S04E70 Exploring Rising Trends in Aesthetic Plastic Surgery

Ever wondered what's behind the sudden surge in aesthetic services? Brace yourselves as the Three Plastic Surgeons and a Microphone Podcast take you on a journey through the latest trends in aesthetic plastic surgery!

Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, and Dr. Sam Rhee @bergencosmetic analyze intriguing data from the Aesthetic Society that indicates a 14% rise in aesthetic procedures but interestingly, a whopping 23% increase in non-surgical treatments at the expense of surgical procedures, which dropped by 12%. We'll ponder on what triggered this switch. Could it be the pandemic? Or perhaps, the current economic climate?

But that's not all! We venture into the future and analyze if there will be a continuing surge non-surgical procedures. Tune in as we dissect the role of manufacturers in this trend, and what it means for both society and patients. More importantly, we underscore our duty as healthcare providers in shaping informed decisions for our patients and optimizing their recovery. As professionals with firsthand experiences, we promise a conversation that marries real-life encounters and professional insights to give you a comprehensive understanding of the changing landscape of aesthetic plastic surgery. You don't want to miss this.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S04E70 Exploring Rising Trends in Aesthetic Plastic Surgery

[00:00:00] Dr. Sam Rhee: All right. Hello, and welcome to another episode of Three Plastic Surgeons and a Microphone. I am here joined as always by my esteemed colleagues, Dr. Salvatore Pacella from La Jolla, California, and also Dr. Sam Jejurikar from Dallas, Texas, and I am Dr. Sam Rhee from Paramus, New Jersey. And we are going to go through the latest statistics from Aesthetic the Aesthetic Society for

[00:00:39] Dr. Sam Jejurikar: What's that? You mean the Aesthetic Society? All

[00:00:45] Dr. Sam Rhee: 50, over 50 years have gone beyond just being board certified with over 3, 000 members spanning the goal, the globe. The Aesthetic Society is at the frontier of innovation in aesthetic plastic surgery, or so they say. And, uh, they basically compiled, uh, using the ANN, ANN, Aesthetic Neural Network data. They partnered with, uh, Ronin Solutions to come up with

[00:01:13] Dr. Sam Jejurikar: all right, all right, you're losing us in the weeds here.

[00:01:15] Dr. Sam Rhee: Okay, so basically there are a bunch of statistics from last year, uh, of the past year compiled looking at aesthetic plastic surgery, and they have come up with a number of key findings, which we'll go through, which I think are very interesting.

Um, and uh, we can discuss that. So Sal, Sal, if you want to go through the disclaimer and we can get going.

[00:01:34] Dr. Salvatore Pacella: Alright. This show is not a substitute for professional medical advice, diagnosis, or treatment. This shows for informational purposes only. Treatment and results may vary based upon the circumstances situation of medical judgment after appropriate discussion. Always seek the advice of your surgeon or other health qualified health provider with any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in the show.

[00:01:56] Dr. Sam Jejurikar: Yes, so, okay, so the Aesthetic Society for our listeners. It's a series of board certified plastic surgeons who specialize in aesthetic surgery. So it's beyond just being a board certified plastic surgeon, it's demonstrating a certain number of cases and then actually getting letters of recommendation to become a member.

And I think we're all members, right? All of us are members of the Aesthetic Society and it's a really useful society to us. I think, at least for me, and I think you guys would probably agree, within plastic surgery, it is the... It's the society that I tend to find the most interesting stuff related to my practice.

And so, um, what they do, like Sam was saying, is they basically pull them, they pull a certain number of the practices and they find out what are the most common procedures that were done. And they come up with these statistics every year. And it's interesting to look at these statistics on a year to year basis to get an idea of what's happening in the U.

S. just

[00:02:47] Dr. Salvatore Pacella: up.

[00:02:47] Dr. Sam Jejurikar: trends. And so in 2022, the data just came out in the last couple of weeks. They showed that the total number of aesthetic procedures had increased about 14 percent from the year before, but interestingly, that rise is predominantly in non surgical treatments, which had gone up about 23%, and then surgical treatments had actually gone down 12%.

Um, So I'm curious, they explain why that happens, but before you guys actually read the details, I can see Dr. Pacella is studying it and reading it right now. Um, why do you think it went down? Um, just out of curiosity. So what, what was it like, have you noticed in your practice that last year, 2022, was a slow surgical year?

I bet you're going to say that the answer is probably no, you didn't notice that was the case. So what, what do you guys think? Why do you think surgical procedures would have gone down from the year before?

