We're celebrating our tenth anniversary! And that means it's the perfect time to take a look back at how the anti–aging and enhancement industry has evolved over the past ten years.

The birth of cosmetic surgery

Records of facial surgery methods date back to 600 B.C. with Indian surgeon Sushruta, whose 184–chapter treatise, Sushruta Samhita, contains instructions for skin grafts, rhinoplasty and more. He recommended that patients be given wine to "dull the pain of surgical incisions."

Dr. John Peter Mettauer, credited as America's first plastic surgeon, performed the first cleft palate operation in 1827. Other modern–day procedures slowly followed. "Published accounts credit American surgeons Robert Weir and John Orlando Roe with the first closed rhinoplasty procedures in the late 1800s," says Dr. Kris Conrad, MD, FRCSC, FRCS, FACS, of the Nasal & Facial Plastic Cosmetic Surgery Institute & Laser Centre in Toronto.

Until the 20th century, plastic surgery focused on repairing tissues affected by disease and facial injuries, most notably those inflicted during the first World War. War wounds, not anti–aging, inspired great advancements in both the procedures and tools used to treat patients. Esthetic surgical procedures garnered attention in the post–First World War era, as physicians realized the same procedures could be used for patients possessing a physical feature that made them embarrassed or uncomfortable.

Front and Centre: Rhinoplasty

Rhinoplasty (otherwise known as a nose job) has long been an in–demand procedure. "It's hard to categorize the procedures I perform as popular," explains Dr. Conrad. "For most of my rhinoplasty patients, it's a necessity. Most people have spent years imagining what their ideal nose will look like." Unlike those receiving anti–aging surgeries, rhinosplasty patients skew younger, in the 15 to 45 age range.

Modern–day techniques link back to the late 19th century. Closed rhinoplasty remained the standard until the early '70s, when Wilfred S. Goodman developed open rhinoplasty, a procedure that includes a cut across the nostril partition as well as the closed procedure's internal nostril incisions. Open rhinoplasty's birthplace was the University of Toronto—Dr. Conrad, then a student, assisted on some of the early surgeries.

Today's rhinoplasty procedures fall into two categories: primary and revised. "In my practice I do more and more revision rhinoplasty procedures compared to years ago," says Dr. Phillip Solomon, MD, FRCSC, a facial plastic surgeon in Thornhill, Ont.

Both Solomon and Conrad state that the complexity of a rhinoplasty procedure, which involves bone, cartilage and the skin, as well as ensuring functionality post–procedure, requires expertise that only comes with specialized training and experience. "With so many factors involved, there is a heightened risk of not achieving the expected result," says Dr. Conrad. That can lead to a patient opting for a revised rhinoplasty once the primary procedure has healed completely.

In the late '90s, endoscopic procedures were introduced. Since then, the trend has returned to the open technique for most rhinoplasty patients. "What hasn't changed is the psychological impact of seeing yourself with a new nose," says Dr. Conrad. "That's significant."

Face Forward

After rhinoplasty, Dr. Solomon cites face lifts, blepharoplasty (eyelid modification) and brow lifts as in–demand procedures back in 2001. "Face Lift" was a feature article in our Winter 2001 issue.

"In the past we often just tightened skin; now we really try to replace volume, and lift and tighten," explains Dr. Solomon. "This has led to improved and more natural cosmetic results from conventional surgical procedures."

And non–invasive treatments such as fillers and injectables are more prevalent than before. In 1981, the FDA approved the use of bovine collagen as a filler. Twenty years later, professionals and patients can choose from five main filler types—collagen (bovine and human), hyaluronic acid (Juvéderm, Perlane), biocompatible treatment (Radiesse, Sculptra), natural sugar compound (Restylane), and harvested fat—and the ever–popular Botox, which was approved by Health Canada in 2001, a year ahead of the FDA.

Since their introduction, fillers have revolutionized the cosmetic enhancement industry. Professionals use them on patients' faces to increase volume, alter contours, reduce wrinkles and create a more youthful appearance. "The results are essentially immediate, and a treatment costs less than a surgical procedure, but the results aren't permanent," says Dr. Conrad. Meanwhile, "lip augmentation has changed both in demand and in the materials used. Before the advent of fillers, Gortex was placed into the area to make a lip appear larger with mixed results," says Dr. Conrad. While bigger may have been better, the trend now is toward a more natural but fuller appearance.

"The most significant trend compared to a decade ago is that the age of patients has shifted down. Patients aren't waiting as long as they used to," says Dr. Conrad. Back then, his clients received their first lifts in their sixties. Dr. Solomon agrees: "There are more and more young patients considering mini facelifts to maintain their looks in their late forties and early fifties."

The benefit: younger skin recovers faster and the results are more subtle. "People will notice how good you look, and not how good your facelift looks," says Dr. Conrad.

