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Trends in cosmetic procedures can differ depending on what state you’re in. Here’s a look at the data and the aesthetic trends in each region.

Los Angeles is known for boob jobs. Miami is where people go for Brazilian butt lifts. New York is all about the face-lift. And everything might not be bigger in Texas after all.

Aesthetic trends in cosmetic surgery can vary widely by region, according to plastic surgeons across the country and data from the American Society of Plastic Surgeons.

The group’s 2024 report on cosmetic surgery trends offered a region-by-region breakdown of the most requested procedures nationwide. For ASPS member surgeons, 43% of cosmetic butt-implant procedures performed were done in central Southern states like Texas and Kentucky, while 33% of chin augmentations performed were done in the Midwest region, which includes states including Ohio, Minnesota and Kansas.

Nationwide, liposuction was the top request last year, according to the report. And with the increased ease of access and popularity of GLP-1 drugs such as Ozempic and Mounjaro for weight loss, surgeons said patients everywhere were asking to get smaller. They also ascribed a spike in excess-skin removal and lifts in areas such as breasts and thighs to the rise of weight-loss drugs.

We spoke to 14 surgeons in 10 states about the most popular trends and what they were seeing in their own practices. Here’s a look at the data and trends across different regions.

Outdoorsy features in Mountain states and the West Coast

People living in the mountain states including Colorado and Utah tend to request procedures that give them a sleek, trim frame, several surgeons said. Residents want to look like they’re getting their fresh air and staying active, without calling attention to work they’ve had done.

In Park City, Utah, “you see very fit, small implants, very tight abdomen, built bodies,” said Dr. Renato Saltz, a plastic surgeon who works there and in Salt Lake City. “Everybody is riding their bikes, running, hiking. In the winter, everybody’s skiing.” He said that facial procedures, breast augmentations and tummy tucks were in-demand with his patients in Utah.

Utah has one of the highest numbers of plastic surgeons per capita in the country. Patients in the state often ask for a more natural look, surgeons there said.

“Every single face I do here, patients from here, they always remind me, ‘Renato, I’m here. I’m not in California. I’m not in Florida. Don’t pull too much!’” Saltz said.

The report found that 37% of the country’s breast augmentations—already a popular procedure nationwide—were recorded by ASPS member surgeons in the Pacific and mountain states, such as California and Utah.

On the West Coast, particularly in Southern California, surgeons said that they’ve noticed breast implants are often vastly bigger than the country’s average.

“This is a well-known thing,” Dr. Kelly Killeen, a plastic surgeon in Beverly Hills, said. “Even here in Southern California, the Orange County surgeons put in implants that are 400 or 500 CCs [cubic centimeters], and the Los Angeles plastic surgeons are putting implants in that are 200 to 300 CCs.”

Despite the larger-than-average implant sizes, some California surgeons also said they were seeing more patients asking for their previous breast augmentations to be shrunken down or removed entirely—part of a broader nationwide shift toward smaller implants.

Subtlety and youth in the Northeast and Midwest

Body-contouring procedures such as tummy tucks, liposuction and breast lifts are in high demand in the Northeast and parts of the Midwest, surgeons said. The data from the American Society of Plastic Surgeons also showed that lifts to the lower part of the body, such as the thighs, were among the most popular body procedures in those two regions. Top facial procedures included chin augmentations, particularly in the Midwest area, face-lifts and rhinoplasties, also known as nose jobs.

Plastic surgeons in the Northeast said their patients preferred a trim, less curvy body shape. That’s why the Brazilian butt lift is not a top request for Northeast surgeons overall, some surgeons there said. Patients coming to Dr. Naveen Ahuja, a plastic surgeon in New Jersey, often ask him to make them look younger, in more natural ways. His top requests from patients are tummy tucks, breast augmentations and liposuction. Rhinoplasties are also a common request, he said.

“When you get to Southern California and you get to Miami, I think you get a preference for a more aggressive form of correction, more products, tighter lift, that kind of thing, more than I typically see here,” Ahuja said. “My colleagues, when I look at their before-and-afters from those locations, I’d say there’s more of a prevalence of that.”