[00:03:35] Dr. Salvatore Pacella: Well, I think a couple reasons, Sam. I think, um, number one, we're not really in the best economy right now. Um, and that's particularly evident with interest rates, right? So, um, as you may know that the feds are continuing to raise interest rates with the intention of stopping inflation or curbing inflation.

[00:03:58] Dr. Sam Jejurikar: That's predominantly a 2023 phenomena, right? So, but this is actually, I'll just, I'll, I'll cut, I'll cut to the chase.

[00:04:04] Dr. Salvatore Pacella: 22. Custom

[00:04:05] Dr. Sam Jejurikar: for 2022, they basically said that in 2021, because of the pandemic and the tail end of the pandemic, everyone was just sitting around getting plastic surgery and the numbers were so high in 20, you know, particularly in the beginning

[00:04:17] Dr. Salvatore Pacella: Jejurikar, Rhee,

[00:04:18] Dr. Sam Jejurikar: of 2021, There was an invariable drop back down to sort of pre pandemic levels.

It's still above what it was before the pandemic. So that's why I think 2023, though, in terms of what you're saying, will definitely show an even bigger drop. Um,

[00:04:33] Dr. Salvatore Pacella: Jejurikar. That was another point I was going to make as far as disposable income, you know. People, I think were sort of not going on vacation, not going out to eat, at the tail end of the pandemic, they had perhaps, uh, more resources and used that for plastic surgery.

[00:04:49] Dr. Sam Jejurikar: now, um, hopefully you guys haven't studied the list too much, but, um, they list what the top five procedures, surgical procedures were. What would you? Guys, think that they were, and does it match what you see in your own practice? Or are you guys staring at the list right now?

[00:05:04] Dr. Sam Rhee: I already peeked at it, so I'm

[00:05:06] Dr. Sam Jejurikar: Okay.

[00:05:06] Dr. Salvatore Pacella: the list.

[00:05:07] Dr. Sam Jejurikar: Alright, well the list, uh, I mean, does this surprise you?

The number one operation is liposuction, number two is breast aug, number three is tummy tuck, and then, uh, the fourth and fifth ones are breast lifts and breast implants for replacement. None of them are facial procedures, which I know, um, It doesn't really match Pacella's, um, you know, uh, procedure logs so much because I know you do a lot of noses and faces and, and all that, but is this, are these some of the most common procedures you guys are seeing?

[00:05:39] Dr. Salvatore Pacella: Yeah. I think, you know, when, when you look at liposuction, you know, liposuction is, um, a procedure that's not usually a standalone procedure. You're doing something at the same time, either tummy tuck, b b l, breast lift, et cetera. So it, it's not surprising that the, um, you know, this would be counted.

Probably as a multiple add-on procedure. So that, that kind of explains that for me. I think.

[00:06:03] Dr. Sam Jejurikar: Yeah.

[00:06:04] Dr. Sam Rhee: are my top five procedures. Personally, I, I mean, I do more liposuction and tummy tuck work, uh, than anything else in my practice. Same with breast augmentation and breast lift. I will be su and surprisingly, I am a little surprised that breast implant removal or replacement, uh, made the top five.

But, it that is also one of the big things, for some reason, that I do as well. So, I am surprised and not surprised. I'm surprised that my practice mix mirrors they have, uh, shown as their top five.

[00:06:40] Dr. Sam Jejurikar: I mean, these, these are all basically components of what we call mommy makeovers, right? I mean, to some various degree, they basically just deconstructed a mommy makeover. And, um, and these are the, um, you know, kind of the top five procedures. You know, I will say I do a lot of standalone liposuction as well, but I also do it in combination with other procedures.

So, I would, I would agree that when I'm doing a tummy tuck, there's always liposuction. Many times I'm doing a tummy tuck, there's a breast lift or a breast aug, removal and replacement. So, yeah, these all, these are all very much. Interlinked. The other thing that was interesting was the, the demographic breakdown in terms of men and women.

Um, did you, have you guys seen this statistic? Do you, what? Okay. So it's 95 percent of plastic surgery, uh, plastic surgery is done on women. And apparently 5 percent for men. Is that kind of what you guys see in your own practice?

[00:07:35] Dr. Salvatore Pacella: I, I would say so, yes.

