The interest in cosmetic plastic surgery worldwide is reflected in the increasing numbers of people who have undergone such changes over the past decade. This is not just a U.S. phenomenon but is seen in many countries ranging from Brazil to Estonia.  People are interested in looking and feeling better in record numbers. There is a lot of reasons why this is occurring from advancements in surgical techniques and materials to the internet and marketing.

There is no single reason that explains the rise in cosmetic surgery but one can not exclude the power of celebrity and star influence. Just as you read about them in the supermarket checkout counter or on innumerable internet websites, how the many stars and entertainers look and what they do commands a lot of attention. Their influence is undoubtably greatest on the young, who are the most impressionable. But many are known to those much older even if by comparison they don’t want to look like them.

In the November issue of the Journal of Adolescent Health, a study was published on ‘Adolescents, Celebrity Worship and Cosmetic Surgery’. The purpose of the reported study was to determine if young adults who admired celebrities was a predictor of whether cosmetic surgery was done later. Over 130 adults filled out questionnaires which measured their attitudes towards a celebrity that they admired and their attitude and experience to cosmetic surgery. Eight months later, they were then asked whether they had undergone cosmetic surgery. The investigators found that intense personal admiration for the body shape of celebrity was a strong predictor of future cosmetic surgery being done.

To a plastic surgeon today, this study is no surprise. In the eighteen to thirty-five year old age group, it is extremely common for a prospective patient to ask if they get the shape of a body part of a certain celebrity. Or they may use a picture or advertisement of a celebrity or model to show what they would like. Some of the most typical examples are the lips of Angelina Jolie, the buttocks of Kim Kardashian, the nose of Jennifer Aniston or the breasts of Halle Berry. Conversely, celebrities can serve as the antithesis of what a young adult wants such as the nose of Michael Jackson, the lips of Melanie Griffith, or the breasts of Heidi Montag.

While one may disagree with such attention to highly visible and well known people, their influence is undeniable. This is nothing new and has always been this way. It is only extremely evident today because of the internet and the instantaneous access to endless venues that choose to highlight them. Perhaps the coverage of poor or undesired cosmetic surgery outcomes will also serve to educate that these procedures have real risk of complications and are not as simple as airbrushing or Photoshopping one’s desired result.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The great boom in plastic surgery over the past decade has been largely spurned by the use of injectable treatments and lasers for aesthetic facial rejuvenation. This has arisen to a shift in the average age of patients seeking cosmetic changes with a younger age group than ever before. Recent statistics put forth by the American Society of Aesthetic Plastic Surgery confirms what most of us have known for some time…patients are getting younger.

According to the Society’s numbers, Generation Xers as defined by those 31 to 45 years of age accounted for nearly 45% of all reported procedures. Conversely, the Baby Boomers as defined by ages 51 to 64 accounted for less than 30% of all reported procedures. This is a major shift from a decade ago and throws out the historic perception of plastic surgery being for the older crowd.

With this younger patient population, it is now clear that Americans are thinking in droves about early treatment and prevention of facial aging. While facelifts and other true surgical approaches will always be around, much more effort in numbers is directed towards minimalistic techniques. Whether it is light therapies, fractional laser resurfacing, Botox, fillers or skin tuck-up procedures, people now want to embark on treatments early to allay the both the onset and the severity of the physical signs of aging.

One aspect that underlies much of these newer aesthetic facial treatments is skin rejuvenation. Besides light, laser and chemical peels, there has been a virtual explosion of topical agents. Many of these skin therapies have provided antioxidant, growth factor and even purported stem cell compositions. Women, and a few men, are investing in their skin early with the knowledge that they will need to make a continuing effort over their lifetime.

From a surgical standpoint, this newer generation is more body conscious than ever before. From breast implants, Smartlipo fat removal to mommy makeovers, women are being driven by the trends seen in the fashion world and Hollywood. Men, particularly those younger, want to have a more defined facial shape and athletic-appearing bodies.

