Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / Cosmetic Surgeon Predicts Top Aesthetic Trends of 2025
Transcript
- Announcer (00:02): You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis. Kirstin (00:12): Hey, Dr. Koehler. Dr. Koehler (00:12): Hey, Kirstin. Kirstin (00:12): You want to know what we're talking about today? Dr. Koehler (00:18): I do. Please tell me. Kirstin (00:19): It's a surprise for you today. In our last few episodes, we talked about some of the worst trends in aesthetics for 2024, and you told some things to get out of here, get off my lawn. This time around we're going to share our predictions for what's in store for 2025. Dr. Koehler (00:41): I'm not really good with predictions, but okay. We'll give it a shot, Kirstin (00:44): Here. Okay. We'll see. Okay, so the beginning of the year, we're now in 2025 and New Year's resolutions are always a thing. So do you have one? Dr. Koehler (00:57): Yeah, I'm still going to to the gym. I'm just going to keep going to the gym. That's my resolution. Don't quit going, Kirstin (01:05): Don't quit. Okay. Nothing new, just continue. Dr. Koehler (01:09): Consistency. That's the key. Kirstin (01:12): I like that Dr. Koehler (01:12): Consistency. Yeah, I'm not trying to do anything crazy in 2025. Just consistency. Kirstin (01:21): Ask me mine. Dr. Koehler (01:23): What are you going to do? Are you going to go to the gym? Kirstin (01:26): Oh no. My New Year's resolution is to make more TikToks and social media posts of you. Dr. Koehler (01:36): Oh, good. Great. Awesome. Kirstin (01:38): Yeah. Dr. Koehler (01:39): Looking forward to it. Kirstin (01:40): So I guess you could say that's part of your resolution too. Dr. Koehler (01:43): Yeah, I didn't make that one, but okay. Kirstin (01:48): Okay. All right. You ready to get into it? Dr. Koehler (01:51): Sure, let's do it. Kirstin (01:52): Okay. Weight loss medications are the story of the year, so they're having a massive impact on not just weight loss, but also aesthetics. So do you think in 2025 people will, more people will be using these weight loss medications like Wegovy, Ozempic, that kind of thing? Dr. Koehler (02:15): Yes, but I think there's going to be some blowback on this at some point. These drugs are very helpful for type two diabetics. It's just one of these lovely side effects, that people can get weight loss with it, and even if they're not diabetic, but we do know that people lose muscle mass. It's not just fat that you're losing, you're losing muscle mass. And even if it is done in conjunction with working out and doing weights to try to preserve muscle mass, people still lose muscle mass. But there's always little side effects and things. We're aware of the gastroparesis that occurs, the slowing of the emptying of the stomach. And if you're a patient of ours and you've come in for surgery, one of the things we talk to people about is, Hey, you've got to come off of your Ozempic or Wegovy or whatever it is, and we want you off of that for at least a couple of weeks before surgery because we don't want to have the risk of aspiration where when you go to sleep and your muscles relax, then your stomach contents come back up and it gets in your lungs and it can cause pneumonias and other things. Dr. Koehler (03:19): So we already know that it creates this gastroparesis, and I've heard of some rare case reports where that can be longstanding and problematic. So everything that's out there, it doesn't matter what the drug is, there are always a small percentage of people that deal with some of the problems and complications, and when enough people are on it, the general number goes up. And I just think that coming in 2025, these are still going to be very, very popular drugs. I just think that you're going to start seeing the TV commercials if you've been on Ozempic and you've been on whatever. So I wouldn't be shocked to see some of that stuff happening. For people who struggle with weight loss, it is encouraging to those folks because they can start losing some weight, but it has to be accompanied with other stuff, lifestyle change, and it can't be your drug that you're forever on. I think it's a good kickstart. Kirstin (04:17): So with medications like these that we are talking about and everybody slimming down because of the weight loss meds, do you think that body contouring is about to have its biggest year yet? Dr. Koehler (04:30): Weight loss is going to be a big thing for this year, and whether body contouring is part of it, maybe. Typically the people that really benefit from those kinds of surgeries are people who have lost significant amounts of weight, and a lot of people who are on these drugs are not losing a hundred pounds. They really just need to lose maybe 10 to 20 pounds and they just want to do it as quickly as possible. Kirstin (04:52): Okay. Well, this year wellness has had a huge presence in cosmetic surgery practices. So what do you think wellness means? Dr. Koehler (05:05): Well, hopefully it means people are taking a little bit more long-term approach to health