Cosmetic surgeons report the latest trends, including the top procedures among today’s men and women.
Word Lisette Hilton Photography Tommy Chung
In this economy, people might be more hesitant to open their wallets and purses. But based on the results of a recent survey conducted by the American Academy of Cosmetic Surgery (AACS), that doesn’t mean they’re not paying attention to how they look. In fact, AACS surgeons in the U.S. reported an eight percent increase in the number of cosmetic procedures they performed on patients between 2008 and 2009, according to the AACS 2009 Procedural Census.
In 2009, AACS members performed an estimated 1.7 million cosmetic surgery procedures—more than double what members reported in 2005.
Trend Spotting
The trend in today’s economy is to have less invasive procedures, according to the survey. From 2008 to 2009, less invasive cosmetic surgery procedures increased by 19 percent compared to a three percent growth for more traditional surgical cosmetic surgery procedures.
Michael J. Will, MD, DDS, FACS, a board-certified oral maxillofacial surgeon and general cosmetic surgeon, says that less invasive is a sign of the times.
“The economy has affected our cosmetic surgery practices—influencing patients to make decisions on maintaining or improving their appearance, with less invasive procedures,” says Dr. Will, an AACS member who practices in Ijamsville, Md.
“Foremost in many patients’ minds today: Minimal downtime and being able to re-integrate into society and the workplace without taking an extended leave of absence.”
Procedures from which patients can recover over a weekend, such as laser-assisted liposuction and fillers, are gaining in popularity, he says.
Heidi Waldorf, MD, a dermatologist, associate clinical professor at Mount Sinai Medical School in New York and the director of laser and cosmetic dermatology at Mount Sinai, New York City, has noticed a clear trend toward noninvasive or minimally invasive rejuvenation procedures. Still, the emphasis on appearance is as strong as ever.
“During the economic downturn, many patients either felt guilty spending or couldn’t spend for large ticket items,” Dr. Waldorf says. “However, I frequently heard people say they needed to look their best because they were in the midst of a job search—both those who had lost their jobs and those coming out of retirement.”
Plastic and reconstructive surgeon Michael S. Kluska, DO, who practices in Greensburg, Pa., acknowledges that the more invasive procedures have taken a hit with the economic downturn but says that he sees the cosmetic pendulum swinging back toward more surgical procedures.
“Because of the ever changing economy, we have also seen cosmetic surgical prices go down and this may be the reason that cosmetic surgery is on the rise again. It has become more accessible to the average person,” Dr. Kluska says.
So, what are today’s top cosmetic procedures? AACS polled member cosmetic surgeons and found the top five invasive and noninvasive procedures in 2009.
The Top Five “Invasive” Procedures
1: Liposuction
Liposuction, also known as liposculpture, leads the way as the most commonly performed surgical procedure among AACS cosmetic surgeons, who performed more than 92,000 fat removal and body contouring procedures on men and women in 2009.
The average price of liposuction, according to cosmetic surgeons nationwide, ranges from $4,243 for traditional liposuction to $4,600 for laser liposuction and $5,750 for water jet liposuction. The average price of traditional liposuction actually decreased by $162 from 2008 to 2009.
The fact that liposuction has been the most popular procedure performed by cosmetic surgeons since 2005 (with the exception of 2006, when sclerotherapy, a procedure that treats varicose and spider veins, edged liposuction in the “invasive” category) comes as no surprise to Dr. Will.
“Liposuction is at the top of the list in my practice,” Dr. Will says. “The aspect of liposuction that is most noteworthy, at this point, is the laser-assisted version. The majority of patients request laser-assisted liposuction because there is less downtime, less bruising, less swelling, less pain.”
2: Blepharoplasty (eyelid lift)
The second most popular invasive procedure among AACS practices in 2009 was blepharoplasty, which surged 132 percent in popularity from 2005 to 2009 (increasing 190 percent among men!). More than 60,500 men and women had the surgical eyelid lift, a procedure aimed at removing excess fat and skin from the upper and lower lids.
AACS members reported an average price tag of $4,341 for blepharoplasty, which is generally an outpatient procedure.
“If you are looking to rejuvenate a focal point on the face and are trying to keep downtime to a minimum, blepharoplasty is a great place to start,” Dr. Will says.
3: Breast augmentation
AACS cosmetic surgeons performed nearly 38,000 breast augmentation surgeries in 2009 (a 7 percent decrease from 2008). According to the AACS report, patients pay an average $5,090 for breast augmentation, which results in larger and shapelier breasts, as well as corrects breast asymmetry and size differences.
The popularity of breast augmentation is nothing new, says Dr. Kluska. “Breast augmentation has been on the rise for the last decade. This progressive increase is most likely due more acceptance of cosmetic surgery in the general population.”
