Everything You Need to Know About "Non-Surgical" Cosmetic Procedures

A deep dive into those non-surgery-surgeries taking over your Instagram feed.
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A patient receiving Coolaser skin resurfacing treatment in Dr. Simon Ourian's office. Photo: @simonourianmd1/Instagram

A patient receiving Coolaser skin resurfacing treatment in Dr. Simon Ourian's office. Photo: @simonourianmd1/Instagram

A young woman smiles at something off camera. The lights glint off of her dark eyes and catch in the gauzy white medical headband holding back her sleek brown hair. Slowly, the photo begins to shift, melting out of shape like the bastard child of a Dalí painting and the '90s "Animorphs" TV show before resolving into a new version of her own face, slightly altered. The dip at the bridge of her nose is shallower, the tip a touch more turned up and it somehow seems more slender all around. She's still recognizably herself. Indeed, even with the slowly morphing GIF it's hard to tell exactly what's changed without looking closely. Yet she is definitively changed, all in a matter of moments. That's not just a by-product of digital wizardry, either — this woman, like so many others with their before and after photos plastered on social media, really did pull a presto-change-o on the shape of her nose in a matter of minutes, with the help of a so-called "noninvasive" nose job.

The conversation surrounding plastic surgery has always occupied a space somewhere in the Venn diagram overlap of fetishization and demonization, part schadenfreude body horror, part fantasy fulfillment: How would I change my body if I could? What would I look like? What would people think of me? For decades, society's fascination with cosmetic procedures has been gauche, even tawdry; the stuff of late-night television and talk shows where people throw chairs at each other. The kind of thing you don't bring up at dinner parties. But that's all changing. Where once celebrities lashed out at the implication of "having work done," they talk openly about boob jobs and Botox; influencers record themselves getting fillers on Snapchat and shows like Botched are ratings heroes. Some of that is down to changing attitudes and some of that is because of how the technology of cosmetic procedures themselves have changed.

Terminology

If you've spent any time surveying the social-media beauty scene, you're bound to have seen these stunning before-and-afters and the occasional ick-inducing in-process videos. More often than not, these posts throw around phrases that seem to be begging for a dramatic As Seen On TV voice-over — "Non-Surgical!" "No Pain!" "NonInvasive!" "Just 5 minutes!" But what the hell does all of that actually mean?

From a practical standpoint, this new generation of procedures breaks down into two general categories: 1) Noninvasive ones like CoolSculpt and laser treatments that are performed on the outside of the body, not penetrating the barrier of the skin; and 2) Procedures that do require breaking the skin, either with needles or by making incisions that allow something to be inserted or removed from the body, essentially everything from injections to liposuction, to implants.

That doesn't make the language easy to parse, though. In fact, none of these descriptors are actually regulated; there's no standing definition for the difference between non-surgical, noninvasive, and minimally invasive techniques. "Minimally invasive procedures are often lumped in with noninvasive ones," explains dermatologist Annie Chiu. "Classically, minimally invasive procedures include non-surgical, little-downtime procedures that do require breaking the skin; the most obvious examples would be injectable fillers. I often see these procedures lumped with noninvasive ones as being non-surgical." Regardless of the technical terminology, Chiu says, to the Average Joe, a non-surgical rhinoplasty simply means a procedure with minimal downtime and limited physical signs (like bruising) that plague patients of more traditional cosmetic procedures.

Injectables

Ironically, the rise of easy-to-hide procedures has made discussing and even flaunting a little nip and tuck more common than ever, possibly because getting a touch-up is itself becoming more run-of-the-mill for both men and women. Dr. Simon Ourian, a cosmetic dermatologist who has garnered over a million Instagram followers with his before-and-after shots (and celebrity clientele, which includes multiple Kardashians and Jenners), insists that these procedures have become the cool kid in school because of more than how easy they are to fit into a lunch break. "Not only [are these procedures] less invasive, they're safer, typically non-permanent and have less risks for complication," he says.

