America is a melting pot of beauty ideals. Aesthetic physicians from major metropolitan hubs to rural areas report a spectrum of influences that affect consumers’ aesthetic aspirations and ultimately what they will do to enhance their looks. The bottom line: There is no single standard of beauty and many different trends. An individual’s perception of beauty might be driven by race, ethnicity, culture, gender, geography, environment, age, social media, celebrities and more.
Cosmetic dermatologist Jason Emer, MD, who practices on the iconic Sunset Boulevard in West Hollywood, Calif., says he definitely sees changing perceptions in what is beautiful.
“On the West Coast, we’re seeing more accentuated features – people with higher cheekbones, sharper jawlines and a higher brow arch,” he notes.
A big trend among some men: Feminine is the new masculine. For example, men want smoother, softer skin, according to Dr. Emer.
“I think it is more prominent in the entertainment industry and for people in media – they are wanting to look softer. They want more feminine features that make them more approachable and more attractive to other males and females,” Dr. Emer points out.
“Men are doing a lot of peels, microneedling, facials and laser treatments to tighten the skin, when they weren’t doing these preventive treatments before.”
In addition, men also want softer and defined, not overdone, lips, so Dr. Emer uses hydrating fillers like Versa™ from Revanesse USA, Juvéderm Volbella® from Allergan, or Restylane® Silk from Galderma to soften the lips without adding a lot of volume.
Women want to keep things tight, Dr. Emer emphasizes. Women, many of whom are already getting dermal fillers and neurotoxin injections, are more likely to want neck tightening and jowl treatments.
“They want a more slender look to their face, rather than a squared off look. Angelina Jolie’s structured and wide jawline, which is a masculine feature, was considered feminine before. Now, we are finding that women want slimmer facial features. They are getting neurotoxin injected in their jawline and neck for the neck bands,” Dr. Emer says.
Patients are doing more thread lifting to lift and define features of the skin, Dr. Emer states.
In Hollywood and Los Angeles, overfilling is out, but lifting and tightening is in – even in young patients. Patients in their 20s are getting thread procedures to keep facial skin tight and build collagen, without looking filled, says Dr. Emer.
Dr. Emer, who sees patients from around the U.S., says East Coast metropolitan patients tend to be more sensitive to extreme changes than people on the West Coast.
“They’re not going to have as high of a cheek lift or brow arch. They’re probably going to be OK with a few more wrinkles to appear more ‘natural.’”
Body-wise, Dr. Emer says the snatched waists and big buttocks of years’ past are evolving to more athletic builds for women and chiseling for men.
“Instead of using fat grafting to the buttock for size, we’re lifting the buttock or tightening the skin. It is not necessarily sculpting or sizing, but rather tightening of the skin.”
Dr. Emer says he is using skin tightening treatments for the body and he likes the truSculpt® iD from Cutera, for not only removing localized fat, but also skin tightening. And he combines truSculpt with other technologies for fat reduction and skin tightening, especially in patients who are thinner, athletic or with smaller problem areas.
And for increased definition or for small areas not improved by these types of technologies, injectable lipolysis can be used to shrink down and permanently remove fat in stubborn areas, he says.
In addition to abdominal muscles, men also want sculpting on the chest and neck, Dr. Emer adds.
“For the chest, we’re doing implants and fat grafting to lift the chest. And we are removing glands in the chest to give people an athletic look,” Dr. Emer says.
Today’s social media influencers and celebrities, from Christie Brinkley to Jennifer Aniston and Gwyneth Paltrow, are opting for minimally invasive treatments that tighten skin and even muscle. Social media continues to have a big impact on younger patients, and doctors who post videos and content are becoming influencers in our field, Dr. Emer points out.
Even trendsetters want “natural”
Charles Galanis, MD, a plastic and reconstructive surgeon in Beverly Hills, Calif., says he and colleagues around the country – even the world – are seeing a trend toward a more natural aesthetic.
“Plastic surgery traditionally has been equated with sort of that artificial or plastic look,” Dr. Galanis says. “I think what we are seeing is a transition to people who want to retain much of their identity with less drastic and more understated changes. In other words, they might want to get work done, but they don’t want it to look like work was done. Whether it is breast augmentation or facial rejuvenation, I think a morenatural look is the goal.”
With breast or buttock augmentation, for example, the ideal is not so exaggerated but rather more modest and proportional to one’s frame, he says.
Social media continues to impact just about every aspect of what patients view as beauty ideals. Influencers, movie stars, reality show celebrities and others are impacting especially what young patients think is beautiful, Dr. Galanis points out.
“I think it is a moving target. Just as with any trend, things can change with one influential person’s statement,” he says.
Cultural influences also impact the beauty ideal, Dr. Galanis reveals. “Some cultures prefer a larger body, for example.
Some cultures put a thin or lean body on a pedestal. So, there will always be cultural differences on what defines beauty,” he says. “Because the internet has sort of made the world smaller, are we going to homogenize what we think the beauty ideal is? I still think whether it is body contouring surgery in South America or jaw shaping surgery in Southeast Asia, there are still certain things that are culturally unique in terms of what people pursue.”
South florida beauty vibes
Shino Bay Aguilera, DO, a dermatologist who practices on trendy Las Olas Boulevard, in Fort Lauderdale, Fla., says the Sunshine State continues to embrace Brazilian and other South American influences, as well as beauty icons like Jennifer Lopez and Kim Kardashian.
