2013 Plastic Surgery Statistics Report

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1 All figures are projected. * Data unavailable in prior year. **72% of total breast implants were silicone; 28% were saline. ***Botulinum toxin type A numbers are of anatomic sites injected. ASPS National Clearinghouse Embargo of for Release March 21, 2011 Procedural Statistics The American Board of as well as I I I I 1

2 Statistics Table of Contents Introduction About the American Society of Plastic Surgeons... 3 Methodology and Validity... 4 Quick Facts - Trends... 5 Quick Facts - Demographic Trends... 6 Statistical Reports Cosmetic Procedure Trends... 7 Cosmetic Procedure Charts... 8 Reconstructive Procedure Trends and Charts... 9 Cosmetic Surgery Gender Distribution Female Top Five Cosmetic Surgery Gender Distribution Charts Female Cosmetic Surgery Gender Distribution Male Top Five Cosmetic Surgery Gender Distribution Charts Male Cosmetic Surgery Age Distribution (13-19) Cosmetic Surgery Age Distribution (20-29) Cosmetic Surgery Age Distribution (30-39) Cosmetic Surgery Age Distribution (40-54) Cosmetic Surgery Age Distribution (55 and Over) Regional Distribution Cosmetic Procedures Average Surgeon/Physician Fees Cosmetic Procedures Cosmetic Demographics Reconstructive Demographics Reconstructive Breast Procedures Body Contouring after Massive Weight Loss

3 Statistics About the American Society of Plastic Surgeons The American Society of Plastic Surgeons ASPS, a non-profit organization, supports members in their efforts to provide the highest quality patient care through education, research and advocacy. It is the only organization with two decades of plastic surgery statistics ASPS is the largest organization of board-certified plastic surgeons in the world. With more than 7,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of, Inc. (ABPS ) or The Royal College of Physicians and Surgeons of Canada. The ASPS mission is to advance quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice, and research in plastic surgery. ASPS Member Surgeons are uniquely qualified to perform cosmetic and reconstructive plastic surgery on the face and all areas of the body. Consumers can visit the ASPS at PlasticSurgery.org to find ASPS Member Surgeons in their area or learn more about cosmetic and reconstructive plastic surgery, like us on Facebook.com/ PlasticSurgeryASPS and follow us at Twitter.com/ASPS_News. ASPS Spokespersons Network The ASPS Spokespersons Network is a valuable plastic surgery resource. It comprises more than 100 plastic surgeons from across the United States and Canada trained and available to assist journalists. These spokespersons provide expert perspectives on a broad range of plastic surgery topics including procedural details, the patient-physician relationship, emerging trends, teens, and minorities. They are also knowledgeable about the Society s positions on health care reform, scope of practice and other issues that affect patient care. To arrange interviews with members of the ASPS Spokespersons Network, contact the Department. PlasticSurgery.org The ASPS online newsroom is the most comprehensive site for journalistic research on cosmetic and reconstructive plastic surgery on the Internet. The latest news releases and the online version of the National Clearinghouse of Statistics are available. Full color graphics and statistical graphs can be downloaded or are available by contacting the Department. Pre- and Postoperative Photos and B-Roll ASPS has a library of pre- and postoperative images and B-roll available to the media by contacting the Department. ASPS Member Surgeons have the following qualifications: Are certified by The American Board of and trained specifically in plastic surgery. Have at least 6 years surgical training, minimum of 3 years plastic surgery training. Operate only in accredited medical facilities. Adhere to a strict code of ethics. Fulfill continuing education requirements, including patient safety techniques. Are partners with patients in cosmetic and reconstructive plastic surgery. 3