One thing that is very clear in the shift to the younger ages is that patients are no longer seen as a one-time surgical effort, but rather more of a lifetime. What starts as Botox and skin care today may eventually become a tummy tuck or a facelift a decade later. This makes seeing patients as a concept over decades rather than an isolated surgical procedure. Patients should also see their plastic surgeon as a lifetime resource, providing suggestions and solutions to their aging concerns over their lifetime.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Inadequate training and poor judgment account for a disproportionate number of complications and unsatisfactory results that occur annually from cosmetic surgery procedures. With so many different types of doctors doing cosmetic surgery, how can one make a safe and wise choice? In days gone by, the use of the terms such as ‘board-certified’ and ‘specializing in’ were enough to demonstrate to the public a doctor’s expertise, but today that is not enough. Often these physician descriptors can actually be confusing and even deceiving.

I would advise potential patients to research the following categories for any cosmetic surgeon that they are going to see. Some but not all of information can be obtained but doing a little research online.

What Are They Board-Certified In?

Are they board-certified in plastic surgery or another specialty? Many new cosmetic surgeons are board-certified but not in plastic surgery. Their board certification may be in General Surgery, Dermatology, Oral Surgery or Ob-Gyn to name a few. Some may even have an additional board-certification in cosmetic surgery. But this self-created board should not be assumed to be equivalent to those certified by the American Board of Plastic Surgery. There is a significant difference between board-certified plastic surgeons and board-certified cosmetic surgeons that makes them not equivalent at all.

In established medicine, board certification is the result of doctors being educated through long-established training programs sanctioned by the American Board of Medical Specialties. This governing board sets the standards for the education, training and testing of doctors. Of the 24 recognized specialties and boards, plastic surgery is one of them but cosmetic surgery is not. Years of residencies done in hospitals under experienced physician mentors is what is needed to qualify for plastic surgery board certification. Cosmetic surgery allows one to use their basic training in any medical specialty, with or without some private training, to quality for their boards. This is why knowing whether the doctor has hospital privileges for certain cosmetic procedures is so valuable to know. (if you can access that information)

The American Board of Plastic Surgery is the only cosmetic surgery board recognized by the American Board of Medical Specialties. The two exceptions are the American Board of Facial Plastic and Reconstructive Surgery, which is a sub-specialty of otolaryngology-head and neck surgery and the American Board of Opthalmologic Plastic Surgery, which is a subspecialty of ophthalmology. This does not mean, however, that facial plastic surgeons are trained to be doing breast augmentations or ophthalmologists are trained in facelifts or rhinoplasty surgery.

How Often Does The Doctor Do Your Procedure of Interest?

This is a hard piece of information that is not easy to ascertain. Certainly asking the doctor seems the most obvious route to learning how many they have done, but that is not the exclusive source I would use. Look at their websites and see how many before and afters of the procedure are posted. Ask for before and after photographic results and to talk to some more recent patients. (done in the past 3 to 6 months) Word of mouth still remains as a good method of recommendation. Willingness to easily and quickly divulge this information is a good sign. Hesitancy or avoidance of doing so would be of concern.

The premise of asking or having an idea of how often the surgeon performs the procedure has, at its foundation, that there is some magical number. In reality, there is no specific number for any procedure but it should suggest some degree of frequency of it being performed. This will vary based on the type of cosmetic surgery procedure and how commonly it is requested and performed on a more global basis.

Is The Surgery Being Done In a Nationally Accredited Facility?

Hospitals are obviously certified and have to meet highs standards of care and comply with stringent regulations. Surgery centers can be quite different and you want to go to one that has been accredited by either the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This accreditation and a state license to operate means the facility adheres to safe and clean operating conditions. Doctor’s office are fine for minor surgery but most are not accredited for more significant surgeries and any anesthesia that may be needed.

Who Is Doing The Surgery?

I am often surprised after a long consultation that a new patient asks me if I would be doing their surgery. Not understanding who else would be (and having had this long discussion why I would let someone else do it), I have come to learn that this may not always be standard practice. In some cosmetic practices or centers, most of the interaction may be done with other people than the surgeon themselves or they may not see the surgeon until the day of the surgery. Insist that you meet with the ‘real’ surgeon before the day of surgery.

