Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / 2026 Trends: What’s Real and What’s Hype?
Transcript
- Announcer (00:02): You are listening to Alabama the Beautiful. Kirstin (00:05): I'm Kirstin Jarvis and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler and Dr. Gardner. Dr. Koehler (00:13): Hey, Kirstin. Dr. Gardner (00:14): Hey, Kirstin. Kirstin (00:15): All right. Today you're both in the hot seat. We're halfway through 2026 and I'm going to start reading off some trends for this year and I want your gut reactions. Let's talk about injectables first. It looks like filler migration is all over TikTok and people are scared or talking about their filler migrating. Is the internet overreacting or is this a true concern for people? Dr. Koehler (00:43): I think there's just more awareness. When people got filler many years ago, a lot of doctors didn't have ultrasounds in their office to actually evaluate or even assess that migration of filler. But a lot of practices now have access to ultrasounds and things like that so they can actually look and see because a patient could come to you and say, "Well, I had filler in my cheeks and it's migrated." I'd be like, "If I didn't see them before, and even if I did, these things are often subtle that the patient notices, but if you haven't seen the patient in six weeks and you've seen hundreds of patients since then, you're not going to be able to notice those differences. So having the ability to image it I think allows us to really assess it. So I think we have better tools in assessing that's happening. (01:24): And also, I think we kind of went through a trend where the companies were pushing filler a lot. I mean, they have fillers for every body part practically and people were getting almost too much filler. And so I think we're seeing a trend away from as much filler and I think we're seeing more awareness on the effects of filler or the negative effects of filler. Dr. Gardner (01:46): Yeah, I agree. We saw a lot of celebrities having their filler dissolved and a lot of these celebrities looked really overdone and being overdone is not an attractive look. And I think I agree with Dr. Kohler, the trend is to get away from excessive filler. I think filler can be a great tool in the right hands and on the right face, but I agree too much filler is not great. Gravity has never lost a fight and it works. Us like when we put implants in, I always tell my patients, gravity's going to pull on the implants just like it does regular breast tissue. And if you load a face up with filler, then you probably are going to get some migration and some droop. Kirstin (02:36): Okay. Biostimulators like Sculptra and Radiesse have been sold as a natural alternative to filler. Are they actually better or are they still just filler with a better publicist? Dr. Koehler (02:50): Better publicist. They're certainly not natural. I mean, sculpture is like acrylic basically. It's a polymer that's ground up in a powder. They do stimulate collagen formation. It's just a different way. In some ways they're very useful and in certain areas I do actually like them over other fillers, but I don't like to use them in filler naive patients because they're not reversible. So if you don't like it, you got to ride it out. It's not like the hyaluronic acid fillers where if you don't like it, we can put an enzyme in there and we can dissolve it. These fillers, if you get it and you don't like it or you have little nodules or other things, you're just kind of stuck with it until it finally goes away. So I don't know. Natural, I don't know if that really falls. Fillers are what they are. (03:36): They are a filler. They work in different ways, but I wouldn't say one is more natural than the other. Would you? Dr. Gardner (03:42): I wouldn't, but I agree with what you said that HA fillers are great because they are reversible. And if somebody has filler regret for whatever reason, you can address it. Whereas with some of these other modalities you can't. And I think it's a better option because people sometimes don't know what they want. And like with all of these modalities, at some point either you have to dip your toe in the water and try them or you don't. But if you try it with an HA, at least there's a way to reverse it if you have regret. And I would add to that, it's rare. I mean really rare. I can think of a couple of times in my career where I've actually dissolved filler that I put in. So I would throw that caveat. It is a very rare instance that we actually dissolve filler. Kirstin (04:35): Okay. This one might be controversial. Okay. Lip flips. Is it a real technique or just a way to upsell a few units of Botox? Dr. Koehler (04:46): You go first, Dr. Gardner. Dr. Gardner (04:48): I don't know if it's real or not. I mean I would have to obviously, well, I shouldn't say obviously, but I've never had it done personally, so I can't comment - Dr. Koehler (04:56): I'll do it for you. Dr. Gardner (04:57): Whether or not I... Yeah. Get it ready. We'll do it after this. I don't know. I don't know if it's real or not. I think there are plenty of people that say they absolutely love the effect. And so that's how I judge this on with this particular treatment. It's four to five units of Botox. So if you're talking about an upsell, it's not really an upsell. I mean, it's not very expensive. And I always tell people if they're on the fence, try it. And if they love the results, it'll last three months. And if they hate it, it's going to last three months and then they'll know. Dr. Koehler (05:34): Whether or not it's an upsell, I feel like it's a social media trend prior to the term lip flip. In fact, the first time I heard that, I was like, "What? Lip flip?" I didn't even know what that... I'd never heard it. And they're like, "Oh yeah, you put Botox in the lip." I'm like, "Yeah, I've been doing that forever, but not for the purposes that people were claiming it for. " So typically we would be putting similar doses in the upper lip, and it was typically in older patients that would complain of perioral lines. And it was usually on, it had to be with facial animation. So we always say lines at rest don't go away. Botox won't fix that. But when people purse their lips, if they formed heavy perioral lines, you could put low dose Botox there. The downside is, of course, if you want to suck out of a straw or something like that, it makes it very difficult because you can't purse your lips. (06:24): But in terms of it actually showing more vermilia or more of the pink part of the lip, I'd love to see some really well done controlled before and after pictures. And I think a lot of people, maybe when they smile, they maybe don't get as much flattening of the lip. But to me, it's a very subtle thing. Certainly, I don't think there's anything wrong with doing it. It's just the expectations need to be there. It's not the same as filler and it's certainly not the same as a surgical lip lift. So I don't know, kind of a lukewarm on it. Kirstin (06:59): My very first time getting Botox ever, it was not here. It was at another practice and I was very young, but I was like, "Yeah, I know I need lip filler. So if I can get the effects of lip filler for cheap, just go ahead and give me a lip flip." And first experience with Botox, like I said, it lasted maybe two weeks. It barely upturned my lip just a little bit and it lasted two weeks and I couldn't drink out of a straw. I just had water falling on my mouth. That was all. Dr. Gardner (07:28): So did it look like this? Kirstin (07:29): Yes. Yeah, I kind of look like that. Next we're going to go to Dr. Gardner's turf and talk about body trends. So the first thing we're going to talk about is microdosing Ozempic, such as for maintenance or even for people who really aren't overweight who just want maybe some of the effects of curbing their appetite or quieting through noise, things like that. So is there a line that we should draw or how do you feel about that? Dr. Gardner (08:02): Good question. And I'll preface it by saying I can't give you any concrete data, but the microdosing is the trend and I think there's probably some merit to it. And when you talk about complications or side effects from GLP-1s, most people feel like that it has to do with the dosing. You start out at a lower dose and you gradually increase your dose until you max out or you have the effect that you need, which is weight loss and satiation of your gut cravings. So I think that there are some benefits and anti-inflammatory neurocognition are the two big ones or neuroinflammation or decreasing neuroinflammation and just general inflammation in the body. I think those things are probably real. The problem is I don't know that they've been well studied and I would have to go do some research on it, but I think that's the problem is we don't have a lot of hard data on it yet. (09:04): And I do think that when we talk about complications, pancreatitis and some of these other things that can be devastating, most people I think would agree that it's a dose-dependent effect. And when you have somebody on really large doses, that's when we tend to see complications as opposed to microdosing. So I think it's probably much safer. I just don't know that you're going to get the effect that you're looking for, especially when we're dealing with satiation of cravings because that's not really what microdosing is about. Kirstin (09:36): Okay. How about at-home body sculpting gadgets and endless lymphatic massage? Is there anything real to this or is it just vibes? Dr. Gardner (09:48): I mean, it's a great business to be in if you're selling a device. I mean, it's just like all the facial microneedling. And I'm not saying that some of this stuff doesn't work, but it does make the patient responsible for a part of their care. But I don't know that it's doing as much as they think that it's doing. And again, most of these devices are not controlled. They're not regulated. And so you really can't, I don't think, make any big assumptions. I think it's a huge market. People are making a lot of money. I think there may be some merit to it, but think about this. When we talk about surgeries, if there's one good way to do an operation, then there's one operation. But when you have 20 different operations to address the same problem, what it tells you is that there's not really a great operation for that. (10:41): And so people are constantly trying to reinvent or invent one that works well. Inguinal hernia surgery's a model for that. There are so many iterations of inguinal hernia repair because a lot of people would argue there's not one great one. And prior to mesh placement, there were a bunch of ways to do that. So I think that's probably, in my opinion, I think a lot of these home treatments are in that category. Kirstin (11:11): How about vibrating plates? Do you have a vibrating plate? Dr. Gardner (11:15): I don't have one. Honestly, I haven't done any reading on that. And yeah, I mean, again, I have patients that love them and they say that they help. And so the question is, do they help because they're