4 Statistics Methodology and Validity Methodology Since 1992, the American Society of Plastic Surgeons (ASPS ) has been the source of cosmetic and reconstructive plastic surgery statistical trends in the U.S., and this series represents two decades of procedural data. ASPS has partnered with Data Harbor Solutions, a health care industry data management and technology development company, to ensure objectivity in the gathering, analysis and publication of its procedural statistics. Since 2000, the report represents a universal and comprehensive estimate of cosmetic and reconstructive plastic surgery procedures performed by ASPS Member Surgeons as well as other physicians most likely to perform plastic surgery procedures. These physicians are all certified by American Board of Medical Specialties (ABMS) recognized boards. ABMS is the umbrella organization for the 24 approved medical specialty boards in the United States. Established in 1933, ABMS serves to provide information concerning issues involving specialization and certification in medicine. The American Board of (ABPS ) represents physicians who are certified by ABPS, the only ABMS member board that certifies surgeons in plastic surgery of the face and entire body. ASPS offers the most comprehensive, reliable statistics on cosmetic and reconstructive plastic surgery procedures performed in the United States. The annual questionnaire was distributed to 23,700 ABMS board-certified physicians (An online and faxed version of the questionnaire were made available. A total of 801 active physicians returned questionnaires, consisting of 479 plastic surgeons, 221 dermatologists, and 101 Otolaryngologists. Overall, 1160 active physicians were included in the final sample). This data is combined with the first online national database for plastic surgery procedures Tracking Operations and Outcomes for Plastic Surgeons SM (TOPS SM ). All responses are aggregated and extrapolated to the entire population of more than 24,500 board certified physicians most likely to perform cosmetic and reconstructive plastic surgery procedures, resulting in the most accurate census available. Validity Results of the survey are based on a 95 percent confidence level with a ±3.41 percent margin of error. 4

5 Quick Facts Cosmetic and Reconstructive Trends The American Board of as well as Percentage change vs million cosmetic procedures 3% 1.6 million cosmetic surgical procedures 1% 13.4 million cosmetic minimally-invasive procedures 3% 5.7 million reconstructive procedures 2% Top 5 Cosmetic Surgical Procedures vs Breast augmentation (290,000) 1% Nose reshaping (221,000) 9% Eyelid surgery (216,000) 6% Liposuction (200,000) 1% Facelift (133,000) 6% Top 5 Cosmetic Minimally-Invasive Procedures vs Botulinum toxin type A (6.3 million) 3% Soft tissue fillers (2.2 million) 13% Chemical peel (1.2 million) 3% Laser hair removal (1.1 million) 4% Microdermabrasion (974,000) no change Top 5 Reconstructive Procedures vs Tumor removal (4.4 million) 5% Laceration repair (254,000) 13% Maxillofacial surgery (199,000) 5% Scar revision (177,000) 4% Hand surgery (131,000) 6% Breast augmentation continues to be the top cosmetic surgical procedure and has been since Silicone implants were used in 72%, and saline implants in 28%, of all breast augmentations in. Cosmetic surgical procedures, not among the Top 5, with notable gains in include: Male breast reduction (gynecomastia) up 11% Tummy Tuck up 5% Neck lift up 6% Facial rejuvenation procedures experienced the most growth, as marked the highest number of botulinum toxin type A injections to date, with 6.3 million injections! Tumor removal is overwhelming the top reconstructive procedure performed every year with more than 4.4 million procedures in! 5

6 Quick Facts Cosmetic Demographic Trends The American Board of as well as Age year olds vs Make up the least number of cosmetic procedures only 2% of the total. Some of the most common procedures for teens were: nose reshaping, male breast reduction, ear surgery, laser hair removal and laser skin resurfacing. 220,000 total cosmetic procedures 3% 64,000 surgical 5% 156,000 minimally-invasive 3% year olds vs ,000 total cosmetic procedures 1% 245,000 surgical 1% 557,000 minimally-invasive 1% year olds vs million total cosmetic procedures 2% 350,000 surgical no change 2.2 million minimally-invasive 2% year olds vs Make up the majority of cosmetic procedures 49% of the total. 7 million total cosmetic procedures 3% 527,000 surgical 2% 6.5 million minimally-invasive 3% 55 and over vs million total cosmetic procedures 4% 375,000 surgical 3% 3.4 million minimally-invasive 4% Gender Female vs % of all cosmetic procedures 13.1 million total cosmetic procedures 1% 1.4 million surgical 1% 11.8 million minimally-invasive 3% Male vs % of all cosmetic procedures 1.2 million total cosmetic procedures no change 204,000 surgical no change 1 million minimally-invasive no change Ethnic vs Caucasians (10.5 million) 3% Hispanics (1.7 million) 6% African Americans (1.2 million) 5% Asian Americans (988,000) 1% Did you know Business from repeat patients increased 4% $12.6 billion was spent on cosmetic procedures in the U.S., up 15% Office-based cosmetic procedures are up 4% Region with the most cosmetic procedures performed in the U.S. is Mountain/Pacific 4.3 million procedures 6

