Inside the Plastic Surgery Boom

Industry Trends Plastic Surgery

By: Natalie Hope McDonald | Contributing Editor

Published: 1/20/2022

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Increased demand from patients and physicians investing in innovative care will continue to grow the billion-dollar outpatient market.


Two decades ago, most plastic surgeries were performed in hospitals. Patients, even those who underwent minimally invasive procedures, were usually required to stay at least overnight with additional recovery time at home. This was before the plastics market went mainstream, before celebrities made it chic and before social media apps such as TikTok and Instagram promised better living through Botox. 

Coupled with advances in technology — computer-aided imaging, alloplastic materials and even the potential for gene therapy — the plastics market has radically transformed to make surgery not only easier and safer for patients, but also more lucrative for facilities.

By 2026, the plastic/cosmetic surgery market is expected to have an estimated worth of almost $70 billion with annual out-of-pocket patient expenditures on even the most minimally invasive procedures exceeding $8 billion in the U.S. alone.

However, the future wasn’t always so bright for this skyrocketing service line. Fifteen years ago, opening a freestanding plastic surgery center was a risky proposition. There were plenty of legitimate questions: Would there be enough patients to support the facility? Would it be able to invest in the latest technology? How many elective procedures would it take to turn a profit?

Today, as cosmetic procedures surge in popularity and minimally invasive procedures represent a rapidly expanding revenue stream, outpatient plastic surgery centers have become the norm. While many are physician-owned, there are plenty of others that are affiliated with hospitals and major health systems. How these facilities will evolve will ultimately be determined, in part, by the mainstream acceptance of plastic and cosmetic surgery, and whether it continues to grow among a wider, much more diverse demographic.

Popular procedures during the pandemic

COVID-19 temporarily put the brakes on elective procedures and caused caseloads (and revenue) to plummet for the bulk of 2020, but the “Zoom Boom” made plastic surgery an exception. Increasing numbers of patients who grew tired of looking at themselves during hours of virtual meetings sought treatment to correct perceived flaws in their appearance. According to the American Society of Plastic Surgeons, the most popular procedures performed in 2020 were eyelid surgeries, face lifts, rhinoplasties, liposuction and breast augmentations. The most requested non-invasive procedures were Botox injections, laser skin resurfacing, chemical peels, light therapy and soft tissue fillers.

Since 2015, more than 90% of these procedures have been performed on an outpatient basis, either in a surgical center or office-based setting. As the wider culture recognizes the benefits of being able to tuck, lift and reshape, more patients than ever are considering having less-invasive procedures performed, including the newest laser skin resurfacing and intense pulsed light (IPL) treatments.

Michael H. Wojtanowski, MD, FACS, a plastic surgeon who runs the office-based Ohio Clinic for Aesthetic and Plastic Surgery in Westlake, has worked in the industry for more than 40 years. Dr. Wojtanowski says he’s seen it evolve, particularly when it comes to the lessening stigma over procedures such as facelifts and neck lifts. “The interest in Botox, fillers and skin care has increased exponentially,” says Dr. Wojtanowski. “I’ve been busier now than I’ve ever been.”

He attributes the increased demand to more people using videoconferencing apps, resulting in them spending much more time looking at their own faces on screens. “Many patients say to me that they never really noticed they had long earlobes, a double chin or bags under their eyes,” says Dr. Wojtanowski. “It’s created a self-awareness at a level that they didn’t have before.”

And while it took a while before patients began coming back into his clinic after it was closed to elective surgeries, facial cosmetics have once again become a very big business as more patients seem to be spending the money they saved during the pandemic on elective procedures. Today, plastic surgery is less of a luxury than it once was or, as Dr. Wojtanowski puts it, “It’s not just for the rich and famous.”

The role of technology

NOTABLE EXCEPTION While most service lines saw their caseloads plummet during the pandemic, many plastic surgery facilities experienced a boost in volume.  |  Michael Wojtanowski

He offers both surgical and non-surgical treatments, the most typical being facelifts and facial fat injections to smooth wrinkles, as well as eye, neck and breast lifts, tummy tucks, breast augmentations (including male breast reductions), liposuctions, ear pinnings and rhinoplasties. Newer, non-invasive treatments have also been growing in popularity, such as a fat-freezing procedure, a non-invasive radio-frequency skin treatment, injectables, fillers and paramedical skin care.

