On a recent Monday morning, five of the thirteen operating rooms at Manhattan Eye, Ear & Throat Institute (MEETI) are scheduled for a full day of elective cosmetic surgery procedures. Two days later, six of the thirteen operating rooms were busy with cosmetic procedures at one point. The remainder of the week was less hectic, but had an ample number of cosmetic surgeries. This suggests that the sag in the cosmetic surgery business in Manhattan is on the road to recovery.
Actually, the plastic surgeons at MEETI have seen this trend for the past six weeks both in our surgical schedules, and the number of new patient calls to our offices. This is not to suggest that the extremely busy surgery schedules, and long waiting list for appointments prior to the economic recession have returned or will ever return.
However, my philosophy is that a long waiting list is only good for one's ego. As long as a surgeon has his or her surgery days full, they should consider themselves busy. Is this recent increase in surgery volume an aberration from the trend in cosmetic surgery around the country? I am not sure. The economic recession is obviously worldwide. The calls and surgery for out of town and international patients at my office are returning.
Manhattan Eye, Ear & Throat Institute has for more than forty years been considered the busiest cosmetic surgery facility in the world. Many of the best-known plastic surgeons in New York City and indeed the country, operate at MEETI. If the demand for cosmetic surgery procedures is again on the rise, one might expect to see it there.
The American Society of Aesthetic Plastic Surgery (ASAPS) recently released their 2008 statistics showing that there were over 10 million surgical and non-surgical cosmetic procedures performed in the United States in 2008.
The cost of this was $11.8 billion. While this is a small number compared to what it takes to bail out an automobile company or a failing bank, it is still a big number for most of us. In 2008 there was a 12% decrease in the total number of cosmetic procedures, (surgical and non surgical), compared to 2007.
Surgical procedures in 2008 decreased by 15%. Given the state of the economy, that is not surprising at all, especially if one remembers that the Dow Jones at the end of 2008 was 37.4% lower than it's high in October of 2007.
At the present time the Dow Jones is approximately 39% lower than it's 2007 high. All cosmetic surgery procedures are considered by insurance companies as purely elective and are not covered by insurance. What this means is that those who are interested in their appearance, and feeling better about themselves even during the country's worst financial recession ever, only held up their discretionary spending for self-enhancement by somewhere between 12 and 15%.
Wanting to look good and be healthy and fit has become part of our culture. Thirty years ago we didn't have gymnasiums and health clubs all over Manhattan. It is the same in any small, medium or large city around the country. Any hotel that is worth its clean sheets has a health club and probably a spa where every grooming desire can be met. Today there is no stigma attached to having cosmetic procedures.
In a recent 2009 survey by the ASAPS, 73% of women polled stated that, if they had cosmetic surgery in the future, they would not be embarrassed if people outside the immediate family, or close friends, knew about it. Sixty nine percent of men responded in a similar fashion.
Cosmetic surgery means making people look better than nature intended. It is not frivolous nor is it all about vanity. Cosmetic surgery is for young girls and young boys who have body parts with which they are unhappy. A young girl or boy with very large protruding ears may experience ridicule, teasing and name calling, such as Dumbo, from their friends and classmates.
One can imagine the impact that this may have on a child's psychological and social development. The young woman, who has asymmetrical development of her breasts, or significant overgrowth of her breasts, can likewise be handicapped in terms of her athletic activities, social development or buying clothes.
Likewise, cosmetic surgery is important to many people in bridging the gap between being youthful and vigorous, and the signs and changes that occur in middle age as the signs of the aging process begin to show. There is no shortage of people in that category. Baby boomers represent just under 30% of the United States population (approximately 100 million people are baby boomers). There is a baby boomer turning 50 about every 8.5 seconds. There will be more than 4 million people turning 50 in 2009.
Many patients that I see say they are not requesting cosmetic surgery for their spouse or significant other or even for social reasons. They just want to look better when they see themselves in the mirror. And I believe them. There is little question that an individual communicates and relates to others in a more positive fashion when they have a greater sense of self-confidence in their appearance. There is also a group of patients who do want to have cosmetic surgery for social reasons. They are interested in looking better and more attractive for all the personal reasons that one might imagine. The positive benefits of one feeling that they are appealing in appearance to other people are pretty easy to understand.
The current economic climate has pushed unemployment to an all time high. Many middle-aged individuals are back into the job market where they are competing with workers in their twenties, thirties and early forties. Many patients, male and female, that I see tell me that they feel that improving their appearance is an investment in their future. There is no question that all things being equal, the more attractive, energetic applicant is likely to have a step up in a job interview. A sagging chin and jawline and baggy tired eyes, can become a professional disadvantage.
In the past four or five years, there has been a huge increase in the marketing and patient request for minimally invasive and non-surgical procedures. Facial fillers, (for wrinkles and depressions), and Botox to decrease muscle activity, (such as frown lines and crow's feet), have had a tremendous increase in popularity. Laser treatments to help improve wrinkles in the facial skin, remove skin blemishes, spider veins etc., have also had a tremendous increase.
Minimally invasive surgical procedures for face-lifting, eyelid surgery and nasal surgery are likewise frequent requests by patients. Despite the abundance of less invasive procedures for facial rejuvenation, facelifts are an increasingly popular choice for consumers, as many patients who opt for non-surgical procedures alone, end up disappointed when the outcomes don't meet their expectations. In addition patients may spend thousands of dollars on less invasive treatments when a surgical procedure could have delivered more satisfying and long-term results faster, and more cost effectively. With today's modern anesthesia techniques, and improved surgical procedures, the recovery time for many surgical procedures delivering maximum results has significantly decreased to where one can attend social functions, return to work or full athletic activities within 1 to 3 weeks.
At this point it is hard for me to determine if the economy is getting better, or if the requests for cosmetic surgery has been stimulated by those seeking an improved appearance for personal and professional reasons.
I have noticed in the past few weeks that it has gotten more difficult to get a reservation at the best and most expensive restaurants in Manhattan. And I found it interesting in a recent report that the revenue on Broadway, as of the end of May 2009, is up $30 million when compared to the same time last year. There are 43 new productions opening this season, which are the most new productions since the early 80's. Broadway has pulled in $713 million this season. This is somewhat surprising because just a few months ago the lights on Broadway were dimming with more than a dozen shows closing in January alone. Maybe when people are put in a severe economic compromise, they want to look well, eat well and be entertained. I look forward to following the trends in the next few months.
Keep up the good work Dr. Aston - Love your new book!
It would have been even nicer had his interest in 'modern anesthesia techniques' extended to the anesthesia chapter by Drs. Zelman & Geradini in Aston's 2009 'Aesthetic Plastic Surgery' textbook. Neither the subject of brain monitoring, modern anesthesia for at least the past decade, nor PK anesthesia recognized for at least the same period of time were referenced or mentioned.
Brain monitored PK anesthesia was the thrust of the 2007 book, 'Anesthesia in Cosmetic Surgery' from Cambridge University Press, inspired by the 2004 death of Olivia Goldsmith at MEETI.
On June 1, 2009, the Portuguese translation of 'Anesthesia in Cosmetic Surgery' went on sale in Brazil, the world's biggest market for cosmetic surgery.