7 Cosmetic Statistics Cosmetic Procedure Trends Top 5 procedures appear in bold. All figures are projected. * Data unavailable in prior year. **72% of total breast implants were silicone; 28% were saline. ***Botulinum toxin type A numbers are of anatomic sites injected. The American Board of as well as EMBARGOED UNTIL: February 26, 2014 at 12:01 AM EST COSMETIC SURGICAL vs vs Breast augmentation (augmentation mammaplasty)** 290, , ,500 1% 37% Breast implant removals (augmentation patients only) 23,770 21,609 40,787 10% -42% Breast lift (mastopexy) 90,006 89,067 52,836 1% 70% Breast reduction (aesthetic patients only) 41,164 42,022 * -2% * Breast reduction in men (gynecomastia) 22,939 20,723 20,351 11% 13% Buttock augmentation with fat grafting 9,993 8,654 * 16% * Buttock implants * 1% * Buttock lift 2,438 2,898 1,356-16% 80% Calf augmentation * 31% * Cheek implant (malar augmentation) 12,004 12,698 10,427-5% 15% Chin augmentation (mentoplasty) 19,108 18,645 26,924 2% -29% Dermabrasion 74,721 72,805 42,218 3% 77% Ear surgery (otoplasty) 24,111 25,730 36,295-6% -34% Eyelid surgery (blepharoplasty) 215, , ,514 6% -34% Facelift (rhytidectomy) 133, , ,856 6% 0% Forehead lift 46,323 44, ,971 4% -62% Hair transplantation 15,076 16,377 44,694-8% -66% Lip augmentation (other than injectable materials) 25,156 25,144 18,589 0% 35% Lip reduction * -32% * Liposuction 199, , ,015-1% -44% Lower body lift 7,281 7, % 3,417% Neck lift 55,346 52,189 * 6% * Nose reshaping (rhinoplasty) 221, , ,155-9% -43% Pectoral implants * 2% * Thigh lift 8,709 8,894 5,303-2% 64% Tummy tuck (abdominoplasty) 111, ,628 62,713 5% 79% Upper arm lift 15,769 15, % 4,565% TOTAL COSMETIC SURGICAL 1,668,420 1,655,360 1,901,049 1% -12% COSMETIC MINIMALLY-INVASIVE vs vs Botulinum toxin type A (Botox, Dysport )*** 6,321,160 6,134, ,911 3% 703% Cellulite treatment (e.g., Velosmooth, Endermology) 29,318 33,123 23,952-11% 22% Chemical peel 1,163,333 1,133,821 1,149,457 3% 1% Intense pulsed light (IPL) treatment 602, ,293 * 9% * Laser hair removal 1,077,158 1,118, ,996-4% 46% Laser skin resurfacing 511, , ,951 1% 199% Ablative 146, ,271 * -1% * Non-ablative (e.g., Fraxel ) 365, ,784 * 1% * Laser treatment of leg veins 208, , ,424-10% -15% Microdermabrasion 970, , ,315 0% 12% Sclerotherapy 321, , ,555-10% -63% Soft tissue fillers 2,242,621 1,988, ,885 13% 243% Calcium hydroxylapatite (e.g., Radiesse ) 284, ,346 * 3% * Collagen 60,565 67, ,615-11% -90% Porcine/bovine-based (e.g., Evolence, Zyderm, Zyplast ) 14,465 16,317 * -11% * Human-based (e.g., Cosmoderm, Cosmoplast, Cymetra ) 46,100 51,460 * -10% * Fat 66,223 63,128 65,270 5% 1% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane, Prevelle Silk ) 1,675,601 1,423,136 * 18% * Polylactic acid (Sculptra ) 138, ,038 * 0% * Polymethyl-methacrylate microspheres (Artefill ) 17,317 18,342 * -6% * TOTAL COSMETIC MINIMALLY-INVASIVE 13,447,933 13,034,750 5,500,446 3% 144% 7 TOTAL COSMETIC 15,116,353 14,690,110 7,401,495 3% 104%

8 Top Five Cosmetic Procedures Cosmetic Procedure Charts Top Five Cosmetic Surgical Procedures Breast Augmentation 290,000 1% from 2012 Nose Reshaping 221,000-9% from 2012 Eyelid Surgery 216,000 6% from 2012 Liposuction 200,000-1% from 2012 Facelift 133,000 6% from 2012 Top Five COSMETIC Minimally-Invasive Procedures Botulinum Toxin Type A 6.3 million 3% from 2012 The American Board of as well as Soft Tissue Fillers 2.2 million Chemical Peel 1.2 million Laser Hair Removal 1.1 million Microdermabrasion 970,000 13% from % from % from 2012 No change EMBARGOED UNTIL: February 26, 2014 at 12:01 AM EST 8

