Plastic Surgery Essay

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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.

Bibliography:

  1. 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).
  2. 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).
  3. Sargent, Larry, Raymond Morgan, and W. Bowdoin Davis. “John Staige Davis: Pioneer American Plastic Surgeon.” Clinics of Plastic Surgery, v.10/4 (1983).

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