Is The Lowest Cost A Good Choice?

The cost of cosmetic surgery is always of concern and no one wants to overpay for their procedure(s). But the cost of cosmetic surgeries is influenced by market factors just like any other retail business. This makes a fairly consistent price range for procedures in any given geographic region. If after getting several consultations one price is considerably lower than another, the question should be why. Where are the costs being reduced to offer such a lower price? This is what makes the whole concept of Groupon and other discount programs for cosmetic surgery so unnerving. (or they should be to patients)

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

A front page article in USA today reviewed a burgeoning problem in the world of cosmetic surgery…a growing number of complications spurned by surgeons of dubious training backgrounds. As insurance reimbursements have continued downward to abysmal levels, doctors who are trained in many other medical specialities than plastic surgery are either doing or opening their own cosmetic surgery practices.

Because federal and state laws have little to no governance over what goes on in an office setting, cosmetic operations are popping up everywhere. When combined with the ease of having a professional and slick-looking presence on the internet, it is seemingly hard for the public to separate legitimate from questionable doctors and practices. With a growing age and body conscious society, there is no shortage of potential patients who are willing to spend money on a wide variety of cosmetic procedures.

We live in world now where just about anything seemingly goes. ER doctors and internists are performing liposuction, Ob-Gyns are inserting breast implants, Dermatologists are practicing facelifts and Eye doctors are having their hand at rhinoplasties, to name just a few incongruous combinations that a decade ago were unthinkable.

The unsuspecting general public understandably asks how can this be? With no oversight in a doctor’s office or in some private surgery centers, any doctor with a medical license can do whatever they want. With the allure of cash payment upfront and no interference from insurance companies which don’t oversee cosmetic surgery, little more than a doctor’s conscience separates some cosmetic operations from prospective patients.

For those procedures that require expensive equipment to perform, the manufacturers actually exacerbate this problem. They will sell any piece of equipment, lasers and liposuction machines as the most common devices, to any doctor that has a medical license regardless of their background. With such devices that cost anywhere from $25,000 to $150,000, they apparently need to expand their potential sales market. In my city of Indianapolis, I know of ENT surgeons that perform breast augmentations in their own facilities. When asking the local sales representative why would a breast implant manufacturer sell breast implants to a doctor with no formal breast surgery training, he shrugs and says we have to because that is company policy.

When you don’t have good training and a long history of satisfied patients, one of the most appealing pitches is that of a lower cost. Offering steep discounts over many board-certified plastic surgeons, lower prices help drive many non-discerning patients through the doors. With the growing discount concept like Groupon, price will continue to be a driving motivation for new cosmetic patients. But lower prices almost always reflect that the procedure will be done in the office under local or sedation anesthesia where costs can be saved. But it may also reflect that the doctor lacks adequate training and qualifications to perform the procedure in a hospital-associated or accredited facility.

While on the surface this appears nothing more than a turf battle between board-certified plastic surgeons and cosmetic surgeons, the issues go way beyond trying to stifle competition. This is an issue of adequate training, competency, and patient safety. Being trained in a plastic surgery residency program (cosmetic surgery has no residency program and is not a recognized specialty of the American Board of Medical Specialities) assures patients that the doctor has already done his/her learning on other patients beforehand.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

The well publicized death of Donda West  in November 2007 after undergoing cosmetic surgery has given rise to a new California law. Governor Arnold Schwarzenegger has taken a step towards making more strict laws pertaining to cosmetic surgery following the tragic death of rapper Kanye West`s mother. The new bill is designed to provide greater safety for people who seek cosmetic surgery.

The bill introduces the Donda West Law which requires anyone undergoing plastic surgery in the state to receive a mandatory physical examination first. The Governor had vetoed the first phase of the bill last year, but has now finally signed it after it was resubmitted in February this year. Ensuring that a patient is  healthy enough to go through surgery is an obvious important consideration to decrease risks after the procedure. While some patients may think they are well enough for cosmetic surgery, in reality, they may not be for certain types of procedures.

