It wasn’t so long ago — just last year, in fact — that social media was awash with would-be Kardashians: super-straight shiny hair, bee-stung lips covering blinding white teeth, doe eyes streaked with mascara and a wasp waist dividing an ample butt and prominent breasts. But — in tandem with the rise of Ozempic and other GLP-1 medications — that image is fading fast. Even the Kardashians themselves are deflating, with butts apparently reduced and fillers seemingly dissolved. But as always in plastic surgery, it’s all about the details, and those vary from industry to industry. THR asked surgeons on both coasts to reveal what their clients are asking for these days.

Less (Conspicuous) Is More…

“Lifts and even breast reductions are on the rise, along with tummy tucks to make the midsection look more fit,” says New York plastic surgeon Darren Smith. He also reports a 25 percent uptick in mini arm lifts, which give the area a more streamlined and toned appearance, without the unsightly scars of a true brachioplasty.

“I see a 20 percent increase in women coming in for lifts this year over last,” notes Lyle Leipziger, chief of plastic and reconstructive surgery at both North Shore University Hospital and Long Island Jewish Medical Center. “And those that want implants only want to go up one bra size.”

…But L.A. Is Gonna L.A.

Some things don’t change: L.A. still wants bigger boobs — an average of 200 ccs more per implant than on the East Coast, says plastic surgeon Troy Pittman.

Safer Stuff

Pittman reports that women nationwide are clamoring for Motiva, the new implants approved in September by the FDA that are more biocompatible, meaning there’s less risk of rupture or capsular contraction that results in hardening. “They’ve put to bed a lot of safety issues and are a game-changer,” he says.

“Injectable Backlash”

The country is in the grip of filler fear. Dr. Annie Chiu, who has a practice in Redondo Beach, feels it’s largely the result of social media. “We are facing an injectable backlash, and the filler market has been down in ’24,” she observes. “At first, everyone was encouraged to get that very contoured, overfilled Instagram face, but now there is a real fear of looking weird. My colleagues think that L.A. is more overdone, but there is bad work everywhere, especially Miami and Dallas, and the Housewives of New York don’t exactly have that subtle look.” Chiu points out the counteraction was felt by Kristin Davis when she appeared in And Just Like That. “She is a consummate New Yorker and was attacked online for being overfilled, but she had it corrected and now looks better.”

Howard Sobel, a New York dermatologist, reported that his patients from Los Angeles still want a fuller, more rounded face than his New Yorkers request. “They want an exaggerated feminine look because that gets you noticed, but that look has never been New York. They bring in pictures of celebrities they want to look like, but they don’t even have similar facial structures.”

Facelifts Get a Facelift

Ironically, facelifts are now seen as less drastic and altering than injectables, and even fat that was routinely added during a lift is being avoided. “I continue to see an increasing number of patients trading years of fillers for a facelift, and many of them are adamant about not looking overfilled with fat grafting,” says Sean Alemi, a New York facial plastic surgeon. “In fact, I would say that I’m performing almost 80 percent of my facelifts without fat these days. It’s a new era.”

Fashionably Late

The typical customers for body work long have been women from their 20s to their 40s. But doctors notice a trend of people coming for such procedures later than ever before. “I now have women in their 60s, 70s and even 80s coming in to get their breasts and tummies done,” says Leipziger.

Start ‘Em Young

People may be getting work done later, but they are also starting earlier and doing less drastic surgeries, some even without going under. “It’s the tweakment movement,” says Alemi. “People in their 40s don’t want to wait until aging affects their entire face, so they are getting lower eyelid skin pinches and upper lid lifts to get rid of hooding, using just local anesthesia. It freshens without changing the shape of the face.” Leipziger also has witnessed a marked increase in requests for mini facelifts from women in their 40s.

Dermatologist Soren White says his colleagues in L.A. are seeing patients come in even earlier for anti-aging. “In L.A., it’s not unusual for an 18- or 20-year-old to come in for filler — it’s a rite of passage,” he says.

Your Wattage May Vary

When it comes to smiles, “L.A. has more of a brighter, bigger, wow effect, and it doesn’t have to look natural,” says Larry Rosenthal, a New York dentist whose patients have included Donald and Ivanka Trump and Sumner Redstone. “In New York, people want a wider smile.”

Dr. Marc Lowenberg, whose office has treated the teeth of Martha Stewart, Julianna Margulies, Heidi Klum and Cindy Crawford, says New York patients specifically ask to not have the West Coast style. “I have a guy in my chair right now who said he doesn’t want his teeth to walk in the room before he does. People say, ‘I don’t want Hollywood white.’ Things have been toned down, but in general, in L.A. they call more attention to your smile than we do here.”

Cosmetic dentist Lana Rozenberg, who tends to the mouths of Justin Theroux, Clive Owen and Helena Christensen, said patients have become more participative in the artistic end of smile improvement, thanks to AI:  “With new software, such as Overjet and SmileFy, patients can envision their future smiles before going through the process of placing crowns or veneers on their teeth. This makes it more accurate, and more interactive.’’

Lowenberg feels that D.C. is still even more under the radar. “The veneers have always been more conservative, with the exception of Joe Biden’s, which were so white that people commented on them.”

Not So On-the-Nose

Noses also have become more natural as surgeons say goodbye to the upturned and button varieties. “Noses have changed; we try to leave more structure behind now,” says Linda Li, a Beverly Hills plastic surgeon who was in the original cast of Dr. 90210. “You want a nose that fits. If you have a broad face, a tiny-ass nose looks ridiculous.”

I’ll Have What Tom Cruise Is Having

Buccal fat removal, once a hugely popular procedure in L.A. that sharpened facial contours, is on a sharp decline. “I am getting fewer requests for it now because it can accelerate the aging process and make people look gaunt,” observes Carl Truesdale, a Beverly Hills facial plastic surgeon. Truesdale says there is a greater emphasis on the neck now, including removing some salivary glands. “Men see that Brad Pitt and Tom Cruise are looking younger, and they are opting for a sharper jawline, which can be achieved with submandibular gland removal and muscle tightening.” (Not all docs are fans of this controversial procedure, as it is aggressive and can affect the production of saliva.)

No More Fox Eye

Truesdale also is seeing less lateral brow lift, a swing Matt Gaetz seemed to have missed. Notes Truesdale, “Last year, people asked to look like Bella Hadid, but this year the fox eye is downtrending.” Dr. Robert Schwarcz, double board certified NY oculoplastic surgeon, says the classic severe brow lift — which altered the hairline — has made way for a more subtle forehead adjustment. “Brow lifts are trending on social media due to the popularity of the temporal lift, a shortened version which addresses the tail of the brow,’’ he explains. “This gives a lift to the upper eyelids without a surprised look.” 

This story appeared in the Nov. 20 issue of The Hollywood Reporter magazine. Click here to subscribe.