WSJ: Plastic Surgery decreased in 2009

Nice summary of 2009 plastic surgery trends in the Wall Street Journal, showing the effect of hard economic times on elective plastic surgery volume.

I've reproduced it, below. I've added some editorial comments in parentheses.

In addition, you can see the latest ASAPS statistics on plastic surgery, by clicking the link here.

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By ANJALI ATHAVALEY, Wall Street Journal

The number of cosmetic-surgery procedures in the U.S. sagged for the second year in a row in 2009, according to an annual survey released Tuesday by a plastic surgeons' association.

There were 10 million surgical and nonsurgical procedures last year, down 2% from 2008, according to a survey of 928 board-certified physicians by the American Society for Aesthetic Plastic Surgery, a Garden Grove, Calif., group of plastic surgeons specializing in cosmetic surgery. (ASAPS is the largest, most important group of cosmetically-oriented plastic surgeons.)

Driving the decline was a 17% drop in surgical procedures, to 1.5 million surgeries. "People just couldn't go for the big items," said Renato Saltz, the association's president.

Tummy tucks, rhinosplasty and other surgical procedures can cost thousands of dollars more than nonsurgical measures, and they require a longer recovery. (But of course, the surgeries do much more than any non-surgical alternative.)

Indeed, fear of job loss is the main reason people are putting off their surgeries, says Phil Haeck, president-elect of the American Society of Plastic Surgeons, a separate group that has yet to release its annual survey. Dr. Haeck, a plastic surgeon in Seattle, said that marks a shift from last year when consumers cited cost as a primary hurdle. This year, "job priority is number one, cosmetic surgery is number two," he said.

Breast augmentation beat out liposuction as the most popular surgical procedure for the second year in a row. Dr. Saltz attributes renewed popularity of breast augmentation to the 2006 Food and Drug Administration decision to lift the ban on cosmetic use of silicone breast implants. Breast augmentations numbered 311,957 last year, down 12% from 2008; liposuctions numbered 283,735, down 17%.

Nonsurgical procedures, such as injections of Botox or hyaluronic acid to fill facial wrinkles, were flat, inching up 0.6% to 8.5 million.

Two surgeries are surging in popularity. Buttock lifts, which involve reshaping of the bottom, increased 25% to 3,024 procedures, and buttock augmentations increased 37%, to 4,996. Increasingly, people want to reshape their rears after losing weight, Dr. Saltz said.

The procedures, costing from $4,000 to $5,000, are fairly new, with both benefiting from recent technique improvements, he added. As the economy recovers, more baby boomers are expected to seek procedures, and more physicians will likely offer nonsurgical options. Surgical procedures have increased by 50% since 1997, while non-surgical procedures grew 231%. Places like health clubs and spas are already offering minimally invasive procedures. (Not recommended!) Cosmetic-surgery associations recommend that consumers seek out procedures that are conducted under the supervision of a board-certified physician.

They should also do research before going overseas for cheaper rates for surgical procedures, which physicians say is a growing trend. "Right now, there is not an association that verifies that the physician is appropriately trained to do what they are doing," said Dr. Haeck. "Very few of the countries where these are being offered have anything that approximates the rigorous boards in the United States." (Canada is one exception - their training standards are equivalent to the U.S.)

Saline Lip Implants

I noticed a new (to me) product at the 2009 ASAPS meeting: a saline-filled lip implant. I kid you not.

Known as VeraFIl, it has actually been FDA approved for about a year. Essentially, it is a tapered tubular implant with a silicone shell and a gore-tex outer coating. A tunnel is made in the substance of the lip under anesthesia, and the device is placed and filled - like some sort of miniature saline breast implant.

Theoretical advantages:
- permanent lip enhancement

Possible problems:
- encapsulation and firmness, with possible distortion of lip
- migration of implant (shifting)
- exposure of implant
- infection of implant
- difficulty of removal, with possible irreversible tissue changes / thinning of lip
- less shaping control than with injectable products
- deflation

We've tried lip implants before, with various companies that made Gore-tex tubes for lip augmentation. They felt, in my opinion, like "shoe leather" inside the lip, and thus were not realistically soft, like a lip should be. I didn't use the product.

I have serious doubts that this generation of lip implants will be significantly different.

The company claims that their new design fixes many of the problems with previous types of lip implants. As you can probably tell, I remain unconvinced.

Time will tell.

ASAPS 2009: new technologies in body contouring

At the recent ASAPS meeting, a number of breakthrough new technologies were presented, as potential alternatives / improvements on the standard liposuction technique. Bear in mind that most of these wonder gadgets are still in the developmental phase, and do not yet have FDA approval.

But some of the before & after photos looked pretty exciting! Definitely something to watch for over the next few years!

The techniques presented included:

Focused external ultrasound for fat reduction: "Liposonix", "UltraShape"
Radio-frequency assisted liposuction: "BodyTite"
Water-assisted liposuction: "BodyJet" - which is FDA approved.

The BodyTite before and afters seemed to show some clinically significant skin shrinkage effects. Their built-in skin temperature monitoring system may offer a better degree of protection and higher effectiveness than competiting laser lipo machines. But the UltraShape and Liposonix machines have the advantage of being external, non-surgical treatments with minimal "downtime", even though the results are more subtle than traditional liposuction surgery.

It's too early to tell which horse will win this race....

Best new concept at ASAPS 2009 - Revance therapeutics

Sounds like science fiction, right? - a wrinkle-fighter that works without needles...

One of the coolest products in development that I heard about at the ASAPS meeting belongs to a company called Revance therapeutics, based in Palo Alto, California. They seem to be the first ones to have cracked the problem of getting large molecules into the skin. Usually, large molecules can not be absorbed transdermally, so relatively few medications can be compounded in a gel or patch formula.

While there are countless applications for this drug-delivery technology, their first commercial application using this technology is with botulinum toxin (aka Botox), creating a gel that you put on the surface of the skin, in the area of the animation wrinkles, and presto! - you get the expected Botox-like relaxation effect - no needles involved.

It's still in clinical testing, and is not yet FDA approved, but the presentation I saw of their phase I results for wrinkles in the lateral canthal (crow's feet) area were impressive. The stuff works! Applying the gel in the armpit area also works to reduce excessive sweating, again without the multiple injections we currently use.

Besides working for Botox, the same technology could be applied to a number of other drugs. Imagine, for example, using this idea with insulin - diabetics wouldn't need to use needles.

This could be a real game changer, folks.

The 2009 Aesthetic Meeting

The most important educational meeting for aesthetic plastic surgeons, in my opinion, is the ASAPS annual meeting. It's happening next week - and yours truly will be there. We'll hear "what's hot", "what's new" and "what's not working". All of the "major league" players of aesthetic plastic surgery will be there, discussing the best ways to do facelifts, rhinoplasty, eyelid surgery, breast surgery, body lifts, as well as fillers, peels and lasers. A huge vendor display area allows attendees to see many new products as well.

My favorite sessions are the panels, where experts - often with conflicting opinions - debate the merits of their particular approach.

I'll be taking my notebook with me - and should have plenty of hot & juicy plastic surgery news to blog about!