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Table 1. 
Cost Outcomes of Facial Plastic Surgery Survey Demographics*
Cost Outcomes of Facial Plastic Surgery Survey Demographics*
Table 2. 
Geographic US Trends in Cosmetic Facial Plastic Surgery Procedure
Frequency and Cost for 1999 and 1989*
Geographic US Trends in Cosmetic Facial Plastic Surgery Procedure Frequency and Cost for 1999 and 1989*
Table 3. 
Temporal Trends in Cosmetic Facial Plastic Surgery Procedure
Frequency and Cost*
Temporal Trends in Cosmetic Facial Plastic Surgery Procedure Frequency and Cost*
Table 4. 
Predictors of Increased Cosmetic Facial Plastic Surgery Procedure
Frequency in 1999*
Predictors of Increased Cosmetic Facial Plastic Surgery Procedure Frequency in 1999*
1.
Krieger  LMShaw  WW The effect of increased plastic surgeon supply on fees for aesthetic surgery: an economic analysis Plast Reconstr Surg. 1999;104559- 563Article
2.
Krieger  LMShaw  WW Aesthetic surgery economics: lessons from corporate boardrooms to plastic surgery practices Plast Reconstr Surg. 2000;1051205- 1210Article
3.
Krieger  LMShaw  WW Pricing strategy for aesthetic surgery: economic analysis of a resident clinic's change in fees Plast Reconstr Surg. 1999;103695- 700Article
4.
ALSARRAF  R Outcomes research in facial plastic surgery: a review and new directions Aesthetic Plast Surg. 2000;24192- 197Article
5.
Alsarraf  RLarrabee  WF  Jr Outcomes research in facial plastic surgery Arch Facial Plast Surg. 2001;37Article
6.
Wilkins  EGLowery  JCSmith  DJ  Jr Outcomes research: a primer for plastic surgeons Ann Plast Surg. 1996;371- 11Article
Citations 0
Original Article
January 2001

Cost Outcomes of Facial Plastic SurgeryRegional and Temporal Trends

Author Affiliations

From the Hedgewood Surgical Center, New Orleans, La (Drs Alsarraf and Johnson); and the Larrabee Center for Facial Plastic Surgery, Seattle, Wash (Dr Larrabee).

 

From the Hedgewood Surgical Center, New Orleans, La (Drs Alsarraf and Johnson); and the Larrabee Center for Facial Plastic Surgery, Seattle, Wash (Dr Larrabee).

Arch Facial Plast Surg. 2001;3(1):44-47. doi:
Abstract

Objective  To describe the geographic and temporal trends in cosmetic facial plastic surgery procedure costs and frequency during the last decade and to evaluate factors that may influence changes in the demand for cosmetic procedures.

Methods  A survey sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (ie, face-lift, brow lift, blepharoplasty, and rhinopasty) for 1999 and 1989.

Results  The annual frequency of the aging-face procedures (ie, face-lift, brow lift, and blepharoplasty) have increased 41% over the last decade while rhinoplasties have declined slightly (18%). Each of the procedures studied have increased in cost since 1989; however, only face-lifts have increased at a rate greater than inflation during this period (average surgeon's fees, $3154-$4582). Although the average cost of each of these procedures is stable across US geographic areas, there seem to be fewer aging-face procedures being performed in the East (represented largely by New England and the northeastern states) compared with the Midwest, South, and West (P≤.03), while rhinoplasty frequency across these regions is essentially unchanged. In addition to variables such as age, years in practice, and degree of marketing, the strongest correlates with increased cosmetic procedure frequency were the costs of these procedures (P≤.008).

Conclusions  Although the cost and frequency of cosmetic facial plastic surgery procedures continues to rise across the United States, there are interesting differences in these trends between different regions and procedure type during the last decade. There also seems to be an association between increased cost and increased frequency of these cosmetic procedures.

COST OUTCOMES of cosmetic plastic surgery procedures have been a focus of several recent studies given the unique nature of cosmetic procedures compared with other insurance-based procedures.1-3 Krieger and Shaw2 have argued that cosmetic procedures, unlike other areas of health care, can be analyzed by traditional economic methods and should react in traditional ways to market forces. For this reason, measurement of the supply, demand, and pricing of cosmetic facial plastic surgery procedures may allow one to determine the economic relationships of these important factors as well as any significant predictors of increased productivity or demand.

Although there has been this recent impetus within general plastic surgery to evaluate and understand the economic forces at play in the realm of cosmetic plastic surgery, to our knowledge, there are no current studies in facial plastic surgery that attempt to analyze these important economic issues. Measuring cost outcomes is also an integral component of outcomes research in general and we, as well as others, have suggested that increased effort is needed to evaluate the outcomes of facial plastic surgery procedures in a more rigorous and comprehensive manner.4-6 Cost outcomes as much as procedure outcomes (or effectiveness) will be an important part of any cost-effectiveness evaluation in the future. In addition, there is clearly anecdotal evidence that certain procedures (eg, the aging-face procedures) have been increasing in frequency, while others (eg, rhinoplasty) have been declining in recent years, but there is little population-based data in the literature to support these anecdotes.

