Kiwis are increasingly fuelling a multimillion-dollar cosmetic surgery and appearance-medicine industry, driven by social media, a perceived need to look young to compete at work or simply because they want to look healthy. Jane Phare looks at what’s on offer, what it costs and who’s having work done.
Anabelle* a former Auckland events organiser first had cosmetic surgery 30 years ago - a breast reduction in her late 30s.
“Men would stare at my boobs all the time and it would drive me nuts. I could never wear strapless dresses.”
Next was a lower facelift to remove sagging around her jawline, and neck surgery to remove tethered skin beneath her chin – something she’d always disliked. Some years later she had a second lower facelift.
Since then there have been fillers, a “vampire” facial – a micro-needling procedure using platelet-rich plasma (PRP) - and regular injections of botulinum toxins (Botox is one of three brands approved in New Zealand).
She’s lost count of the thousands of dollars worth of cosmetic and appearance medicine procedures she’s had but says the cost was worth it.
Now retired from her previous career, but still having regular Botox injections, Anabelle says her desire for surgery was driven by the pressure to look good in her public job – presenting at meetings and pitching for contracts. Looking back she regrets none of it, saying the facial improvements made her feel more confident.
She’s one of thousands of Kiwis who regularly invest in appearance medicine and plastic surgery, keeping hundreds of cosmetic surgeons, doctors and practitioners busy with injectables, scalpels and an ever-increasing array of equipment aimed at rejuvenating the skin in an effort to either turn back time or at least hold it in place.
On offer are radio-frequency, laser, ultrasound or pulsed light devices to tighten skin and improve its texture, remove pigmentation, tighten muscles and sculpt the body without surgery. It is a global industry estimated to be worth $134 billion last year, with non-invasive procedures sharing around 40 per cent of that market, and growing. By 2030 the industry is projected to be worth $233.5b.
Those in the industry say the subject of appearance medicine and cosmetic surgery is no longer taboo, and is more openly talked about in New Zealand. Although Kiwi men are increasingly wanting their looks tweaked, with a steady stream wanting facial surgery and Botox, the large majority of clients are women.
And why not, Caci Clinic co-founder Jackie Smith says. Nothing irritates her more than hearing reports of men, who might spend money on tickets to the rugby or playing golf, telling their wives or partners that they’re wasting their money on appearance medicine, adding “I love you the way you are.”
“Actually it’s got nothing to do with them,” Smith says. “In a healthy relationship, you’re not doing it so you can look more beautiful for your husband.”
Women invest in aesthetic medicine so they can look on the outside how they feel inside, and that’s an equally valid spend as a new set of golf clubs, she says.
It’s a view echoed by others spoken to by the Herald. Women talked about constantly putting the family first when the household outgoings were divvied up. Braces, school uniforms, school camps, school sports, new phones and iPads came first.
Elizabeth*, who works in advertising and marketing, says she always put her clients, staff, parents and children first. School fees came before facial treatments, she says. Eventually,10 years ago, she decided it was time to invest in herself.
“So I started with the Botox. Call me addicted if you will but when those lines come back, I get them dealt to.”
So far she’s stuck to appearance medicine, spending around $5000 a year on her face with a trained doctor. She’s had a little filler, regular Botox and Profhilo, a hyaluronic acid dermal filler to improve skin texture and firmness.
“It’s about personal satisfaction, it’s about how we perceive ourselves. If anything we do it for other women, so we look smart with our peer group rather than for the men.”
Smith, who launched Caci Clinic 30 years ago with her husband David and now has more than 80 franchised clinics, agrees saying women often feel judged and compared. Wanting to improve the way they look is nothing new, she says. People have been adorning, tattooing and piercing their bodies to look more attractive for centuries.
Natural is best
Those in the industry have learned from mistakes made in the early days of cosmetic surgery - the Hollywood horrors, distorted faces that looked nothing like the original person, caricature-style trout-pout lips, the Michael Jackson nose.
These days large breasts with oversized lips to match are out. Instead, Kiwis opting for appearance medicine and surgery are adamant they want to look natural.
Cosmetic medicine physician Dr Joanna Romanowska says she’s never been a fan of overdone cosmetic procedures.
“If someone can tell a patient has had work done, it’s likely overdone.”
