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Cost Outcomes of Facial Plastic Surgery
Regional and Temporal Trends
Ramsey Alsarraf, MD, MPH;
Wayne F. Larrabee, Jr, MD;
Calvin M. Johnson, Jr, MD
Arch Facial Plast Surg. 2001;3:44-47.
ABSTRACT
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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.
INTRODUCTION
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.
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Table 1. Cost Outcomes of Facial Plastic Surgery Survey Demographics*
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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.
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Table 2. Geographic US Trends in Cosmetic Facial Plastic Surgery Procedure
Frequency and Cost for 1999 and 1989*
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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.
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Table 3. Temporal Trends in Cosmetic Facial Plastic Surgery Procedure
Frequency and Cost*
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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.
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Table 4. Predictors of Increased Cosmetic Facial Plastic Surgery Procedure
Frequency in 1999*
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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.
AUTHOR 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{at}earthlink.net).
From the Hedgewood Surgical Center, New Orleans, La (Drs Alsarraf and
Johnson); and the Larrabee Center for Facial Plastic Surgery, Seattle, Wash
(Dr Larrabee).
REFERENCES
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1. Krieger LM, Shaw WW. The effect of increased plastic surgeon supply on fees for aesthetic
surgery: an economic analysis. Plast Reconstr Surg. 1999;104: 559-563.
2. Krieger LM, Shaw WW. Aesthetic surgery economics: lessons from corporate boardrooms to plastic
surgery practices. Plast Reconstr Surg. 2000;105:1205-1210.
PUBMED
3. Krieger LM, Shaw WW. Pricing strategy for aesthetic surgery: economic analysis of a resident
clinic's change in fees. Plast Reconstr Surg. 1999;103:695-700.
PUBMED
4. Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg. 2000;24:192-197.
PUBMED
5. Alsarraf R, Larrabee WF Jr. Outcomes research in facial plastic surgery. Arch Facial Plast Surg. 2001;3:7.
FREE FULL TEXT
6. Wilkins EG, Lowery JC, Smith DJ Jr. Outcomes research: a primer for plastic surgeons. Ann Plast Surg. 1996;37:1-11.
ISI
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