Some patients have asked him for aggressive transformations, but for the most part, they want softer changes.

“There has been a trend towards ‘less is more,’” said Dr. Sameer Patel, plastic surgery chief at Philadelphia’s Temple University Hospital and president of the Robert H. Ivy Pennsylvania Plastic Surgery Society. “For instance, there’s smaller breast implants, less filler. So again, enhancement, but not huge implants or unnatural results.”

Dramatic transformations in the South And Southeast

Texas is populous and geographically large, painting a more complicated picture. Dr. Kristy Hamilton, a Houston plastic surgeon, said that at a plastic surgery training meeting in July where she met surgeons from all over the country, she learned that the breast-implant sizes for patients in Los Angeles were far bigger than the ones she’s been inserting recently in Houston.

“If you see the implants that had been placed 20 years ago with patients that are now coming in for revisions, they are big,” Hamilton said, referring to patients who come to her to shrink their previous breast augmentations through revision or removal of implants.

Across the board, she said, augmentations at her practice have gotten smaller. “There’s the saying, ‘Everything is bigger in Texas,’ but that’s not what my patients coming in now are looking for,” she said.

“Texas is diverse,” said Dr. Henry Mentz, a plastic surgeon in Houston. By his observations, Austin and Houston residents typically prefer a more natural look, while those in Dallas go for more dramatic changes.

In Florida, a curvier silhouette is still prized, said surgeons practicing in the state. Miami, a body-conscious and tanning-friendly party destination, is known among plastic surgeons as a major hub for augmentations and lifts as well as large-volume implants or fat transfers. 50% of butt augmentations performed by ASPS surgeons using fat grafts—fat transfers from one part of the body to another—were done in the Southeast region in 2024, according to data from the American Society of Plastic Surgeons.

“In Florida they want high-end results, and they don’t care if someone goes, ‘Oh, my God, you got a face-lift!’” said Dr. Norman Rowe, a plastic surgeon who operates clinics in Palm Beach, New York and New Jersey. “If that ever happened in New York, if one of my patients’ friends said that to him, I’d be out of business.”

In Palm Beach, Rowe said the majority of his requests were face-lifts, breast augmentations and blepharoplasties—an increasingly popular type of eyelid surgery with a fast recovery period. Most patients in Florida favor surgery over less invasive techniques like Botox or lasers, he added.

Requests for plastic surgery at his clinic in Palm Beach exploded, he noted, just after Donald Trump won the 2024 presidential election, and the number of patients rolling in since then has stayed high. (Trump often spends time at his estate in Mar-a-Lago.)

“As soon as he won in November, there were people coming in wanting procedures done,” Rowe said. “And they want more of an aggressive [lift]. They’re more into looking chiseled, they want their jawline super defined.”

Not every surgeon believed in hard-and-fast visual cues. Dr. Sara Dickie, a plastic surgeon in the Chicago area, said, “I don’t go to a region and say, ‘Oh that person looks like they’re from the Midwest.’”

Such incidents have led to brain injuries for crew and passengers, The Wall Street Journal reported recently

Delta Air Lines DAL -1.77%decrease; red down pointing triangle is replacing power units on more than 300 of its Airbus AIR -0.23%decrease; red down pointing triangle jets in an effort to stem cases in which toxic fumes have leaked into the air supply and led to health and safety risks for passengers and crew.

The move is one of the most aggressive efforts by a major U.S. airline to address what in recent years has increasingly become a hidden hazard of modern air travel.

The airline is about 90% of its way through the process of upgrading the engines, a type known as the auxiliary power unit, on each of its Airbus A320 family jets, according to a spokesman for Delta. The airline operates 310 of the narrow-body type, including 76 of the latest generation models as of the end of June.

The APU is typically a third engine that sits in the tail of an aircraft and is used to generate electricity and pump air into the cockpit and cabin when the two primary engines aren’t running, for example during taxiing. A leak in the APU can also contaminate the air even when it’s not in use, according to maintenance specialists and internal troubleshooting documents.

