Fading stars: Procedures plastic surgeons are doing less of – and why

In the world of aesthetics, trends don't typically come and go – they evolve. Procedures that once dominated headlines and consultation rooms are now being reconsidered as new techniques, technologies and patient preferences reshape the landscape of plastic surgery. What was once viewed as cutting-edge may now feel overly aggressive, less natural or simply outdated in the context of today's more refined approach to aesthetic care.

For many patients, especially those who are younger, the focus has shifted towards results that feel subtle, balanced and aligned with their natural features. This evolution has led many surgeons to move away from certain procedures or techniques in favor of options that offer improved safety profiles, more predictable outcomes and a more modern aesthetic. In some cases, this means replacing older surgical approaches with less invasive alternatives. In others, it means refining how procedures are performed to better match current expectations.

So, what's fading fast and what's rapidly rising? To better understand how the specialty is changing, we reached out to ASPS Member Surgeon John Burns, MD. Keep reading to discover his insights around which procedures he is performing less frequently, why those shifts are happening and what patients are choosing instead.

ASPS: What are some procedures you're performing less frequently today compared to five or 10 years ago?

Dr. Burns: There are a few. I would say number one is old-school eye lifts. In the past, we used to take fat out of the upper and lower eyelids in addition to removing excess skin. Today, we don't do that anymore. The procedure, in a lot of ways, has become simpler.

The second procedure that comes to mind is the corona, or open, brow lift, where you go from the ear over the top of the head to the other ear, and then you fold the brow open. The brow lifts we perform are now done endoscopically or through a lateral brow lift hidden in the hairline.

Number three is that we are taking a much less aggressive approach to the BBL (Brazilian butt lift). We used to lean towards overstuffing, but are now more conservative and deliberate in how much fat we place.

ASPS: What's driving the decline of these procedures? Patient preference? Safety? Better alternatives?

Dr. Burns: The trend today is a compliment to the younger generation and aesthetic preference. Plastic surgery is not a status symbol anymore, where patients want to look like they had something done. They want to look natural and not overdone. It's kind of an interesting psychological point to make. It's really a healthy thing that people are doing it more for themselves than for the status of having it done. They want to look like a better version of themselves rather than something that's not natural.

ASPS: Are there any procedures that you would consider outdated at this point?

Dr. Burns: There may be different ways now that we approach different problems, but there is still really great, solid work being done with tried-and-true methods as well. There are new things that do not necessarily make the old things obsolete. However, I am seeing less facial augmentation using mid-face or jaw implants in favor of more natural methodologies, such as fat grafting.

ASPS: How have aesthetic preferences changed in a way that's influenced these trends?

Dr. Burns: The modern aesthetic trend is definitely leaning towards a more natural approach, with subtle tweaks rather than drastic changes. Patients want to look like a better, more refined version of themselves rather than unnatural or overdone. This seems to especially trend high in younger patients.

ASPS: Are there procedures that haven't necessarily declined, but are being done very differently now?

Dr. Burns: What's been really revolutionary is the deep plane facelift and its different modifications. Our facelifts are much better today than even ten years ago. This is a big thing. Facial rejuvenation, in general, is so much better.

Another procedure that's being approached differently is skin resurfacing. Aggressive skin resurfacing is falling out of favor, and less aggressive approaches that preserve your skin pigment and don't have as many complications have become more popular.

ASPS: From a male vs female patient perspective, are you seeing different procedures fall out of favor?

Dr. Burns: There has not been a huge shift in procedures falling out of favor, but I have seen an uptick in the number of men venturing into plastic surgery.

ASPS: How has the rise of minimally invasive treatments impacted surgical demand?

Dr. Burns: The two actually go hand-in-hand! Minimally invasive procedures have not really had a long-term impact on surgical demand. Instead, it brings people into the industry early, and I think that it does actually help in the long run rather than hurts. These treatments do help, but they cannot replace surgical results just yet.

ASPS: Are there any procedures you think are misunderstood and deserve a second look?

Dr. Burns: One procedure that we do not really see talked about a lot is labiaplasty, whether due to taboo or lack of knowledge about it. For a lot of women, this is a real concern, and it is such a personal thing that they are hesitant to bring it up with a provider. I have found that my patients are very grateful, and this procedure makes such a big difference in their self-esteem and life overall. It is very effective and worthwhile for the right person!

ASPS: If you could "retire" one procedure entirely, what would it be and why?

Dr. Burns: Lip implants, but this really has not ever been a popular thing. I performed a few of these procedures back in the day, but have since removed them.

Another procedure would be breast implants that exceed the patient's measurements. Any time that you use a breast implant that is too large for a patient, you are going to have problems down the line, 100 percent of the time.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.