Botox, Salmon Sperm Facials and More Top Cosmetic Procedures From 2024

2024 has been the year of nonsurgical lifting techniques, laser resurfacing, and micro-injections of Botox and Rejuran (a.k.a., the salmon-sperm solution). Celebrity dermatologist Dendy Engelman, M.D., says she’s noticed waning interest in traditional hyaluronic-acid (HA) injectables this year, and one of her pharmaceutical reps told her filler sales are down. “My celebrity patients love these kinds of treatments where you can’t pick out anything specific that’s changed in a before-and-after photo,” says Engelman. “They just look refreshed.”

New York City’s top dermatologists say patients are less focused on plumping or sculpting and more interested in looking lifted (in a well-rested way that makes it impossible for anybody to tell what work they’ve had done). “I think the overall perversion of injections in the med-spa market — the overdoing of these things — has made people a little bit wary, so they’re looking for non-injectable alternatives,” says dermatologist Paul Jarrod Frank, M.D.

Read on for the year’s most popular treatments.

We can thank Kim Kardashian for salmon-sperm facials

“Ever since Kim Kardashian talked about it, we’ve had a bunch of interest in the salmon-sperm facial,” says Engelman. “But the name makes no sense because it’s not a facial and it’s not salmon sperm.” Rejuran, the treatment she’s talking about, is the brand name for a solution containing polydeoxyribonucleotides (PDRN) derived from purified fragments of DNA that have been extracted from, yes, salmon sperm. The PDRN acts as a bio-stimulator, meaning it triggers the body’s own repair processes and collagen production. In South Korea, where Rejuran is hugely popular, aesthetic providers do micro-injections of the solution all over the face. In the United States, Rejuran is only approved for use as a topical cosmetic. Still, some physicians are using micro-needling devices or micro-injections to deliver it deeper for more efficacy. Engelman says the treatment speeds healing time after other procedures and also makes skin appear more hydrated and smoother. “Sort of like that glass-skin look,” she says.

Botox for a mini face-lift

Let it be known that Botox is going nowhere, especially since it was FDA approved for use in the platysma muscles of the neck earlier this year. Melissa K. Levin, M.D., the founder of Entière Dermatology, says people are getting more comfortable with all the ways they can use Botox to rejuvenate. She says she likes injecting it “pan-facially,” delivering small doses to soften the facial muscles that pull downward, resulting in a more lifted look. “We do the brows, the lip flip, the tip of the nose if that’s starting to fall, the outer corners of the mouth, even the chin,” she says.

Engelman has been doing a procedure colloquially called the Nefertiti neck-lift: She injects Botox, or a similar cosmetic neurotoxin, into the muscles that pull down on the jawline, chin, and neck. “When you do that, you get this springback effect,” she says, where the muscles that pull upward are more in control. “Your jawline looks smoother, you have less sagging, and it can help with ropiness and those horizontal lines on the neck,” she says.

It’s all about tightening

Now that the millennials are moving into their early 40s, dermatologist Dhaval G. Bhanusali, M.D., says he has a lot of patients coming in to talk about the lower halves of their faces. “We’re the generation that grew up on the internet, with Instagram and selfies, and we’re finally watching ourselves, you know, age in real time,” he says. “And jowling is usually the first indicator of that aging.” To tighten the skin on the lower face — or anywhere, really — his office has been doing a lot of Ultherapy, a treatment that uses ultrasound energy to lift and tighten skin, in part by causing collagen fibers to contract. “People are like, ‘Okay, what are my options if I don’t want a face-lift?’ And the answer is you can do ablative lasers, which is essentially resurfacing the face to minimize the appearance of wrinkles, so it actually looks like a fresh layer of skin, then you can tighten it, which is more Ultherapy,” he says. “So that combination gives you that middle ground between a face-lift and non-invasive procedures.”

Lasers, lasers, lasers

In years past, there was a lot of interest in laser “facials” done with non-ablative lasers like Fraxel and Clear + Brilliant, which stimulate collagen production without affecting the skin’s surface. Now, people seem more open to the big guns: ablative lasers that trigger collagen production and also remove sun-damaged skin. “For a while, people didn’t want an ablative laser because there’s more down time,” says Levin. “But lately, this past year, people seem ready.” And new technology and techniques mean ablative lasers don’t have to be as destructive as they used to be. Levin has been doing a lot of treatments with a fractional erbium laser. “It’s actually great around the eyes — upper eyelids and underneath, too — especially for crêpey skin. Millennials and Gen-Xers are getting that type of skin where they want to tighten up a bit.” Bhanusali also likes an erbium laser for resurfacing (he says he often uses one from the manufacturer Sciton to treat scars).

Dermatologist Morgan Rabach, M.D., the co-founder of LM Medical, has been using an ablative laser more frequently, too. She does a procedure she calls “CO2 dusting,” where she uses a CO2 laser at a lighter setting. Traditionally, the laser removes the top layer of skin for a full-on peel, but Rabach adjusts the settings for a less-intense effect. “Think balayage highlights instead of platinum blonde,” she says. “The dusting gives a long-term glow and health to the skin, but you don’t need to hide from everyone after you get it done. Doing it in your 30s or 40s can be really beneficial to build that collagen that we started losing in our late 20s.”

Using people’s own blood to fill their face (yikes?)

And, finally, for patients who want subtle skin plumping and don’t like the idea of putting foreign substances in their body, Frank recently started offering injections of very small embryonic-like stem cells (VSELs) made from his patients’ own blood. He draws the blood, spins it to separate the platelet-rich plasma (PRP), then treats the PRP with a photoacoustic laser to activate its VSEL cells. From there, he can heat and cool the cells to turn them into a new injectable he calls VSEL-Rich Gel (VRG) Filler. “It has the viscosity of something between, like, an old collagen [filler] and a Restylane [filler],” he says. VRG Filler doesn’t volumize like some of the thicker injectable fillers now available, but, he says, “I’ve been using it around the eyes, around the mouth, and it does hold.” The plumping is short term, and, more importantly, the VSEL cells have a long-term bio-stimulatory effect that helps to improve wrinkles, crêpey skin, and fine lines over time. Frank says it’s “more naturopathic and permanent” than filler. And subtler, too.

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