actually doing something or because the patient has kind of bought this plate, now they have to use it. Not only are they using the plate, but they're moving more, they're eating better, and it's the combination of that whole process that's making them overall better. So if that's the situation and they pay for a vibrating plate and it motivates them to do all these other things, then I think it's a great investment. But I don't know that the vibrate... It's not like you can't continue to eat poorly, not exercise and just step on a vibrating plate for 20 minutes a day and think that you're going to get better. Kirstin (12:06): True. Okay. This one is for Dr. Koehler. We're talking about fast and cheap shortcut trends. Something that we've talked about before is lunchtime and one stitch facelifts. Is there anything similar to a real fast facelift? Dr. Koehler (12:29): Well, yeah, those quick lunchtime procedures I just wouldn't go into it with a whole lot of expectations. And quite frankly, I think sometimes they can be, I don't want to say harmful, but you're going to waste your money. So I just, like I said, recently just did a patient who had 20 threads placed in her face and basically had a non-result after 20 threads. And I'm sure that was not an inexpensive office-based lunchtime procedure, but the operation that was needed was a actual facelift. And so in our office, if something is non-surgical, even though we're primarily a surgical practice, there's lots of non-surgical things that we do. And not everybody wants to have surgery. So we'd like to be able to offer all of the things, surgical and non-surgical. And people may understand, well, I might not get quite as good a result if I choose the non-surgical route, but that's what I'm willing to do and I'm not willing to undergo surgery. (13:33): So we want to be able to offer that. And I can just tell you, we do not offer thread lifts because I've just not seen them to be effective. So yeah, I would be very cautious with these quick fix procedures. They may sound good and they're appealing in a lot of ways just because of no downtime, short procedure, all this kind of stuff. But in the end, if you spent a bunch of money and you didn't get a result or you got very minimal result or it didn't last very long at all, then it was like, well, was it worth it? Kirstin (14:06): All right. This one's for both of y'all. We are going to talk about flying overseas for surgery. When does saving money end up costing way more? Dr. Koehler (14:18): When you have a complication. That's when it really becomes a problem. If you've got unlimited funds and you can fly back to your doctor and all of that sort of thing, but if you have a serious complication requiring hospitalization or other things, it's like finding somebody to take care of that problem, that's where it's problematic. People don't want to have to clean up after somebody else. And even if it's minor things like, oh, my sutures are spitting or this or that. When you had your surgery in Mexico or somewhere overseas and then you want some other doctor's office to take care of your routine postoperative care, even though spitting sutures is something that's not uncommon, it happens. But if the doctor didn't do the surgery, he's not going to be so inclined to take you on as a new patient to handle somebody else's issues. (15:08): So that's when I think it gets expensive is when you have problems and they need addressed. Dr. Gardner (15:15): I agree. I mean, I think that like Dr. Koehler said, nobody wants to take care of somebody else's problem and that's the big issue. And we are here post-op all the way through for our patients. And I think that is one of the biggest things that we offer is we want you to have a great result. And part of a great result is the aftercare. And if somebody's not there for you for the aftercare, what are you going to do for the seroma? What are you going to do for the hematoma? And like Dr. Koehler said, once you get back to the States, you're going to be somebody else's problem. And when you show up to the ER, there are very few people that are going to be really interested in taking care of a problem that was a cash paying benefit that you had in another country. (16:02): And then now you're here. And again, whether you have insurance or not, it may or may not be a covered benefit. So you have to think really long and hard about that because if you get back here and like I said, say you don't have insurance or whatever, no coverage, or your coverage denies it as a benefit because you had it done out of country in a cash paying scenario. So take those things into account when you try to make that decision of whether or not you're going to go overseas. Kirstin (16:35): For sure. Okay. What about picking your surgeon based on follower count? Dr. Koehler (16:41): Based on what? Kirstin (16:42): Follower count. Dr. Gardner (16:43): Social Media follower. Kirstin (16:45): Instagram or TikTok or whatever followers they have. Dr. Koehler (16:49): Just because you find somebody's social media entertaining doesn't necessarily mean that's how you pick your doctor, but you definitely want to be able to feel like you can connect in some way to your doctor or surgeon. So that's maybe you kind of go, "Oh, I think that seems like a nice person. I might like him." But that would not be the deciding factor. That might just be the plus on the end of it. Looking at their before and afters, looking at reviews, if you have other patients who've seen that doctor and just general reputation in general. But