9 Reconstructive Statistics Reconstructive Procedure Trends Top 5 procedures appear in bold. RECONSTRUCTIVE vs vs Dog bite repair^ 26,935 27,752 43,089-3% -37% Birth defect (congenital deformities) 30,257 27,626 40,076 10% -25% Breast implant removals (reconstructive patients only)**** 18,223 16,596 16,287 10% 12% Breast reconstruction**** 95,589 91,655 78,832 4% 21% Breast reduction (reconstructive patients only) 62,611 68,416 * -8% * Burn care^^^^ 16,113 16,989 * -5% * Hand surgery (excluding microsurgical) 131, ,377 * 6% * Head and neck reconstruction**** 26,481 27,161 * -3% * Hernia repair**** 9,458 8,949 * 6% * Laceration repair (other than facial)^^ 253, , ,666-13% -29% Lower extremity reconstruction (including microsurgical)**** 17,026 16,603 * 3% * Maxillofacial surgery^^^ 198, ,464 79,331-5% 150% Pelvic floor reconstruction**** 1, * 40% * Scar revision 177, , ,858 4% -20% Tumor removal (including skin cancer) 4,426,634 4,211,134 * 5% * Other reconstructive procedures 242, , ,270-19% -35% TOTAL RECONSTRUCTIVE 5,734,120 5,612,549 * 2% * Top Five Reconstructive Procedures Tumor Removal 4.4 million 5 % from 2012 All figures are projected. * Data unavailable in prior year. ****Counts of procedures performed by ASPS member surgeons only. ^In 2000 figure included all animal bites. ^^In 2000 figure included facial laceration repair. ^^^In 2000 figure did not include facial laceration repair. ^^^^The number of procedures in 2012 has been restated due to a modeling change. The American Board of as well as Laceration Repair 254,000 Maxillofacial Surgery 199,000 Scar Revision 177,000 Hand Surgery 131,000-13% from % from % from % from 2012 EMBARGOED UNTIL: February 26, 2014 at 12:01 AM EST 9

10 2012 Cosmetic Surgery Gender Distribution Female Top 5 procedures appear in bold All figures are projected. * Data unavailable in prior year. **72% of total breast implants were silicone; 28% were saline. ***Botulinum toxin type A numbers are of anatomic sites injected. The American Board of as well as COSMETIC SURGICAL TOTAL TOTAL FEMALE % OF TOTAL vs vs Breast augmentation (augmentation mammaplasty) 290, , % 1% 37% Breast implant removals (augmentation patients only) 23,770 23, % 10% -42% Breast lift (mastopexy) 90,006 90, % 1% 70% Breast reduction in men (gynecomastia) 22, % - - Buttock implants % 10% * Buttock lift 2,438 2,254 92% -16% 72% Calf augmentation % 30% * Cheek implant (malar augmentation) 12,004 8,818 73% -4% 1% Chin augmentation (mentoplasty) 19,108 9,345 49% 5% -48% Dermabrasion 74,721 64,498 86% 3% 131% Ear surgery (otoplasty) 24,111 13,990 58% -8% -27% Eyelid surgery (blepharoplasty) 215, ,243 86% 6% -31% Facelift (rhytidectomy) 133, ,621 90% 5% 2% Forehead lift 46,323 41,239 89% 4% -62% Hair transplantation 15,076 4,401 29% -12% 8% Lip augmentation (other than injectable materials) 25,156 24,063 96% 0% 31% Liposuction 199, ,259 88% -2% -42% Lower body lift 7,281 6,637 91% 2% * Nose reshaping (rhinoplasty) 221, ,662 74% -10% -32% Pectoral implants % - - Thigh lift 8,709 8,268 95% -2% 63% Tummy tuck (abdominoplasty) 111, ,462 96% 5% 78% Upper arm lift 15,769 15,445 98% 2% 4470% TOTAL COSMETIC SURGICAL 1,561,307 1,357,275 87% 1% -10% COSMETIC MINIMALLY-INVASIVE % OF TOTAL TOTAL TOTAL FEMALE vs vs Botulinum toxin type A (Botox, Dysport )*** 6,321,160 5,935,802 94% 3% 757% Cellulite treatment (e.g., Velosmooth, Endermology) 29,318 25,159 86% -11% 5% Chemical peel 1,163,333 1,068,708 92% 2% 13% Laser hair removal 1,077, ,612 82% -4% 47% Laser skin resurfacing 511, ,920 88% 0% 200% Laser treatment of leg veins 208, ,158 87% -10% -20% Microdermabrasion 970, ,933 82% 0% 1% Sclerotherapy 321, ,715 99% -10% -62% Soft tissue fillers 2,225,304 2,129,943 96% 13% 253% Calcium hydroxylapatite (e.g., Radiesse ) 284, ,606 93% 3% * Collagen 60,565 57,634 95% -11% -89% Fat 66,223 61,952 94% 5% 1% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane, Prevelle Silk ) 1,675,601 1,628,231 97% 18% * Polylactic acid (Sculptra ) 138, ,520 84% -1% * TOTAL COSMETIC MINIMALLY-INVASIVE 12,827,957 11,782,950 92% 3% 142% TOTAL COSMETIC 14,389,264 13,140,225 91% 1% 106% 10

