Customers of cosmetic surgery

The Customers

Cosmetic medical care, already popular, has gained a big boost with the coming of age of the postwar baby-boom generation, whose size will continue to drive the cosmetic medicine machine through the next several decades. Since World War II, youth has been our defining cultural ideal, and in recent decades people middle- aged or older have found their social currency devalued. Cosmetic surgeons used to see as patients mostly socialites, millionaires, wannabe movie stars, and those with ethnic noses; now they see patients from nearly every age, economic, and ethnic group.

The majority of twenty-first century cosmetic medical care patients are middle-class women, most of them middle-aged Caucasians. Although accurate statistics are impossible to obtain, the best numbers we have indicate that in 2005 between 10 million and 11.5 million cosmetic procedures were reported; approximately 90 percent of the patients were women, and 80 percent of the patients were Caucasian.

The actual number of cosmetic patients is unknown because more than one-third undergo multiple simultaneous procedures, about 40 percent are repeat customers, and nobody knows how many procedures are performed by providers operating under the radar of professional organizations. Although cosmetic medical procedures are performed everywhere in America, the West Coast sees the highest volume and Florida reportedly has the highest rate per capita.

Seeking a cosmetic change is about more than beauty for the typical patient. She (or he) wants to look less old, less tired, less unattractive, less outside the “ideal” range. People seek to improve their self-esteem, to encourage notice, to improve their chances of success in employment, to enlarge their social circle.

Middle- aged mothers often feel that they must compete with younger, childless women and may seek to restore their bodies to their prepregnancy condition. Because pregnancy can alter every aspect of a woman’s body, from her skin color to her shoe size, a woman who is unable to accept these changes can have a very long list of things she wants altered. The obesity epidemic in America has also expanded the cosmetic surgery market. The majority of adults in this country are considered obese, and the percentage is higher in women. It is well documented that obese people are presumed to be less intelligent and suffer discrimination in the job market.

Centuries ago, when the general population was hungry, corpulence was a status symbol; today fat is a social handicap. As a result, the weight-loss surgery business is burgeoning as much because of the social stigma of obesity as of the medical consequences. After all, one rarely sees an obese public figure, and many of those who are go to great and well-publicized lengths to lose weight. Because the typical dieter has difficulty abiding by weight-loss rules and restrictions for long periods and experiences repeated failures to maintain weight loss, the idea of a surgical fix can be quite appealing. One of the fastest growing segments of the cosmetic surgery market is the postbariatric patient population that is, those seeking surgery to restore body contours after massive weight loss.

Children also undergo cosmetic procedures, although the numbers are often exaggerated. Children under eighteen years of age underwent approximately 333,000 cosmetic procedures in 2005, about 4 percent of all reported procedures, with the vast majority of those being minimally invasive procedures such as chemical peels, microdermabrasion, and laser hair removal.

Nearly 12,000 Botox injections were performed on teens in 2005. Teens also underwent major cosmetic surgery, with rhinoplasties and otoplasties (ear pinnings) being the most common by far, followed by breast augmentation (less than 4,000 reported, down 10 percent from 2004), breast reduction surgery in boys, and liposuction. A smattering of other surgical procedures was performed, but the numbers are small.

Despite press reports implying that men are seeking cosmetic surgery in droves, men continue to account for less than 20 percent of the cosmetic medical care procedure total, and that has been the case for more than a decade.

It seems unlikely that the numbers of men undergoing cosmetic procedures will ever achieve parity with those of women because the underlying cultural pressures are different. Studies have repeatedly shown that age, although it can matter in certain job markets, makes much less difference for men in the social realm. In fact, there remains a certain social bias against heterosexual men who focus too much on vanity concerns (Queer Eye for the Straight Guy notwithstanding).

Young adults also undergo cosmetic procedures in significant numbers, and in the past, individuals in this age group risked being labeled emotionally immature if they sought cosmetic interventions. The prolonged adolescence of today’s twenty- and thirty-somethings is legendary, yet it has become hard to justify labeling this group of patients as immature simply because they are emulating the example set by their elders indulging in cosmetic alterations.

Younger adults tend to have limited financial resources, and paying for cosmetic procedures often requires them to make economic sacrifices. This fact is felt to be one explanation for the increasing popularity of less invasive and less expensive cosmetic procedures.

Regardless of whether more than one procedure is recommended to correct a perceived fl aw, historically most psychologically healthy patients have not sought serial cosmetic surgery. In this era of temporary injectables, less invasive and often less effective procedures, and dramatic public makeovers, providers now encourage patients to become repeat customers. Nonetheless, physicians do see some patients who seek cosmetic interventions in an addictive fashion or who wish to look like a famous person. All segments of the beauty and health-care industries, including cosmetic medicine, are patronized by some consumers who pursue their private goals to excess. Witness the struggles of anorexics and bulimics, the compulsive runners, and the more extreme vitamin and herbal medicine devotees.

Some of these individuals thrive, at least for a time, on externally imposed regimens that promise results for those able to stick with the program, whether it be Weight Watchers, prescription drugs such as Retin-A and glycolic acid–based skin creams, or months of twice-a-week visits to “treat” cellulite. The big business aspect of cosmetic medicine will always find a market in obsessives.

Of the 10 million to 11.5 million documented cosmetic procedures performed in 2005, approximately 2 million were surgical and the rest were of the minimally invasive variety. The most popular surgeries are liposuction, nose reshaping, breast augmentation, eyelid surgery, and abdominoplasty (tummy tuck). Off the top five list for the first time is facelift, which is steadily losing ground to lesser procedures. The most popular minimally invasive procedures are Botox injection (by a wide margin), chemical peel, microdermabrasion, laser hair removal, and filler injections. The demand for soft tissue injectables is growing rapidly, with hyaluronic acid products now surpassing collagen as the most popular filler. Body fads come and go. American women (and men) are presently obsessed with breasts and bellies. Other cultures may be more concerned with the shapes and sizes of buttocks, for example. Noses are almost universally subject to judgment and frequently to surgery.

Today in Iraq, where the incidence of cosmetic surgery has doubled since the fall of Saddam Hussein, the characteristically prominent Arab nose has become pathological, at least according to one local surgeon, and rhinoplasty a cultural imperative. Recently during a National Public Radio interview the Iraqi plastic surgeon stated, “All the noses in Iraq need cosmetic surgery” because, as he put it, they are too long and too wide, and have an “abnormal” bony hump.5 Like Americans, Iraqis look to popular entertainers (many of whom have had rhinoplasties and other cosmetic procedures) for their ideal images.

Still, in whatever way one might view the frenzy to pump up lips and overinflate already adequate breasts, much of what the public sees in the media are images of what is being done to celebrities and to a certain small segment of the population in the big coastal cities.

Fish lips and the cartoonish shapes one Web wag termed the Frankenstein Barbies are not as common in the heartland, nor are the trendy Botox parties and other group “events” designed to entice the curious and the brave to undergo a variety of cosmetic medical procedures. Of course, you don’t have to go to a Botox party for entertainment. Just pick up your remote control.

Customers of cosmetic surgery

The Customers

Legal Disclaimer

Related Articles