[00:07:38] Dr. Sam Rhee: I mean, I see about 95. 5. Uh, you know, I think for the non surgical treatments, I would say the demo is skewing with more, like I'm seeing more males probably over the past five or six years than I had before. I think Botox and, and fillers are starting to become more popular with men. But, you know, if you look at the top men procedures that they listed, like gynecomastia, liposuction, bleph, rhinoplasty, like, yeah, there's still a fraction of what the women in terms of my patient demographics are, for sure.

[00:08:13] Dr. Sam Jejurikar: What was interesting was that the fifth most common procedure for men, seeing how we're talking about their procedures is actually tummy tucks. Um, and then when I think back and reflect on the number of male tummy tucks that I have done over the last two or three years, it's a surprisingly high numbers. Um, how, how, you know, and I think again, it just reflects that inner population as people are losing more and more weight. The men are obviously not having children, but whether it's bariatric surgery, whether it's diet and exercise, whether it's some of the new GLP 1 agonist medications like semaglutide and serozepatide and all that stuff, um, we're seeing more and more men with, with lax skin who are getting tummy tucks. I can't say I do a male tummy tuck every week, but I probably do one every month.

[00:08:59] Dr. Sam Rhee: What,

[00:08:59] Dr. Salvatore Pacella: You know, it's a,

[00:09:00] Dr. Sam Rhee: Go ahead.

[00:09:00] Dr. Salvatore Pacella: go ahead. Um, so, you know, it's interesting, uh, they have a specific, under GU surgery, they have a specific, um, category for transgender surgery, and I, I don't remember this being a category in the 2020 to 2019 area. Um, and, you know, it's surprising that that went down, actually. I think that's only on the up and up, and, and then I'm curious as to, do they indicate As to if a patient had a transgender surgery, do they count that as a male or female surgery?

You know, and that it's not a small number of patients. It's 19, 1900, I think it listed in the, um, in the cat.

[00:09:40] Dr. Sam Rhee: Yeah, I think, I'm not sure, but, I mean, they listed undergenital urinary surgery, so I assume these are all bottom surgeries. And I would say that it's really... A specialty that not, is practiced widely amongst all surgeons, like, I don't know, I mean, I haven't done genitourinary transgender surgery since residency, I think, so, I mean, I don't know.

[00:10:06] Dr. Sam Jejurikar: Yeah, I don't think

[00:10:07] Dr. Salvatore Pacella: you read, did you read that as the, as Only transgender GU surgery? Or, I, I, cause I, I read that as, maybe I mistakenly read that as all transgender surgery, and then they just put it in that category.

[00:10:23] Dr. Sam Jejurikar: I

[00:10:24] Dr. Salvatore Pacella: I don't know.

[00:10:25] Dr. Sam Rhee: I mean, I've done tops, I do a fair amount of top surgery, so I don't know, like, I would think it would be much higher than what they listed, it was only like, 1, 600 or so procedures listed, so I don't know.

[00:10:38] Dr. Sam Jejurikar: yeah. I mean, I do some as well, but, um, yeah, I don't think, I think they would, I guess my guess is they would probably list it as the gender that the patient identifies with. Gender that they may have been biologically born with.

[00:10:52] Dr. Sam Rhee: You know what blows me away is the face, if you look under face, neck, brow procedures, the biggest increase is in thread lift, 72 percent increase, which is ridiculous. I mean, what do you guys make of that from

[00:11:06] Dr. Sam Jejurikar: I don't, I, so I don't think it's ridiculous at all. I think, I think it shows the trend in, in society. Because, you know, we, we recently did a podcast on facelifts for instance, right, and one of the things that we talk about during our podcast on facelifts is the recovery time that is associated with it and how people are going to look bruised, battered, and swollen and socially unacceptable for a long period. And I think one of the biggest take home messages of this list, which I was, you know, we haven't gotten to yet, but now's a great time to transition to, is how much more prevalent non surgical treatments are. I mean, you look at 40 percent of all non surgical treatments done are some sort of toxin, like whether it's Botox or a competitor, um, skin treatments, you know, peels, hydrafacials were next.

Fillers were next. I mean, the demand for these procedures, I mean, plastic surgeons make up just a very small component of the people doing it, whether it is other doctors, you know, whether it's the core specialties, like dermatology or oculoplastics, you know, you, you know, um, Facial plastics, whether it's nurse injectors, whether it's non core specialty injectors.

