Apparently the reason why there was the minimally invasive revolution of fillers and fat graft was because US doctors were / are terrified of being sued. If that's true then I don't know why most other western countries followed suit. But yeah as for fillers there are the other factors like less hassle, less complications and possibly more profitable than implants in the long term if you get the patient hooked.
I wonder if they teach surgeons studying plastic surgery about implants as comprehensively now as they used to, or if they are even discouraged.
"but until then, we're in the dark ages." That's one way of looking at it but I think it's pretty incredible what changes can be done through the right surgery. I am grateful for all the options that we have at our disposal.
Its not only that, but its also a money issue from the patient's standpoint. You have to realize that a large majority of Americans don't even have $1000USD of savings! If this is the case, then how the heck would anyone be able to afford even a $5000 procedure? They couldn't. Filler and botox is much more obtainable. And surgeons are catering to this.
Now, that said, upper middle class Americans could afford more crazy hardcore osteotomies, but I guess they want to cater to the masses and even often push BS, useless, waste-of-time procedures onto the upper middle class audience.
"I am grateful for all the options that we have at our disposal."
What options? Sorry to be pessimistic, but honestly there isn't much that can be done. I saw an awesome result for a monobloc osteotomy that people were initially like "wait, that's the same person?" But never in hell will we be able to find a surgeon who does it cosmetically.
What is needed is artificial bone, better AI for automated procedure, or at least semi automated procedures to allow precise cuts, and surgeons to explore and go into more "exotic" procedures (obscure ones) and what not.
But really, if one is rich and motivated to want a better face (actual improvements too), then hell, he/she could even create a research team specifically for them, lol. Think about a guy who makes 5 million dollars a year. That guy could spend 2 million dollars a year on a doctor or two and a small set of researchers along with equipment, etc to make them research that guy's specific case and take specific precautions, etc to do crazy stuff which they might be willing to do at a high price.