11 Cosmetic Surgery Gender Distribution Charts Female Top Five Female Cosmetic Surgical Procedures Breast Augmentation 290,000 1 % from 2012 Nose Reshaping 164,000 Liposuction 176,000 Eyelid Surgery 185,000 Facelift 121,000-10% from from % from % from 2012 Top Five Female Cosmetic Minimally-Invasive Procedures Botulinum Toxin Type A million 3 % from 2012 The American Board of as well as Soft Tissue Fillers million Chemical Peel 1.1 million Laser Hair Removal 887, ,000 Microdermabrasion 825, , % from % from from 2012 no change 11

12 Cosmetic Surgery Gender Distribution Male Top 5 procedures appear in bold All figures are projected. * Data unavailable in prior year. ***Botulinum toxin type A numbers are of anatomic sites injected. The American Board of as well as COSMETIC SURGICAL TOTAL TOTAL MALE % OF TOTAL vs vs Breast augmentation (augmentation mammaplasty) 290, % - - Breast implant removals (augmentation patients only) 23, % - - Breast lift (mastopexy) 90, % - - Breast reduction in men (gynecomastia) 22,939 22, % 11% 13% Buttock implants % 12% * Buttock lift 2, % -15% 283% Calf augmentation % 32% * Cheek implant (malar augmentation) 12,004 3,186 27% -8% 91% Chin augmentation (mentoplasty) 19,108 9,763 51% 1% 7% Dermabrasion 74,721 10,223 14% 3% -29% Ear surgery (otoplasty) 24,111 10,121 42% -3% -41% Eyelid surgery (blepharoplasty) 215,641 30,398 14% 5% -47% Facelift (rhytidectomy) 133,320 12,699 10% 7% -16% Forehead lift 46,323 5,084 11% 3% -61% Hair transplantation 15,076 10,675 71% -6% -74% Lip augmentation (other than injectable materials) 25,156 1,093 4% -2% 371% Liposuction 199,817 23,558 12% 3% -55% Lower body lift 7, % 0% 211% Nose reshaping (rhinoplasty) 221,053 57,391 26% -7% -62% Pectoral implants % 2% * Thigh lift 8, % -3% 100% Tummy tuck (abdominoplasty) 111,986 4,524 4% 4% 97% Upper arm lift 15, % 1% * TOTAL COSMETIC SURGICAL 1,561, ,032 13% 0% -48% COSMETIC MINIMALLY-INVASIVE % OF TOTAL TOTAL TOTAL MALE vs Botulinum toxin type A (Botox, Dysport )*** 6,321, ,358 6% -1% 310% Cellulite treatment (e.g., Velosmooth, Endermology) 29,318 4,159 14% -13% * Chemical peel 1,163,333 94,625 8% 5% -53% Laser hair removal 1,077, ,546 18% -2% 43% Laser skin resurfacing 511,795 63,875 12% 2% 196% Laser treatment of leg veins 208,069 27,911 13% -9% 33% Microdermabrasion 970, ,410 18% -2% 107% Sclerotherapy 321,477 4,762 1% -8% -82% Soft tissue fillers 2,225,304 95,361 4% 8% 90% Calcium hydroxylapatite (e.g., Radiesse ) 284,488 18,882 7% 4% * Collagen 60,565 2,931 5% -13% -94% Fat 66,223 4,271 6% 6% 9% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane, Prevelle Silk ) vs ,675,601 47,370 3% 13% * Polylactic acid (Sculptra ) 138,427 21,907 16% 4% * TOTAL COSMETIC MINIMALLY-INVASIVE 12,827,957 1,045,007 8% 0% 65% TOTAL COSMETIC 14,389,264 1,249,039 9% 0% 22% 12