“All of these are outpatient procedures,” explains Dr. Wojtanowski. “Technology has allowed that to happen. We have better anesthesia machines, better drugs and better techniques that have allowed patients to undergo surgery with far less recovery time.”

He credits technological innovations for creating a surge in plastics’ popularity, especially among new patients. For example, ablative and non-ablative lasers are being used to vaporize the top layer of skin or work deeper under the skin. These lasers can be used to treat fine lines and wrinkles, acne scars and age spots, or simply to tighten skin. But with basic laser machines costing between $20,000 and $250,000, facilities and surgeons need to perform enough procedures to justify the investment.

Dr. Wojtanowski says patients who begin with non-surgical procedures such as laser treatments and Botox often become surgical patients over time. “That has helped to really grow the business,” he says.

We have better anesthesia machines, better drugs and better techniques that have allowed patients to undergo surgery with far less recovery time.
— Michael H. Wojtanowski, MD, FACS

To stay on top of the specialty’s latest advances, Dr. Wojtanowski seeds profit into his own ongoing education by attending conferences and learning new techniques. He also invests in new machines and solutions that make sense for his demographic. The operating costs for an outpatient surgical center specializing in cosmetic surgery ultimately must be offset by the procedures themselves, especially with the platforms needed to perform new treatments such as the fat-freezing procedure costing six figures and up.

“It’s a formidable investment,” admits Dr. Wojtanowski. “I’m a cautious investor. I’ve seen many treatments come and go. When they were brand new, they were hot. It was a while before I even did Botox.”

He says owning the facility in which he operates is a definite advantage that allows him to control how it evolves. “It’s an expensive investment up front,” he explains, “but it’s the best investment I’ve ever made.”

 

Essential care escalates

CHANGING NARRATIVE Plastic surgery used to be seen as a luxury only afforded to extremely rich and famous patients, but that stigma has gradually eroded over time.

At the Healing Hands of Nebraska Clinic in Norfolk, the focus is on peripheral nerve surgery, allergy and ENT treatments, and reconstructive procedures. Demetrio J. Aguila III, MD, FACS, an ENT, reconstructive and plastic surgeon and the clinic’s founder, says patients also undergo cosmetic procedures related to nasal airway surgeries, scar revisions and other facial reconstructions.

Each of the procedures is done in an outpatient setting where it’s not unusual for Dr. Aguila to work on skin flaps or even perform a rhinoplasty. “Patients come in because they have some kind of visual defect that they would like fixed,” he says.

In terms of demographics, the patients who undergo scar revisions tend to skew younger, while individuals seeking rhinoplasties tend to be over 40. Eyelid lifts are usually performed on patients who are 60 years old and up. “Historically, the procedure is more common among women than men,” he says, “but over the last year it’s been a mix — two-thirds women and one-third men.”

Most of the clinic’s focus is on reconstructions designed to repair a deformity of some kind. For instance, trauma to the nose could impact breathing, while other patients might want to repair skin that’s been affected by skin cancer and subsequent surgery. 

The COVID-19 pandemic certainly created some challenges for the clinic’s reconstructive patients, but as restrictions eased across the country Dr. Aguila was able to operate again — performing everything from burn and wound care to migraine treatments and craniofacial procedures.

Although some of Dr. Aguila’s patients will delay surgery if they feel that they can do so, many come to him in some sort of pain to discuss treatment options, making his work different from elective cosmetic surgery. 

When he’s not in the operating room, Dr. Aguila spends a good deal of his time researching the newest technologies. For instance, he’s recently added ultrasound scanning tech, which is an effective way to visualize soft tissue structures.

Because most of the reconstructive work Dr. Aguila does involves soft tissue, having a more effective imaging modality available can make a big difference in terms of time spent operating and the accuracy of the procedures. 

Ultimately, he’s always looking for less invasive ways to treat patients, which can mean making bigger upfront investments in newer solutions. Dr. Aguila is also seeing a resurgence in cosmetic and reconstructive surgery cases, even as the pandemic continues to rage on. “People have, in some instances, delayed care,” he says. “A lot has to do with where a surgery is being done.” 

That creates an inherent advantage for outpatient clinics, he says, especially for patients who want to have procedures performed while avoiding hospitals and inpatient stays out of fears about COVID-19.

Just recently, one of Dr. Aguila’s patients who was scheduled to have a rhinoplasty in a hospital decided to have it done at his outpatient clinic. He performed the surgery under local anesthesia within just a few hours. “Before the pandemic,” he says, “I would have never considered doing the procedure without heavy sedation.” OSM

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