Medical Spas & Cosmetic Crimes

From our friends over at Healthy Aging Magazine, an article that may or may not surprise you......

Depending on what statistics you read, tight economic times can either produce crime increases or decreases. However, a particularly peculiar variety of crime seems to be increasing these days—vanity crimes.

No, I’m not talking about the crime of going too big on your lip plumper or stripping 20 years off your skin when 10 would look more natural. I’m talking about people ripping off the dermatologists and plastic surgeons they’ve gone to for aesthetic procedures. 

A newspaper in Florida reported recently on several cosmetic crime cases:

• A woman came in for Botox and fillers totaling $3,300 then pulled a dine and dash. When she walked out of the office to visit an ATM to get the money, she bolted and never returned. Although she declined the before and after pictures, the office captured her on security video.

• A women received a $9,000 breast augmentation and tried to pay for it with a stolen credit card.

• A Fort Lauderdale women was charged with using a stolen credit card to pay for a tummy tuck.

• In a similar case, a Des Moines woman was accused of identity theft when she used a credit card to pay for over $6,000 in cosmetic surgery. She took out the credit card in her estranged husband’s name—probably not a good way to win him back.

An article on MSNBC cites Botox bandits Newport Beach, CA; Port St. Lucie, FL; Tampa, FL; Brisbane, Australia and Kenton, England. Jeff Karzman from the American Academy of Cosmetic Surgery states that it's a problem happening "coast to coast."

Dallas plastic surgeon Rod Rohrich, MD, says he's having patients pre-pay for procedures to prevent what he calls "runners." Many medical spas have turned to an up-front payment system. 

Is smoother skin or a slimmer figure really worth a crime? How many months or years in the slammer would you do for a breast job or Brazilian butt lift? What should practice owners do to protect themselves against this kind of thing? Post security guards? Perform preemptive credit and background checks? Charge for procedures up front? If charge up front, should that apply to all patients or just new or suspicious ones? 

Guest post by Grant Clauser, Editor of Healthy Aging Magazine.

Submit a guest post and be heard.

Is Taiwan Asia's Next One-Stop Plastic Surgery Shop?

Tourists who frequently return to Taiwan might recommend savoring succulent street food or exploring Taipei's boisterous night markets. Or they may pass along the business card of a favorite plastic surgeon or dermatologist....

And why not? Taiwan has long been popular with its expatriate population as a medical-travel destination. At Taipei's abundant health care facilities, the equipment is modern and sophisticated, and most importantly, prices are considered a steal. Some of the biggest savings are in liver-transplant surgery, which runs to around $91,000, compared with some $300,000 in the U.S.

Price tags like that have built a small but devoted following for Taiwan's niche medical-tourism market, and it's about to get a lot more customers. Taiwan's neighbors across the strait have been making their way to the island for a nip or a tuck since travel restrictions for Chinese tourists were lifted in mid-2008. Now, in the latest of a series of agreements and concessions between China and Taiwan, Taipei announced last week that Chinese tourists will soon be allowed to travel individually to the island — a development that many medical-tourism proponents are hoping will be a boon to their industry - especially the plastic surgeons.

Taiwan's current policy only permits controlled tour groups from the mainland, which limits options for Chinese who seek varied medical services.

Under group-travel restrictions, tourists are told where they can go and when. They can't deviate from the set itinerary," says David Wang, a plastic surgeon and chairman of the Taiwan Medical Tourism Development Association. "I've heard of a few people who will secretly come [for plastic surgery], perhaps under a fake name or by claiming they are here on business."

Now, Chinese patients seeking operations can plan ahead and book Botox treatments and eye-bag or double-eyelid surgery at Wang's offices on their own schedule.

Mainland tourists could be a huge boost. According to Taiwan government statistics, just over 972,000 tourists from China journeyed to the tear-shaped island in 2009 — a 195% jump from the figure in the previous year, when the two sides made transit and tourism agreements. Further encouraging cross-strait exchanges, last month Chinese aviation officials announced a 10% to 15% reduction in airfares for flights between the two sides. With over a million projected to visit this year, even more mainlanders will be emptying their wallets into Taiwan's service sector.

Wang, the plastic surgeon, already travels to China about once a month to promote his practice, and he isn't the only one. Many enterprising proponents of Taiwan's medical tourism have been making the cross-strait journey in the hopes that they, too, might entice more mainlanders to seek medical care on the island.

Not many people know about the quality of Taiwan's health care system," says Richard Wu, CEO of Taiwan Task Force for Medical Travel. "It's our priority to first put out Taiwan as a brand name and then promote individual hospitals for services."

The fact that these customers will now be able to travel to Taiwan solo will only help. "No one would join a group tour that lets everyone else know they are going for plastic surgery or other medical reasons," Yen says. "With individual travel, you can just tell your neighbor you are going to Taiwan for vacation."

Son Of Botax

I was just reading the text of the proposed changes to the Healthcare reform bill. Hidden in the middle of dozens of pages is this gem:

IN GENERAL.—There is hereby imposed on the sale of any taxable medical device by the manufacturer, producer, or importer a tax equal to 2.9 percent of the price for which so sold.

Well guess what, people - Mr. Obama & company may have backed off on the 10% cosmetic surgery tax, but he's still sticking it to you with a 2.9% tax on implants and surgical supplies.  It would also increase the cost of lasers, liposuction equipment, and many other surgical and anesthesia supplies we all use.

That's in addition to the additional 3.9% tax you'll be paying for any profit on investment income. So, if you invested and "saved your pennies" like an honest, hard-working American, you might be penalized up to 6.8% for having cosmetic surgery!

This tax also would apply to pacemakers, stents, heart valves, cataract lenses, artificial hip & knee implants, motorized wheelchairs, and implantable defibrillators. As if these things weren't expensive enough! It's the "Son-of-Bo-tax". Boo!!!

From:  Tom Fiala, MD

Idiot Ass Augmentations Hospitlize Six In New Jersey

In the 'you've got to be kidding me' category... Six women in NJ ended up in the hospital after they were injected with 'bathroom tile calk' from unlicensed ass-injectors.

This rings of the other idiots who are/were injecting themselves at home with an unknown 'do it yourself Botox' substitute.

(CBS/AP)  Six women in New Jersey are recovering after they received buttocks-enhancement injections containing silicone used to caulk bathtubs.

State health officials say the women, from Essex County, apparently underwent cosmetic procedures from unlicensed providers.

Investigators have not determined if the cases are related.

No arrests have been made.

Instead of medical-grade silicone, the women received a diluted version of nonmedical-grade silicone.

"The same stuff you use to put caulk around the bathtub," said Steven M. Marcus, executive and medical director of the New Jersey Poison Information and Education System, according to The Star-Ledger.

State epidemiologist Tina Tan says there's the risk for more serious complications when infections are not treated early.

Gregory Borah, chief of plastic surgery at Robert Wood Johnson University Hospital in New Brunswick, told the newspaper the incident was "a tragedy."

Using over-the-counter silicone can cause abscesses that he said resemble "a big zit."

Borah, also president of the New Jersey Society of Plastic Surgeons, said the botched procedures underscore the need for patients seeking such enhancement to seek out licensed professionals in a sterile setting, the newspaper reported.

Plastic Surgery Trends For 2010

The Consumer Guide to Plastic Surgery thinks they know what’s in store for cosmetic medicine in 2010, from how the newly proposed “Botax” could affect your self-improvement plans to which new products will come to market. Here's what you might see in 2010:

Even More Botox-Like Products Will Come to Market
First there was Botox Cosmetic; then 2009 brought the Botox alternative Dysport. In 2010, expect to see a few more Botox rivals, including a topical form of the popular wrinkle relaxer and at least one more injectable. A couple of injectable Botox cousins are in development, but PurTox will likely be the next to get a nod from the Food and Drug Administration (FDA). The main difference in these injectables seems to be how long the results last and how quickly the products start to work on your crow’s feet.

Fat Injections to the Breast Will Be Used Cosmetically
After being condemned by plastic surgery associations, fat injections to the breast were deemed OK for "touch-ups" after breast reconstruction in 2008. But these once controversial injections may soon play a role in cosmetic breast augmentation. Taking fat from a part of the body where there is too much (your thighs or butt, for example) and injecting it into your breasts where there is too little, may replace the need for breast implants when done in conjunction with a breast lift. Some kinks still need to be worked out, but fat injections to the breast are likely here to stay.

Surgeons Will Invent – and Perfect – Body Contouring Surgeries to Follow Massive Weight Loss
More and more people are undergoing bariatric surgery to lose weight, only to be left with hanging fat and flab in highly visible areas. As plastic surgeons put on their thinking caps to better address these issues, expect to hear about many new procedures, including the corset trunkplasty. This new surgery targets above-the-belly-button flab, to recreate an hourglass silhouette in formerly obese women and get rid of love handles in men who have lost massive amounts of weight. This area has been ignored by many traditional body contouring procedures that target the lower abs, buttocks and/or thighs. We will hear more about corset trunkplasty and other innovative body contouring procedures in 2010.

Fat Freezing Heats Up in 2010
Fat freezing (or cryolipolysis) may give liposuction a run for its money in the coming years. This technology works by freezing fat cells and breaking them down. Zeltiq is in clinical trials now, and results look promising. Stay tuned.

Cohesive Gel Breast Implants Receive FDA Approval
These so-called "gummy bear implants" have been making their way down the pike for some time, and they just may get the long-awaited FDA nod in 2010. Filled with cohesive silicone gel, these leak-resistant implants – used in Europe and Brazil – are being studied in the United States. Gummy bear implants have the positive attributes of silicone gel, but the gel doesn't migrate. This is a good thing, because if the shell should fail, the gel wouldn’t leak into surrounding tissue.

Lipodissolve Study Results Stun Skeptics
Lipodissolve, an experimental "fat-melting" technology, is being billed as a non-surgical alternative to liposuction. Also called mesotherapy, lipodissolve is performed via injection of a cocktail of chemicals into muffin tops, saddlebags, love handles and other trouble spots to dissolve fat cells. Critics were outspoken, which is why the American Society for Aesthetic Plastic Surgery started a rigorous scientific study of lipodissolve, using standardized ingredients. And while even the trialists were skeptical at first, and the final results have not been tallied, it works. The study results – to be released in 2010 – may encourage many doctors to offer lipodissolve. Still, lipodissolve is only for small areas of localized fat and will never replace liposuction.

“Botax” Will Raise Eyebrows
A health care reform bill will be passed in 2010, and it just may include a five percent tax on all cosmetic surgery procedures (except those deemed medically necessary). Let’s say that breast augmentation with implants costs $10,000 in 2008; add a five percent levy, and the total becomes $10,500 in 2010. With business already down, most plastic surgeons are up in arms about the Botax. There is also fear that taxing cosmetic surgery in the U.S. will encourage many to seek out services abroad or through unskilled providers who offer procedures at cut rates in America, compromising their safety.

Surgery-Free Tummy Tucks Trim Waistlines
Non-invasive body contouring procedures such as Thermage, VelaShape, UltraShape, LipoSonix and Zerona will continue to grow in popularity in 2010. Once reserved for the face,

Thermage also uses radio waves to lift and firm skin on your stomach, knees, arms, legs, hands or butt. VelaShape employs bipolar radiofrequency energy to reduce the size of the fat cells, along with infrared heat to tighten the skin. And Zerona uses a “cold” laser to painlessly zap the fat cells beneath your skin. These technologies (and more) may give tummy tucks and lower body lifts a run for their money in 2010.

Face Transplants Face Upsurge
Face transplant surgery was once nothing more than fodder for sci-fi thrillers like the movie Face/Off, but they are now becoming a reality. Eight have been performed so far in the United States and abroad, but there will likely be many more as reconstructive facial surgeons further hone their skills and work toward perfecting their highly complicated techniques.

Minimally Invasive Cosmetic Procedures Experience Rebirth
As our economy starts to show signs of life again, more people may opt for cosmetic surgery procedures, reversing the steep decline of the last two years. Don't expect the numbers to reach their record highs anytime soon, though. There will likely be a slight increase in plastic surgery procedures – especially minimally invasive ones such as injectables that allow people to put off more invasive (and expensive) procedures like face lifts until they really need them (and can better afford them).

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories. Consumer Guide to Plastic Surgery is a registered trademark of Ceatus Media Group LLC. http://www.yourplasticsurgeryguide.com

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.

Botax: Taxes on Botox and plastic surgery?

The medical spa and plastic surgery community is in an uproar over some proposed legislation that could make a trip to the plastic surgeon or a Botox injection at the medical spa more expensive.

People are calling it the Botax. It's a 5 percent tax on elective procedures such as Botox, Juvederm, Restylane, laser hair removal, facelifts, breast augmentation and other nips and tucks that lawmakers are hoping will help fund the nearly $1 trillion health care plan.

The bill says the tax would not apply to surgeries to fix a deformity either from birth, accident, or disease. It would apply to procedures like face lifts, liposuction, cosmetic implants and teeth whitening.

But as Dr. Paula Hicks points out sometimes cosmetic surgeries have very medical purposes.

"Certainly breast reduction surgery is a very good surgery for a lot of women and a lot of them will get denied by the insurance company as cosmetic surgery," said Dr. Hicks of the Ave Medical Laser Spa and Laser Clinic.

Under the proposal, Dr. Hicks says an eyelid tuck, which can help with vision, would cost an extra $100 in taxes on top of the $2,000 price tag for the procedure.

She says that could be a big hit to her business since most of her clients are not wealthy.

"Most of these procedures are not done on people that are rich and have endless amounts of money, it's middle class working women that would be targeted with this tax and it's really not fair."

According to the American Society of Plastic Surgeons 86 percent of cosmetic surgery patients are women. Sixty percent of them have annual incomes between $30,000 and $90,000.

The tax, if approved, would raise $6 billion over 10 years.

Allergan, which sells Botox, took a civil rights angle: The tax “discriminates against women,” the company said in a statement. Some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year, according to Allergan.

“What’s next? Are we going to tax people who color their hair?” the CEO of Medicis, a drug company that sells fillers, told Dow Jones Newswires.

The American Academy of Cosmetic Surgery, which is fighting the provision, says “a large portion of those being taxed would be the baby-boomer generation. And as this age group continues to age, the more interest will be generated in cosmetic procedures.”

A spokesman for the 2,500-member group said they were surprised to see the provision in the Senate bill this week, because it had already surfaced and sank in July. The tax is not in the House bill.

The tax is on elective procedures, and would not apply to any procedure to correct birth defects or issues arising from disease, accidents or trauma. The CBO says it would raise about $5 billion over the next decade.

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Plastic Surgery Product Placement

Be Born Again

To promote Dr. Kim's plastic surgery office, this life scale poster was placed at the entrance of his office and by the elevator in the main lobby of the hospital building.

via dfckr.com

A slick little promo for a plastic surgery practice. You have to love well done attention-getting advertising and medical spas and plastic surgery clinics are certainly rife with products that lend themselves to great advertising and marketing. I've got perhaps hundreds of these types of ads that I keep as something of a library.

Do it yourself Botox? ABC News wants to talk to you.

Have you tried do-it yourself plastic surgery or home Botox injections?

In tough economic times, many try to cut costs, including in their beauty regimen. Despite the risks, some people have decided to skip the doctor -- and obtain and self-administer cosmetic treatments.

If you have self-injected products like Botox, Restylane, Juvederm, silicone, and other substances, 20/20 would like to hear your story.

Please fill out the form below, including information about your experience, and a producer may be in contact with you.

You can tell ABC all about it here.

Plastic Surgery Face Lift.. Or Stem Cells From Korea?

The same company in Korea that's cloning dogs and cats is now offering anti-aging treatemtns that are being touted as a delaying tactic for plastic surgery and face lifts:

Those who view aging as an ugly inconvenience usually turn to plastic surgery to nip and tuck their troubles away. Little do they know the answer for reversing the aging process might be found in their own stomachs.

Run in conjunction with the Beijing Tian Tan Puhua Hospital, which offers stem cell therapies to last-hope Parkinson’s and spinal cord injury patients, the RNL Puhua Plastic and Cosmetic Medical Center offers stem cell therapy for the face that may reverse the aging process using the patient’s own body matter.

Using a treatment developed by Korean company RNL Bio—the same company that clones dogs and sells them on the international market for upwards of USD$150,000—the Puhua Center offers non-invasive beauty treatment alongside traditional plastic surgery staples like liposuction, face peels and eye tucks.

For a cool ¥28,000, patients can have fat cells removed from their abdomens using a needle and local anesthetic. Two weeks later, after doctors have grown a crop of stem cells from the collected fat cells, patients return to have doctors inject the stem cells into their faces in a series of shots that plump out skin, erase wrinkles and generally take a decade off your appearance, says Ingela Palomäki, a former Beijing Tian Tan Puhua Hospital marketing representative and current director of Fortune Cookie, a stem cell product import/export company. Included in the price is a stem-cell top-up six months later. Patients can also have their stem cells stored at the clinic for ¥1,500 per year. Stem cells have a shelf life of about 15 years. The clinic is currently the only place in the world offering the therapy, Palomäki says.

RNL Bio flew in aging South Korean celebrity Kyung-gyu Lee for a test-run of the treatment at the clinic’s inauguration less than half a year ago.

“Koreans are flocking here by the busloads for the treatment,” Palomäki says. “It’s buying time.”

Because the treatment uses the patient’s own cells, there is no risk of the body rejecting the injections, she points out. The only concern is that the stem cells could copy cancer cells in the body—so cancer patients and survivors will want to take a pass.

While the U.S. and other countries weigh the benefits of stem cell therapies, many patients from abroad are already coming to Beijing for therapies they hope might make them forever young.

This use of technology solutionos around bio-engineering and stem cells could well percipitate a break through. Nanotechnology is an other area that offers the promise of using a nonsurgical medical technology in lieu of traditional plastic surgery.

Thermage and Botox are examples of technology that sprang from other areas of medicine in just this way.

Medical Spa MD Listed As Top Medical Social Networking Site

Medical Spa MD is at the top of the list of medical social networking sites in the lastest issue of cosmetic surgery times.

View the page here

It's nice to see that others are aware of the community here. It opens up a number of interesting opportunities.

We're currently in discussions with multiple compounding pharmacies, laser companies, technology providers, SEO and SEM service providers, and a few other categories sprinkled in.

In the relatively near future (ie when we select a provider and the technology in place) Medical Spa MD members will be able to order Botox or Restylane in bulk, get discounted services from selected provider that sell to med spas and cosmetic practices, and genearlly make bank.

If you're a service or technlogy provider that can provide benefits to Medical Spa MD Members, let us know.

If you haven't joined Medical Spa MD yet? Now's the time.

Plastic Surgery & Cosmetic Surgery Trends For 2008

The ASAPS (American Society for Aesthetic Plastic Surgery) reports 10.2 Million Cosmetic Procedures in 2008. The Aesthetic Society, after collecting multi-specialty procedural statistics since 1997, says the overall number of cosmetic procedures has increased 162 percent since the collection of the statistics first began. The most frequently performed nonsurgical procedure was Botox injections and the most popular cosmetic surgical procedure was breast augmentation.

Top nonsurgical cosmetic procedures among men and women in 2008:
Botox - 2,464,123
Laser Hair Removal - 1,280,964
Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane) - 1,262,848
Chemical Peel - 591,808
Laser Skin Resurfacing - 570,880

Top surgical cosmetic procedures among men and women in 2008:
Breast Augmentation: - 355,671
Lipoplasty (liposuction) - 341,144
Eyelid Surgery - 195,104
Rhinoplasty - 152,434
Abdominoplasty - 147,392

source: ASAPS press release

“For the first time in the twelve years these statistics have been collected liposuction is a runner up in popularity to breast augmentation. There is no doubt that this turnabout will generate discussions in the medical community and the public at large,” Alan Gold, MD, Aesthetic Society president, reflects that “changes in fashion, i.e. décolletage baring styles, might be a factor behind this change.”

TRENDS AND DEMOGRAPHIC DATA

Top surgical and nonsurgical cosmetic procedures among men and women in 2008:
Surgical	# procedures	Nonsurgical	# procedures
Breast Augmentation:	355,671	Botox	2,464,123
Lipoplasty (liposuction)	341,144	Laser Hair Removal	1,280,964
Eyelid Surgery	195,104	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	1,262,848
Rhinoplasty	152,434	Chemical Peel	591,808
Abdominoplasty	147,392	Laser Skin Resurfacing	570,880

Top cosmetic procedures for WOMEN:
Surgical	# procedures	Nonsurgical	# procedures
Breast augmentation	355,671	Botox	2,239,024
Lipoplasty	309,692	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	1,200,420
Eyelid surgery	166,426	Laser Hair Removal	1,101,255
Abdominoplasty	143,005	Chemical Peel	554,492
Breast Reduction	139,926	Laser Skin Resurfacing	532,008
____________________________________________________________________________________________________
Women had almost 92 percent of cosmetic procedures. The number of procedures (surgical and nonsurgical) performed on women was over 9.3 million, a decrease of over 11 percent from the previous year. Surgical procedures decreased 15 percent; nonsurgical procedures decreased by 11 percent. Since 1997, surgical procedures increased 104 percent, while nonsurgical procedures have increased 233 percent.

Top cosmetic procedures for MEN:
Surgical	# procedures	Nonsurgical	# procedures
Liposuction	31,453	Botox injection	225,099
Rhinoplasty	30,174	Laser hair removal	179,708
Eyelid Surgery	28,678	Hyaluronic Acid (including Hylaform, Juvederm, Perlane/Restylane)	62,428
Gynecomastia	19,124	IPL laser treatment	46,887
Hair transplantation	18,062	Microdermabrasion	39,824
____________________________________________________________________________________________________
Men had over 8 percent of cosmetic procedures. The number of procedures (surgical and nonsurgical) performed on men was over 800,000 a decrease of over 21 percent from the previous year. Surgical procedures decreased 18 percent; nonsurgical procedures decreased 22 percent. Since 1997, surgical procedures have decreased over 15 percent while nonsurgical procedures have increased 239 percent.

Frequency of cosmetic procedures by AGE GROUP:
% of total	Age	# procedures	Top surgical procedure	Top nonsurgical procedure
45%	35-50	4.6 million	Liposuction	Botox
26%	51-64	2.7 million	Eyelid Surgery	Botox
22%	19-34	2.2 million	Breast augmentation	Laser Hair Removal
6%	65 and over	634,667	Eyelid Surgery	Botox
2%	18 and under	160,283	Rhinoplasty	Laser Hair Removal

Racial and Ethnic Distribution

Racial and ethnic minorities accounted for 20 percent of all cosmetic procedures in 2008. Hispanics again led minority racial and ethnic groups in the number of procedures: Hispanics, 8 percent; African-Americans, 6 percent; Asians, 4 percent; and other non-Caucasians, 2 percent.

Location and Fees
Over fifty-three percent (53 percent) of cosmetic procedures in 2008 were performed in office-based facilities; 26 percent in freestanding surgicenters; and 19 percent in hospitals. Americans spent just under $12 billion on cosmetic procedures; $7.2 billion was for surgical procedures, and $4.6 billion was for nonsurgical procedures.