Breast augmentation is now the most popular surgical procedure, according to statistics recently released by the American Society of Aesthetic Plastic Surgery.

More than 10.2 million surgical and non-surgical cosmetic procedures were performed in the United States in 2008, according to the latest statistics released by the American Society for Aesthetic Plastic Surgery (ASAPS). While there is no definitive data on cosmetic procedures in Australia, US trends are usually predictive of demand on Australian shores.

The ASAPS statistics found that surgical procedures represented 17 percent of the total number of cosmetic procedures performed last year in the US, and non-surgical procedures made up 83 percent.

The most frequently performed non-surgical procedure was Botox injection (2.5 million procedures) and the most popular surgical procedure was breast augmentation (356,000 procedures).

‘For the first time in the 12 years these statistics have been collected, liposuction is a runner up in popularity to breast augmentation,' says ASAPS president Dr Alan Gold. ‘Changes in fashion, such as décolletage-baring styles, might be a factor behind this change.'

Additionally, Dr Gold says an increasing number of women are seeking breast augmentation after their childbearing years. ‘People are more focused on the ageing-related changes that allow them to remain competitive in the job market,' he says.

The US Food and Drug Administration's (FDA) resumption of silicone implants on the market in late 2006 may also be a factor behind breast augmentation surgery reaching the number-one spot. ‘For anyone who was concerned about the safety of the procedure, the FDA decision further relieved their anxiety,' says Dr Gold.

Women underwent almost 92 percent of the cosmetic procedures administered. The number of procedures (surgical and non-surgical) performed on women was more than 9.3 million, a decrease of 11 percent from 2007. Surgical procedures decreased by 15 percent; non-surgical procedures decreased by 11 percent.

Men underwent more than 800,000 cosmetic procedures, making up eight percent of the total. The number of procedures for men decreased 21 percent from the previous year.

Overall, there was a 12 percent decrease in the total number of cosmetic procedures compared with 2007. However, since 1997 the total number of cosmetic procedures has increased by more than 162 percent - 80 percent growth in surgical procedures and 233 percent growth in non-surgical procedures.

The decline in cosmetic procedures performed in 2008 is an inevitable response to the global economic downturn. ‘This is part of people's general reluctance to spend money in this economy and doesn't reflect a permanent change,' says Dr Gold. ‘These things tend to bounce back.'

The statistics on non-surgical facial rejuvenation also echo the current economic environment. Laser skin resurfacing was one of the few procedures that posted positive growth, reflecting the use of fractional lasers which offer patients less recovery time compared with traditional resurfacing lasers used in the past. More than 500,000 laser skin resurfacing procedures were performed in 2008, up 12 percent from last year. Chemical peels also showed a 2.9 percent increase from the previous year. This is perhaps indicative of patients opting for non-surgical facial procedures instead of surgery due to lesser costs and reduced time needed off work to recover.

Consumer attitudes: future outlook

The ASAPS Consumer Attitudes Survey 2009 found that 40 percent of women would consider having cosmetic surgery now or in the future, compared to 18 percent of men. This is an increase of nine percent and two percent, respectively, from the 2008 Survey.

Almost three-quarters (73 percent) of all women and 69 percent of all men surveyed said that if they had cosmetic surgery they would not be embarrassed if other people knew about it.

Additionally, 23 percent of women and 18 percent of men are more favourable towards cosmetic surgery compared with five years ago.

Other key findings of the study include:

- Out of all age groups, men and women between the ages of 25 and 34 are the most likely to consider cosmetic surgery for themselves now or in the future.

- Men and women aged 18 to 24 are the most likely to approve of cosmetic surgery (65 percent).

- Ethnicity has no effect as to whether respondents would be embarrassed if people outside their immediate family and close friends knew they had cosmetic surgery. Seventy-one percent of white respondents and non-white respondents said they would not be embarrassed.

Biggest growth procedures

Hair transplants
The biggest increase in 2008 among surgical procedures was for hair transplantation surgery, posting a growth of 10 percent. There was a 13 percent increase among women and a 10 percent increase among men for this type of surgery.

Laser skin resurfacing
Laser skin resurfacing showed the strongest growth among the non-surgical cosmetic procedures. Due to advancements in laser technologies, particularly the development of fractional lasers, the number of laser resurfacing procedures increased by 12 percent compared with the 2007 statistics.

Top five surgical cosmetic procedures in 2008

1. Breast augmentation (355,671 procedures)
2. Liposuction (341,144 procedures)
3. Eyelid surgery (195,104 procedures)
4. Rhinoplasty (152,434 procedures)
5. Abdominoplasty (147,395 procedures)

Top five non-surgical cosmetic procedures in 2008

1. Botox injection (2,464,123 procedures)
2. Laser hair removal (1,280,964 procedures)
3. Hyaluronic acid injection (1,262,8484 procedures)
4. Chemical peel (591,808 procedures)
5. Laser skin resurfacing (570,880 procedures)

Quick facts

• People aged between 35 and 50 had the most procedures performed in 2008 - more than 4.5 million and 45 percent of the total.

• Botox injection has increased by 3,682 percent since the statistics were first collected in 1997.

• Americans spent almost US$11.8 billion (AU$17 billion) on cosmetic procedures last year.

ACSM #44