Plastic surgeon Dr. Melissa Doft has many high profile patients who would never admit that they've had work done—and get away with it, too, thanks to her subtle touch. "My personal aesthetic is a little bit less-is-more," she explains. Here, the Park Avenue doctor dishes on surgery in the social media age, from why Kylie Jenner isn't to blame for the rise in lip injections to the surprising reason many teenagers are sitting in her waiting room.

You have a lot of teenage patients. What are they asking for?
I actually do a lot of teenage operations. I think one of the reasons is because I’m still on the younger side for plastic surgeons, so I think that makes me a little more approachable for younger girls. They can kind of identify with me a little bit, as opposed to this sort of old, masculine surgeon.

For a lot of the young girls who have come in, how they choose a doctor is very interesting. Sometimes they really care about if you’re female or male. Another thing that is really interesting in the younger population is that online reviews are so important. People actually have told me that they are more likely to believe online reviews than word of mouth, which is the opposite of what my generation, and my parents’ generation preferred. For many people over 40, plastic surgery was something that was whispered about between very, very close friends, But with the advent of social media, it's no longer whispered about. You have a lot more exposure. Young people today are more open about it, and maybe more open to having plastic surgery.

Are your older patients more private about it?
Yes and no. They’ll be very private about some things and not private about others. They'll admit they had a facelift but never tell somebody they had Botox. Or they might say, “I would tell my son that I had my facelift, but I’d never tell my daughter." There are little games that people play. The other thing that I think younger patients really care about is they want to like you as a person, and sometimes older people think that too, but I get a lot of comments along the lines of, “I really liked your smile, and that’s why I came in.”

What are the most common treatments?
I’d say the common operations that I do for teenagers are noses. I wait until they have full skeletal growth, which is around age 15, 16, depending on when the girl got her period. Boys are more around the age of 17, 18. So, that’s one. Breast reductions are another. I think the youngest patient that I’ve had was 15. Some women are getting their period when they’re ten years old. So, by 15 they’re pretty well-developed. I do a lot of these surgeries over the summer, particularly if they’re a teenager, because they’re all trying to go to Harvard, so they can’t miss too much school in junior high or high school. But in about October, November, I usually start getting letters from the mothers, saying, “I’ve never seen my child perform so well in school. I’ve never seen my child try out for a school play. I’ve never seen my child try out for athletics.” I’m very pro doing teenage surgery for the right reasons.

Do you get a lot of male patients in their teens and twenties?
I do. Gynecomastia, male breasts, is an issue. Sometimes I'll do a little liposuction for men in their 20s.

Where?
Usually the stomach, is kind of, tends to be where they have it, sometimes a little bit underneath the chin. The other thing for young adults is the lip injections. They are so popular.

Do you ever refuse to do lip injections on someone?
I think if they’re too big already, there’s a certain ethical code. But you also want to do the right thing, because they’re going to tell their friends that they came to Dr. Doft, so you don’t want to be a terrible advertisement. My personal aesthetic is a little bit less-is-more, and so I tend to go with smaller breast implants, or a little bit less filler. I’d rather have you come twice a year, or a little bit more often, and do smaller amounts, because I that it’s a more natural approach, and then you sort of always look great, instead of looking overdone, and then underdone, overdone.

Do you see any kind of celebrity clients?
We see some. We have taken care of a couple celebrities, very big celebrities, but they are always the ones that would never want to talk about it. They have actually publicly said that they don’t believe in plastic surgery. There was one that had publicly said, “I’ve never had surgery,” and she has had three major surgeries. I think it’s fine not to say that you’ve had surgery, but I don’t think it’s totally fair to say, “I would never have surgery, I don’t believe in it,” and then wonder wonder, “but how is your body is so perfect, after multiple children?” It’s an unfortunately reality for women. So we tend to have patients who would never talk about it. They come through the back door. We also have a lot of international patients that are from royal families or very posh international families, and a lot of government-type people, like senators or representatives ...

Male and female?
Male and female, and sometimes it’s for medical reasons. For example, they may have skin cancer. We take care of a lot of judges, which is sort of random, and also we’re taking care of a lot of fancy New York Tri-State Area people, a lot of powerful women, which is really fun to see, because these are people who really worked hard, so I enjoy taking care of them. They tend to be really smart women, so it’s a fun conversation.

As you get older, you get a lot of little lines around the mouth. What I love to do with the lip injections is to redefine that lip line. I put in a very little bit off filler, just so you don’t have the wrinkles. Also, as you get older you lose the cupid’s bow, which is right here, and it makes the upper lip look flatter, and that makes you look older. So if you redo the cupid’s bow, it makes your upper lip look shorter, and it gives you a very much more youthful look. By doing all this, you basically can go out, put on a little lip gloss, and you’re done. You don’t have to do the lip liner, the pencil, and the lipstick, all of these things that older women will do to get definition, because they have no definition.

There’s so much that has been written about the huge uptick in lip injections, that they're all saying, “We want to look like Kylie Jenner.” I don’t think most of my patients know who Kylie Jenner is.” My patients aren’t on social media. They’re running Fortune 500 companies. There has to be a different explanation than Kylie Jenner. And yet every plastic surgeon claims, “No, this is because of Instagram and social media.” They just want to look good.

What about liquid rhinoplasty?
I would say that the liquid rhinoplasty I think we’re seeing more and more of, but I don't want people to think everything can be fixed with fillers. If you have a little bump, you can camouflage it well. If you have a teeny amount of asymmetry, you can camouflage it well. It’s a nice opportunity for somebody to really try something out. I think it’s also from people who have had a rhinoplasty before, and maybe there are one or two aspects that are not quite perfect, or there’s a little indent here. And then you’re using it in their cheeks or in their lips or in their, you know, somewhere else, that it works really well there, but I think it’s something that is kind of a fun topic, and it can make a really big difference.

Who is most interested in this treatment?
People in their 20s. I think people in their 20s are really drawn to these quick fixes. I think they don’t always want to do a permanent change, I think they appreciate that. They want to kind of try it out, because now they have the ability, I mean, it’s a whole different ballgame now. We didn’t have this ability ten years ago, 15 years ago. These fillers haven’t been out for that long, and so this whole idea of, “Let me try it out, let me see how it looks, and then before I make a permanent change with having surgery” is new.

How early do you do Botox?
Botox is really interesting. I definitely don’t say that you should be doing it to prevent something. I mean, I probably shouldn’t be saying this, but it’s expensive. Buy Louboutins. Or do something else. There are other things to do besides premature Botox. Use a great vitamin C lotion. Do something with antioxidants. You have to do retinol that early? Probably not, and it dries out your skin.

I do have some patients who’ve been in tanning bars since they were teenagers, and really have wrinkles. So, if you have the wrinkles, then, okay, we can treat it. It’s ridiculous. You’re 25 and you have wrinkles. I mean, you look like you’re 40, because you were in a tanning bar for so long. So, for those patients, you know, when I can see it, then…

Then you’ll treat it. But if I can’t see it, give it a little bit more time. Why don’t we do facials? If they want to do something I say, “why don’t we do something else more age-appropriate."

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