and wellness. I didn't know the subject, I really didn't before we started, but you asked about what I wanted to do for me personally, for 2025, and I really mean that that consistency has been something that I've struggled with. I'll go through periods of time where I worked out, got in a great shape, and then some things happen, you get derailed a little bit and the next thing you know, it's like you might go a year. And then you get motivated to, oh, you know what, now this is the year and you get to the gym and you do it. And like everybody else, that first three, whatever, six weeks, everybody hits the gym and the gym's the busiest it's ever been, and then come back in a couple more months and we're back to normal. Dr. Koehler (05:49): People quit, they don't do it. But I think general health and wellbeing is going to be hopefully a little bit more about, surgery's not the answer, weight loss is not the answer. None of these things hold the entire answer. The answer is a combination of a little bit of all of these things, moderation. So if we're really truly looking at wellness as a practice, we want to at least address weight concerns. We want to encourage people to eat healthy and do all these other things. I don't know that we do that very well as a practice and hopefully we could do a better job, but I think healthcare in general doesn't do a very good job of that. Kirstin (06:24): Does Mary Emma have any plans to expand her services in 2025? Dr. Koehler (06:29): The hormone replacement and the weight loss part of the practice is growing. And again, I think it's a very significant and important part of general health. She is good about taking that holistic approach. Just fixing your hormones doesn't fix all your problems. Losing weight just doesn't fix all your problems. What Mary Emma tries to do specifically is identify those problem areas, see where the deficiencies lie and where we can help you. Even if we can't help you, where we can direct you to get the help that you need. But definitely the whole medical weight loss and hormone replacement for those that need it, I think that's going to be a part of our practice that's going to grow for sure. Kirstin (07:11): I agree. Okay. Well, you've already mentioned that liposuction is consistently the top surgical cosmetic procedure every year along with breast augmentation. Do you think that will continue to be the trend for 2025? Dr. Koehler (07:28): Yeah, I mean, I think year after year those procedures tend to be near the top of the list. I don't think that's going to change a whole lot when it comes to breast augmentation. For a lot of folks, they're getting augmentation, cuz they really don't have much in the way of breast tissue and they're not going to grow any breast. They're fully grown. So I think what we do see trends with when it comes to, let's say breast augmentation is for instance, size of implant. I mean, I think there's regionally differences. Different parts of the country are more into smaller implants and some other places might be more inclined to do larger implants. There's sort of shifts in the culture as well. There were people, even Pamela Anderson, she had big, big implants and then she, at a later point in her life, she's like, no, I don't want to be this big. Dr. Koehler (08:11): I want to be smaller. I think those kinds of trends change as far as what would be considered aesthetically pleasing. We talked about it in a previous episode, the BBLs, it's not all about just getting a huge butt. It's like a BBL is still popular, but these BBLs to just kind of improve the shape, not necessarily to get lots in the way of size. We're seeing a lot of that now where people are like, yeah, I want a BBL, but I just don't want it big. I want you to help me with shape. So I don't think the absolute numbers of the procedures will maybe change a lot in 2025, but I do think trends kind of go through like we're seeing now. BBLs are still happening, they're just smaller. We still have people that want more fullness, but it's less often. Kirstin (08:55): Yeah. Okay. Well, last year breast implant removal went up by about 10% compared to the year before. Do you think that will continue, and why do you think people are wanting their implants out? Dr. Koehler (09:10): Well, we had a whole discussion about breast implant illness on a previous episode, but a lot of it's social media driven. I would refer back to that episode, but I mean to just enlighten people. I mean, we know that black box warnings have been put on the implants by the implant companies to let people know that associated systemic illness, autoimmune diseases and things like that, there could be a relationship there. It's not been well established and at this point it isn't established. But because of the social pressure and particularly, all these women that are reporting health issues and feel that their implants are the problem has resulted in the changing in the labeling of these devices. Social media is a very, very powerful thing. Not to discredit or poo poo anybody who thinks