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The impact that the practice of plastic surgery has on the United States and global economics is undeniable. This entry will discuss the evolution of plastic surgery and its ever-growing influence on the economy and consumer behavior.
Plastic surgery owes its history to Dr. John Staige Davis, who was the first surgeon to devote his entire career to this new specialty at the Johns Hopkins Hospital in Baltimore, Maryland. Davis was the first chairman of the American Board of Plastic Surgery, and he published the first textbook on plastic surgery in 1917. Furthermore, he established a formal training program in plastic surgery in 1924. Johns Hopkins, a new medical school established in 1890, had adopted the European model of training, notably the first surgery residency in the American health care system. This concept was endorsed by the pioneer visionaries Dr. William H. Welch (Pathology), Dr. Sir William Osler (Internal Medicine), Dr. Howard A. Kelly (Gynecology), and Dr. William S. Halstead, the first chairman of Surgery. Prior to this time in the history of American medicine, there were apprenticeships in medicine/surgery but no graduated, stepwise education culminating in eligibility to call oneself a specialist (e.g., a plastic surgeon).
Plastic comes from the Greek word plasticos, which means “to mold,” or “give form.” The earliest purposes for plastic surgery were to reconstruct the faces of victims of World War I and World War II. Plastic surgeons were called upon to do all of the detailed work that the general surgeons, who were saving the lives of those with serious injuries, did not have time to accomplish. Such detailed work focused on the hope of restoring a soldier to near normalcy. Over time, plastic surgery has evolved into two related but very different disciplines. The reconstructive plastic surgeon focuses on a wide variety of deformities (e.g., maxillofacial, such as cleft lip and palate, and inherited facial anomalies, burn reconstruction, hand surgery, microsurgery, skin grafts and major soft-tissue reconstruction, reconstruction after cancer surgery). On the other hand, there are the cosmetic plastic surgeons, who focus on molding an aesthetic body and face. In an interesting reflection of the times, the American Society of Plastic and Reconstructive Surgery, founded in 1931 and representing 94 percent of America’s around 7,000 board-certified plastic surgeons, changed its name to delete the word reconstructive and became the American Society of Plastic Surgery in 1999. For the purposes of this entry, we have elected to look at the motivations as well as the reflections of the economy mirrored in the practice of aesthetic (cosmetic) plastic surgery.
As to the motivation for aesthetic surgery, we live in a somewhat narcissistic society. With the technology revolution and social media, people are marketing their images on Facebook to prospective friends, romantic interests, and employers and thus want to put their “best face forward.” As a reflection of the economy, in 2007 to 2008, with the economic downturn, there was a 5 percent reduction in cosmetic plastic surgery. Yet as Dow Jones has regained its losses of 2007–2008, the American Society for Aesthetic Plastic Surgery reported in its 17th annual multispecialty statistical data (2013) that there had been a 12-percent increase in the number of cosmetic procedures performed in the United States. This equates to a total amount of $12 billion being spent on a total of 11 million cosmetic procedures performed by board-certified plastic surgeons, dermatologists (skin), and otolaryngologists (ear, nose, neck, and throat) in the United States. Of this, $7 billion was spent on invasive surgical procedures and more than $5 billion on nonsurgical procedures. Of the surgical procedures performed, liposuction (fat suction) had for the first time, in 2013, trumped breast augmentation procedures. Of the roughly 11 million surgical procedures, 10.3 million, or 90.6 percent, were performed on women, and more than 1 million cosmetic procedures, or 9.4 percent of the total, were performed on men. This reflects a 273-percent increase in the number of males electing to undergo cosmetic plastic surgery from 1997 to 2014. The top surgical procedures for men were liposuction, eyelid surgery, nose jobs, male breast reduction, and lop ear reconstruction. All of these elective procedures indicate that people are investing in their appearance as a reflection of both economic activity and a society that is obsessed by the power of physical appearance.
For an aesthetic plastic surgeon, considering the two types of procedures one may elect to undergo (the less extensive, minimally invasive treatments such as Botox and fillers versus the more expensive, invasive surgical procedures), it is a delicate balance between safety and economic impact. In times of economic downturn, there is an increase in the cash business of minimally invasive, less expensive procedures to plump up the lips (fillers) or paralyze the wrinkles (Botox). On the other hand, the much more expensive business of invasive plastic surgery, requiring patients to pay cash out of pocket, must be retained as a cash source important for the plastic surgeon’s strategic plan during good economic times. These cash-only, high-ticket operations must remain to balance the leaner times of popularity for the lower-ticket, noninvasive procedures, which proportionally increase during slow economic times. This concretizes the notion that there is always a quest for beauty regardless of the state of the economy. However, this decision is not necessarily based on whether a procedure should or should not be conducted but on its affordability for the patient. There is an emerging concern for surgeons that certified specialists, navigating the Affordable Care Act, and physicians (regardless of their training and credentials) will not be driven to open without proper credentials a cash cosmetic practice to accommodate the unwary public of the baby boomer generation, who are notably interested in remaining youthful because of their desire to remain in the workforce.
In a study investigating the relationship between the three major U.S. stock market indices, Standard and Poor’s, Dow Jones, and NASDAQ, and consumer-driven cosmetic plastic surgery, statistically significant correlations were found between the three indices and specific plastic surgical procedures. Isolating forehead lift, face-lift, breast augmentation, liposuction, breast reduction, breast reconstruction after mastectomy, and carpal tunnel release as variables, face-lift, liposuction, and breast augmentation were found to be significantly correlated with all three major market indices. Forehead lift correlated only with the NASDAQ index but did not achieve statistical significance with either the Standard and Poor’s or the Dow Jones index. Breast reduction and breast reconstruction after mastectomy were also significantly correlated with two of the three major stock market indices, whereas carpal tunnel surgery (for numbness in the thumb, and index and long fingers), which has long been considered a reconstructive procedure, was negatively correlated with two of the three indices. The findings of this study are reflective of the fact that necessary procedures (i.e., carpal tunnel) are not directly associated with the economy and are considered a covered benefit of third-party health insurance carriers, including the federally underwritten Medicare program, regardless of the health of the economy.
Plastic surgery, similar to other economic sectors and entities, mirrors the economy on both the national and the global level. This is particularly noteworthy in this era of social media, where the face counts as the influence broker for the future of plastic surgery for all generations.
- The American Society for Aesthetic Plastic Surgery. “American Society for Aesthetic Plastic Surgery Advises Consumers to Avoid Unqualified Personnel Performing Cosmetic Procedures.” http://www.surgery.org/media/news-releases-the-american-society-foraesthetic-plastic-surgery (Accessed August 2014).
- Gordon, Chad, Landon Pryor, Ahmed Afifi, Paul Benedetto, C. J. Langevin, Francis Papay, Randall Yetman, and James E. Zin. “Cosmetic Surgery Volume and Its Correlation With the Major S. Stock Market Indices.” Aesthetic Surgery Journal, v.30/3 (2010).
- Sargent, Larry, Raymond Morgan, and W. Bowdoin Davis. “John Staige Davis: Pioneer American Plastic Surgeon.” Clinics of Plastic Surgery, v.10/4 (1983).