Airbus has previously identified the APU and how it is integrated on the A320 as a leading cause of toxic fumes contaminating the so-called bleed air system. A fume event typically occurs when oil leaks into the engine or power unit’s compression chamber and is vaporized at extreme heats, releasing unknown quantities of neurotoxins and other chemicals into the cockpit and cabin air.

The Wall Street Journal reported earlier this month that fume events have been surging in recent years, driven in large part by incidents on the Airbus A320 family, and that they have led to brain injuries and other illnesses in both crew and passengers.

Delta hasn’t previously disclosed the APU replacement program, which began in 2022.

Replacing the APU, which can become more prone to fume events with age, mitigates some of the risks from toxic leaks but doesn’t address them entirely. Airbus last year found that most cases on the A320 were linked to leaks entering the APU via an air inlet on the aircraft’s belly.

Another separate cause is leaks in the jet engines themselves, which provide most of the bleed-air supply when active.

Delta and other U.S. carriers have seen a surge of incidents across A320 family aircraft that has outpaced the number of reported fume events on other Airbus and Boeing aircraft, according to the Journal’s analysis of reports to the Federal Aviation Administration.

Over the past year, APU-related fumes on Delta’s A320 jets have led to emergency diversions and abandoned takeoffs, pilots donning oxygen masks and an instance of a passenger vomiting, the analysis showed.

It is difficult to assess whether some carriers have more of those incidents than others because not all fume events are flagged by crew, and airlines have different standards when reporting to the FAA.

A Delta spokesman said that though fume events are rare, the company treats each seriously, as it does for all safety matters. “Nothing is more important than the safety of our customers and people,” he said.

An Airbus spokeswoman referred to a previous statement that the company was working with airlines and regulators to enhance its aircraft and ensure “the best possible cabin environment for passengers and crew.” That statement also said: “Airbus aircraft are designed and manufactured according to all relevant and applicable airworthiness requirements.”

Delta declined to comment on costs associated with the replacement program or to identify the manufacturers of APUs on its A320 fleet, but records filed to the FAA show that Delta operates models made by Honeywell and RTX’s Pratt & Whitney.

Both Honeywell, which dominates the APU market, and Pratt & Whitney have had issues with models deployed on the A320 family for years, according to internal maintenance and company documents, engineering specialists and legal complaints. The issues have spanned defects with gearboxes and cooling fans, but predominantly affected seals meant to protect against oil lubricants leaking into the air supply.

Pratt & Whitney introduced three separate fixes in 2019 and 2020 for its APU model on the A320 family, according to an internal Airbus presentation, while Honeywell has developed new upgrades to address defects including for the APU’s load compressor seal.

The Honeywell fix—the company’s third attempt to address problems with that seal since 2007—was announced late last year. In a marketing document at the time, the company listed as a primary benefit of the upgrade: “An improved passenger experience thanks to reduced possibility of odor in cabin events.”

A similar version of Honeywell’s APU is also used on Boeing’s 737 family of jets.

Honeywell and Pratt & Whitney declined to comment.

The increase in incidents follows changes to maintenance requirements that Airbus began approving from 2017, which allowed airlines to regularly send aircraft back into service after a fume event had occurred.

Two years after the change, Airbus and Honeywell issued a “good practices guide” to help airlines mitigate APU-driven fume events. That included extensive weekly visual inspections to the power unit and a suggestion that pilots wait three minutes after turning on the APU before activating the bleed air to give the APU seals time to adjust to the temperatures and start working properly.

The companies also suggested that airlines consider operating flights with the APU air supply turned off—removing air conditioning on the ground—if conducting maintenance might cause disruption to their flight schedules.

“Corrective maintenance action can be planned at a better opportunity,” Airbus and Honeywell wrote in the March 2019 joint presentation. They also reminded airlines that the precautions for mitigating fume events were only an optional guide to help operators suffering from repetitive fume events.

Internal maintenance and other documents show that Airbus and Honeywell have been aware of fumes-related issues with load compressor seals in the APU for over two decades.

An internal Airbus email from 2019 showed staffers debating how best to address a request from American Airlines, which had asked for specific data on root causes of fume events. The Airbus team found an internal study conducted over 20 years ago that identified issues with that specific seal.