that their implants might be affecting their general health. You've probably heard me say this before, but certainly it's possible. Dr. Koehler (10:06): All drugs, all devices have potential side effects. It's not been well established, and it's been kind of a very difficult argument because there's not a test that we can run or do that really shows that an exact cause and effect, and that's what we struggle with. Hopefully the advances in the research are going to help us to pinpoint those people that might be more susceptible so that maybe in the process of counseling people about implants, we'd say, oh, if we had some genetic panel or something, we could run and say, oh, you test positive for this gene. We don't think it's a good idea that you get breast implants or whatever. But we're not at that point. Kirstin (10:43): Interesting. Dr. Koehler (10:43): Anyhow, I think the numbers, I don't know that they're going to go up. I know in my personal practice, probably five years ago it might be a little more than that, we went from having people come for explants was rare, and having people come for explants because they thought it was affecting their health was really rare. And then we just saw an exponential increase in that. And I'd say it's been pretty steady the past few years. I mean, we still are seeing a lot of people for this, and a lot of people are seeing benefit from having them out. We don't really know if it's just the relief that comes with the fear that that may have been causing their health issues or if there truly is a resolution of their health problems and all things that were being looked at. And people are constantly looking at that. Kirstin (11:33): Okay. Are there any new advancements or technologies that you know of that are coming our way in 2025? Are we going to 3D print breast implants or? Dr. Koehler (11:44): Yeah, no, I've heard a few little devices and things that, who knows where they're at. Some of this stuff just gets kind of rehashed. I know there's a particular company that I don't know where they're at, but there's discussion of removing tattoos, a different kind of technology, not the traditional laser technology. Anyhow, I guess I'm saying, I don't know. There's lots of little things on the horizon, but I can't think of something that really jumps out at me like, oh man, this is the thing that I think is going to be the big change for 2025. Kirstin (12:19): It's crystal ball time. Do you have a prediction of what the next big cosmetic trend is going to be this year? Dr. Koehler (12:26): I don't know. I guess it's going to depend on who makes the most interesting video on social media. Kirstin (12:34): Oh that's true. Yeah. I think lasers are going to boom because all the influencers on social media, people were like, oh my God, your skin looks so beautiful. Your skin looks so beautiful. What do you do? And they always say, oh, it's the laser. It's my laser girl. And then they never want to spill their secrets of what lasers they get or what the laser girl does. So we got a laser girl and she hooked me up the other day, so that's why I'm feeling like a snake and my skin's going to be beautiful after this. And I also think last year at the conference, there were these people there that had this facial scanner. You look at an iPad and it tells you if you need filler or if you need this or that or laser or whatever. So I think that AI facial scanning is going to be a big thing this year. Dr. Koehler (13:34): I know AI is definitely going to be. Kirstin (13:36): Or a skin analysis or something like on the iPad. Dr. Koehler (13:41): Yeah, I mean the skin analysis stuff, that's not new. I mean, it's been around for quite some time. I think the definitely technology's changed when it comes to imaging and stuff like that. We had breast imaging, we got rid of it a few years ago, but 3D imaging with virtual reality, we would take a scan of the patient and then they could put the virtual reality glasses on and we could with a push of a button, choose a different size or style of implant and it would simulate the change and the person with the virtual reality glasses could look down at their chest and they could see what, yeah, they could see the change in the size of their breasts and they could look in the mirror. It was a virtual mirror, not a real, they have the VR glasses on. They could look in the mirror and look at their breasts, and it was really cool and it was fun to mess around with, but it really wasn't, in my opinion, very accurate. And yes, it was kind of interesting to kind of see yourself go through this change and it's no different than when you do your Snapchat or whatever it is you do, and the filter's on there and you're like, it's kind of fun to see, oh, what do I look like with bigger lips or heavier eyebrows or whatever. Dr. Koehler (14:51): I mean, it's funny and it's interesting, but really when it comes down to what are you actually going to look like, I still feel like a lot of these simulators are just not where they need to be, and the technology always is