The Price of Looking Good in the Credit Crunch: An Expert Interview With Sherell J. Aston, MD, FACS

Pippa Wysong


August 17, 2009

Editor's Note:

According to the 2008 national procedural statistics report from the American Society of Plastic Surgeons (ASPS), cosmetic surgeons have been feeling the effects of the recession. In 2008, surgical numbers dropped 9% and minimally invasive numbers rose 5%. However, some surgeons report there are signs of an upward swing. Medscape's Pippa Wysong spoke to Sherrell J. Aston, MD, FACS, who is optimistic that cosmetic surgeons will soon see an improvement. Dr. Aston is director and chairman of the department of plastic surgery at Manhattan Eye, Ear, and Throat Hospital in New York. He is also a professor of plastic surgery at the New York University School of Medicine, and is certified by the American Board of Surgery and the American Board of Plastic Surgery.

Medscape: Data from the ASPS suggest that the demand for cosmetic surgery decreased from the start of the recession. Are things are on the upswing now?

Dr. Aston: Yes. The national statistics for 2009 will not be available for a year, but we can look at the published statistics for last year, and know where we were at the end of 2008. According to the American Society for Aesthetic Plastic Surgery (ASAPS), there was about a 12% decrease in 2008 for total cosmetic procedures (both surgical and nonsurgical). There was a 15% decrease in surgical procedures alone.

But, if you look at the Dow Jones Industrial Average at the end of 2008, it was down about 34% from its high in 2007. Looking at the economy globally, which had pretty much stalled, a decrease in cosmetic procedures of 12% overall is a pretty small decrease in comparison. Yes, it is down; but, by the same token, it's a significantly better number than just about all other parameters by which you would measure the economy.

Medscape: Interesting.

Dr. Aston: In my office, we've recently seen plastic surgery surgical volume and calls by new patients for appointments come back significantly. I don't know if the economy of the country is improving as a whole. But in New York the apparent barometers of what people are spending money on -- cosmetic surgery, the best restaurants, and Broadway -- seem to have turned the corner from January, February, March, when things were significantly depressed.

Medscape: Has there been a change in demand for certain procedures?

Dr. Aston: The less-invasive procedures, such as injectables, increased significantly in the past decade as they hit the market. In the past 10 years, surgical procedures increased about 80%, but nonsurgical procedures -- such as injectables -- increased about 230%. Many patients now realize that the less-invasive procedures, such as injectables, are more expensive over time. Some fillers and injectables last only 3- 6 months.

Medscape: This trend of people switching from injectable to surgical treatments -- is that just in your clinic or is that from national data?

Dr. Aston: I don't think ASAPS data answer that. My impression is that people are now thinking about the long-term financial cost to them in terms of getting injectables vs surgery. It will be interesting when the 2009 statistics come out a year from now. I suspect we'll see the surgical procedures have increased with a drop-off in the fillers.

Medscape: What are the sociodemographics of those getting cosmetic surgery?

Dr. Aston: According to the ASAPS statistics, about 80% of people having cosmetic surgery are white, 8% are Hispanic, 6% are black, and 4% are Asian. In the past decade, there has been a significant increase in the number of men having cosmetic surgery. Plus, we see people from a wide variety of financial categories, from those who are quite wealthy, to those who are struggling. We are also treating a number of people who use credit companies that cater specifically to cosmetic surgery patients; for example, CareCredit®.

Medscape: Could you expand on accessibility of cosmetic procedures to the less well-off?

Dr. Aston: The CareCredit® approach is one way. For people who can get to a teaching hospital setting, there are many plastic surgery clinics where plastic surgery residents or fellows perform the surgery, at a lower cost. Of course, their work is under the supervision of one of the attending surgeons.

Medscape: Over the past 15-20 years there's been an increase in minimally invasive procedures, improved technology, improved anesthesia, and so one that contribute to shorter surgical times, and shorter recovery. Has this affected the cost of procedures?

Dr. Aston: Let's start with what "less-invasive procedure" means. A less-invasive procedure usually means a procedure that's done with a smaller incision. Consider the example of the forehead lift to reposition the eyebrows. The traditional procedure includes an incision across the top of the head from 1 ear to the other. The forehead tissue is turned down over the face, and the muscles on the forehead are operated on. The forehead is repositioned, and excess tissue excised before it is sutured back together.

Today, the majority of the forehead lifts are performed using an endoscope under the skin. This less invasive procedure takes a little longer than the traditional surgery, and it's a very meticulous procedure that requires a totally different skill set for the surgeon.

It's less invasive, there's less swelling when you do the procedure, and patients are left with a smaller scar. Because the procedure takes just as long and requires just as much sophisticated surgery, I think the price is about the same as it was, or is, for the traditional procedure. It's not cheaper than it was 10 years ago.

It's a similar story with the 'minimally invasive facelift.' Some patients get a 'short incision,' and the procedure done under the skin is pretty sophisticated. It's like building a ship in a bottle.

Now, that procedure is not applicable to all patients having facelifts. Some undergo a short incision facelift, while others require the bigger incision, depending on their anatomy and features. Minimally invasive or less-invasive procedures are not appropriate for everybody.

Medscape: Going back to the recession topic. What can the plastic surgeons do to help their business survive during tighter times?

Dr. Aston: Most business comes from word of mouth. The quality of the care, how patients are treated in the office, and your results affect business and what patients say about you. During all their visits, patients need to feel they are treated with respect, and that they are getting high quality service and great results.

I would suggest expanding your business. It seems to me many plastic surgeons are riding out the storm by doing more reconstructive surgical procedures. Some New York surgeons tell me they had forgotten that they felt good doing reconstructive procedures -- but they had let them go for financial reasons. It'll be interesting to see if, when the economy improves, the surgeons cease performing reconstructive procedures. I suspect many will continue doing reconstructive procedures along with their elective cosmetic surgery. In addition, you can do more fillers and injectables.

Medscape: Have plastic surgeons been hit hard by the recession?

Dr. Aston: I've heard about some surgeons leaving their offices because their income wouldn't let them support their staff or pay rent. But I'm not aware of any official numbers on this.

Medscape: Well, generally it sounds like things are picking up again.

Dr. Aston: It appears so.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.