News Special: Latest Statistics in Cosmetic Surgery

The number of procedures performed and recorded by cosmetic surgeons has been declining for the last two years,1,2 however the annual audit conducted by the British Association of Aesthetic Plastic Surgeons (BAAPS) indicates that the number of treatments carried out in 2018 has seen a small increase of 0.1% compared to 2017, in addition to the rise in non-surgical treatments.3 The statistics released indicate that 28,347 surgical procedures took place in 2018, a small uplift of 32 surgeries from the previous year.4 The most notable rise was in liposuction procedures, with a 12% increase in women having this procedure compared to 2017. Surgical browlifts saw the biggest decline, now at an all-time low, with just 383 procedures being performed in 2018 compared to 2,138 in 2013 when the treatment was at its peak.4 Consultant plastic surgeon and former BAAPS president, Mr Rajiv Grover, who compiles the statistics each year, says, “The 2018 BAAPS audit shows that demand for cosmetic surgery remains buoyant, despite a year when the high street has struggled.5 While demand for non-surgical treatments such as fillers and skin tightening is rising,3 it’s important to note that, once there is actual loose skin, only surgery is likely to make a significant long-term improvement.” Aesthetics interviews consultant plastic surgeon and BAAPS member Mr Ali Juma and aesthetic practitioner Dr Vincent Wong about their thoughts on the results, examining some of the potential influences behind the key variations in statistics. What’s stopped the decrease? “I would postulate that the very small increase in the BAAPS cosmetic surgery figures is multi-factorial,” shares Mr Juma. “The report shows a very small increase against a difficult and uncertain economy, particularly with the ambiguity around Brexit, as well as competition from independent companies and overseas providers. However, I believe that BAAPS members have managed to buck the trend and maintain the share of a difficult market by being able and visible to those seeking their expertise to achieve the highest of outcomes. All of this has been achieved against a tough economy and strong competition with much bigger spending power,” he explains. Dr Wong agrees that the figures reflect a more educated and accepting market, “I think surgical procedures are much more acceptable and readily available these days. The fear of looking ‘frozen’ or ‘overdone’ is slowing decreasing too, primarily down to the expertise of those performing the treatments. We all know that the nonsurgical specialty has been a factor in the previous drops in statistics and the lack of regulation has been highlighted in recent news. I think patients are slowly becoming more and more aware of this too, even though we are not quite 0 there yet, it’s definitely a step in the right direction.” Mr Juma highlights, “Although the rise of non-surgical procedures

The Latest Statistics in plays a significant part, surgery may be the only option for some patients and there is definitely less of a stigma around surgery Cosmetic Surgery these days.” A drop in browlifts Aesthetics reviews the data released from the BAAPS From 2009, when BAAPS released the annual audit and highlights some of the most results of its first ever annual audit, this particular procedure saw a steady increase notable changes during 2018 until 2015. However, from then on, browlifts dropped significantly. It was reported that there was a 71% decrease in 2016, a 27% decrease in 2017 and now a further 14% drop, with just 383 browlift procedures performed in 2018, compared to 2,138 in 2013 when the treatment was at its most popular (Figure 1). Both Mr Juma and Dr Wong believe that this significant decrease is primarily due to the growth in popularity and recognition that botulinum toxin, dermal filler and thread treatments can work for both preventative and corrective measures. “I see patients in their 30s requesting non-surgical browlifts on a regular basis in my practice, when very minimal signs of ageing are starting to appear. The good thing about offering these types of treatments is that they’re really subtle,” says Dr Wong. Mr Juma echoes, “Here we are talking about a significant decline in this procedure. Patients nowadays tend to be more inclined to have treatments that allow them to walk out of a clinic with no telltale signs that they have undergone treatment and continue their day. When carried out by a medical expert, non-surgical treatments can achieve excellent results in correctly-selected patients, although the outcomes do not have the longevity of surgery. However, patients simply find it more convenient and the minimal to no scarring, with almost no down time, are certain attractions.” A rise in liposuction The biggest increase in treatments amongst women was liposuction, up 12% from the previous year and 9% for both men and women combined, something which Mr Juma found to be particularly interesting. He says, “I would have thought the number of liposuction procedures would have stayed the same or seen a very small increase due to the volume of non-surgical body contouring devices on the market, which don’t need to be 2,500 2,000 1,500 1,000 500 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Figure 1: The rise and fall in surgical browlift procedures

administered by a medical professional.” Dr Wong suggests that this spike may be due to the popularity in athleisure, the fashion trend which sees workout clothing worn in other settings. In 2017, the athleisure market was worth £2.5 billion and the trend is predicted to increase by 22.6% by 2020.6 He comments, “We know already that social media and reality TV shows could be playing a part in the rise of these types of procedures, however I believe that fashion is also having an influence more so than ever before. It’s never been so trendy to wear sportswear and people think that you have to have an athletic body to look good in it.” Dr Wong adds, “Generally, the results from non-surgical body-contouring devices can be fairly slow and can become expensive due to needing repeat sessions, which is why patients may be turning to liposuction.” Mr Juma agrees that needing repeat sessions could be a contributing factor, “The statistics show us that many people are looking for more than what the current devices can manage. In the majority of surgical cases, a patient has one treatment, the results are visible immediately and they continue to improve for up to six months.” The practitioners also agree that surgery should never be portrayed as the ‘easier’ option. Mr Grover emphasises the risks around the procedures, adding, “The danger of cosmetic surgery becoming too closely linked to reality TV or celebrity endorsement is that it can make surgery seem like a commodity, which should never be the case. An operation is not something that can simply be returned to the shop if you have second thoughts.” Working in tandem Both Mr Juma and Dr Wong recognise that the gap between nonsurgical and surgical treatments is now closer than ever and agree that it is one of the many ways that the industry is evolving. Dr Wong says, “I work with a surgeon in my practice and it’s a great partnership. There is absolutely space for both categories; it’s just about finding what is right for the patient.” Mr Juma concludes, “I’m hoping that we will see an increase in the non-surgical treatments performed by BAAPS members and that in due course we will see official audit reports around the two areas working in harmony. This will, of course, take time but would be a great step forward for our specialty.”

REFERENCES

1. Gronow C, Cosmetics Surgey’s Decline in 2016, Aesthetics journal, March 2017, <https:// aestheticsjournal.com/feature/cosmetic-surgery-s-decline-in-2016> 2. Cooke K, The Decline in Cosmetic Surgery – a healthier perception or a struggling economy?

Aesthetics journal, March 2018 < https://aestheticsjournal.com/feature/the-decline-in-cosmeticsurgery-a-healthier-perception-or-a-struggling-economy> 3. American Society for Aesthetic Plastic Surgery, 2018 Trends, 2018 <https://www.surgery.org/sites/ default/files/ASAPS-Stats2018-Trends.pdf> 4. BAAPS, Cosmetic surgery stats: number of surgeries remains stable amid calls for greater regulation of quick fix solutioins, May 2019 <https://baaps.org.uk/media/press_releases/1708/cosmetic_surgery_ stats_number_of_surgeries_remains_stable_amid_calls_for_greater_regulation_of_quick_fix_ solutions> 5. BBC News, What went wrong on the high street in 2018?, December 2018 < https://www.bbc.co.uk/ news/business-46646990> 6. Growth Funders, The growth of athleisure, July 2018 <https://blog.growthfunders.com/the-growth-ofathleisure>

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