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Plastic surgery has been batted around as a predictor of how we’re doing economically. Tough times, the thinking goes, translate to fewer nose jobs. But New Jerseyans who’ve been waffling over what to do about a neck wattle or have lately become the butt of dad-bod jokes may be disproving that sensible theory. 

What’s happening in plastic surgery in 2022, a cadre of home state doctors say, is nothing like in 2008, the last time Americans pining for gastric bypass and other procedures had to tighten their belts in a way they didn’t want and hadn’t bargained for.

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“In 2008, I think you saw a decline in overall elective plastic surgery procedures,” says Dr. Colin Failey, president of the New Jersey Society of Plastic Surgeons and a board-certified plastic surgeon at the Peer Group in Florham Park. “Everyone was hit equally in that downturn. I think this downturn has hit people in an unequal fashion. This time, we haven’t seen the same decline in numbers.” 

That doesn’t necessarily mean the “Zoom Boom”—the 2020 and 2021 phenomenon of people clamoring to fix perceived problems with their faces, the result of an abundance of pandemic screen time—is still happening. (Last year, above-the-shoulder surgeries like brow and face lifts increased 54 percent nationally, according to the Aesthetic Society.) 

Failey and others say that, across the state, we’re tinkering from head to toe as we try to put the pandemic behind us. “Breast augmentation and liposuction tend to lead the charge in New Jersey,” he says, with rhinoplasties, facelifts and tummy tucks rounding out the top five procedures. That list looks much the same as it did before the pandemic, he adds.

What’s changing now, as the surge in Zoom Boom patients levels, are the outcomes patients wander in looking for, their aesthetic preferences, and the range—especially in age and gender—of patients looking to go under the knife. Mommy makeovers and other popular procedures are not going away anytime soon. But here, they’re getting more refined and, some might say, tasteful. Dads are getting in on the do-overs more often, too.

THE KARDASHIAN EFFECT

Credit (or blame) for the current evolution in plastic surgery can be laid at the expensively manicured hands of the Kardashians, says Dr. Alexis Parcells, the founder of Parcells Plastic Surgery in Eatontown and a board-certified plastic surgeon who specializes in reconstructive breast surgery, abdominoplasty and labiaplasty.

“In the last two years we’ve been seeing this dramatic shift in the public’s opinion of plastic surgery,” she says, because of celebrities’ openness about what they’re having done on social media. The candor of the Kardashians, whose recently discussed procedures she says she has to count on two hands, have been key. But in general, “the atmosphere has become much more casual, way less hush-hush. It helps us jump in and dispel myths.” 

New to plastic surgery? Expect a myth-busting conversation at an initial consultation, and not just with Parcells. If you have set your post-surgery expectations sky-high after a heavy hit of Insta scrolling, and if you’re seeing a reputable board-certified surgeon, Failey says, a sobering conversation is likely in store. “There’s reality, and then there’s what patients are asking for,” he says. “What they see on TikTok and Instagram and what’s possible don’t necessarily align. We have to educate everybody.”

Sometimes, doctors have to educate themselves before they can start myth-busting. “People come in and ask me about procedures I’ve never even heard of,” says Dr. Steve Fallek, a past president of the New Jersey Society of Plastic Surgeons who performs breast and body procedures at his Englewood Cliffs practice. 

The mystery procedures, he adds, always stem from social media. “There’s a lot of Photoshopping that goes on out there,” he says. “Our response is to temper enthusiasm. I’ll say, ‘Look, I’ve been doing this 20 years and I’m good at what I do. But I can’t do that.’” 

KEEPING IT REAL

That said, doctors are noticing more reasonable expectations from patients when it comes to a few procedures, especially breast augmentation. 

Parcells says race car driver Danica Patrick’s posts about her breast implant removal this spring coincided with an uptick in implant revisions and removals at her office. When it comes to inflated-looking breasts, “women are just sort of over it,” she says. “They want to be as healthy and as natural as possible.” Even mothers who feel flattened after breastfeeding aren’t necessarily sizing up. “They just want to fill out their bras.” 

