The British Association of Aesthetic Plastic Surgeons (BAAPS) published the findings of their 2014 audit in January, with a surprising revelation: after rising steadily for ten years, the number of people undergoing cosmetic surgery last year plummeted by 9%.1 “The difference between 2013 and 2014 may seem surprising, but the dramatic double- digit rise last year was clearly a post-austerity ‘boom’, and figures are now returning to a more rational level,” says former BAAPS president Rajiv Grover. However, could there be more to it? With the range of non-surgical treatments expanding and increasing in efficacy almost by the month, and with big name products such as Botox and Restylane now well established and largely trusted by patients, could it be that consumer focus has shifted away from surgery and towards minimally invasive treatments?
Given the current lack of regulation regarding medical aesthetic procedures, it is practically impossible to get a true approximation of the number of people undergoing non-surgical cosmetic treatments each year. While the British Association of Cosmetic Nurses (BACN) and British College of Aesthetic Medicine (BCAM) do carry out audits, they don’t audit the number of procedures performed in the same way that BAAPS does. Even if they did, a like-for-like comparison may well be wildly inaccurate, as one patient might have four botulinum toxin treatments within a year, which would appear as four separate procedures within an annual audit, whilst a facelift patient is unlikely to return within a decade. This means that a surgical audit offers a much more realistic idea of the number of patients choosing to undergo surgery than a non-surgical audit is able to produce of non-surgical procedures. Added to that, these industry organisations – even the BACN, which has 800 members and growing – represent a relatively small proportion of the total number of people performing medical aesthetic treatments in this country. With beauty salons on every high street in the UK offering laser hair removal, facial injectables and more, it is reasonable to assume that any numbers produced by the official governing bodies can be multiplied several times to get close to the true figure.
An upward trend
However, the few statistics available suggest that non-surgical procedures are on the
up. The Harley Medical Group, who offer both surgical and non-surgical procedures and so can be considered as an impartial source in this respect, reported a 10% increase in the number of non-surgical treatments performed last year.2 Bernadette Harte, non-surgical manager at the Harley Medical Group, attributes this upsurge to a more demanding public that knows what it wants. She says, “What patients are looking for is subtle enhancement, where they can go back to work the next day... they cannot afford the downtime [associated with surgical procedures].”
It is also true, however, that the Harley Medical Group increased its advertising spend on the non-surgical side last year, and as BCAM president Dr Paul Charlson explains, marketing activity can muddy the waters. “I have seen an increase in my own practice,” Dr Charlson states, “but it’s difficult to judge because I’ve made changes in my practice in the last year, I’ve changed my advertising and I’ve got a higher profile.” As one of the largest cosmetic surgery and non-surgical providers in the UK, it is unlikely however that the Harley Medical Group would invest money in advertising without good reason and, in fact, a OnePoll survey commissioned by the group in 2014 showed that 17% of UK women were considering non- surgical aesthetic treatments,2 compared to 9% considering cosmetic surgery,2 so it is likely that their increased marketing spend was based on prediction of a trend. A more sophisticated market?
One suggestion by BAAPS for the drop in surgery last year was that the market is becoming more sophisticated, with the public becoming “more thoughtful, cautious and educated in their approach to surgery,” according to Mr Grover. Many non-surgical practitioners seem to support this view. Dr Charlson, for example, says, “People realise the potential of what you can do now. People don’t come to me and say I want Botox, they’re saying ‘what can you do around my eyes?’” Sharon Bennett, nurse prescriber and chair of the BACN, has a different view. “Patients believe they are better educated, and they certainly have a lot of information, but it’s not always correct.” Bennett believes that it is the practitioners themselves who are becoming better educated about alternative or combination treatments, which may be able to provide patients with improved overall aesthetic results.
Operating with caution
Another possible reason for this shift from surgery is that surgeons themselves are offering more non-invasive options. As Dr Charlson contends, “I think more and more surgeons are beginning to see the value of performing non-surgical procedures instead, to put o surgery to a later date.” In the wake of the PIP scandal, however, which most of the practitioners interviewed suggested was a possible reason for the fall in breast augmentation operations performed last year (23%1), is there a more pressing reason for surgeons to expand their minimally-invasive offering? “I suspect that insurance costs and the attitude of the insurance industry to cosmetic surgery means that surgeons are becoming more cautious about who they choose to operate on, and are probably treating fewer patients as a result,” Dr Charlson speculates.
Best face forward
It remains to be seen whether the BAAPS gures represent a one-off blip in an otherwise upward trajectory for cosmetic surgery, or whether patients really are becoming more reluctant towards surgery, but reports from the industry show a booming specialty that continues to grow. Whether this is due to a savvier public, better-educated practitioners or more reluctant surgeons, or – more likely – a combination of each, the future looks very bright for medical aesthetics.