While this law is certainly only a good thing, it is a shame to see that the government has to enact legislation that is really only good medical practice. All practitioners of cosmetic surgery are physicians who graduated from medical school and are licensed in their state. Regardless of what specialty they come from before performing cosmetic surgery, every physician has the medical training to evaluate a patient’s health status. At the very least, they have a medical history which lists their medications, allergies, past surgeries, and known medical problems. Based on this information, they can make the judgment whether further medical testing and work-up is warranted by the patient’s own physician. To require legislation to ensure this is completed (we are talking about a simple physical examination here) suggests that cosmetic practitioners can get a little complacent and forget that we are still practicing medicine, albeit not life-saving.

But despite a good medical evaluation and/or work-up before surgery, risks and complications can and do occur after cosmetic surgery. Even a clean bill of health does not guarantee a complication-free recovery. Fortunately, such significant complications are rare given the millions of cosmetic surgeries that are performed per year in the United States. Certain plastic surgery procedures of the body, particularly tummy tucks and liposuction, present higher risks of potential significant complications (e.g., deep vein thrombosis, pulmonary embolism) given the surface area that is being traumatized. Limiting the length of the surgery, recovering patients overnight under medical supervision if necessary, and encouraging early physical activity is just as important as a good preoperative evaluation.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Over the past few years, I have noticed a fair number of internet inquiries about the desire for cosmetic surgery from members of the armed services. I get at least once a week such an inquiry from someone stationed either locally or anywhere around the world, most commonly Iraq and Afghanistian.

 I suspect this level of military interest is the combination of all the deployments and increased armed forces activity since 2001 and the continued development of the internet and computer technology. It is now possible to be sitting in the desert in Iraq or on a ship in the middle of the Pacific and connect with any doctor’s practice in the world. Who would have thought that possible just a mere ten years ago?

In appreciation of the level of interest and for the sacrifices made by all branches of the armed services and their families, I have decided to offer a discount program on cosmetic surgery for them. I have been asked frequently whether we offer such a discount that it is time that I put that request into play.

Therefore, any active duty member of any branch of the armed services and their families is eligible to receive a 25% discount on any cosmetic procedure that my Indianapolis plastic surgery practice offers. Some of the most popular requested plastic surgeries include liposuction, breast augmentation and breast lifts, tummy tucks,  rhinoplasty, facial contouring with implants and scar revision. These comprise the common procedures done on patients under the age of 40, which constitutes the age makeup of most of the armed forces requests.

Consultations can be arranged through the internet by e-mailing an inquiry on the home page of my website listed below or sending an e-mail to info@eppleyplasticsurgery.com  and ask about the Patriot Plastic Surgery program. We can have a phone consultation done after first completing some basic paperwork online. (Health History Form) When possible it is also helpful to see photographs of your concern which may be requested after we have received your health history form.

There many fine plastic surgeons in the military stationed around the world and they may be a first resource for your cosmetic surgery desires. If you are unable to meet your needs through that resource, however, I would be happy to be of assistance to you.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

One of the most interesting and relevant concepts in elective cosmetic plastic surgery is that of value. In short, what are you getting for what you are paying. As I often say to patients in my Indianapolis plastic surgery practice, ‘we are not saving any lives here or curing cancer….it is just cosmetic surgery.’ So the importance of a good return on a patient’s investment is an important key is their interpretation of the result and the experience.

Clearly, managing a patient’s expectations through a thorough and frank discussion before surgery remains the cornerstone of influencing a patient’s satisfaction and their happiness with the outcome. While much hype and marketing exists in plastic surgery, particularly on the internet, one of my main tasks when I consult with a patient is to bring reality to the forefront and get them grounded in what can and cannot be achieved.

But this issue aside, there is another important value concept in plastic surgery that never gets any play. And that is the inherent value or lifespan of each individual plastic surgery operation. In other words, how long is the change that the patient is having last….or the time expectancy of the procedure. Interestingly, this will vary greatly depending upon what is being done.