“Women in South Florida are concerned about the buttocks. Pretty much everyone has breast implants [or] some work in that area to enhance their breasts. But now we’re getting a lot of calls and requests for things that are going to shape the buttocks. Some can be surgical, like the Brazilian butt lift and some of them don’t have any fat to transfer so they do things like Sculptra® Aesthetic (injectable poly-L-lactic acid) from Galderma, or now there’s EMSCULPT from BTL, which can actually give patients a more toned, lifted, round butt,” Dr. Aguilera says.
Toning is a big theme among both women and men. “You could work out every day, but if you don’t have the genetics you may not look up to par,” Dr. Aguilera advises. “Now with new technology, like the EMSCULPT, you don’t have to do 20,000 squats and still fall short in your aesthetic goals in that area.”
Men in South Florida also want visible abs, according to Dr. Aguilera. EMSCULPT helps with that, too.
“We live in the Sunshine State, so life here revolves around doing things on the water and having your shirt off,” he says.
As for the face, like in Los Angeles, men and women from many Florida cities are veering away from the overfilled look, which Dr. Aguilera says is well known just up the coast in Boca Raton, Fla.
“People are moving away from the fake look. They are looking for a more natural, refreshed look. They don’t want to look like something’s been done. In South Florida, we have a reputation for having people who look overdone, similar to Los Angeles. Now people come in and say ‘please don’t make me look like the people in Boca Raton. I don’t want to have that Boca babe look.’ And everybody understands what that means,” Dr. Aguilera reveals. “People are looking for more discreet and natural. They want to look like something was done, but not noticeably.”
According to Dr. Aguilera, cheekbones are the facial focal point.
“Everyone wants their cheekbones enhanced to make the face look more defined,” he says. “Maybe this stems from makeup techniques of highlighting and contouring, but patients want to achieve that look without putting makeup on. This influence could come from other races that have more of the ethnic look, where the cheekbones are more pronounced.”
When it comes to millennials, they don’t really need procedures; they want them mainly for enhancement, Dr. Aguilera says.
“A lot of millennials want contouring. If anything, they want to look like the Snapchat version of themselves.”
Beauty ideals in rural america
Carl R. Thornfeldt, MD, a dermatologist in Fruitland, Idaho, reports that people in rural areas are often exposed to the outdoors, including sunlight, pollution and other environmental hazards in their lines of work.
It’s a perfect recipe for skin aging, he says.
While city dwellers might want to make more drastic changes to their looks and are willing to pay the price for trendy procedures, people who live out in the country want to look their best, but not different. They want good value, meaning products and services that offer results, not a lot of recovery or downtime (because they can’t take a lot of time off) and are affordable.
“They have accelerated aging because of their outdoor lifestyles and high desert exposure to airborne pollution and environmental changes. So, they want to soften that blow as much as possible, but they are also less willing to have more drastic procedures. They don’t necessarily want to look like they have class III or class IV photoaging, but they don’t mind having class II photoaging,” he says.
In Dr. Thornfeldt’s experience, while some of his patients get fillers or neurotoxins, many would rather have a procedure that lasts longer.
“So, we are getting more interest from people wanting threads and the types of treatments that have a longer-term effect, including photodynamic therapy (PDT).” PDT addresses their concerns about skin malignancy, as well as diminishes signs of aging.
Designing regimens suited to the rural lifestyle that help skin stay healthy and achieve aesthetic ideals is important, Dr. Thornfeldt states. He recommends patients use topicals for sun protection, barrier repair and skin rejuvenation, as well as supplements for skin health. In addition to his own skincare line, Epionce, Dr. Thornfeldt recommends supplements, such as Heliocare® (Polypodium leucotomos extract [PLE]), from Ferndale, and/or niacinamide and Pycnogenol® (pro-anthocyanidin), from Horphag Research, which help to prevent and reverse skin damage from the elements.
Based on patients’ lifestyles, Dr. Thornfeldt also considers when they should or shouldn’t have treatments. For example, having a procedure in which patients shouldn’t get sun exposure in the days following treatment shouldn’t be done in high summer, unless patients have the option of staying indoors or getting proper sun protection.
Ideals and the consult
Dr. Galanis says it is important for plastic surgeons and other aesthetic physicians to stay on top of beauty trends and ideals, but, when it comes to sitting down with individuals during the consultation, he doesn’t pay any attention to what’s trending.
“My only attention is on the patient’s individual desires. My job is not to instruct someone on what is beautiful. My job is very simply to listen to what it is that patients want to address – not for anybody else, but for themselves. Whether it is something that is just holding them back from living their most confident life, or if for some reason they see a disconnect between their inner and outer beauty, my job is to listen to that, understand that and then offer them possible options to address it,” Dr. Galanis shares.
The most important thing an aesthetic physician can do is not assume what a patient perceives as beautiful, Dr. Thornfeldt adds.
“In the intake I ask them what bothers them most and what are their expectations,” Dr. Thornfeldt says. "You need to be responsive to the patient.”
Dr. Emer underscores the importance of establishing relationships with patients who have realistic expectations.
“I think the first consultation is very important. When you are talking to that person face-to-face, you can make sure you are on the same page,” Dr. Emer says.
If the physician and patient are not on the same page, physicians should consider not moving forward with procedures. It is best that people with unrealistic ideals and unattainable expectations do not become your patients, Dr. Emer concludes.