When Madonna showed up at a New York City club on New Year’s Eve, a video of her somewhat misshapen — and large — behind went viral and raised a stink on the internet.
She didn't say if she had butt implants, but if she had she would be one of the many people who are experiencing what some plastic surgeons call the “the Kardashian” effect.
“There is definitely a big push for breasts and butts like the Kardashians,” said Dr. Jason Cacioppo, of Community Howard Regional Health in Kokomo and Indianapolis.
More and more patients — particularly young people — are getting butt implants, breast augmentations, liposuction, lip augmentation, and other procedures.
“In the age of selfies, people are very aware of their self-image,” said Dr. Robert Paul, a plastic surgeon with St. Vincent Medical Group. “We live in a celebrity culture. We’re seeing people who want to look like someone else, where their goal is unnatural beauty. Good surgery should look natural.”
By the numbers
The American Society of Plastic Surgeons (ASPS) groups states into regions. Indiana is in Region 3 along with Illinois, Michigan, Ohio, Wisconsin, Iowa, Kansas and Minnesota. More than 332,000 cosmetic surgeries were performed in 2017 in Region 3.
Also in 2017, 17.5 million cosmetic surgeries were performed in the United States, and many surgeons expect those numbers to grow.
Currently, women make up 92 percent of patients getting cosmetic surgery.
“There’s been a steady rise in male surgery, but it doesn’t approach the number compared to females,” said Dr. Alan Matarasso, president of the ASPS.
“Trend-wise, most numbers are up, but breast augmentation is still the most requested surgery,” he said.
On the ACPS website, Dr. Jeffrey E. Janis, past president of the organization, states, "Breast augmentations are consistently reported as one of the highest patient satisfaction procedures because it positively affects a woman's quality of life.”
After breast augmentation, the top five cosmetic surgical procedures are liposuction, nose reshaping, eyelid surgery and tummy tuck.
The top five minimally non-invasive cosmetic surgeries are Botox, soft tissue fillers [these are injections of collagen or hyaluronic acid to give an aging face more elasticity and volume], chemical peels, laser hair removal, and microdermabrasion.
“These procedures make people prettier, but more importantly, it helps their self-esteem,” said Paul.
One area that surprised doctors is a rise in breast reductions. After a 4 percent decline in 2016, the procedure increased by 11 percent in 2017, according to the ASPS. Some of those numbers might be attributed to the number of men who are getting breast reductions.
Butt implants are another surgery that has increased dramatically, up by 10 percent in 2017 over 2016.
“In the butt you can do fat injections or silicone injections, and you can lift or do both,” said Matarasso.
One popular — and controversial — procedure is a Brazilian butt lift, which calls for removing fat from different parts of the body and injecting the fat into the buttocks.
“This is an injection that can cause a lot of complications,” said Matarasso. “The anatomy in that area is very unique. This procedure has a high mortality rate (1 in 3,000). It has the highest mortality rate of any elective surgery. It kills because the fat can embolize in blood vessels. So if you’re thinking about this, make sure you have a very highly qualified surgeon.”
“There’s also a non-cosmetic way to enhance your butt, known as a buttress pillow, which is essentially padded shorts that make you look like your butt is bigger and rounder than it actually is,” according to the ASPS. “It could simply be that Madonna wanted to throw on a pair of these before her performance to give her a little extra, uh, cushion.”
One of the biggest changes plastic surgeons have seen over the last few years is the level of technology that is now available.
“Surgical innovations continue to evolve,” said Matarasso. “This technology means smaller incisions, less risk and less down time for the patient.”
One area he stressed that has improved dramatically are breast implants.
“We have new technology that provides a more natural feel and they look better and are safer when it comes to leakage.”
Another area that is changing is the age of the patient. Women ages 40-54 are still the ones getting more procedures done than any other age group, but the number of young people getting elective surgery is on the rise.
“Younger generations are preventative rather than reactive,” said Cacioppo. “We’re doing a good job educating people that we can prevent changes. People in their late 20s to early 30s want to prevent wrinkles.”
Laser peels, Botox, and other procedures are becoming very popular in that age group, too, he said.
Additionally, Cacioppo said there are constantly new products on the market that include “great skin care lines.” He also added that a new Botox product has been approved by the Federal Drug Administration and should be available soon.
Another area that is becoming popular is “combination” procedures where a patient gets two surgeries at once to save money and to avoid too much down time, said Matarasso.
“For instance, we can do liposuction and skin-tightening procedures because we have new, energy-based devices that allow us to do two things at once,” he said.
Lip volumizing has also grown, again due to the Kardashian effect.
“There’s been a paradigm shift in aesthetics of the lips. Ten years ago people wanted lip reductions. Now, that’s an almost obsolete operation,” said Matarasso.
Another area that has grown in popularity is tummy tucks.
Tummy tucks, which dropped from the top five most popular cosmetic surgical procedures in 2016, rebounded their way back into the top five in 2017. There were over 2,000 more tummy tuck procedures in 2017 than there were in 2016.
"An improved abdominal contour is something that many of us strive for, but for some patients, that may not be attainable through diet and exercise alone," said Janis. "Age, pregnancy and significant weight changes can impact both the skin and underlying muscle.
“Tummy tucks performed by a board-certified plastic surgeon remove excess fat and skin and, in most cases, restore weakened or separated muscles to create an improved abdominal profile."
More people are choosing to shape different parts of their bodies using ultrasound, radio frequency, infrared light, vacuum massage and injectable medication to reduce fat cells, according to the ASPS. Non-invasive procedures to eliminate fat and tighten the skin are gaining popularity, with the fastest growing procedure, cellulite treatments, up nearly 20 percent over last year.
"Plastic surgeons are able to give patients more options than ever …," said Janis. “Patients appreciate having options, especially if they can act as maintenance steps while they decide if getting something more extensive down the line will be right for them."
Following are the national average costs of non-invasive cosmetic procedures and how many people underwent the procedure in 2017 [the most recent numbers available]:
• Wrinkle treatment injections: (botulinum toxin type-A, such as Botox, Dysport); 7 million procedures; $385
• Hyaluronic acid fillers: 2 million procedures; $644
• Chemical peel: 1.3 million procedures; $673
• Microdermabrasion: 775,014 procedures; $138
• Laser treatments (Intense Pulsed Light); 656,781 procedures; $433
Among the more popular cosmetic surgical procedures and their related costs were:
• Breast augmentation: 290,467 procedures; $3,719
• Liposuction: 235,237 procedures; $3,200
• Nose reshaping: 223,018 procedures; $5,046
• Tummy tuck: 127,633 procedures; $5,798
• Buttock augmentation: 18,489 procedures; $4,356
Source: American Society of Plastic Surgeons
Finding the right doctor
“The first thing patients should do is figure out what they want,” said Dr. Jason Cacioppo, of Community Howard Regional Health. “As certified plastic surgeons we can help them reach their goals.”
Dr. Alan Matarasso, president of the American Society of Plastic Surgeons, said it’s important to do your homework on the doctor and facility where the procedure would be performed and to make sure the doctor is a certified plastic surgeon.
Following are questions to ask your doctor:
• Are you certified by the American Board of Plastic Surgery?
• Are you a member of the American Society of Plastic Surgeons?
• Were you trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• Where and how will you perform my procedure?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my surgery?
• Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?