A 5-Year Study of Aesthetic Surgery Providers in Southern California

Abstract

INTRODUCTION: Over the last decade, there has been a surge in the number of non-plastic surgeons performing aesthetic procedures. This has raised concerns regarding issues of patient safety and competition between plastic surgeons and non-surgically trained providers. To better elucidate plastic surgeons’ presence in the medical aesthetic field, this study examined the trend of providers who offer minimally invasive and invasive cosmetic treatments in the Southern California region. METHODS: A 70,860 square mile area encompassing the Los Angeles and San Diego megalopolis was studied. Providers of minimally invasive aesthetic procedures in the Southern California area were catalogued using the sales from the manufacturers of hyaluronic acid fillers. Liposuction treatments were used as a marker of invasive aesthetic procedures; corresponding providers of liposuction were compiled from various websites and internet search engines. The board certification and training background of each provider was detailed. A five-year trend was studied using data comparisons from August 2009 and August 2014. RESULTS: From 2009 to 2014, the number of providers offering minimally invasive injectables increased from 2,472 to 3,362 (a 36.0% increase) (Figure 1). Of these, plastic surgery providers comprised 29.1% of the providers in 2009 and 26.8% in 2014. Non-plastic surgeon providers increased by 40.5%, comprising 70.8% in 2009 to 73.2% of providers in 2014. In this 5-year period, dermatologists composed the second largest group of providers of cosmetic injectables (20.5% in 2014) and primary care physicians composed the third largest group (19.9% in 2014). The number of providers practicing liposuction increased from 1,160 to 1,324 (a 14.1% increase) during this study period. Non-plastic surgery-trained providers increased by 38.9%, surpassing the growth of plastic surgery providers (2.5%). Plastic surgeons comprised 68.1% of liposuction providers in 2009 and 61.2% in 2014. The number of non-surgical providers increased from a prevalence of 12.6% in 2009 to 17.1% in 2014 (a 55.5% increase).Figure 1: Providers of minimally invasive procedures.Providers of minimally invasive procedures increased by 36% during the 5-year study period with growth in all 3 groups of providers. Although there was an overall 25% increase of plastic surgeons providing minimally invasive procedures, this group made up 29% of providers in 2009, but decreased to 26% of the providers in 2014. Plastic surgeons made up a smaller composition of the total number of practitioners. In contrast, the 51% increase in the overall number of non-core physicians was statistically significant and composition of providers increased from 34% to 38%. Providers of invasive aesthetic procedures increased by 14% during the 5-year study period. There was a 2.5% increase of plastic surgeons providing these operations, who made up 68% of providers in 2009, which decreased to 61% in 2014. Plastic surgeons now comprised a smaller percentage of the providers (Figure 2).Figure 2: Providers of invasive aesthetic procedures.In contrast, the 55% increase in the number of practitioners not trained in surgery was statistically significant and their composition of providers increased from 11% to 16%. Providers of non-plastic surgery specialties, especially those with no surgical training, now make up a larger percentage. CONCLUSIONS: This study revealed a substantial number and steady growth of non-plastic surgeons performing both minimally invasive and invasive aesthetic procedures. The significant growth in non-plastic surgeon providers may suggest that using injectables opens the gateway to practicing more invasive procedures. Plastic surgeons must continue to educate patients that board certification in plastic surgery is critical, especially when they are seeking invasive treatments. For all these reasons, the unification of plastic surgeons is of utmost importance. A lack of strong front-line resistance against infiltration tactics has the potential for plastic surgeons to lose footing in their own specialty.