U.S. Markets for Energy-Based Aesthetic Devices and Therapies

The word “aesthetics” is derived from the Greek aisthanesthai, which means “to perceive” or “to apprehend by the senses.” Aesthetics is 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. Aesthetic procedures are often performed on patients who have 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 they and 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, facelifts, and liposuction; however, noninvasive or nonsurgical energy-based aesthetic treatments also contribute a very large and growing part of the overall aesthetics market. Energy-based aesthetic treatments utilize various forms of intense pulsed light, laser, plasma, radiofrequency (RF), ultrasound, and other forms of light or heat-emitting energies to perform a wide variety of fast, virtually painless, noninvasive office-based treatment. These treatments—including laser hair removal and various skin improvement treatments, such as laser-based acne reduction, pigmentation/scar/vascular/vein removal, and skin resurfacing, as well as skin tightening, wrinkle reduction, and other procedures—have grown out of increased patient demand and awareness, and availability provided by dermatologists/plastic surgeons, obstetricians/gynecologists (OB/GYNs), and non-physician spas (medical spas) or skin care centers.

While laser hair removal, pioneered by Palomar Medical Technologies in the late 1990s, is the leading energy-based aesthetics application in the U.S. today, many newer aesthetic technologies such as skin resurfacing and tightening (introduced by Thermage), and emerging noninvasive cellulite removal and fat reduction treatment have, and may continue to, drive the growth of the nonsurgical aesthetics market.

A major driver of the nonsurgical aesthetics market (which not only includes energy-based aesthetics but the ever-increasing topical dermal fillers and neurotoxins, such as Botox and Restylane) 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 noninvasive aesthetic procedures are not reimbursed by insurance has resulted in the widespread adoption of nonsurgical aesthetics in physician’s offices due to the increased need to increase profitability in a market fraught with reimbursement issues and lower profitability. 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 topical aesthetic products, energy-based aesthetic treatments, and emerging products and technologies.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), “nonsurgical” or noninvasive cosmetic procedures (including energy-based aesthetics and other growing procedures, such as Botox and dermal fillers, microdermabrasion, and sclerotherapy) contributed to the vast majority—more than 9.5 million or 83.2%—of the 11.5 million total surgical and nonsurgical cosmetic procedures performed in the U.S. in 2006. Noninvasive cosmetic procedures have risen dramatically—at nearly 750%—in the U.S. since 1997. In contrast, “surgical” or invasive cosmetic procedures (which include approximately 20 different procedures such as breast augmentation, liposuction, and facelifts), contributed the minority, or approximately 17.0% of total cosmetic procedures in 2006, or only 1.9 million procedures—a decline of 9.0% over 2005.

Although surgical procedures posted a large gain of 98% since 1997, this cannot compare to the phenomenal 750% gain of nonsurgical procedures. As energy-based aesthetics contribute a major part of this market, it is the focus of this report and market analysis.