The Role of Injectables in Aesthetic Surgery: Financial Implications

Goals/Purpose:

In response to an increase in cosmetic injectables being offered by noncore cosmetic medicine providers, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) joined efforts to form a Cosmetic Medicine Task Force. In a survey sponsored by the Task Force, 47 percent of consumers said they would choose a provider they previously used for a noninvasive procedure as their first choice for an invasive procedure. It has been suggested that this represents a significant portion of patients who eventually undergo facial aesthetic surgery. There is little objective data documenting the generally held supposition that patients who undergo minimally invasive procedures ultimately undergo more invasive ones and are therefore an important patient resource. In this report we document the rate at which this occurs over a ten year period in a single surgeon's practice and address the financial implications.

Methods/Technique:

All patients receiving botox or fillers were analyzed and those who ultimately underwent surgery were identified. We did not evaluate patient records, nor address financials, for those who were introduced to cosmetic injectables after having undergone surgery by the primary surgeon. We included patients seen from 2004 to 2013, shortly after FDA approval of botox and hyaluronic acid fillers. Our goal was to identify those who had no initial specific intention to undergo an invasive aesthetic surgical procedure. Data gathered includes: demographics, injectable procedure specifics, aesthetic surgical procedures, and related revenues.  Injectable revenues were calculated utilizing billing records while aesthetic surgery revenues were derived from the most current ASAPS average fees per procedure.

Results/Complications:

From 2004-2013, 375 patients were introduced to the investigating surgeon's practice by receiving an injectable treatment, resulting in a total of 1049 injection sessions. Of these, 59 patients (16%) subsequently underwent an aesthetic procedure at an average interval of 19 months after their initial encounter. Patients underwent an average of three injectable sessions prior to surgery. Filler was most commonly placed in the naso-labial fold, and Botox was most used to treat dynamic glabellar rhytids (Figures 1 and 2). Males and females had similar conversion to surgery rates of 16%. Of all patients initially seen for injectables, Botox was the most common (78%) followed by hyaluronic acid fillers (64%), and 43% received both types of products. Those receiving only one type of injectable, Botox or filler, had similar conversion rates, both at 14% respectively. A significantly higher (18%, p<0.01) conversion rate to surgery was seen with those who received both botox and filler. The most common initial aesthetic procedures performed after undergoing injectables included: 21 facelifts (35%), 16 upper blepharoplasties (27%), and 14 browlifts (24%). Thirteen (22%) patients went on to have a total of 21 additional aesthetic surgical procedures. Overall, 119 aesthetic surgical procedures were performed on patients initially encountered by providing injectables (Figure 3). Thirty-four (58%) patients continued injectable sessions after their aesthetic surgery resulting in $164,110 in additional revenue. We demonstrate a trend in increasing annual injectable sessions resulting in a consistent flow of aesthetic procedures annually (Figure 4). Revenue stream from those converted to surgery remained fairly constant over the ten-year period (Figure 5). All revenue for patients introduced to the practice through use of injectables has reached $1,270,783 over a nearly 10 year span. Injectable sessions and aesthetic surgical procedures resulted in $874,617 and $396,166 in gross revenues respectively. An average revenue stream per patient who started with injectables and subsequently underwent an aesthetic procedure was $11,520.

Conclusion:

The above data supplies objective numbers to our joint society's contention that cosmetic injectables are a critical part of a plastic surgery practice. We have demonstrated that initial injectable experience ultimately leads to invasive procedures and consistent revenue stream.

 

TABLE 1		Revenue
Patients who started with injectables and subsequently had surgery (n=59)	Revenue of all injectable sessions prior to surgery	$119,386.30 ($2,023.50)
	Revenue of first aesthetic procedure following injectables	$333,492.00 ($5,652.41)
	Revenue of additional aesthetic procedures after first aesthetic procedure	$62,674.00 ($8,953.43)
	Revenue of additional injectable sessions after first aesthetic procedure	$164,109.90 ($8,205.50)
	Total revenues	$679,662 ($11,520)
Patients who only received injectables (no prior or subsequent surgery) (n=316)	Revenue of all injectable sessions	$591,121 ($1,870.64)
SUBTOTALS	Revenue of all injectable sessions for all patients	$874,617
	Revenue for all surgical procedures	$396,166
TOTAL	All revenue for all patients for all injectable sessions and aesthetic procedures	$1,270,783
Table 1: Average revenue per patient in parenthesis following total revenue values