Prioritizing skin quality over facial structure

There was a time when plump cheeks and pouty lips dominated TikTok and Instagram feeds. You couldn't scroll without coming across pictures that emphasized volume above all else, which makes sense since many people equate fullness with youth. What are the cutest features of babies? Those round, chubby cheeks!

Check your feed today, and you may notice that the tables are slowly turning, with bouncy volume giving way to tone, texture and overall skin quality vying for center stage. There is no question that volume can help give patients a youthful appearance, but skin tone and texture can have an even greater impact on a patient's appearance than structural changes alone.

While you don't have to ditch fillers or fat grafting, shifting the focus to skin quality and overall health may be even more effective for achieving a radiant, more youthful glow. ASPS Member Surgeons Lara Devgan, MD and Anureet Bajaj, MD, offer their favorite procedures for patients looking to improve their skin quality.

Skin quality vs skin structure

A shift toward prioritizing skin quality over skin structure seems like an extremely timely topic.

"It does feel like a seasonal shift is underway, and interestingly, we are seeing the same shift aesthetically," said Dr. Devgan. "For several years, the dominant conversation centered around volume, particularly how to restore or augment it. What I am seeing now, both in my practice and more broadly, is a much more sophisticated focus on skin quality itself, which ultimately is what allows any structural intervention to look truly beautiful."

Altering structure is straightforward. If your cheeks look hollow or your lips appear thin, consider adding filler or fat grafting. However, changes in skin quality are more complex and nuanced, which is why many people may be unsure where to start.

"My approach to improving skin quality is layered because the skin itself is layered, and no single modality can address tone, texture, elasticity and reflectivity all at once, said Dr. Devgan.

Let's face it – the skin is the body's largest organ, and while volume is important, overall texture, tone and skin health are what allow this organ to shine. UV exposure, activity levels, diet, lifestyle choices and a person's skincare regimen can all significantly impact the quality and appearance of the skin. Step one in enhancing skin quality is a detailed consultation with an experienced plastic surgeon who can help you pinpoint your concerns and identify which procedures can deliver the aesthetic results you are looking for.

Top procedures to enhance skin quality

Both surgeons we spoke with shared some of their favorite procedures to help patients address specific skin concerns and create a beautifully even, radiant canvas.

Laser skin resurfacing

First on Dr. Devgan's list is laser skin resurfacing treatments.

"Erbium laser resurfacing remains one of the most powerful tools we have," said Dr. Devgan. "I prefer erbium over CO2 in many cases because it allows for precise, controlled resurfacing with a more favorable safety profile in terms of pigmentary change and healing. It improves fine lines, dyschromia, and overall skin reflectivity in a way that is both predictable and elegant."

This technology helps remove the outer layers of skin, revealing the healthy, youthful-looking layers underneath. It can also help stimulate collagen production, reducing fine lines, sun damage, hyperpigmentation and acne scars.

Laser treatments are also at the top of Dr. Bajaj's skin quality treatment list. Her picks are BBL (BroadBand Light) and Moxi laser treatments. She said these laser treatments are excellent for enhancing skin tone and texture.

BBL helps target skin discoloration, such as brown or red spots, caused by hyperpigmentation or irregular skin color. The Moxi laser is a non-ablative fractional laser that can help address deeper skin concerns, such as fine lines, wrinkles and enlarged pores.

Sofwave

One of Dr. Bajaj's top skin quality procedures is Sofwave. It is a noninvasive tissue-regeneration therapy that uses electrohydraulic acoustic sound waves. This sci-fi-sounding treatment releases energy deep into tissues to trigger the body's natural healing response, improving blood flow and reducing inflammation.

The treatment can help stimulate collagen and elastin in the face.

"Results are subtle, but I think of it more as a maintenance procedure that you do once a year," said Dr. Bajaj.

The treatment may also be beneficial for patients with orthopedic conditions, such as ligament injuries, tendonitis and other musculoskeletal injuries or conditions.

Microneedling

Next up on the list is microneedling.

"I am a strong proponent of regenerative microneedling with PRP, particularly gold microinfusion techniques," said Dr. Devgan. "This allows for controlled dermal injury combined with biologic signaling that promotes collagen synthesis and improves texture and tone over time. It is especially valuable for patients who want meaningful improvement with minimal downtime."

Some people also call this procedure the "vampire facial." PRP stands for platelet-rich plasma. Blood is drawn from a patient and run through a centrifuge, which spins at high speed to separate blood components and concentrate platelets. In addition to helping blood clot when blood vessels are damaged, platelets also contain components that aid in new cell growth and tissue repair. When applied back to the patient's skin via microneedling, their own concentrated blood can help stimulate collagen production, creating a smoother, more even-toned complexion.

Autologous fat grafting

Some procedures can help address volume and skin quality, giving patients the best of both worlds.

"When done with a microdroplet technique, it plays an underappreciated role in skin quality," said Dr. Devgan. "Beyond volume, fat has regenerative properties that can improve dermal thickness, vascularity and overall skin health, particularly in areas like the tear trough and midface."

Skincare

Plastic surgery procedures can work wonders on skin tone and texture, but maintaining results comes down to maintenance and skincare.

"Medical-grade skincare is foundational and often underestimated," said Dr. Devgan. "Consistent use of well-formulated vitamin C, retinoids or retinols and barrier-supportive products can meaningfully improve collagen production, pigmentation, and skin resilience. In my practice, I view this as the daily maintenance layer that supports and prolongs procedural results."

Dr. Bajaj also recommends using high-quality, medical-grade skincare products, including retinol, vitamin C and a great sunblock.

Skincare can be confusing with so many products on the market competing for your attention and hard-earned dollars. First and foremost, to help maintain the results of any noninvasive procedure and protect delicate skin, use a high-quality sunscreen daily. Certain procedures can leave your skin more sensitive to UV rays and sun damage, undoing all the progress you've just made.

You can also talk to your plastic surgeon and ask for product recommendations, including which actives you may want to wait to reintroduce to your skincare regimen.

Strategic neuromodulators

Believe it or not, the king of noninvasive anti-aging can also help improve skin quality.

"I use neuromodulators strategically, not just for wrinkle reduction, but to improve skin quality indirectly by reducing repetitive mechanical stress on the dermis," said Dr. Devgan. "When used with restraint, it allows the skin to 'rest' and can enhance the longevity of other treatments."

Neuromodulators have been shown to help reduce pore size, enhance skin texture, and control sebum production, which may help reduce breakouts and excess shine.

Ultimately, volume and skin quality work together to give the skin a youthful, luminous appearance. It takes a team effort. Focusing on volume over skin quality can yield results that may not meet a patient's overall expectations, making it crucial for patients to discuss their goals and concerns with a plastic surgeon so the surgeon can help tailor a strategic skincare plan.

"The broader shift toward skin quality reflects a more mature understanding of beauty," said Dr. Devgan. "Volume without good skin quality looks artificial. Structure without skin integrity looks incomplete. The most compelling results today come from integrating both."

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.