“Don’t officially give them the report because it identifies the airline and aircraft etc, and mentions APU load compressor seal oil leakage (back in 2003 !!),” the Airbus staffer wrote, according to the email exchange reviewed by the Journal.

An airline internal maintenance document shows that Airbus was aware of the issue even sooner. The plane maker notified customers in November 2001 that one operator had experienced “significant oil fumes in the cabin” during a flight due to a worn load compressor seal in the Honeywell APU.

A lawsuit filed Sep. 3 on behalf of three former JetBlue flight attendants against the airline, Airbus and Honeywell cites incidents between 2022 and last year in which oil had leaked from Honeywell APUs and caused noxious fumes to enter the cabin. The suit alleges that the exposure led to lasting symptoms including heart palpitations, tremors and physical and cognitive impairment.

In one example from September 2022, fumes led to passengers complaining of nausea, a child suffering a nosebleed and four JetBlue flight attendants in the hospital. The suit alleges the same aircraft had been diverted two days earlier due to a passenger who was struggling to breathe.

The three companies that are defendants haven’t yet replied to the lawsuit.

In a presentation to airlines last year, Airbus acknowledged that upgrades to seals and other faulty components within the APU would solve only a portion of reported fume events.

Airbus, as part of an internal program called Project Fresh, reviewed instances of fumes from 2016 to 2021 and found 12% related to oil leaks internal to the APU. The remainder were caused by the APU ingesting oil through its air inlet at the bottom of the aircraft. That includes leaks from overfilling of oil reservoirs, landing gear hydraulic fluid or de-icing liquids.

Airbus outlined three fixes, including the most radical, a design change that moved the position of the inlet to the top of the aircraft, and which Airbus said would reduce “smell” events by 85%.

That fix will only apply to new aircraft. For older aircraft, Airbus proposed other changes that it said are less effective.

EU registrations for Tesla slumped nearly 37% in August

BYD’s sales in Europe tripled in August, a sign that customers are embracing its lineup of electric and hybrid vehicles as the Chinese auto giant continues to expand in the continent.

New-car registrations for BYD models, a reflection of sales, tripled on year to 9,130 vehicles across the EU last month, according to the European Automobile Manufacturers’ Association, an industry body also known as ACEA. When including the U.K., Iceland, Liechtenstein, Norway and Switzerland, sales more than tripled to 11,455 vehicles.

SAIC Motor, the Chinese state-owned automaker, also logged robust sales growth. August new-car registrations for its models jumped 59% to 12,822 vehicles in the EU, according to ACEA.

The figures show that BYD and SAIC Motor continue to gain market share in the continent, where Chinese carmakers have been expanding aggressively thanks to their relatively cheap and varied lineups of electric vehicles, while some European rivals struggle to convince customers to transition to EVs.

Last week, German sport-car maker Porsche AG said that unpredictable demand for EVs had forced it to delay the launch of new all-electric models following a comprehensive review of its product portfolio.

ACEA started including BYD in its monthly data when it revealed that the company had sold more cars in Europe than Tesla TSLA 3.98%increase; green up pointing triangle in July. EU registrations for Elon Musk’s electric-vehicle maker slumped nearly 37% in August to 8,220 vehicles, according to the data, extending a streak of disappointing monthly sales this year.

Tesla has been revamping its lineup recently in a bid to appeal to more buyers. Since March, it has refreshed its Model Y crossover SUV, made updates to its luxury Model S and Model X vehicles and released a pared-down, lower-cost version of its Cybertruck.

The August slump in Tesla EU sales came even as the EV market in the bloc improved overall. Sales of battery-electric vehicles increased 30% on year, with 46% growth in Germany. Registrations of hybrid-electric cars rose 14%, while plug-in-hybrid models grew 54.5%.

ACEA said EU passenger-car registrations overall grew 5.3% in August to 677,786 vehicles. Sales were up 5% in Germany and 2.2% in France, but down 2.7% in Italy. Germany’s Volkswagen Group recorded sales growth of 6.3%. Stellantis, the owner of the Jeep and Dodge brands, logged 3.4% growth in registrations.