This stuff is being done all over the place because people are trying to find a way to particularly rejuvenate themselves from the neck on up with minimal downtime. I think threadlifts are very temporary in terms of the results. But I think they achieve in a short term goal what people want. So, if people are okay with a result that's gonna last them months, and I do Botox, it'll last them three months, you know, why not go to someone that's gonna do a thread lift and just know they're gonna have to do it repeatedly? Sam doesn't like that. No.

[00:12:46] Dr. Sam Rhee: I mean, I, I just feel like a lot of these non surgical procedures. are a lot of flash and not that much substance. Like, I mean, some of them are okay. Like if you look at body contouring, I understand why something like Cool Sculpt or some of these other, uh, non invasive, um, removal type of procedures are popular, but we've all seen what kind of results, even the best looking results that people will publish are.

We also have talked some about some of the potential complications for these things. And, you know, Botox and Juvederm will only get you so far in terms of your quest for rejuvenation or aesthetic improvement. So I think, you know, as surgeons, I look at that and I say, listen, these are all sort of entry level. types of procedures that people are starting to try to do. But at some point, if you really want to make a substantial change in terms of your appearance or rejuvenative sort of, uh, quest, you know, these are not, you know, these are not going to hold a lot of people for a long period of time. And I don't have a problem with them.

I do them all the time. It's just. Um, I, I feel like people will eventually seek greater enhancement at some point.

[00:14:12] Dr. Sam Jejurikar: What do you think, Sal?

[00:14:15] Dr. Salvatore Pacella: I think a lot of this is obviously related to cost, right? Um, you know, cost and recovery. So I think those are the two biggest Disadvantages for patients who undergo plastic surgery and the cost, I think, is primarily. I mean, like, you think about the cost of a thread lift being done by an RN injector in the office.

That's going to be a fraction of the cost of me doing a brow lift, right? And so that, that, that hones into a lot of people.

[00:14:44] Dr. Sam Jejurikar: I think, um, I think certainly cost is part of it, but I also think recovery is part of it as well, and this notion that non invasive treatments may actually delay the need for a surgical procedure. Because I think I believe in some of these non surgical treatments maybe a little bit more than you guys do.

I think radiofrequency... You know, radiofrequency microneedling, I think, can have a huge benefit in, in skin elasticity and maybe delaying the need for a facelift. Um, whether it's things like FaceTight, you know, which I, which I think can do a lot for, for tightening the, the neck and jowl line area, I think it can be really beneficial and delay the need for facial procedures.

Um, I think, um, you know, I think, I think there's more and more exciting treatments that I'm not going to claim are the equivalent of surgery. Of course not. They're not, but if done earlier on for patients before they technically might need a facelift, it can delay and potentially, as technology keeps getting better, even prevent the need for a bigger operation. And I think we're seeing that in terms of the trends, right? I mean, no facial. Surgical procedure for women made their, made the top five, um, and where I think if you were to go back 10 years ago, that probably wouldn't have been the case. So

[00:16:01] Dr. Salvatore Pacella: That, that statistic was very surprising for me.

[00:16:04] Dr. Sam Rhee: I mean, I think if you, if you were to look at the future of aesthetic services, you're right. I mean, if you look at energy and other services, that includes the non invasive stuff, chemical peels, body contouring, infusions, microneedling, combo lasers. Uh, Sclerotherapy, other energy and esthetician services.

That grew 25%. Like that is huge. I mean, when you look at the number of surgical procedures versus the number of non surgical procedures and the growth you're seeing on that, that side. And I think a lot of it is driven by the manufacturers. They're coming out with tons of devices. They're pushing a lot of these, uh, new services.

Some of, and we'll see how it plays out. Some of it might be awesome. Some of it not so awesome. But you're right. I mean. If you were an economist or if you were looking to be a medical device investor, this is probably where the money is probably in the future.

[00:17:02] Dr. Sam Jejurikar: yeah, I mean, we don't like this trend in some ways, let's just be honest, because we love doing facial cosmetic surgery. Every single one of us, they're probably our favorite operations to do. Not a lot of people can do these operations, right?

[00:17:17] Dr. Sam Rhee: Only a few.

[00:17:18] Dr. Salvatore Pacella: True

[00:17:19] Dr. Sam Jejurikar: not a lot of people can do them. And so it's nice to be in this, in this, um.

In this select group of people to do, to do these operations that, that we love to do, but we also have to be careful to not be those grumpy old men that are like, you know, sitting, sitting outside yelling at the kids to get off our lawn because only, only our way, you know, it's ultimately like, this is here, this is exploded.

