow patients for years. Microblading that fades into blue or grey over time. Lip blushing that creates an unnatural color or shape. Permanent eyeliner that looks dated as styles change.

The procedures are marketed as semi-permanent, but the reality is that pigment in the skin lasts for years, sometimes for decades, and removal options are limited and imperfect.

If you're considering permanent makeup, do it conservatively, with reputable providers who do small amounts and let you assess before adding more. Don't chase trends that will look dated. Don't agree to bold work that you'll have to live with as it ages.

Why I Wrote This Chapter

I wrote this chapter because some of the worst regret I see in my practice comes from procedures that patients did because they were popular, marketed effectively, or recommended by providers more focused on selling than on their long-term outcomes.

The trends I've listed will eventually fade. Other trends will replace them. The pattern of patients chasing what's hot and regretting it in five or ten years will continue unless the industry, and patients, get more thoughtful about distinguishing trend from improvement.

The best aesthetic work, in my experience, is timeless. It refines what's there. It enhances natural features. It refreshes without transforming. It respects the patient's age, structure, and the way faces age beautifully over time. It doesn't try to make every patient look like the same set of currently-trending features.

If you're considering a procedure, ask yourself whether it would have looked attractive in 2010, and whether it will look attractive in 2035. The aesthetic ideals that hold up across decades are the ones worth pursuing. The ones that exist mostly in the current Instagram algorithm aren't worth investing in long-term.

Part Two ends here. We've covered the procedures, the providers, the consultations, the trends. You should now have the framework to make informed choices about anything you might encounter in this space.

Part Three pulls the camera back. We've been deep in tactics for fifteen chapters. The final section is about perspective. How skin actually changes through the decades. The bigger picture of aging beautifully. Some of the most important conversations in this book are still ahead.