Certain plastic surgery procedures have tremendous value because they will essentially last a lifetime, almost regardless of what the patient does. In this category would be procedures such as rhinoplasty (nosejob), otoplasty (ear pinning), and facial implants (e.g., chin implant) for example. Once these changes are made, barring complications, they are permanent and will never change no matter what the patient’s lifestyle. The same can almost be said for breast augmentation and abdominoplasty (tummy tucks), although how permanent these results are is influenced by at what age and time period in the patient’s life they are done. If a woman is done having children, these two operations can have a long lifespan with little change. If you amortize these more ‘permanent’ procedures over one’s remaining lifetime, they can become just pennies a day. It is hard to find anything you could buy that would last so long as such a low lifetime cost.

More moderate lifetime value plastic surgery procedures are those which can be influenced by one’s lifestyle…the potential for weight gain and change. Liposuction would obviously be the leader in this category. While immediate postoperative changes can be quite gratifying, the short and long-term benefits of the procedure are only going to be as good as long as the patient continues to support their original investment. (diet and exercise) Any anti-aging facial procedure, such as a facelift, browlift, or blepharoplasty (eyelid tucks), falls into this category because it treats the symptoms of the problem and not the actual problem itself. (aging) Therefore, time will always outlast the surgical benefits. (and I would argue you want to outlive how long these operations will last!) The value of these procedures must be judged more in the intermediate term (5 to10 years) and the cost must be averaged over this time period, which makes it a few dollars per day.

Ironically, those procedures that have the shortest value period (Botox, injectable fillers) have become tremendously popular during this decade. While Botox lasts just four months, its cosmetic uses account for nearly a billion dollars in sales for the U.S. company. These very short value procedures overcome the economics due to their ease of application, immediate results, and lack of any recovery from them. In other words, an instantaneous fix at a relatively low cost (compared to actual surgery) increases their relative value.

While elective cosmetic plastic surgery decisions are really emotionally driven, it is interesting to look at their economic value in terms of the lifespan of their results. Such considerations are not a major determining factor in the decision for surgery but may help some in deciding if a certain procedure is ‘worth it’.  

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The classic phrase, “Beauty is only skin deep”, belies the truth. The relevance and importance of beauty is pervasive, penetrating deep into all societies. It has long been acknowledged that people who are deemed physically attractive have a societal advantage. Numerous studies, using photographs, have shown that those who are judged to be physically attractive receive preferential treatment in virtually every societal situation examined including education, employment, medical care, legal proceedings and romantic encounters.  Clearly, appearance does matter.   This emphasis on beauty is the engine that drives the demand for modern day cosmetic plastic surgery.

While the role of beauty in society is readily apparent, the relationship between cosmetic plastic surgery and its psychological effects is not as clear.  The early assumption was that external physical changes lead to psychological improvement. (e.g., higher self-esteem) Such assumptions gave medical credibility to cosmetic surgery.  In this regard, cosmetic surgery was viewed similar to a psychiatric or psychological intervention.

In the middle of the last century when cosmetic surgery began to emerge from the shadows of medicine, it was felt that rampant psychopathology existed amongst cosmetic surgery patients.   As psychiatry developed and more standardized assessments were used ( e.g., DSM-IV) the presumed psychopathology of cosmetic surgery patients was not nearly as extensive as previously believed.

Today, it is fairly well known that the satisfaction of most cosmetic surgery patients is high.  I have seen studies that show two thirds to 90% of all the cosmetic surgery patients were satisfied.  Most would recommend cosmetic surgery to a relative or acquaintance and most stated that they would do it again. Satisfaction levels do differ, however, based the type of procedure with breast reduction, breast augmentation, and facelifts being quite high, while rhinoplasty, for example, is lower.

But what is the psychological effect of cosmetic plastic surgery?  Contrary to popular belief, one’s personality or psychological characteristics doesn’t change after surgery. Numerous studies have shown that you end up after surgery just who you were before surgery. This is why one should never expect their lift to change or improve after an external physical change. This is also why many lottery winners do not end up ‘happier’ after receiving a lot of money. (that they didn’t really earn) Conversely,  one’s personality traits doesn’t seem to influence the psychological outcome of cosmetic plastic surgery either. In my Indianapolis plastic surgery practice, I can safely say that some people with unusual personalities can be completely satisfied with cosmetic surgery results while more ‘normal’ patients often are prone to complaints.  In short, you can not accurately predict beforehand whom may be unhappy afterwards.