In her view, a face should look well rested and normal.
Romanowska practised as a GP for 15 years before starting Clinic42 in Auckland, doing botulinum toxins and dermal fillers in the 1990s. Not only do cosmetic fashions change, she says (think back to the pencil-thin plucked eyebrows of the 60s and 70s), but the anatomy changes as people age.
“What might look amazing on 30 or 40-year-olds might not look so great 20 or 30 years later.”
Auckland plastic and cosmetic surgeon Dr Zac Moaveni, who specialises in facial surgery, says his typical patient is a woman in her 40s or 50s who is healthy and keeps fit. They’ve started to notice, and dislike, signs of ageing particularly around the neck, lower jawline or eyelids.
As a result, a lower face and neck lift, and surgery to the upper and lower eyes are the most popular requests. Clients tell Moaveni they don’t want to look different, just younger and fresher. And almost without fail, each patient will say they’re doing it for themselves, not for their husband or partner.
Men, too, come for surgery wanting their neck tightened, their jowls removed, a big nose altered or a chin implant done if they think they have a weak jaw.
One Auckland cosmetic doctor says 20 per cent of her clients are men having Botox in their faces and other parts of their bodies, including their buttocks.
Auckland plastic and cosmetic surgeon Dr Katarzyna Mackenzie regularly performs upper eyelid surgery on men, and “man boob” surgery - gynaecomastia - on men aged between 18 and 40, usually caused by hormonal changes.
“They never take their shirt off because they feel like they’ve got breasts like a woman.”
Tauranga plastic and cosmetic surgeon Dr Adam Bialostocki has regularly performed facelifts on men – pilots who don’t want to look their age or men who have loose skin after dramatic weight loss following gastric-band surgery.
However, like others in the industry, most of the clients who come to him and his two fellow plastic surgeons, are women.
“In fact the last 18 months I have just been amazed at how many people are turning up to have face lifting.”
Again, his clients don’t want to end up with a face that no longer resembles them. Women tell him, “I want to reverse the clock, I don’t want someone else’s clock”.
Turning heads for the wrong reason
Elizabeth, now in her 60s, says she’s seen some older women take appearance medicine too far.
“They turn heads for the wrong reasons.”
The bee-sting look might look cute on a very young woman but it starts to look odd as the years progress, she says.
“When you’re a woman in your 50s and 60s and you’ve got this big pout mouth, come on, don’t you look in the mirror?”
Dr Sarah Hart has run an Auckland appearance medicine clinic for the past 22 years and has seen fads come and go. Fortunately the “trout pout” is on the way out, she says.
Hart, who is co-president of the New Zealand Society of Cosmetic Medicine which oversees the training of medical professionals, says the artificial Insta-face – wanting to look like the Kardashians – is another influence she’s keen to see the back of. Young women, often impulsive and impressionable, want the full lips, the contoured cheeks, defined eyebrows and exaggerated eyelashes.
“They end up looking very similar to everyone else.”
Buccal fat removal, a procedure to remove fat from the inside of the lower cheeks to create more prominent cheekbones, is another trend causing concern. Moaveni, whose practice gets one or two queries a week, says he has “serious concerns” about the trend.
“It’s just not something that we do. Taking normal fat out of a beautiful young face, it’s a crime.”
He points out that when people age they often need fat volume put back into their face as part of the rejuvenation process.
Mummy makeovers
What is popular is surgery to reduce the effects of childbirth, and hormonal changes when ageing. Known colloquially as mummy makeovers and menopause makeovers, mothers come for a tummy tuck and/or breast lift after having children. Twenty years later they’ll be back for a facelift, including eyelids, and possibly some liposuction.
Mackenzie says the most popular procedure with her patients is the tummy tuck, with many going for the full mummy or menopause makeover. Some women whose breasts increase in size as they age want breast reductions and others want large implants, inserted years ago, removed.
“People are moving away from bigger the better. Now less is more.”
If they’re fit and healthy, Bialostocki will do facelifts for women in their 70s. Patients come from all over the country, including politicians and high-profile people, and plenty from Auckland, particularly those who want to stay under the radar while they recuperate.
Romanowska says men have an advantage when they age because their round or oval faces become more thick-set and square-shaped, and they’re often perceived as becoming more handsome.