13 Cosmetic Surgery Gender Distribution Charts Male Top Five male Cosmetic Surgical Procedures Nose Reshaping 57,000-7% from 2012 Eyelid Surgery 30,000 Liposuction 24,000 Breast Reduction in Men 23,000 Facelift 13,000 5 % from % from % from % from 2012 Top Five male Cosmetic Minimally-Invasive Procedures Botulinum Toxin Type A 385,000-1% from 2012 The American Board of as well as Laser Hair Removal 191,000 Microdermabrasion 178,000 Chemical Peel 95,000 Soft Tissue Fillers 95,000-2% from % from % from % from

14 Cosmetic Surgery Age Distribution Age Top 5 procedures appear in bold COSMETIC SURGICAL AGE TOTAL AGE % OF TOTAL AGE vs 2012 Breast augmentation (augmentation mammaplasty)^ 8,234 3% 0% Breast implant removals (augmentation patients only)^ 84 0% 11% Breast lift (mastopexy) 1,608 2% 1% Breast reduction in men (gynecomastia)^^ 5,866 26% 0% Chin augmentation (mentoplasty) 1,615 8% 1% Dermabrasion 3,260 4% 3% Ear surgery (otoplasty) 6,871 28% -7% Eyelid surgery (blepharoplasty) 2,015 1% 5% Lip augmentation (other than injectable materials) 243 1% 0% Liposuction 3,155 2% -1% Nose reshaping (rhinoplasty) 30,672 14% -9% TOTAL COSMETIC SURGICAL 63,623 4% -5% COSMETIC MINIMALLY-INVASIVE AGE TOTAL AGE % OF TOTAL AGE vs 2012 Botulinum Toxin Type A (Botox, Dysport)*** 17,978 0% 3% Chemical peel 6,119 1% 2% Laser hair removal 69,402 6% -5% Laser skin resurfacing 25,377 5% 1% Laser treatment of leg veins 18,972 9% -9% Microdermabrasion 9,640 1% 1% Sclerotherapy 1,778 1% -9% Soft Tissue Fillers 6,675 0% 8% Calcium hydroxylapatite (Radiesse) 950 0% 3% Collagen 206 0% -10% Fat 587 1% 5% Hyaluronic acid (Juvederm Ultra, Juvederm Ultra Plus, Perlane, Restylane) 3,015 0% 19% Polylactic acid (Sculptra) 1,917 1% 1% TOTAL COSMETIC MINIMALLY-INVASIVE 155,941 1% -3% TOTAL COSMETIC 219,564 2% -3% All values are projected. ^Total represents only 18 and 19 years olds. ^^The number of procedures in 2012 has been restated due to a modelling change. ***Botulinum toxin type A numbers are of anatomic sites injected. The American Board of as well as 14

15 Cosmetic Surgery Age Distribution Age Top 5 procedures appear in bold All values are projected. ***Botulinum toxin type A numbers are of anatomic sites injected. ^^The number of procedures in 2012 has been restated due to a modelling change. The American Board of as well as COSMETIC SURGICAL AGE TOTAL AGE % OF TOTAL AGE vs 2012 Breast augmentation (augmentation mammaplasty) 83,638 29% 1% Breast implant removals (augmentation patients only) 3,167 13% 9% Breast lift (mastopexy) 12,598 14% 0% Breast reduction in men (gynecomastia)^^ 8,006 35% 13% Buttock implants % 9% Buttock lift % -15% Calf augmentation % 30% Cheek implant (malar augmentation) 1,109 9% -6% Chin augmentation (mentoplasty) 2,610 14% 3% Dermabrasion 5,021 7% 3% Ear surgery (otoplasty) 7,117 30% -4% Eyelid surgery (blepharoplasty) 3,884 2% 6% Facelift (rhytidectomy) 381 0% 4% Forehead lift 258 1% 2% Hair transplantation 1,287 9% -7% Lip augmentation (other than injectable materials) 1,204 5% 0% Liposuction 30,891 15% 0% Lower body lift % 3% Nose reshaping (rhinoplasty) 69,748 32% -8% Pectoral implants % 2% Thigh lift 547 6% -2% Tummy tuck (abdominoplasty) 10,699 10% 4% Upper arm lift 1,445 9% 2% TOTAL COSMETIC SURGICAL 245,195 16% -1% COSMETIC MINIMALLY-INVASIVE AGE TOTAL AGE % OF TOTAL AGE vs 2012 Botulinum toxin type A (Botox, Dysport )*** 94,865 2% 2% Cellulite treatment (e.g., Velosmooth, Endermology) 6,275 21% -11% Chemical peel 13,691 1% 3% Laser hair removal 233,132 22% -3% Laser skin resurfacing 28,745 6% 0% Laser treatment of leg veins 26,733 13% -10% Microdermabrasion 75,741 8% -1% Sclerotherapy 13,960 4% -9% Soft tissue fillers 63,416 3% 12% Calcium hydroxylapatite (e.g., Radiesse ) 5,728 2% 4% Collagen 2,749 5% -11% Fat 3,253 5% 5% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, 44,236 3% 19% Perlane, Restylane, Prevelle Silk ) Polylactic acid (Sculptra ) 7,450 5% -1% TOTAL COSMETIC MINIMALLY-INVASIVE 556,558 4% -1% TOTAL COSMETIC 801,753 6% -1% 15

