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

Introduction

Over the last decade, there has been a surge in the number of non-plastic surgeons performing aesthetic procedures. This has raised concern 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 internet search engines. The board certification and training background of each provider was categorized. 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% increase). 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. 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% (from 370 to 514), surpassing the growth of plastic surgery providers (2.5%, from 790 to 810). Plastic surgeons comprised 68% of liposuction providers in 2009 and 61.2% in 2014. The number of otolaryngologists, dermatologists and primary care physicians together increased from 22.6% of aesthetic surgery providers in 2009 to 27.0% in 2014.

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 these 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. The unification of plastic surgeons is paramount as lack of a strong front-line resistance against infiltration tactics has the potential for plastic surgeons to lose footing in their own specialty.