getting better and better, but I just don't know if that imaging is going to quite get there. And imaging is always kind of tricky because you can do anything with imaging, but can you realistically do it in real life? Because the bones and other things that are in the way that it's like, okay, I can't really make that narrow because there's a bone there. Dr. Koehler (15:23): There's something preventing me from doing that. So I'm not skeptical when it comes to imaging, but I just feel like you got to use it carefully because you can build unrealistic expectations or you can see the opposite. I will tell you one story where actually it was beneficial. It was a breast case and she did the imaging and she's like, oh, well, I need my breast to be much closer together than that. And I was like, okay. So it was a good opportunity to explain because of the shape of her rib cage and because of where her nipples were placed and where her breasts were, that was not going to be a realistic goal. And so the imaging was helpful in that circumstance for that particular patient to sort of say, Hey, that's about the extent of what you're going to actually be able to see, but then it's just a disappointment, but at least we built a realistic expectation. Kirstin (16:12): Do you think that AI has a positive impact in that regard, or do you think it's like a sci-fi nightmare waiting to happen? Dr. Koehler (16:21): It's hard to say how it's going to develop in medicine just yet. We're definitely seeing it speed up the way we can do research and other things, how data can be analyzed so quickly, and if you want to put together an outline of something like boom, AI can spit something out and then you can build on the content from there. So there's lots of really cool things that you can do I mean, but it's at the point now where you could just basically say, yeah, make me a lecture on upper eyelids, and practically it'll just build it for you. I don't know where it grabs the stuff from, but it does. So it's pretty interesting. Kirstin (17:00): One trend that we saw kind of start to boom in 2024 is beauty tourism. Lots of people are going to other countries for Dr. Koehler (17:08): Touring supermodels. What is that about? Kirstin (17:10): Oh. Going to other countries to beautify yourself. So it's a thing on TikTok, but people going to, especially Turkey, but also Mexico, Istanbul, other countries for hair restoration, veneers, cosmetic surgery obviously, but also hair extensions, hair coloring, all kinds of stuff. Dr. Koehler (17:38): Yeah, I'm against, I'm against. Kirstin (17:39): Against. Dr. Koehler (17:40): And not for the reasons that you might think. This is not a knock to the skill of surgeons and anywhere else in the world. There's very talented surgeons throughout the world. The United States is not the only place where surgical innovation happens. It's happens all over the world, so we know the talents there. That's not so much the issue. The real issue is if you go somewhere to have surgery, you also need to be prepared that if in the event there's a problem, and again, these things are maybe extremely rare, but if the event there's a problem, are you prepared to stay there for any extended period or be willing to come back for multiple visits if something happens and you need to be seen? And so because people are not going to be necessarily willing to assume the care of somebody that they didn't do the surgery on, and it's not their problem and they don't want to get in the middle of all of it, but especially when you go out of the country, there's so many different things. Dr. Koehler (18:30): Like one of the risks for any surgery is getting blood clots in your legs and much more commonly in body procedures like body lifting and tummy tucks, but still, surgery in general, especially if it's done under general anesthesia, you can be susceptible to getting a clot. And then if you go on a flight that's an international flight that's six hours or something like that, or much, much longer. There already are studies that show that you can get blood clots without any surgery just going on long flights where you're immobile on a plane and a lot of those go undetectable, but they can be serious. And so anyhow, the travel that's involved, who's going to manage your post-op problems, cuz they do happen. Some of them are minor and really not a big deal. If you're doing it for the sole purpose of saving money, that's where I start to go, okay, well, you need to do a little reality check. Dr. Koehler (19:24): You're going out of the country to do something you want to do because it's maybe cheaper in this other country, and in the event that there is a problem, then all of a sudden if there are more costs involved and what happens if you have to now deal with it in your own country, these things just get magnified, I guess is all I'm saying. And it's not as slight to the surgeons that are there, but when you travel, I think you need to be prepared to go, yeah, if I have a problem, I'm okay. If I have to stay X period of time, it would