There are, however, some patients who are definitely at higher risk for after surgery dissatisfaction. Males, younger patients, and patients on depression or anxiety medications are well known examples. Marital and relationship discord is a high risk for a negative psychological outcome, but this is virtually impossible to know beforehand in most patients. Some plastic surgeons consider a patient who is disproportionately affected by a small deformity to be high risk also.

The most recognized problem patient that should be avoided in cosmetic plastic surgery is body dysmorphic disorder. (BDD) These patients are virtually impossible to satisfy.  This is known in the older psychiatric literature as dysmorphophobia and is defined as a markedly excessive preoccupation with a very mild or imagined physical defect.   This preoccupation causes significant distress in relation to their ability to work and interact socially. The incidence of BDD is estimated to be about 5% in any given cosmetic surgeons population and the prevalence in the general society is less than 1%.   BDD patients tend to be younger, single and/or separated and unemployed.  They have an increased tendency for anxiety disorder, depression and OCD and they are more likely to believe that surgery will somehow change their life. As obvious as this type of patient sounds to spot, sometimes they are not. I have seen some that are quite eloquent and well read and quite convincing that a little change here or there is all they need. Their obvious BDD, unfortunately, only becomes apparent after surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

I was seeing a postoperative patient recently and ran into a circumstance that is worth talking about. This was a patient who had some facial surgery and had a few cosmetic issues with the result that were going to require some adjustment. Only then did I find out that the urgency of getting the surgery done in the first place was because of a big upcoming event. Now the patient would have to attend this event not looking as good as they would have liked. Most disappointing for all involved for sure.

 
This unfortunate situation speaks to the timing of elective plastic surgery before an important life’s event. How much time should one allow to properly recover? The answer is going to vary a great deal depending upon the type of plastic surgery that one is having. As a general rule, I find that many patients are a bit optimistic about how long it takes to feel or look good but there is one contingency that is never thought about…complications. The uncommon but real possibility that some problem will develop after surgery that delays one’s recovery. While most of the time complications are certainly an inconvenience but they are catastrophic to one’s life. But in the event of an upcoming wedding or oversea trip for example, the stakes are much higher.

For major plastic surgery of the body, such as tummy tucks and large amounts of liposuction, a good window of recovery is a minimum of 6 weeks. More ideally, one should allow for 3 months before embarking on a cruise, overseas trip, or a beach vacation. These operations are harder on the body than one would think and getting back up to speed to enjoy such events takes a good amount of time. Minor complications such as seromas (fluid build-up) or extruding sutures are common after body operations that involve long incisions and they often don’t appear for several weeks to a month or more after surgery. Three months is a good window of time to get past any of these potential problems.

Plastic surgery of the face poses different recovery issues than that of the body. Facial recovery is more about appearance than being physically limiting. Major cosmetic facial surgery such as facelifts, eyelid and browlifts, rhinoplasty (nose jobs), or multiple facial implants cause swelling and facial changes that take time to get used to. Because we are all very aware and sensitive to even the most smallest detail on our face (even though most other people are not), one may not feel that one looks normal for some time. This is a critical concern when there is an upcoming wedding, public speaking commitment, or any event where one will be the center of attention. Facial complications are almost always minor but they affect appearance and never quite get better quick enough. For these reasons, three months of recovery is a minimum for major facial surgery and 6 months is more ideal.

For more ‘minor’ plastic surgery, such as breast augmentations or more limited cosmetic facial surgery, these recovery periods are not needed. I realize that sometimes the desire for plastic surgery is rather impulsive and its consideration can be emotionally exhilarating. But major life’s events may be one-time occurrences, elective plastic surgery can be done anytime.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Now that 2008 is in the books, it would be interesting to look at the trends and statistics in cosmetic surgery and see what has changed…or what is the same. Unfortunately, we will have to wait until the summer when the surveys and statistics for last year are available. However, the numbers from 2007 have been in since last summer and a review of these and the impact from the economic downturn in the U.S. can make for some predictions as to what happened in cosmetic surgery in 2008.

