U.S. Markets for Surgical and Nonsurgical Aesthetic Products and Therapies

The word “aesthetics” is derived from the Greek aisthanesthai, which means “to perceive” or “to apprehend by the senses.” Aesthetics involves the perception of beauty, and that perception varies from individual to individual. The evolutionary theory of aesthetically pleasing features suggests that those features that are most attractive are those associated with fertility (for the female) and the strength and agility of a protector (for the male)––that is, the features associated with youth.

Common aesthetics standards in the United States (U.S.) include the belief that unblemished skin is more attractive than skin with defects; smoother skin is more attractive than wrinkled or sagging skin; larger, well-spaced eyes are more attractive than smaller, narrow eyes; prominent breasts are more attractive in women than small breasts; narrow waists are more attractive than rotund waists; and leanness, in general, is more attractive than obesity. In men, broad shoulders, a waist that is 90% the width of the hips, and a flat stomach create an impression of strength, but also display a set of genetic traits that are desirable for progeny.

Given these standards, there are several clinical interventions that are able to alter the conditions that are perceived as unattractive and produce a more “attractive” outcome. In the past, aesthetic procedures often were performed on patients who had been disfigured by injury or congenital defects; however, these procedures have become popular over the past few decades by patients who are just trying to maintain a more youthful and attractive appearance. Throughout the world, the desire to look good, or look better, has driven men and women of every culture to expend precious resources to improve how others perceive them. Makeup and cosmetic products have comprised a significant portion of the industrial output of societies since antiquity. Advances in surgical interventions, such as breast augmentation procedures, have widened the spectrum of aesthetic alternatives available to patients. In addition, the advances in other aspects of medicine have significantly increased life expectancy, thus increasing an individual’s ability and desire to live out their later years with the same vigor possessed in youth. As the effects of aging degrade the appearance, the primary focus of most aesthetic interventions is to revert patients to a more youthful (or attractive) appearance.

The U.S. aesthetics marketplace traditionally includes cosmetic and plastic surgery, such as breast augmentation, face lifts, and liposuction; however, noninvasive or nonsurgical facial injectables, such as BOTOX (offered by Allergan) and Restylane (offered by Medicis), contribute a very large and growing part of the overall aesthetics market, and are therefore the primary focus in this report.

A major driver of the nonsurgical facial aesthetics market is the increased interest on the part of patients in aesthetic improvement, and particularly their willingness to pay for these products or treatments “out-of-pocket.” The fact that these procedures are expensive, not reimbursed by insurance, and involve several ongoing treatments, has resulted in their widespread adoption in physician’s offices. These office-based procedures provide physicians a very lucrative business with minimal liability, high turnover, and fast/easy application. This has resulted in a plethora of new and emerging topical or injected aesthetic products.

Of the surgical cosmetic procedures, breast augmentation is once again leading and is expected to continue in its upward procedural growth due to the re-emergence of silicone gel-filled implants with long clinical safety histories and monitoring by strict post-approval safety requirements.

(Dermal fillers and aesthetic neurotoxins are the topic of Chapter 2 of this report, and breast implants are discussed in Chapter 5; competitors and manufacturers’ sales are presented in Chapter 7.)