The most common trend in breast augmentation that Dr. Kluska sees is that patients are more comfortable with silicone gel-filled implants. He attributes this to both a higher-quality implant and the successful marketing of the implants by their manufacturers.
4: Facelift
The facelift’s $7,032 average price tag makes it the most costly of invasive procedures, according to the survey. The facelift is also the favorite among older patients, with an average patient age of 54 years.
Last year, more than 34,000 men and women went to AACS members hoping to improve their most visible signs of facial aging on the lower third of the faces.
Dr. Kluska says that the popularity of facelifts is being fueled by today’s younger patients. “I have patients in their 40s requesting the nip and tuck for their face,” he says.
5: Sclerotherapy
While it dropped in popularity by 34 percent from 2008 to 2009, sclerotherapy remains in the top five invasive cosmetic surgery procedures.
A treatment used to get rid of unsightly spider and varicose veins, sclerotherapy significantly increased in price from 2008 to 2009, from an average $504 to $752. Despite the increase, AACS members performed the procedure 25,315 times in the most recent year of the study.
The Top Five “Noninvasive” Procedures
1: Botox
Dr. Will says that Botox’s popularity is part of a larger trend: The trend to intervene earlier in the aging process with subtle improvements and changes. “Using these less invasive tools, you can help ward off, in a sequential fashion, the aging process and affects of gravity over the full lifespan,” he says.
AACS cosmetic surgeons performed 434,552 Botox procedures in 2009, a 157 percent increase from five years earlier. The number one less invasive choice for men and women, Botox comes in at an average price of $420 a treatment—a huge increase from the $130 a treatment it was in 2008. More than 56 percent of Botox patients are between ages 40 and 59. The average age for Botox, which is used to temporarily diminish frown and other deep lines, has increased more than any other less invasive procedure.
2: Fillers
Fillers, used to address volume loss and other facial aging concerns, are gaining popularity, fast. AACS member practices reported doing 302,807 filler procedures in 2009—that’s up 245 percent for men and women since 2005 (550 percent for men only).
The latest average price, according to the AACS report? $708.
Dr. Will is confident that filler use will continue to increase, as manufacturers develop longer lasting options. “Not long ago, hyaluronic acid fillers lasted four to six months. Now they last as long as a year,” he says.
Compared to a facelift, the price tag for fillers, at least in the short term, is more attractive to many who are looking for a quick fix, Dr. Will adds.
3: Chemical peels
Women seem to be making up for the 38 percent reduction in men seeking chemical peels from 2008 to 2009. In 2009, AACS member practices reported performing nearly 163,000 chemical peel procedures. The average price for the procedure has gone down $111 since the year prior to $561 in 2009.
According to Dr. Waldorf, the resurgence in the popularity of chemical peels is a combination of recognizing that not every problem needs a high-tech answer, plus chemical peels tend to be more affordable than other options in facial rejuvenation.
“Although I still use the standard TCA and Jessner peels, I also love the Vitalize peel by Skin Medica,” she says. “It’s a modified Jessner with retinoic acid that is safe for all skin colors all year round. It won’t give the same results as a series of Fraxel Restore Dual, but not everyone needs that level of treatment.”
4: Laser hair removal
Ringing in at number four, laser hair removal procedures at AACS practices topped 151,000 in 2009, a 26 percent decrease from the year prior. AACS surgeons report that they charge an average price of $318 for laser hair removal, which involves using a laser to remove unwanted hair. The procedure is popular especially among the younger set, with an average age of 38.3.
“The technology has gotten better and better as the years go on.,” says Dr. Marco Barusco, MD, who specializes in hair transplants in Maitland, Fla., outside of Orlando. “But there are multiple treatments required, and that can be frustrating for some, and that may explain why procedures are down a bit. Still, it’s the best [hair removal] treatment out there and it’s painless.”
5: Microdermabrasion
AACS cosmetic surgeons reported performing more than 132,000 microdermabrasion procedures in 2009. The lunch-hour facial rejuvenation and scar revision procedure costs an average $137 at member practices.
Overall, microdermabrasion fits in with what Dr. Will calls the buzz phrase in cosmetic surgery today: Less is more.
“The goal would be to re-establish a youthful appearance without resulting in the over-operated or overdone appearance,” he says. “Consumers are looking for the newest, least invasive, and most tested procedures that are affordable and have a proven efficacy.”
Dr. Waldorf warns that consumers should look for clinicians who have experience and training behind them before electing to do even noninvasive procedures.
“Laser hair removal and microdermabrasion have become ubiquitous,” she says.
“They are offered by every aesthetician, salon and doctor’s office regardless of the specialty. I’m concerned about the trend, because my colleagues and I, who are core cosmetic specialists, are seeing the complications when things are done by people without a good understanding of the technology and without supervision by someone with that expertise.”