Breast Augmentation

The urge to enhance one's breasts is hardly new. The 1897 Sears Roebuck & Co. Catalogue offered such products as "The Princess Bust Developer" and "Breast Cream or Food" to increase the size of breasts.

In 1962, Timmie Jean Lindsay was the first woman to receive silicone breast implants. Fast–forward to the late '80s, and silicone gel implants were under intense scrutiny due to numerous patient complaints and lawsuits regarding leaks and overall comfort.

Both the FDA and Health Canada placed heavy restrictions on the use of silicone gel implants in 1992. "In 2001, we used saline, as gels were still under a health and welfare limited–use program. This limited our choices," explains Dr. Tim Sproule, MD, FRCSC, of Evolution Cosmetic Surgery Clinic and Laser Rejuvenation Centre in Toronto. Despite fewer options, patients were still interested in bettering their breasts. Elevate's Summer 2003 issue featured an article on the topic titled "The Perfect Set."

As far as the procedure goes, don't expect many changes. "I introduced the transaxillary augment to Toronto more than 20 years ago," says Dr. Sproule, "and it is still done pretty much the same way."

Health Canada lifted silicone gel implant restrictions in 2006 after thorough investigations deemed them safe. The increase in options is a true benefit, as both saline and cohesive silicone gel implants have features that may suit some patients better than others. "It is great to have the choice and recommend the best implant for an individual situation," says Dr. Sproule.

Significant changes in breast augmentation over the past decade have seen the reduction in post–operative discomfort and increased recovery times, whether for a patient having a full reconstruction or basic implant procedure.

One thing that hasn't changed: "The breast augment patient is one of my happiest and fulfilled clients," says Dr. Sproule.

Cosmetic Dentistry

While the modern era of cosmetic dentistry is still relatively young, its roots date as far back as 700 BC with the Etruscans making dentures from ivory and bone.

"Patients have either discoloured teeth or an orthodontic problem, or both. That hasn't changed," says Dr. Sol Weiss, DMD, of The Art of Dentistry in Toronto. What has changed, however, is the level of effectiveness and number of options available to patients in 2011.

Take tooth whitening, for example. "You heard a little bit about lasers back in 2001," says Dr. Weiss. "Lasers came and went because they actually traumatized the tooth too much." Today's procedures range from light–infused in–office Zoom! whitening sessions and at–home treatments to veneers and Snap–On Smiles. "They're making at–home teeth whitening kits easier on the enamel and with a better activity when it's on the tooth structure," says Dr. Weiss.

The most significant change in the decade was the introduction of Invisalign, a clear, removable orthodontic treatment. Dr. Weiss was one of the first Canadian doctors offering the procedure back in the early 2000s. "Invisalign has been a huge benefit for people because most cosmetic issues are an orthodontic problem," says Dr. Weiss. Elevate's Holiday 2004 issue included "The Straight Goods," which explored Invisalign and other options.

Dr. Weiss is also doing a lot more crowns on his patients. "Before it used to be that the veneer was the most cosmetic. Now we can make crowns look as good as a veneer and as good as a tooth."

Back in 2001, the only option for patients with "gummy" smiles was gum–reduction surgery. Now Dr. Weiss' patients receive Botox injections. "Three units on either side, and the lip doesn't go as high up anymore. So simple."

Other Changes

What all the doctors agree on is that today's patients are more informed and educated. While we'd love to take all the credit, the Internet has made researching one's options a lot easier—and more challenging.

"Don't take before–and–after photos at face value," advises Dr. Conrad. "Ask questions about the type of procedure it was."

"People don't just come in and say they want nicer teeth anymore," says Dr. Weiss. "They know what they want: whiter, bigger, longer, wider, etc."

"There is more choice now than ever before. A patient may have non–surgical and surgical options available, whereas in the past they may have only had a surgical option," explains Dr. Solomon. So many changes, all in 10 years. We can only imagine what the cosmetic enhancement industry has in store for us in the future—and Elevate will be there to let you know all about it.

Anti–aging Timeline

600 BC – Sushruta performs plastic surgery
1827 – America's first plastic surgery procedure
1887–1897 – Development of modern–day rhinoplasty
1918–1920 – Early stages of esthetic facial surgery
1921 – Canada's first plastic surgery procedure
1946 – Plastic surgery is recognized as a specialty by the Royal College of Physicians and Surgeons of Canada
1962 – First silicone implant breast augmentation
1971–1973 – The open rhinoplasty method is developed
1980 – Modern cosmetic dentistry is born
1981 – FDA approves bovine collagen as a filler
1992 – FDA and Health Canada restrict silicone gel breast implants
1999 – Invisalign's first sales in the United States
2001 – Elevate's first issue is published
2001 – Botox is approved by Health Canada
2004 – Introduction of Snap–On Smile
2006 – Health Canada lifts silicone gel breast implant restrictions
2011 – Non–invasive procedures begin to take centre stage