There is benefits to it. Um, and yeah, sometimes it's done poorly, but sometimes it's done quite well. And so, you know, society, the societal trends really don't lie. And that's why these statistics are so valuable.

[00:17:55] Dr. Sam Rhee: I think some of this is, is that if we do believe that doing some of these procedures are worthwhile, that especially the younger generation, as they continue to age and get older, we have to show the benefits and. Really continue to improve the risk profile, continue to improve the recovery and downtime profile for these, these procedures.

I feel like we haven't done as good of a job sort of talking about, um, optimizing patients recovery from a lot of these procedures. And if we can do a better job with that, um, I think, I think we'll be all right in the future. I think, like you said, this is something that not a ton of people do. It's, uh, to do well requires a high degree of skill and experience and listen, no one's going to cry poverty for us as, uh, plastic surgeons.

But I think one of the things ASPS or, or some of our societal type of organizations aesthetic society should be doing is sort of highlighting some of this, like that, you know, listen, there is going to be a market for this sooner or later as, as our target population continue or demographic continues to age and get older.

These younger patients, and they should have more information about, about what it is that we can do properly

[00:19:17] Dr. Sam Jejurikar: I guess I'm not sure what you mean by that. Well, when you say what we can do properly about what?

[00:19:22] Dr. Sam Rhee: about some of these changes. So, for example, I mean, I know one of the more popular procedures I've had for younger patients has been buccal fat excision, right? Or maybe just like a, a neck or chin lipo. And once they've actually sort of undergone that, and maybe they didn't, they didn't pick up this information from... Uh, Aesthetic Society or, um, ASPS. They picked it up from TikTok, okay? You know, from some sort of media influencer. But once they actually went through this and got the procedure done, they realized, wow, this is pretty quick. The recovery was pretty good. I didn't have a problem. Like, it was less scary to them than what they had thought surgery was going to be.

And I think that that's something that... Uh, you know, I don't want to make light of surgery, but on the other hand, I also want to show that maybe thread lifts are not going to be the answer for you if you actually compare everything and, and, and look at it.

[00:20:23] Dr. Sam Jejurikar: I mean, I think, I think, um, um, I think, can we keep coming back to threadlifts? I've actually, I don't do threadlifts, but I work with estheticians that do do them. There's a role for them for an event and a minimal downtime recovery. You know, that's, that's the role of the threadlift. If you're looking for long lasting results.

That's not what it is. None of us would claim that's what it is. But I think, you know, there's, and that's the thing, like, some people market it honestly, some people don't. But, um, but yeah, you know, ultimately, plastic surgeons, we're not the ones that set or determine societal trends. You know, that ship has sailed.

It's social media, it's generations that are younger. Then, then, you know, the ones doing the operation, but you know, it's up to us to educate people about the long term consequences of their decisions, what the recovery might be like and so on and so forth and whether or not to feasible, but I've, that's why I find these statistics so interesting though, because ultimately you see what society is, has decided was what's important to them and what's not important to them.

And then as plastic surgeons, we, we see if that makes sense to us.

[00:21:31] Dr. Salvatore Pacella: You know, so an interesting, um, interesting factoid, um, you know, I, I sit on the board of directors of the research side of the Aesthetic Society. It's called the, uh, ASERF, the Aesthetic Surgery Research and Education Foundation. And you know, these, these statistics are taken exceptionally seriously. They do a really good job of reaching out to Aesthetic Society members, um, validating the answers, making sure this is legitimate data.

And so, you know, these are, these are key.

[00:22:04] Dr. Sam Jejurikar: Yeah, were there any other observations that you guys wanted to highlight? That's, those are sort of the key things that I have gotten out of the whole thing. I'm not sure if there's anything else you guys thought was worth highlighting.

[00:22:19] Dr. Sam Rhee: No, I, it, it, they're really interesting. I think all plastic surgeons should take a look at it. Um, I think they could sort of look at their own practice demographics and their geographic location and sort of see if this. is in concert with some of these trends that we're sort of seeing here. And, um, and I think that, uh, there's no doubt that the pandemic sort of gave all of us a turbo charge in terms of our procedure counts, uh, but the way the economy is going and the way things have in terms of disposable income, as Sal said, some of the, uh, you know, uh, changes that we've seen economically, like we may, Never see that kind of peak that we saw, uh, post COVID as, uh, as we did, uh, in the past.

[00:23:13] Dr. Sam Jejurikar: Well, gentlemen, as always, it was a pleasure, and I hope you guys enjoy the rest. Thanks for listening, everyone.