Fallek has been noticing the “nothing-huge” trend in his office for a few years. He and Parcells say a more demure decolletage is now standard Jersey style. “New Jersey tends to be more conservative as opposed to Miami, Houston or L.A.,” Parcells says. “People may be looking to New York,” Fallek says. “They want subtle and understated.” 

Just how conservative we might get is lately surprising Fallek. “The majority of patients I’m seeing want something in the 300 to 400cc range,” or the equivalent of going from an A-cup to a C-cup, he says. “But now manufacturers are making less than a 100cc implant. That’s a very small augmentation, almost imperceivable.”

We may be showing signs of subtlety as a state when it comes to our post-surgery butts, too. “I think there’s a pretty good trend now of a more sculpted, less dramatic BBL,” or Brazilian Butt Lift, Fallek says. “Instead of going overboard”—something that can have notoriously disastrous consequences, including death, when the procedure is botched—I’m seeing people who want contour and shape.”

PATIENTS REDEFINED 

Definition in other parts of the body is not as elusive as it once was. Fallek is performing what he calls next-level tummy tucks. “We do more abdominal etching and more of a sculpted look,” he says, not just on stomachs but also on flanks and backs. Patients who have only a little stubborn fat in those areas see the best results. 

Dr. Joseph Capella, a post-bariatric body contouring specialist who practices at Capella Plastic Surgery in Ramsey, more often encounters patients who aren’t candidates for anything resembling a six-pack. His patients have experienced dramatic surgical weight loss. What he offers them he calls a better fitting skin suit. “I put it in a really simple way,” he says. “I tell them, your skin suit is too big. The purpose of contouring is to give you a suit that fits you.” 

Lately he has noticed he’s been adjusting more men’s skin-suit sizes. Other doctors are seeing an increase in male patients, too: Parcells treats men requesting gynecomastia, a surgery to reduce breast tissue. “We’re seeing it more now, with the legalization of marijuana,” she says (an association between cannabis and gynecomastia hasn’t been conclusively proven, but it may lower testosterone levels, according to research). Other factors that can contribute to enlarged male breasts are steroid use and genetics, she says. 

Fallek says men are getting more self-sufficient in their exploration of plastic surgery. “What I used to see, and what I still see, are men who come in with their wives,” he says, for procedures like liposuction, eye lifts and stronger chins and jaws. “I rarely saw a man who would come in by himself.” Now they’re trickling in. “The acceptance, especially among younger men, is certainly higher.” 

All the doctors say their patients still are nearly all women, though. Parcells is booking more appointments with women who want labiaplasties. Often they’re young. “Those procedures increase every year,” she says. They’re popular among 20- and 30-something women because “the younger generation has no shame in their game, as we like to say. They’re open and honest if they want to have something taken care of. They don’t have the guilt component we sometimes see in older generations.” 

THE HORIZON

As acceptance of surgeries for trans people gains ground, New Jersey doctors are responding to a demand for those procedures, too. “Gender affirmation surgery is something we’re seeing more requests for nationally, not just within the state,” says Failey. Gender surgeries, he adds, are not his area of expertise, but he’s noticed more medical residents expressing interest in performing the surgeries with an eye toward making a specialty of them. 

The future, he hopes, will include more in-state doctors well versed in the psychosocial dynamics involved in gender procedures. The American Society of Plastic Surgeons recently put together a task force to help ensure their safety on levels beyond the physical, he says. 

[RELATED: More LGBTQ-Friendly Health Care Facilities Emerge in NJ After Patients’ Cries for Respect]

Twenty years ago, all types of plastic surgery were fairly dramatic interventions: expensive, invasive, permanent and, often, risky. It’s still expensive. In most cases, plastic surgery is not covered by medical insurance.

But Failey says we’re making major advances in getting rid of the risk, especially in New Jersey, where regulations are stricter than in other states, like Florida. “When plastic surgery is done in a qualified setting, it can be safe,” he says. But “you have to be really careful,” and should always pick a board-certified surgeon. 

“I want people to realize we’re here for their safety,” he adds. “I’m a plastic surgeon. But I’m still a trained physician first.”  

Tammy La Gorce is a frequent contributor to New Jersey Monthly.

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