After her fourth child, Lisa Wilkie felt open to getting a little cosmetic work done.
Feeling the toll having children had taken on her body, she made an appointment to discuss breast augmentation. After that procedure in 2017, Wilkie, 34, also began Botox, an appointment she has made every 12 weeks for about two years.
"You just want to feel good," she said. "Now it's part of my routine."
Millennials are showing up in plastic surgeons' offices for a variety of procedures. Some request surgery. But many want "prejuvenation," or what the American Academy of Facial Plastic and Reconstructive Surgery describes as noninvasive treatments such as Botox or chemical peels that aim to slow the results of aging, rather than correct them.
In survey results released Jan. 23, 72 percent of 110 of the group's members surveyed reported an increase in cosmetic surgery or injectables in patients under age 30. Five years earlier, the group noted, that number was 58 percent.
And the group's top prediction for the future? More emphasis on early maintenance for people in their 20s and 30s.
"We're seeing a lot more younger women coming in just for preventive reasons," said Chicago plastic surgeon Dr. Gregory Wiener.
A 2018 survey of about 2,000 adults by RealSelf, a website for people considering cosmetic treatment, revealed that those most likely to consider treatments were parents, and female millennials 18 to 34.
Plastic surgeons say looking natural is a top concern for patients, which Wilkie echoed. She wanted "something that's subtle but definitely noticeable, too, where people can't quite put their finger on what you have had done."
Women are still the most common patients; 86 percent of procedures are performed on women, according to the plastic-surgery academy. Most common were rhinoplasty, revision surgery -- surgery to fix a previous surgery because of patient dissatisfaction or necessity -- and blepharoplasty, an eyelid surgery. Among nonsurgical procedures, most common were Botox, fillers and skin treatments like chemical peels, microdermabrasion or lasers. For men, the most common procedures were Botox, fillers, skin treatments and rhinoplasty.
So why are millennials looking for plastic surgeons?
Social media play a factor, say surgeons, and so do celebrities, like Kylie Jenner, who are open about injecting lips with temporary fillers. Almost all surgeons surveyed -- 97 percent -- said celebrities have an influence on facial plastic surgery. On Instagram, celebs show off enhanced lips and lingerie snaps. Scrolling social media shows selfies in doctors' offices, thanking them for improvements, and people pouting in chairs in before-and-after photos.
Wiener said patients come in and show him selfies, saying, "When I post something and look at what I posted, I don't like what I'm seeing."
"People would tell me that before social media when they'd see a photograph of themselves, but now they're seeing photographs of themselves all the time," he said.
Plastic surgery used to be something people didn't openly share. Social media seem to make young women less inclined to hide the cosmetic work they pursue.
"It's really not taboo anymore, and that goes for surgical procedures too," Wiener said. Botox and fillers, he said, "are just kind of viewed right now as almost reasonable maintenance."
Many might simply see cosmetic surgery as another form of self-care. Dr. Lara Devgan, a New York plastic surgeon and RealSelf chief medical officer, said young women establish self-care routines that translate to aging prevention and maintenance. They ask her for "baby Botox," she said, to look "better but not different."
But what kind of plastic surgery could people in their 20s possibly need? Dr. Phillip Langsdon, president of the academy, said that is a key question for doctors to consider.
"We don't treat everybody just because they come in and they want it," he said. "We have to be very selective in that age category, because some young people can perceive that they need something because they see a photograph of another person on the Internet."
He said doctors should consider, "What do they really need, what are their expectations, is it justified and can we actually achieve what they want?"
In some cases, he would consider procedures for young patients. If someone has very thin lips, for example, with a shape that could benefit from filler, he might go forward. Or he might consider Botox for a 30-year-old with unusually strong lines on the forehead. But he is careful to discuss expectations and whether the procedure will match them.
Denver plastic surgeon Dr. Manish Shah issued a caution to the under-30 set: Don't overdo it. For one reason, it could actually make one look older later. Fillers could eventually thin out lips, making them look older and more wrinkled, he said.
His suggestions? Sunblock, vitamin C, eating healthy and quitting smoking. Even "baby Botox," he said, can be a gateway to larger procedures.
And consumers should do their homework on the person they're seeing for a procedure. Not all those who advertise plastic surgery on social media are board-certified plastic surgeons; patients should check to make sure their surgeon is certified by a medical board. Surgeons said to research the experience of whoever is treating you.
"How much experience do they have, what training does that person have, do they know what they're doing, and can they take care of any complications that could happen?" Langsdon said.
For Wilkie, the feeling of waking up and looking fresh has not lost its magic.
"It's more about preventing things from happening, than something happening and being like, 'OK, let's fix it,'" she said. "It's dancing that fine line. I don't want to do it too early or too late."
High Profile on 03/24/2019