The goal of this study was, thus, to provide a starting point for the evaluation of the cost outcomes of facial plastic surgery by describing the temporal and geographic trends in cosmetic facial plastic surgery procedure costs and frequency during the last decade. This article reports these trends in an effort to supply the facial plastic surgery community with data that may encourage further study of these issues of economic importance to us all.

MATERIALS AND METHODS

A survey was mailed to every active member of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), including fellows, members, and associates (N = 1727). Members were queried as to the surgeon's fees, total patient charges, and annual frequency of 4 common cosmetic facial plastic surgery procedures for both 1999 and 1989: face-lift, brow lift, blepharoplasty, and rhinoplasty. A total of 264 surveys (15.3%) were returned and included in this study.

Analysis was conducted using the SPSS (Statistical Package for the Social Sciences; SPSS, Chicago, Ill) computer software program. Demographic variables, procedure frequency, and cost data were evaluated for the 2 periods surveyed as well as based on 4 US geographic regions (East [represented largely by New England and the northeastern states], South, Midwest, and West) to assess significant trends. Statistical significance was analyzed using independent and paired t tests where appropriate, and significance levels are provided in the tables.

RESULTS

The study population was relatively homogeneous, with most respondents being male and approximately 46 years old, with an average of almost 15 years in practice (Table 1). Most respondents (81.1%) work in private practice and about half (45.5%) had completed AAFPRS fellowship training. Although there was a wide range for the cosmetic nature of each practice, the average respondent's practice was approximately 40% cosmetic in nature. Most of those surveyed used some form of marketing (69.3%); however, this represented only a small fraction (5.1%) of most respondents' annual overhead. Most AAFPRS members (53.8%) in this study, as asked by our survey, felt that there is a current surplus of facial plastic surgeons in their given community, in addition to plastic surgeons in general. This perception of excess surgeons was present for most respondents in all 4 US regions studied except the Midwest, where most respondents (61.5%) felt that there was no such excess.

There was significant geographic variation noted in procedure frequency for both periods analyzed. Specifically, the East was found to have significantly lower annual rates of face-lifts (11.7 vs 24.7), brow lifts (7.6 vs 18.2), and blepharoplasty (19.5 vs 39.8) when compared with the West (Table 2). In contrast, respondents from the West, Midwest, and South reported similar frequencies of these aging-face procedures for both 1999 and 1989 (Table 2). Costs, measured as both surgeon's fees and total patient charges, were not significantly different across all 4 regions. Unlike the aging-face procedures, rhinoplasties were equally as frequent in the East (35.5 vs 35.1) compared with the West and, again, costs were essentially unchanged.

Comparing the results from 1989 and 1999 revealed a significant increase in the aging-face procedure frequency (P≤.004) in contrast with an actual slight decline in rhinoplasties during this same period (44.0-36.0) (Table 3). Although a relatively high percentage of our study population had completed AAFPRS fellowship training (45%), there was no difference in these trends comparing fellowship-trained and nonfellowship-trained respondents, with aging-face procedures significantly increased in frequency and rhinoplasty frequency declined for both groups during the last decade. Costs for all procedures increased from 1989 to 1999 (average total charges, $3545-$4670). After correcting for inflation to 1989 dollars, however, only face-lift costs (both surgeon's fees and total charges) increased at a rate greater than inflation during the last decade.

The demographic variables surveyed were also assessed for any association with increased procedure demand as measured by increased annual procedure frequency. Age, years in practice, and the percentage of overhead spent on marketing were all weakly correlated with increasing cosmetic procedure frequency (Table 4). The strongest correlates with this increased frequency were found to be both the surgeon's fees and total charges for these respective procedures. For instance, increasing surgeon's fees for face-lifts were strongly correlated with increasing annual face-lift number (r = 0.47, P<.001). Further analysis of this relationship by multiple regression analysis was beyond the scope of this article, but will be presented in a separate publication.

COMMENT

Cosmetic facial plastic surgery procedures are free from many of the confounding factors of health care economics since most are out-of-pocket expenses for the patient without third-party involvement. As others have argued, measuring cost outcomes of cosmetic procedures thus may allow one to analyze trends in pricing, supply, and demand using routine economic methods.2

This study found that, since 1989, there has been a 41% increase in aging-face procedures, while rhinoplasties have generally declined by 18%. The East did not show the similar increase in procedure frequency that was found in the West, Midwest, and South. Costs for each of these procedures have increased at about the rate of inflation during this period, with only face-lift costs increasing above this inflationary rate. There has long been anecdotal evidence that US trends during the last few decades have been away from rhinoplasty procedures while aging-face concerns continue to increase. This, in part, is due to the aging US population. In addition, however, there seems to be increased acceptance in most communities of aging-face cosmetic procedures as more Americans undergo these procedures with increasingly successful results. It is unclear if these trends will continue as the baby-boomer generation continues to age; however, this study does confirm this general trend for most regions of the country.

