Minimally Invasive Facial Cosmetic Procedures for the Millennial Aesthetic Patient

January 2020 | Volume 19 | Issue 1 | Features | 100 | Copyright © January 2020

Published online December 13, 2019

Nisreen Mobayed , Julie K. Nguyen , Jared Jagdeo

aDepartment of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY bDermatology Service, VA New York Harbor Healthcare System – Brooklyn Campus, Brooklyn, NY

In general, millennials are considered economically disadvantaged as the generation encumbered with more student debt and lower incomes than other age-group.18 Lower earnings coupled with debt have contributed to lower credit supply, ultimately leading this generation to have fewer assets compared to preceding generations.18,19 With less disposable income, millennials have delayed social commitments like marriage and parenthood, choosing instead to focus on their individual growth through higher education, careers, experiences, and personal fulfillment.20 Yet, even with relatively less money to spend, millennials have invested in self-care and personal wellness, reportedly outspending baby boomers 2:1 in the self-care industry.21 With aesthetic medicine falling in the realm of these self-care services, millennials have become avid consumers of this market, seeking cosmetic procedures to improve the overall quality of their life. Particularly, the volume of minimally invasive cosmetic procedures performed annually has increased tremendously in this demographic.2,3 These procedures are fiscally advantageous given their capacity to provide notable results at a fraction of the cost of more invasive cosmetic surgeries. Thus, millennials have identified the most cost-effective solution to maintaining youthfulness and delaying the aging process: starting preventative treatment at a young age.22,23

Among the latest cosmetic trends in the millennial consumer group is prejuvenation, a portmanteau combining the words prevention and rejuvenation.24 Prejuvenation refers to the use of minimally invasive procedures to maintain a youthful appearance and ideally delay the onset of visible signs of aging. 22,24 This trend highlights the focus of millennials on early maintenance treatments to produce natural-appearing results in order to avoid or delay more invasive procedures down the line. Injectables, specifically neuromodulators and dermal fillers, are the leading products utilized to achieve these results.3

A long-term twin study seeking to evaluate the prevention of wrinkles with neuromodulating agents concluded that longterm onabotulinumtoxinA treatment can effectively prevent facial lines present at rest.25 This study, although limited by design, suggests that long-term treatment with neuromodulating agents can lead to the prevention of future wrinkles, providing supporting evidence for prejuventation. An additional study demonstrated similar results with long-term treatment of glabellar rhytids with onabotulinumtoxinA, further supporting the use of neuromodulators for prejuventation.24

Yet, the efficacy of utilizing cosmetic procedures to prevent facial aging is still highly debated given the relative paucity of long-term, compelling research to support the anti-aging effects. Some physicians believe that providers should not pre-treat younger patients prior to any visible signs of aging.22 Rather, these physicians advocate for skin protection from sun exposure and preventing skin damage by avoiding smoking.22 Regardless of the evidence or lack thereof to support prejuvenation as an effective preventative measure of skin aging, it remains a popular trend particular to millennials.

The Rise of Minimally Invasive Cosmetic Procedures
With the destigmatization of cosmetic procedures, minimally invasive procedures have become incorporated into the aesthetic tool-box of the modern-day millennial. Per Allergan’s 360° Aesthetics Report, “82% of millennial consumers believe injectable treatments to be socially acceptable,” with a reported 52% having considered dermal fillers and 60% having considered neuromodulating agents.1 Worldwide, millennials are also more likely to consider preventative treatments compared to any other age-group.1 The American Society for Dermatologic Surgery’s 2017 Procedures survey reports that use of facial injectables has nearly doubled in those under 30 years in the last 6 years.27 In this demographic, the three most popular minimally invasive facial procedures are botulinum toxin, dermal fillers (eg, hyaluronic acid, calcium hydroxylapatite, facial fat-fillers), and microdermabrasion.3

These reported findings reveal a notable trend in young adults seeking to enhance their physical appearance via cosmetic procedures as adjunct tools to accompany non-invasive cosmetic products.1-3 While botulinum toxin injections and dermal fillers have traditionally been used by older demographics seeking facial rejuvenation, millennials comprise a fast-growing consumer demographic of these products.28

There is a lack of scholarly literature exploring the motivation behind this trend; several hypotheses include the influence of social media, celebrities, and selfie-culture promoting a sense of perfectionism.2 The rise of minimally invasive procedures, particularly injectables, is likely multifactorial in nature. Owing to the affordability of these procedures relative to more invasive plastic surgery, the subtle, yet appreciable results, as well as reasonable recovery times, patients are seeking convenient approaches to achieve their aesthetic goals. Injectables represent a popular option for patients interested in achieving a more youthful appearance but are not ready to commit to more invasive or irreversible options to attain these results.29

Botulinum Toxin
Botulinum toxin injections are the most common nonsurgical cosmetic procedure worldwide.30 According to the American Society for Aesthetic Plastic Surgery (ASAPS), over 2.5 million injectable procedures were performed in 2018, with 67% of these procedures consisting of botulinum toxin injections.29,31 Botulinum injections have increased by 36% since 2014, demonstrating a steady uptrend in the popularity of this procedure.31

Cosmetic injectables, such as neuromodulators, have become