Apparently personal vanity trumps financial concerns during economic hard times. While most Americans and businesses are downsizing and belt-tightening these days over job losses and real estate disasters, the aesthetic surgery sector has experienced a comparatively modest turndown of business.

New statistics from the American Society for Aesthetic Plastic Surgery (ASAPS; New York) show that this sector of healthcare isn't suffering as badly as one might assume. While overall U.S. markets have suffered a 30% to 40% downturn, ASAPS reported this week a 12% decline in the total number of cosmetic procedures in 2008.

"The economic downturn won't change our concerns about our appearances," ASAPS president Alan Gold, MD, told Medical Device Daily. "In fact, current economic pressures mean people will stay in the workforce longer and not be able to retire as early as they like. They may find themselves competing where there are many displaced younger individuals competing for those same spots. They won't want to be subjected to anti-agism perspectives that some employers may have, depending on how tired or old they look."

Gold said that while some individual cosmetic surgery practices have been more adversely affected, he expected to see a more significant overall decrease when ASAPS did its annual survey of board-certified plastic surgeons, dermatologists and otolaryngologists.

"We have seen an adverse affect on our practices before with other economic downturns such as the dot-com crash and 9/11. It will likely be the same kind of rebound effect we've seen before," he said. "But what we see is different from other industries. There is a deferral of demand, not a loss of opportunity. For example, the car manufacturers will be sitting with 2007 to 2009 cars on the lot. When they roll out 2010 cars that are greener and more economical, they are going to find the previous models are a loss. With elective cosmetic surgery, people will just defer their decisions to do something like their eyes until later. There is no lost opportunity that won't be recaptured."

More than 10.2 million cosmetic surgical and nonsurgical procedures were performed in the U.S. in 2008. One of the most interesting trends to note is that, for the first time in 12 years, breast augmentation became the most popular procedure, with liposuction falling to the runner-up spot.

"They both decreased, but liposuction has decreased more and breast augmentation has increased to a greater degree because the FDA last year put silicone implants back on the market," Gold said. "There were still people who were not totally comfortable with the safety of breast augmentation. With the FDA vetting it and releasing it back on market, it gave people greater confidence in the safety of silicone. We're also seeing more older patients having breast augmentation in conjunction with breast lifts. It's the post-partum patient who is looking at tightening her belly and lifting her breasts after the child bearing years are over."

Despite the somewhat positive news from ASAPS, device makers who cater to this group of physicians are likely to still feel a big pinch right now and in the near future.

"In this economy, plastic surgeons are looking to cut back on capital expenditures, so the ability to sell a $150,000 laser or some new technology that's costly has to be balanced against the desire for the public to come in for such treatments at this point," Gold said.

"If I were a manufacturer, I might even change my plans for an introduction of such devices until the economy turns around. I wouldn't buy anything right now, especially laser- or light-based technologies," he said. "These technologies change every six months with newer generations of older models. You are going to find the marketplace for the purchase of these devices slowed considerably."

Other key trends from the survey include:

– Americans spent almost $12 billion on cosmetic procedures, with $7.2 billion going to surgical procedures and $4.6 billion for nonsurgical procedures.

– Price doesn't seem to be a factor in the movement of breast augmentation to the top spot, even though it's more expensive than liposuction, which is now the second-most-popular procedure. On average a liposuction procedure costs $2,900, while breast augmentation costs an average $3,744.

– The top five surgical cosmetic procedures were breast augmentation (355,671 procedures), liposuction (341,144 procedures), eyelid surgery (195,104 procedures), rhinoplasty (152,434 procedures) and abdominoplasty (147,392 procedures).

– The top five nonsurgical cosmetic procedures were Botox injection (2,464,123 procedures), laser hair removal (1,280,964 procedures), hyaluronic acid (1,262,848 procedures), chemical peel (591,808 procedures) and laser skin resurfacing (570,880 procedures).

– Women remain the primary consumers of aesthetics surgery. They had more than 9.3 million cosmetic procedures in 2008, making up almost 92% of all procedures with a decrease of 11%.

– The number of men who had aesthetic procedures decreased by a much bigger clip: 21%. They had more than 800,000 cosmetic procedures, mostly liposuction, rhinoplasty, eyelid surgery, breast reduction to treat enlarged male breasts and hair transplantation, in that order of popularity.

– Baby boomers are the most frequent plastic surgery patients. People age 35-50 made up 45% of the total number of procedures.

– Racial and ethnic minorities accounted for 20% of all cosmetic procedures in 2008. Hispanics led minority racial and ethnic groups in the number of procedures: Hispanics, 8%, African-Americans, 6%, Asians, 4% and other non-Caucasians, 2%.

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