AAFPRS President Reflects on Annual Survey Results

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) released its annual survey results in February. Among the most noteworthy statistics: Facial plastic surgeons reported a 50% rise in the average number of fat grafting procedures performed over the past year; 10% have started personally prescribing GLP-1 medications; 67% said the average age of facelift patients is likely to trend younger; 28% said patients seeking treatments reference symptoms of perimenopause- and menopause-related concerns as a reason for consultation; and 92% reported seeing male patients in their practices. Modern Aesthetics spoke with AAFPRS president Patrick Byrne, MD, MBA, a facial plastic and reconstructive surgeon based in Cleveland, Ohio, about these trends and more.

DO YOU EXPECT THIS LEVEL OF FAT GRAFTING PROCEDURES TO CONTINUE? IS IT JUST THE NATURE OF GLP-1 DRUGS THAT THEY WILL REQUIRE SOME WORK FROM FACIAL PLASTIC SURGEONS?

We don’t know for sure if there is causality here. We have seen this marked increase in the popularity of fat graft over the past year in our survey, and the most obvious explanation is the ascendance of GLP-1, because we all see it in our practices. Patients get deflated a bit, especially if it’s significant weight loss. But coincident with that over several years is a slowly but surely expanding awareness of the benefits of fat grafting. So I would say, I do think in lieu of any other breakthrough for volume restoration, I think the popularity of fat grafting will probably continue to steadily rise.

HOW ABOUT PRESCRIBING GLP-1 DRUGS? IS THAT SOMETHING THAT YOU EXPECT MEMBERS TO DO MORE OF IN THE FUTURE?

That is a good question. We do not have a formal stance on it yet. I can give a high-level view in my role as president: I think our focus needs to be on what we are trained in extensively through our residency and fellowship process. At this point, the medical management of metabolic disorders and obesity is not part of it. So, my focus and our academy’s focus will remain on our core expertise, which is really in the surgical treatment of facial conditions.

WHAT ARE YOUR THOUGHTS ON THE AVERAGE AGE OF FACELIFTS TRENDING YOUNGER? DO YOU THINK THESE PATIENTS WHO HAVE THEIR FIRST FACELIFT IN THEIR MID- TO LATE 30S WILL RUN INTO ISSUES LATER IN LIFE?

That’s a concern that is legitimate. My belief is that the trend of younger includes two distinct, heterogeneous categories. One is aging-related changes that are addressed with facelift surgery. There’s no question if someone is showing signs of aging that can benefit from a facelift—and many of the signs of aging that most trouble our patients benefit very well, especially from the modern techniques—younger is better in terms of the ability of the skin and soft tissues to heal in a way that’s natural and optimal. So, there’s a really positive, logical rationale behind moving from 60s to 50s and in some cases from 50s to 40s. That category of people who are seeking it in their early 40s or in their 30s certainly is pushing the envelope. Yes, for some patients, it could make sense, but I personally think it’s an unusual patient for whom that should be the optimal choice. I don’t think there are many 40-year-olds or 35-year-olds who should be considering facelift for the aging changes. However, there is a second category, and that is the face and neck lift techniques we use that can address anatomic issues that trouble people in their youth. For example, fullness under the chin, a neck-jaw angle that isn’t optimal, a sharp jawline. Some people have room for improvement and it has nothing to do with age. It’s just their anatomy. And it turns out that similar techniques address that really, really well, especially as we get better at these techniques. I try to somewhat bifurcate that way. I had a 38-year-old male patient recently whose skin looked extremely young. He was Indian American, successful, a fit guy, but he noticed this fullness under his chin, especially on Zoom calls, which of course have driven a lot of demand. He’s not really doing it for the aging reason, but it’s going to show up in the statistic if he decides to proceed with a neck lift, which is an aging face procedure. So, it’s important to keep those two populations distinct.

SO THOSE PATIENTS MIGHT NOT BE COMING BACK IN 10 YEARS FOR ANOTHER ONE?

They may or may not, but it’s not as predictable. Exactly.

WERE YOU SURPRISED TO SEE THAT ONLY 28% OF MEMBERS AGREED THAT PATIENTS SEEKING TREATMENTS REFERENCE PERIMENOPAUSE- AND MENOPAUSE-RELATED CONCERNS?

I think the percentage who are driven into the office because of the effects of menopause is much higher than 28%. I think it’s a very high percentage. I was so fascinated that, as my practice started getting busy many years ago, it felt like 50% of the women who presented on an initial consultation for a facelift were exactly 54 years old—not 55, not 53. It is amazing that it clearly somewhat coalesces around this age. It was only after a period of time when I realized the ‘duh’ moment: That’s the effects of menopause, and it’s realistic that women appear to age more rapidly during the years around menopause. Someone who wouldn’t have thought of it for years on end and felt like they were aging slowly might suddenly, over the course of 2 or 3 years, feel like they’ve aged 10 years. They don’t always ascribe it to menopause. I think that’s why the percentage is so low. I think in their mind, they’re not thinking about the estrogen and hormonal changes driving the volume changes, the skin changes, the laxity, and that sort of thing.

HOW ABOUT THE TREND OF MEN SEEKING AESTHETIC TREATMENTS? DO YOU ATTRIBUTE THAT TO AVAILABLE OPTIONS, AWARENESS OF THE OPTIONS, CULTURAL ACCEPTANCE, OR ANYTHING ELSE?

It is all of the above, but if you were to try to identify the most important factor, I think it’s the cultural acceptance driven through social media, particularly around star surgeons who present spectacular outcomes. In the end, there has been a snowball effect as some of our superstar surgeons, nationally and internationally, have presented their results over the past decade. People see how natural and good it looks, even on men, and they see people who look like them, and that has driven a lot of the awareness and acceptance.

WHAT WILL BE THE MOST IMPORTANT FACTORS IN FACIAL PLASTIC SURGEONS EFFECTIVELY INCORPORATING REGENERATIVE MEDICINE INTO THEIR PRACTICE?

I don’t know yet. There’s the hope that we’ll be able to turn back the clock with biologic interventions, with pharmacologic interventions, that AI may even accelerate this as we unleash it into problem solving, and drug discovery is a field where we’re expecting breakthroughs in the coming years because of that. I’m not sure we will see any imminent breakthrough. My guess would be that we will see incremental improvement over time where the modalities we have to treat the soft tissue incrementally improve.