Analysis of variables associated with increased procedure frequency revealed that the strongest associated variables, other than factors such as age or marketing, were the cost outcomes represented by surgeon's fees and total patient charges. As each of these factors increased, the annual number of most cosmetic facial plastic surgery procedures increased as well, a relationship that will be further evaluated in a future study.

The main limitation of this study is the low response rate (15.3%) from those AAFPRS members surveyed. Unfortunately, given the sometimes sensitive nature of price issues, this poor response may have been unavoidable. Those members who did respond, however, represented a good sampling of the AAFPRS community, with a wide range of procedure types (eg, 0%-100% cosmetic), frequency (eg, 0-275 reported face-lifts per year), and cost (eg, face-lift surgeon's fees, $1750-$12 500). Fortunately, with 264 respondents, we were able to perform most statistical analyses without limitations of study number and with enough statistical power to show statistically signficant differences.

Although this study did not measure changes in (surgeon) supply during this period, our study is also limited by not accounting for the presence of other, nonfacial plastic surgery alternatives in the community, such as general plastic surgeons, dermatologists, and oculoplastic surgeons. It is unclear if the presence of these other specialities has affected the regional and temporal trends that are reported herein, but such an evaluation is beyond the scope of our AAFPRS survey. The relationship between variables such as price and demand, however, is not dependent on an understanding of changes in supply, and our analysis describes a unique increase in demand that seems to occur with increased price for cosmetic procedures. Patients who undergo cosmetic facial plastic surgery are certainly able to choose between various treatment options and surgical practices. The patient may have other options to choose from (eg, a general plastic surgeon rather than a facial plastic surgeon), and these options may affect the annual frequency of procedures as measured in our study. In any case, an analysis of the relationship between specific variables within the AAFPRS community itself provides a starting point for understanding the economic factors at play in cosmetic plastic surgery as a whole.

An evaluation of the factors that may be associated with the cost and frequency of cosmetic facial plastic surgery procedures relies on an understanding of the basic geographic and temporal trends of these procedures as a starting point. From this foundation one may analyze these trends with regard to specific predictors of increased demand, correlation with demographic variables of interest, or in the context of general or economic US societal attitudes. The demand for cosmetic plastic surgery procedures is clearly tied to the social perspective of a given time and place. Future studies that attempt to analyze economic outcomes in facial plastic surgery should not overlook these important regional and temporal differences.

CONCLUSIONS

The annual frequency of all of the aging-face procedures (ie, face-lift, brow lift, and blepharoplasty) have increased over the last decade while rhinoplasties have declined slightly. Each of the procedures studied have increased in cost since 1989; however, only face-lifts have increased at a rate greater than inflation during this period. Although the average cost of each of these procedures is stable across US geographic areas, there seem to be fewer aging-face procedures being performed in the East compared with the Midwest, South, and West while rhinoplasty frequency across these regions is essentially unchanged. In addition to variables such as age, years in practice, and degree of marketing, the strongest correlates with increased cosmetic procedure frequency were the costs of these procedures.

Although the cost and frequency of cosmetic facial plastic surgery procedures seem to be continuing to rise across the United States, there are interesting differences in these trends between different regions and procedure type during the last decade. Additionally, there seems to be an association of increased prices with increased procedure frequency. There should be greater efforts on our part as AAFPRS members to describe, assess, and understand these important trends in the cost outcomes of facial plastic surgery procedures, if we hope to better understand the economic factors that may predict increased demand and future productivity.

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Article Information

Accepted for publication September 10, 2000.

Corresponding author: Ramsey Alsarraf, MD, MPH, Hedgewood Surgical Center, 2427 St Charles Ave, New Orleans, LA 70130 (e-mail: ralsarraf@earthlink.net).

References
1.
Krieger  LMShaw  WW The effect of increased plastic surgeon supply on fees for aesthetic surgery: an economic analysis Plast Reconstr Surg. 1999;104559- 563Article
2.
Krieger  LMShaw  WW Aesthetic surgery economics: lessons from corporate boardrooms to plastic surgery practices Plast Reconstr Surg. 2000;1051205- 1210Article
3.
Krieger  LMShaw  WW Pricing strategy for aesthetic surgery: economic analysis of a resident clinic's change in fees Plast Reconstr Surg. 1999;103695- 700Article
4.
ALSARRAF  R Outcomes research in facial plastic surgery: a review and new directions Aesthetic Plast Surg. 2000;24192- 197Article
5.
Alsarraf  RLarrabee  WF  Jr Outcomes research in facial plastic surgery Arch Facial Plast Surg. 2001;37Article
6.
Wilkins  EGLowery  JCSmith  DJ  Jr Outcomes research: a primer for plastic surgeons Ann Plast Surg. 1996;371- 11Article
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