How To Navigate Cosmetic Procedure Trends According to a Trusted Boston Plastic Surgeon

Ask your neighborhood trendsetter what plastic surgeries they might want, and they’ll practically have a wishlist on deck. They’re likely influenced by the social media filters that dominate platforms like Instagram and TikTok—contouring users’ cheekbones, volumizing their lips, and ultimately creating the “ideal” one-size-fits-all face. Because these trends dilute the distinctions of a person’s face, they can make it seem universally desirable, and the idea that everyone can benefit from them makes these kinds of cosmetic operations go viral.

But the surgeons on the forefront of the plastics industry are steering patients in a healthier direction—both mentally and physically. Where filter-replicating trends encourage a look that is generic, often unattainable, contemporary plastic surgeons are treating their patients as unique individuals. 

In Boston, Dr. Waleed Ezzat, MD, FACS, at the Boston Center for Facial Plastics and his team, are leading practitioners of this movement for plastic surgery to be tailored to a person’s unique features, and natural tendencies. “We’re not performing your grandparents’ plastic surgery,” he says. So, we spoke to Dr. Ezzat for some expert insight on how to get the best of on-trend techniques and looks that won’t just look good on social – but also in real life.

Knowing Your Options

When a patient first consults with Dr. Ezzat, he reserves time to educate the patient on the reality of their goals and on the appropriate techniques to get there. The aim is to ensure that patients “have an understanding of what we will and won’t do so that we maintain their natural features,” he says, in order to make sure that balance is maintained across the face and that the procedure will hold up over time.

That’s not to say you shouldn’t collect before-and-after images of the procedure you want. But it is to say that a good surgeon won’t take your goals at face-value, so to speak. Getting more defined cheekbones doesn’t mean that the buccal fat removal transformation clips you’ve seen on YouTube are the procedure you require. 

In fact, buccal fat excision is, in a number of patients, not the most appropriate option. 

In part, that’s because buccal fat is critical for your face to maintain volume as you age. The viral buccal fat removal videos often leave out that if the surgery is overly aggressive or not not right for your face, it can actually accelerate visible aging in the face or give the face a malnourished appearance. In these cases, patients end up back in their surgeon’s office less than 10 or 15 years down the line, undergoing additional procedures to restore the volume they once did away with. 

But just because buccal fat excision might not be for you doesn’t mean that a more contoured face is out of reach. Dr. Ezzat recommends looking into the full “toolkit” that exists to achieve any goal you might have, from surgery to filler, implants to minimally-invasive treatments. And with international conferencing between doctors, ever-evolving research, and personalized plans being developed for patients around the globe, these options are only becoming more expansive. 

One Size Doesn’t Always Fit All

Since the dawn of facial plastics, people have always had the tendency to flock to the same cosmetic procedures. A generic approach to plastic surgery, namely with rhinoplasty, is nothing we haven’t seen before. 

As little as 20 years ago, a regressive idea of what makes a face beautiful dominated plastic surgery. Rhinoplasties were structured around an idealized nose termed “Caucasian,” and the result was akin to the one-size-fits-all digital tricks of today’s filters. 

But from the very beginning of rhinoplasties, and up until today’s trends, the same remains true: Just because a feature might look good on certain faces doesn’t mean it’s the right choice for every face. “There are many different types of ethnicities out there with different types of anatomic variations in the nose that you have to take into account,” says Dr. Ezzat.

Slight progress was made in the industry as a second type of rhinoplasty came into popularity. For nonwhite patients, an “ethnic” rhinoplasty became the go-to, in an attempt to avoid doling out noses that interrupted the harmony of patients’ faces. Although this was a first attempt to consider the unique cartilage, skin thickness, and balance of facial features that each patient brings, the industry was still making sweeping generalizations.

Today, surgery works to transcend stereotypes and incorrect groupings, and sees patients for who they are. For all procedures, and rhinoplasties especially, surgeons understand that evaluating a patient’s full face is imperative to building a result they’ll be happy with long-term—one that both meets their aesthetic goals and sings the same tune as their eyes, mouth, and other features. Dr. Ezzat recently spoke at the American Academy of Facial Plastic and Reconstructive Surgery National Meeting in San Diego, CA, about the need to change how surgeons view the nose.  “The term ‘ethnic’ is not accurate in describing the nose – both socially or scientifically.  It is critical that plastic surgeons are more savvy in how we view the nose.” Dr. Ezzat states. 

There are tons of anatomic variations in the face, and at the Boston Center for Facial Plastics, Dr. Ezzat teaches that these must be taken into account. “If you don’t,” he says, “you’re really not doing your patient a service—you’re doing them a disservice.”

How to Avoid Changes You’ll Regret

Aesthetics might be a driving factor behind someone’s decision to pursue plastic surgery, but they’re only one component of a successful operation. That’s why doctors who are most committed to pleasing their patients aren’t just thinking about the initial reaction a patient will have to their healed result—they’re thinking about the face’s look and function in the long term. 

When operations aren’t personalized to account for a patient’s biology, they can ultimately lead to a loss of function down the road. In these situations, regret is nearly inevitable. For example, say a patient comes in requesting the “button” nose they’ve seen celebrities donning, but this patient also has weak nasal cartilage. In cases such as this, it becomes dangerous to have that small nose because it was never compatible with your nasal cartilage. 

“If we give that patient a small “button” nose, they might get it, but they’ll also have days where they won’t be able to breathe,” Dr. Ezzat says. “The nasal passages would be too small, because the cartilage was too weak to begin with.” Your surgeon should be able to foresee these circumstances.

Standardized operations can be dangerous for a patient’s mental health, too. Decorating your face with cookie-cutter features can feel like a good idea when you’re caught up in a trend, but it’s not uncommon for patients to return to doctors with regret after years or even decades later, wanting to reverse their procedures. 

These patients look in the mirror and say “This is not me, this was not supposed to be me,” Dr. Ezzat tells us. They want to go back to their original face, or at least as close to the original as they can get, which usually requires a costly revision procedure and a lengthy healing process. 

“Plastic surgery should really be all about bringing harmony to the face,” Dr. Ezzat says. That’s why, for prospective patients, finding a surgeon who can get you close to your aesthetic goals without sacrificing your facial function or harmony is critical.

This is a paid partnership between The Boston Center for Facial Plastics and Boston Magazine