Hormonal changes in women on the other hand can cause the face to look more masculine. People develop expressions on their face as they age that don’t match how they feel inside. Romanowska has had teachers and salespeople who want to minimise their frown because they look grumpy and unapproachable.
“But they’re all keen on maintaining their crow’s feet [laughter lines around the eyes] which are friendly.”
Elizabeth says that having aesthetic treatments helps boost her self-confidence and is the equivalent of having “a good hair day”.
The treatments help her to look as youthful as she feels, she says.
“I’m a granny now and I like the fact that I look like a youthful granny.”
She notices when the effects of her regular treatments start to wear off.
“My bitchy resting face becomes more bitchy,”
As for the ongoing cost of facial maintenance, she waves it away.
“We think nothing of trading up to a new phone or dressing in contemporary fashion, so what’s the problem with doing something to your face?”
The cost of anti-ageing
The cost of appearance medicine and even surgery varies depending on the experience of the practitioner and their overheads. Treatment in Auckland is likely to cost more than in Dunedin for example.
Botox is charged by the unit (1ml) and can range from $16 to $30. A frown line might take between 12 and 24 units; crow’s feet might cost $300; Botox on the upper lip is around $150.
The “vampire” (PRP) treatment could cost anywhere between $600 to $2000. Laser treatment to improve skin texture costs between $300 and $900.
A 1ml syringe of hyaluronic acid dermal filler will cost between $500 to $1000, enough to change someone’s lips and the drooping corners of their mouth.
Altering nasolabial folds, the folds between the nose and the corners of the mouth, might take 1ml to 2ml of dermal filler depending on the depth. Cheeks take between 2ml and 4ml.
Bialostocki thinks non-invasive appearance medicine has its place where surgery is not necessary or advisable. Cosmetic appearance nurses at Tauranga’s Da Vinci Clinic, from where he practices, offer standard treatments like botulinum toxins and new procedures like CoolScultping where fat is frozen without destroying the skin, a process known as cryolipolysis.
If appearance medicine isn’t enough, surgery is the next option and it’s here that the costs start to mount up.
They include:
- An eyelid lift (under local anaethestic, between $1000 and $7000
- A lower face and neck lift, between $20,000 and $30,000
- A full facelift will cost between $30,000 and $40,000, more if extras need doing
- Breast implants, $15,000 to $25,000
- Breast reductions and breast lifts, $10,000 to $30,000
- A tummy tuck, $20,000 to $30,000, more if extra liposuction is needed
- Mummy makeover and menopause makeover, including tummy and breasts, $20,000 to $50,000
One procedure surgeons are reluctant to do are Brazilian butt lifts – think of the Kardashian’s ample bottoms – because of the high risks involved. Between 2010 and 2022, 25 deaths related to Brazilian butt lifts performed in Florida were recorded. Fat embolisms can enter the bloodstream and travel to the lungs or brain after surgery.
No pain, no gain
Surgeons and appearance medicine doctors say yes, the procedures can be uncomfortable but there are ways to reduce that.
Moaveni, who also works at Middlemore Hospital doing facial reconstructive surgery, says the surgery is surprisingly pain-free. Most patients need only simple painkillers like paracetamol and possibly some anti-inflammatory medication. The pain is nothing like that experienced from an abdominal operation or an orthopaedic joint operation.
“We’re not cutting into bones or muscle. Those are the things that really hurt.”
Anabelle says she coped well with her two lower facelifts.
“You just take the pain meds.”
Romanowska is upfront when asked if procedures like injectables and micro-needling hurt.
“When patients go to me ‘is this going to hurt?’ I say, ‘well yes, I’m sticking needles into your skin’.”
However, the needles are tiny, she says.
“It’s uncomfortable but it’s less painful than having a blood test.”
In certain cases Romanowska offers a patient an injectable or topical anaesthetic to minimise discomfort in sensitive areas like around the mouth.
Bruising as a result of the needle is another risk, she says.
“So patients need to factor that into their social schedule, that they may end up with bruises.”
* Anabelle and Elizabeth’s names have been changed to protect their identities
Jane Phare is a senior Auckland-based business, features and investigations journalist, former assistant editor of NZ Herald and former editor of the Weekend Herald and Viva.