So how exactly do these procedures work? Injectable treatments operate in a variety of ways, often either by paralyzing muscles, stimulating collagen or building up volume in targeted areas. Fillers are the go-to, lending a hand with many different forms of face sculpting, from the wildly popular non-surgical nose jobs and lip augmentations to perking up cheeks, decreasing eye bags and making weak chins more prominent without the need for an implant. A doctor carefully injects the appropriate filler into a given area of the face to sculpt the shape you're looking for in a process that usually takes a few minutes, is suitable for all skin types, and can, in most cases, be reversed if you're not happy with the results. 

There are downsides to going for the ultra-easy route, though. For starters, fillers wear off over time, meaning that those flawless Rosie Huntington-Whiteley cheekbones you walk out with on day one will turn back into the proverbial pumpkin at midnight (or, you know, anywhere from six months to a couple of years down the road, depending on what filler you go with). Maintaining that perfectly sculpted look means regular appointments, which can be both time consuming and expensive, though a trip to the derm is obviously still far cheaper than the multi-thousand dollars required for traditional cosmetic surgery. The other thing to keep in mind is that while judicious application can have an amazing effect on the face, with the exception of products like Kybella, which kills off fat cells, injectables can only add volume, not subtract it. Want a smaller schnoz? Going under the knife is still the only way to make that happen.

Doctors are also quick to point out that "quick" and "inexpensive" doesn't mean that just anybody off the street can pick up a syringe and give your face a tweak. "Injectable procedures can seem easy, which often leads to a wide market saturation of people who may not be as qualified or experienced doing them," says Chiu. "For example, there are rare risks of injecting into an artery, causing tissue death, or even extremely rarely, blindness." Different fillers are also FDA approved for different areas of the face, and for different uses, so going off-label could be a hazard to more than just your beauty. The bottom line, as Chiu says, is that getting injectables is still a medical procedure, so it's important to find a doctor with the experience and training to perform them well and address any potential complications — even if that means shelling out a little more in the process.

Body work

So what about these other minimally invasive procedures? The ones that can leave you with a bigger cup size or smaller pants size? The kind that requires a little more knife work? While these definitely qualify as surgery, compared to traditional alternatives the areas where the skin is broken are significantly smaller, the treatments are faster, and in some cases don’t even require the patient to undergo anesthesia.

Case in point: AirSculpt, a minimally invasive version of liposuction that uses pressurized air, a 2mm incision (you know those rhinestones and studs on nail art? About that big.) and a teeny tiny tube to remove individual fat cells on awake patients. Yes, really. "Not 'twilight,' or sedated, but awake," says cosmetic surgeon Aaron Rollins, who invented AirSculpt. "Most patients say it's a lot like a massage." Rollins says that his patients often go out to lunch afterward (no overnight stay in the hospital) and that he even helped one recent patient drop from a size 13 to a 6 in two days. Sounds like sci-fi, right? How about this: Though you do have to be put under for rapid recovery breast augmentations, in which the implant is placed under the muscle through a very small incision, the whole process typically takes less than 30 minutes to perform and just days to recover — Iggy Azalea performed at the American Music Awards in 2014 a mere four days after getting hers done.

As appealing as the quick turn around is, unlike most things in life, faster might actually be safer when it comes to these more involved cosmetic surgeries. The key factor here is the anesthesia. Though complications from anesthesia are uncommon, studies have found that the risks to the patient increase with the amount of time spent in la la land. Less time under = less chance of things going wrong. Throw in the fact that smaller incisions heal faster and decrease the areas vulnerable to infection, and you have a process that many doctors feel is safer than the classic methods of cosmetic procedure.

Of course, as with anything where you're getting cut into, the health requirements are a bit higher, so these less invasive options aren't necessarily a get around for those who wouldn't qualify for more traditional surgeries. Likewise, while the permanent factor in this area goes up, so do the costs, with most minimally invasive augmentations costing comparably to their more traditional counterparts, and some meaning even more bucks flying out of patients' wallets. Likewise, the price tag for truly noninvasive procedures like fat freezing or radio frequency tightening can be similarly high once the required number of treatments have been performed.

Do these new technologies mean we're at the forefront of a plastic surgery revolution? Only time will tell. But evolutions in technology are certainly changing the face (pun intended) of cosmetic procedures and the way that people get them. 

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