just to pick it solely on how many followers they have, I just don't think that's a wise way to pick a doctor. Dr. Gardner (17:33): Yeah, I agree. I mean, social media is interesting and we all do it every day to some extent. There are certain things, whatever you like, you're going to follow. And I think that I wouldn't do it solely based on social media, but I think that's a good starting point if you find somebody you like. But I agree you've got to kick the tires, you have to look at the reviews, try to find some relevant reviews and go based on reputation. Because at the end of the day, our results are our reputation and we want people and I would say my favorite probably person is somebody that I've operated on a friend or a family member and they referred them because they have some understanding of how our office works and how they're going to be treated and how they're going to be taken care of post-op. So it is important, but obviously it's just a piece of the puzzle. Kirstin (18:29): Love it. I agree. Okay. Well, now let's talk about the hype around gadgets and glow. When we talk about skin boosters injected for glow, is there anything to it beyond hydration that you would just get from drinking a litle extra water or is it actually fact? Dr. Koehler (18:49): Yeah, I'm not convinced. So I mean, I think injecting things or putting things in there to try to give your skin more hydration, I'm not sold on that. Kirstin (19:01): Okay. Every new laser that comes out claims to replace another laser. Have you found one that actually does the job or does what it claims? Dr. Koehler (19:11): Yeah, there's lots of lasers that do what they claim. It's just that the wavelength of light is the wavelength of light. They can adjust the power or the way that that light is delivered or that laser energy is delivered, but a CO2 laser is still a CO2 laser just like it was 30 years ago. The wavelength hasn't changed and the chromophore that it targets has not changed. And that's true of all the lasers. So there's some advances on maybe how to make the patient more comfortable during these treatments for different cooling devices and things like that. But the gold standard, for instance, in skin resurfacing is still a CO2 laser and that technology has not really changed. I mean, just different ways of delivering that energy. But yeah, there's not been some magical new wavelength that's come out that's transformed the laser industry. Dr. Gardner (20:10): I agree. There's different ways and how each of these companies creates a slightly different pattern or depth or any way you can adjust and tweak the laser based on the input that you give to the computer. But ultimately it's either a fractionated treatment or it's a full field treatment and most of these are going to be fractionated treatments. But I agree, nothing really changed as far as the laser itself. Dr. Koehler (20:40): Yeah. And the thing to remember is that depending on what you're trying to achieve, it can require multiple different lasers. Some lasers are targeting pigments, some lasers are targeting the water in the skin. If we're targeting reds or browns. So depending on the purpose or what we're trying to treat, you might have to use sometimes more than one type of laser to achieve the effect. And so yeah, there's not one laser that fixes all these problems. Kirstin (21:12): Okay. So to wrap up, I'm going to ask each of you a question and I want you to just off the cuff spit out your answer and se if it's similar. So each of you, what is a one 2026 trend that you think people will regret in five years? Dr. Gardner (21:29): Well, let's talk the vibration plate maybe. I don't know. Dr. Koehler (21:34): I can't think of a specific thing. And when you say it like that, to me, I'm trying to think of is there some kind of trend where there's no turning back. For instance, when you do something surgical, sometimes you can't undo what you just did. So if you don't like it, you got to live with it. I mean, there's going to be lots of these little non-surgical trends. You may regret what came out of your wallet, but a lot of these things aren't going to be giving you any kind of permanent change that you're like, okay, now I can't undo this. So I don't know, I'm having a hard time thinking of a trend that is out right now that could be irreversible. Kirstin (22:16): What's the worst trend of 2026 so far that you've seen? Or is there one that you like? Dr. Gardner (22:20): I mean, I think we like GLP-1s until we don't. I mean, it's like anything else, we love it until we don't and there's a problem that pops up. I still think GLP-1s are going to be the thing that stays because they're going to continually come out with another one and another one. It's like a statin. Kirstin (22:40): Yeah, now it's GLP-3. Dr. Gardner (22:42): Yeah. And if you can't tolerate this, then we'll find one that you can tolerate and the prices are going to come down because people are meant to be on these for life. Kirstin (22:52): Okay. I'm down for it. Do you have a burning question for Dr. Koehler or Dr. Gardner 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 and Dr. Gardner. Dr. Gardner (23:06): Thanks, Kirstin. Dr. Koehler (23:06): Thanks, Kirstin. Kirstin (23:07): Go back to making Alabama Beautiful. Announcer (23:12): Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about 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 Podcasts, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @easternshorecosmeticsurgery. 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