16 Cosmetic Surgery Age Distribution Age Top 5 procedures appear in bold All values are projected. ***Botulinum toxin type A numbers are of anatomic sites injected. ^^The number of procedures in 2012 has been restated due to a modelling change. The American Board of as well as COSMETIC SURGICAL AGE TOTAL AGE % OF TOTAL AGE vs 2012 Breast augmentation (augmentation mammaplasty) 105,877 36% 1% Breast implant removals (augmentation patients only) 7,011 29% 9% Breast lift (mastopexy) 26,748 30% 1% Breast reduction in men (gynecomastia)^^ 4,062 18% 12% Buttock implants % 9% Buttock lift % -17% Calf augmentation % 31% Cheek implant (malar augmentation) 2,450 20% -5% Chin augmentation (mentoplasty) 2,554 13% 2% Dermabrasion 7,505 10% 2% Ear surgery (otoplasty) 4,204 17% -7% Eyelid surgery (blepharoplasty) 13,500 6% 5% Facelift (rhytidectomy) 2,053 2% 7% Forehead lift 1,917 4% 4% Hair transplantation 1,226 8% -8% Lip augmentation (other than injectable materials) 3,199 13% 1% Liposuction 67,360 34% 0% Lower body lift 1,960 27% 1% Nose reshaping (rhinoplasty) 53,254 24% -10% Pectoral implants 61 18% 0% Thigh lift 2,472 28% -3% Tummy tuck (abdominoplasty) 39,565 35% 5% Upper arm lift 2,257 14% 1% TOTAL COSMETIC SURGICAL 350,465 22% 0% COSMETIC MINIMALLY-INVASIVE AGE AGE AGE TOTAL % OF TOTAL vs 2012 Botulinum toxin type A (Botox, Dysport )*** 1,119,798 18% 4% Cellulite treatment (e.g., Velosmooth, Endermology) 15,935 54% -11% Chemical peel 150,063 13% 4% Laser hair removal 311,661 29% -5% Laser skin resurfacing 44,081 9% 1% Laser treatment of leg veins 63,868 31% -9% Microdermabrasion 224,329 23% -1% Sclerotherapy 65,990 21% -9% Soft tissue fillers 250,292 11% 14% Calcium hydroxylapatite (e.g., Radiesse ) 23,137 8% 2% Collagen 9,404 16% -11% Fat 8,648 13% 5% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, 193,387 12% 19% Perlane, Restylane, Prevelle Silk ) Polylactic acid (Sculptra ) 15,716 11% 1% TOTAL COSMETIC MINIMALLY-INVASIVE 2,246,017 18% 2% TOTAL COSMETIC 2,596,482 18% 2% 16