be inconvenient. It wouldn't be good, but I'm prepared to do that. Or I am prepared to make multiple trips if needed. It would be great if you have people that have been through the process and know and can tell you, look, if you have issues, the doctors easily or their staff are easily contacted, they're really good about reaching out. Dr. Koehler (20:10): I'm not opposed to people can do whatever they like, but I'm not a big fan of traveling across the world. I think traveling throughout the country is probably reasonable. Again, it's flattering that people are willing and want to come and see you from other places, and we certainly don't say, oh no, you can't come see us. You're too far away. But you definitely want to at least have those conversations like, Hey, if you come and have surgery with me, we want you to stay in town for 10 days or whatever it is before we let you go home, to make sure that we feel comfortable that everything is good. As long as you're good with the terms of what we were wanting to do to make sure that you're safe and that we feel like you're good to go home, then yeah, it's fine. Alright, is that grumpy enough? Kirstin (20:50): No, you're not grumpy this time. Dr. Koehler (20:52): Okay, good. Kirstin (20:52): Yeah. Dr. Koehler (20:53): Alright. Kirstin (20:54): Did you want to be grumpy? Dr. Koehler (20:55): No, I don't. Kirstin (20:56): Okay. No, you're not grumpy this time. How do you think social media like TikTok and Instagram will continue to influence people about their body image and get their desire to have work done? Dr. Koehler (21:09): There's a really deep question there behind the question, which is it really depends on the ethics of the company and what they're really wanting to achieve. So you have to look at this from the perspective of Facebook, Meta, whatever it is, and Instagram and TikTok and all. They want their viewers and they want their viewers often and frequently. They want you to sit and spend lots of time on there because they sell advertising and they sell all these other things. You've seen already people say, I swear my phone's listening to me. I just mentioned the other day I wanted Kirstin (21:42): They do. Dr. Koehler (21:43): A waffle maker, and now I've got this exact waffle maker showing up in my feed. We know that they are going to have the ability to say, oh, he spends twice as much time looking at posts that have this content versus that content, and they're going to feed you more of the content that you want. Let's say you have an insecurity of how your nose looks. Okay, well, we'll keep feeding them images of rhinoplasty and this and that. That's where I think AI can be good and it can be bad. Yes, it's great that it knows I'm interested in rhinoplasty and maybe it'll feed me some more content that I can educate myself on it, but maybe my nose isn't that bad. I'm interested in it, and now I've just developed a complete obsession, that maybe my nose isn't good enough for my face, and so now I'm going to just sit and scroll to social media until then I absolutely need to get my nose done. It'll depend on where their ethics are and what they're really, hopefully they're there to help you get the information you want to get quicker and good information and quality information, but it could also be used in a very negative way, create negative body images. There can be depression in young kids associated with too much time on social media. They feel left out, they feel like they're not good enough, and of course, they don't even have real conversations anymore. They have texting or Snapchatting or whatever they do. I mean, I love technology and it is very interesting what we'll be able to do and in a very efficient manner, but the flip side of that coin is a little scary as well. Kirstin (23:06): Okay. Well, anything else you'd like to discuss or any other trends you think are coming our way? Dr. Koehler (23:13): You know what? I think AI would potentially replace the office manager role in my office. I don't know if that's coming in 2025, maybe 26. It's not quite there yet. Kirstin (23:24): I would love if AI could help me do some stuff. If it could scan my emails and just be like, delete, delete. Oh, I need to answer that one. That's what I want. Dr. Koehler (23:36): Yeah, that would be nice. I mean, that's what you're hoping for, right? Is like, Kirstin (23:40): Yeah, don't let it replace me, but it can answer my emails. Dr. Koehler (23:43): You're not replaceable, Kirstin. You know that. Kirstin (23:47): That hit me right in my cold dead heart. Dr. Koehler (23:49): Yes. Kirstin (23:51): All right. Do you have a burning question for Dr. Koehler or me? You can leave us a voicemail on our podcast website at AlabamatheBeautifulpodcast.com. We'd love to hear from you. Thanks, Dr. Koehler. Dr. Koehler (24:03): Thanks, Kirstin. Kirstin (24:04): Go back to making Alabama Beautiful. Dr. Koehler (24:04): I'm on it. Announcer (24:06): Got a question for Dr. Koehler. Leave us a voicemail at AlabamatheBeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.