In 2012, we reported on the growing number of men seeking plastic surgery in the Capital Region (“Male Enhancement” by Allen Young, March 2012). We caught up with one of the doctors interviewed, Dr. Debra Johnson of the Plastic Surgery Center of Sacramento, to see what the makeup of her waiting room looks like now.

Four years ago, we reported that the most common procedures for men were rhinoplasties (nose jobs), otoplasty (ear tucks), hair transplants, liposuction, gynecomastia (breast reduction) and pectoral implants, among others. These days, Johnson says minimally invasive procedures are increasingly common and preferred among men, but when it does come to plastic surgery: It’s all about “fat transfers.”

“[Fat transfer] is a little more user-friendly than putting in an artificial implant,” Johnson says. It can be used for any sort of augmentation to add a little more curve. “Fat is kind of a big deal right now. It can certainly volumize if you’ve got a dent. It’s like your body’s spackle.”

Minimally invasive surgeries like hair transplants and skin care treatments like laser hair removal have also become increasingly popular: In fact, Johnson says, although men comprise only about 10 percent of her clientele, (up from about 1 percent, she guesses, when she joined the practice in 1989) roughly 20 percent of the patients at the adjoining skin care center are men.

Hair transplants have undergone a rebirth, as evolving technology has moved into “micrograft hair transplantation,” Johnson says. The new procedure is less noticeable and can diminish the stigma many people, men included, face when it comes to cosmetic surgery.

Gynecomastia, or breast reduction, also saw a large surge in male patients recently: For the first time, men accounted for 40 percent of the roughly 68,000 gynecomastia procedures done in 2015 in the U.S., according to the Plastic Surgery Foundation and the American Society of Plastic Surgeons — that’s a 5 percent increase from 2014.

“They want to look better longer,” Johnson says. “Everyone is thinking, ‘How can I tread water longer?’”