17 Cosmetic Surgery Age Distribution Age Top 5 procedures appear in bold All values are projected. ***Botulinum toxin type A numbers are of anatomic sites injected. ^^The number of procedures in 2012 has been restated due to a modelling change. The American Board of as well as COSMETIC SURGICAL AGE TOTAL AGE % OF TOTAL AGE vs 2012 Breast augmentation (augmentation mammaplasty) 85,516 29% 2% Breast implant removals (augmentation patients only) 9,704 41% 11% Breast lift (mastopexy) 34,914 39% 1% Breast reduction in men (gynecomastia)^^ 3,049 13% 10% Buttock implants % 11% Buttock lift 1,032 42% -16% Calf augmentation 86 15% 32% Cheek implant (malar augmentation) 5,391 45% -6% Chin augmentation (mentoplasty) 4,670 24% 4% Dermabrasion 28,878 39% 2% Ear surgery (otoplasty) 3,593 15% -6% Eyelid surgery (blepharoplasty) 92,779 43% 7% Facelift (rhytidectomy) 43,510 33% 4% Forehead lift 18,068 39% 5% Hair transplantation 3,151 21% -7% Lip augmentation (other than injectable materials) 9,041 36% 0% Liposuction 78,133 39% -2% Lower body lift 3,187 44% 3% Nose reshaping (rhinoplasty) 45,299 20% -9% Pectoral implants 65 19% 3% Thigh lift 4,179 48% -2% Tummy tuck (abdominoplasty) 46,074 41% 5% Upper arm lift 6,783 43% 2% TOTAL COSMETIC SURGICAL 527,471 34% 2% COSMETIC MINIMALLY-INVASIVE AGE AGE AGE TOTAL % OF TOTAL vs 2012 Botulinum toxin type A (Botox, Dysport )*** 3,637,545 58% 3% Cellulite treatment (e.g., Velosmooth, Endermology) 7,096 24% -11% Chemical peel 485,121 42% 2% Laser hair removal 393,219 37% -3% Laser skin resurfacing 207,133 40% 0% Laser treatment of leg veins 63,125 30% -11% Microdermabrasion 428,276 44% 1% Sclerotherapy 156,980 49% -11% Soft tissue fillers 1,087,086 49% 13% Calcium hydroxylapatite (e.g., Radiesse ) 110,680 39% 2% Collagen 21,696 36% -12% Fat 22,500 34% 5% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, 853,736 51% 17% Perlane, Restylane, Prevelle Silk ) Polylactic acid (Sculptra ) 78,474 57% -1% TOTAL COSMETIC MINIMALLY-INVASIVE 6,465,581 50% 3% TOTAL COSMETIC 6,993,052 49% 3% 17

18 Cosmetic Surgery Age Distribution Age 55 and over Top 5 procedures appear in bold All values are projected. ***Botulinum toxin type A numbers are of anatomic sites injected. ^^The number of procedures in 2012 has been restated due to a modelling change. The American Board of as well as COSMETIC SURGICAL AGE 55 AND OVER TOTAL AGE 55 AND OVER % OF TOTAL AGE 55 AND OVER vs 2012 Breast augmentation (augmentation mammaplasty) 6,934 2% -7% Breast implant removals (augmentation patients only) 6,959 2% 0% Breast lift (mastopexy) 3,804 16% 11% Breast reduction in men (gynecomastia)^^ 14,138 16% 2% Buttock implants 1,956 9% 41% Buttock lift 69 7% 11% Calf augmentation % -16% Cheek implant (malar augmentation) 37 6% 32% Chin augmentation (mentoplasty) 3,054 25% -5% Dermabrasion 7,659 40% 2% Ear surgery (otoplasty) 30,057 40% 4% Eyelid surgery (blepharoplasty) 2,326 10% -7% Facelift (rhytidectomy) 103,463 48% 5% Forehead lift 87,376 66% 6% Hair transplantation 26,080 56% 3% Lip augmentation (other than injectable materials) 9,412 62% -8% Liposuction 11,469 46% 0% Lower body lift 20,278 10% -1% Nose reshaping (rhinoplasty) 1,434 20% 1% Pectoral implants 22,080 10% -10% Thigh lift 41 12% 0% Tummy tuck (abdominoplasty) 1,511 17% -1% Upper arm lift 15,648 14% 5% TOTAL COSMETIC SURGICAL 374,553 24% 3% COSMETIC MINIMALLY-INVASIVE AGE 55 AND OVER AGE 55 AND OVER AGE 55 AND OVER TOTAL % OF TOTAL vs 2012 Botulinum toxin type A (Botox, Dysport )*** 1,450,974 23% 3% Cellulite treatment (e.g., Velosmooth, Endermology) 12 0% -8% Chemical peel 508,339 44% 3% Laser hair removal 69,744 6% -5% Laser skin resurfacing 206,459 40% 2% Laser treatment of leg veins 35,371 17% -11% Microdermabrasion 232,357 24% -1% Sclerotherapy 82,769 26% -9% Soft tissue fillers 817,835 37% 12% Calcium hydroxylapatite (e.g., Radiesse ) 143,993 51% 4% Collagen 26,510 44% -10% Fat 31,235 47% 5% Hyaluronic acid (e.g., Juvederm Ultra, Juvederm Ultra Plus, 581,227 35% 18% Perlane, Restylane, Prevelle Silk ) Polylactic acid (Sculptra ) 34,870 25% 0% TOTAL COSMETIC MINIMALLY-INVASIVE 3,403,860 27% 4% TOTAL COSMETIC 3,778,413 26% 4% 18

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