According to the 2007 statistics on cosmetic plastic surgery from the American Society of Aesthetic Plastic Surgery, roughly 12 million cosmetic surgical and non-surgical procedures were performed in the U.S. with expenditures of over $13 billion. I suspect we will see in 2008 that these numbers are roughly the same and perhaps even down a bit. The last quarter of the year saw a dramatic dwindling of patients undergoing procedures although this may have been tempered by the peak of the ‘holiday cosmetic season’ when many plastic surgeons post their highest monthly averages in December due to being being off work and those patients having procedures may have already saved or budgeted for them at that point. While 2007 saw an 8% increase in procedures compared to 2006, 2008 will likely show zero growth.

Cosmetic surgery accounted for 2/3rds ($8 billion) of the expenditures compared to non-surgical procedures (e.g., Botox) but these dollar figures highly skew the number of procedures performed. Because each surgery costs considering more than any non-surgical procedure (often 10 - 20 times more), cosmetic surgical procedures pale in comparison to non-surgical procedures in terms of numbers, roughly 1.5 million (surgery) to over 10 million (non-surgery) procedures. This dramatic trend of increasing non-surgical procedures will likely continue to be seen from 2008, representing by far the largest growth area of cosmetic procedures.

The top five surgical procedures in 2007 were liposuction, breast augmentation, eyelid surgery (blepharoplasty), abdominoplasty (tummy tuck), and breast reduction. (although breast reduction should really be considered a reconstructive plastic surgery procedure as the vast majority are paid for by health insurance) Facelift or rhinoplasty (nose job) should really displace breast reduction from this list. The top five non-surgical procedures in 2007 were Botox, injectable fillers, laser hair removal, microdermabrasion, and light and laser treatments. The popularity of these surgical and non-surgical procedures in 2008 will not change and the types and order of popularity should not change.

Women still account for the vast majority (91%) of cosmetic patients in 2007 and should remain around the same number, making decreasing to 90% in 2008. While it is true that more men than ever are having cosmetic procedures, calling it as jumping on the bandwagon, is a bit overstated. In 2007 men having cosmetic procedures, particularly non-surgical, increased significantly. (up 20%) However I would wager that a large amount of this increase was for one non-surgical cosmetic procedure only…laser hair removal. Go to any facility that has a high volume laser hair removal business and you will find that nearly half of their patients are men…for back hair removal. This one procedure accounts for much of the male cosmetic procedure trend. In 2008 this upward male trend for cosmetic procedures will likely continue, mainly in the non-surgical procedures.

In 2007 the age range with the most cosmetic procedures was 35 to 50, accounting for nearly half of all cosmetic procedures. It is this age range, and the non-surgical procedures that is done in this group, which has accounted for much of the large increase in cosmetic procedures done in the past 10 years. Liposuction and Botox remains the most popular procedures in this age group. The next age range (51 - 64) accounted for a quarter of the procedures (eyelid surgery headed the most common surgical procedure to no surprise) while senior citizens (age 65 or older) had a mere 5 percent. (seniors don’t spend a lot of money on cosmetic procedures due to retirement and fixed incomes) The age range of 19 to 34 rivals the senior group in number of procedures but breast augmentation and laser hair removal dominate the procedures. It is this age range that I suspect will see some drop in 2008 as they are one of the most cost sensitive groups due to their student status and early work force entry) Contrary to many reports of a boom in teenage plastic surgery, teens accounts for only 2% of the number of cosmetic procedures with ear surgery (otoplasty) and laser hair removal being the most popular procedures. Their number hardly represents a boom and that perception is largely media hype. In 2008, these age ranges will likely not have shifted at all as the ability to afford procedures relative to other household expenses is what drives cosmetic procedures for the vast majority of people.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis