The Role of Injectables in Aesthetic Surgery: Financial Implications
Bryson G. Richards, MD, William F. Schleicher, MD, George Collis, MD, Deepa Cherla, MD, Raymond Isakov, MD, James E. Zins, MD, FACS.
Cleveland Clinic, Cleveland, OH, USA.
In response to an increase in cosmetic injectables being offered by noncore cosmetic medicine providers, the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) joined efforts to form a Cosmetic Medicine Task Force. In a survey sponsored by the Task Force, 47 percent of consumers said they would choose a provider they previously used for a noninvasive procedure as their first choice for an invasive procedure. It has been suggested that this represents a significant portion of patients who eventually undergo facial aesthetic surgery. There is little objective data documenting the generally held supposition that patients who undergo minimally invasive procedures ultimately undergo more invasive ones and are therefore an important patient resource. In this report we document the rate at which this occurs over a ten year period in a single surgeon’s practice and address the financial implications.
All patients receiving botox or fillers were analyzed and those who ultimately underwent surgery were identified. We did not evaluate patient records for those who were introduced to cosmetic injectables after having undergone surgery by the primary surgeon. We included patients seen from 2004 to 2013. Our goal was to identify those who had no initial specific intention to undergo an invasive aesthetic surgical procedure. Data gathered includes: demographics, injectable procedure specifics, aesthetic surgical procedures, and related revenues. Injectable revenues were calculated utilizing billing records while aesthetic surgery revenues were derived from the most current ASAPS average fees per procedure.
From 2004-2013, 375 patients were introduced to the investigating surgeon’s practice by receiving an injectable treatment, resulting in a total of 1049 injection sessions. Of these, 59 patients (16%) subsequently underwent an aesthetic procedure at an average interval of 19 months after their initial encounter. Patients underwent an average of three injectable sessions prior to surgery. Males and females had similar conversion to surgery rates of 16%. Botox was the most common injectable (78%) followed by hyaluronic acid fillers (64%), and 43% received both types of products. Those receiving only one type of injectable, Botox or filler, had similar conversion rates, both at 14% respectively. A significantly higher (18%, p<0.05) conversion rate to surgery was seen with those who received both botox and filler. The most common aesthetic procedures performed included: 21 facelifts (35%), 16 upper blepharoplasties (27%), and 14 browlifts (24%). Thirteen (22%) patients had two or more aesthetic surgical procedures. We demonstrate a trend in increasing annual injectable sessions and procedures. This patient population generated $1,106,673 in gross revenues. Injectable sessions and aesthetic surgical procedures resulted in $710,507 and $396,166 in gross revenues respectively. An average revenue stream per patient who started with injectables and subsequently underwent an aesthetic procedure was $11,520.
The above data supplies objective numbers to our joint society’s contention that cosmetic injectables are a critical part of a plastic surgery practice. We have demonstrated that initial injectable experience ultimately leads to invasive procedures and consistent revenue stream.
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