1 ISAPSInternationalSurveyonAesthetic/Cosmetic ProceduresPerformedin2010 Methodology: Surveyparticipantscompletedatwo‐page,English‐basedquestio nnaire thatfocusedonthenumberof surgicalandnon‐surgicalprocedurestheyperformedin2010. TheInternationalSocietyof Aesthetic PlasticSurgeons (ISAPS)issued an invitationtoparticipateinthe studytoapproximately20,000PlasticSurgeonswhosecontactinformationishou sedintheirproprietary database.In addition, a request was made that all National Societies encourage their members/constituentstotakepartinthesurvey.Threereminderrequestsweredistributedin orderto maximizetheresponse. Atotalof698completedresponseswerereceivedintimefortabulation. Final figures have been projec ted to reflect international statistics and are exclusively based on the estimated number of Plastic Surgeonsineach country and the responding sample.Wher eas the U.S.‐ basedstudyfundedbytheAmericanSocietyofAestheticPlasticSurgeryincludesBoardCertifiedPlastic Surgeons,Dermatologists, andOtolaryngologists,thisInternationalSurveyisfocuseden tirelyon board certified(ornationalequivalent)PlasticSurgeons. To aid in tallying the world‐wide number of plastic surgeons, representatives from National Societies providedthecountsforover90%ofthe33,000totalestimatedplasticsurgeons.Forcasesinwhichthe National Society didnot provide its country’s total, a regressionequation was created to estimate the numb erofplasticsurgeonsinthecountrybasedonitspopulationsizeandGrossDomesticProduct. In cases where a country received an insufficient survey response, the projection base included respondentsfromthecountry’scontinent.Aweightingsystemwasemployedtoemphasizeresponses fromtheparticularcountr y. Caution is urged when comparing against prior years, because studies such as this can experience substantial variances within specific procedures.In addition, the overall methodology was slightly modified and National Societies from several countries materially restated their estimated number of plasticsurgeonsfor2010.Figuresfor2 009werenotrecomputed. Though the confidence intervals change by procedure and by country‐depending on the sample size andresponsevarianceofeach‐theoverallsurveyportionofthisresearchholdsastandarderrorof+/‐ 3.67%ata95%levelofconfidence. TheInternationalSurveyonAesthetic/CosmeticProceduresPerformedin2010wascompile d,tabulated, andanalyzedbyIndustryInsights,Inc.(www.industryinsights.com),anindependentresearchfirmbased inColumbus,OH.TheSurveyleaderwasScottHackworth,aCertifiedPublicAccountantwhoalongwith hisfirmhasconductedvariousformsofresearchontrendsinAestheticPlasticSurgeryforover15years. 2 CountriesbyNumberofPlasticSurgeons(Top25) Rank PlasticSurgeons PercentofTotalPlastic Surgeons PercentofTotalProcedures Rankin 2009 1 U.S. 5,970 18.1% 17.9% 1 2 Brazil 5,024 15.2% 13.6% 3 3 China 2,000 6.1% 6.8% 2 4 India 2,000 6.1% 6.2% 4 5 Japan 1,831 5.5% 6.4% 6 6 Mexico 1,518 4.6% 4.9% 5 7 Italy 1,500 4.5% 4.4% 13 8 Korea,South 1,250 3.8% 4.2% 7 9 France 953 2.9% 2.8% 14 10 Colombia 950 2.9% 2.7% 18 11 Germany 863 2.6% 2.4% 8 12 Turkey 700 2.1% 2.3% 9 13 Spain 567 1.7% 1.6% 10 14 Russia 515 1.6% 1.5% 12 15 UnitedKingdom 450 1.4% 1.3% 17 16 Canada 425 1.3% 1.4% 15 17 Venezuela 383 1.2% 1.1% 22 18 Taiwan 350 1.1% 1.2% 16 19 Argentina 347 1.1% 1.0% 11 20 Greece 286 0.9% 0.9% 19 21 Thailand 265 0.8% 0.9% 20 22 Australia 228 0.7% 0.8% 21 23 SaudiArabia 225 0.7% 0.8% 23 24 Netherlands 215 0.7% 0.6% 24 25 Romania 200 0.6% 0.6% * NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin2010 comparedtothefigureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffectranking comparisons,since2009rankingswerenotrecomputed. *DidnotplaceintheTop25in20 10.PortugalfellfromtheTop25listin2010. 3 CountriesbyTotalNumberofProcedures(Top25) Rank TotalSurgical Procedures %oftotal surgical procedures Total Nonsurgical Procedures %oftotal nonsurgical procedures Total Procedures %oftotal procedures Rank in 2009 1 U.S. 1,620,855 17.1% 1,693,437 18.6% 3,314,292 17.9% 1 2 Brazil 1,592,106 16.8% 925,672 10.2% 2,517,778 13.6% 2 3 China 588,880 6.2% 676,280 7.4% 1,265,160 6.8% 3 4 Japan 525,790 5.6% 657,530 7.2% 1,183,320 6.4% 6 5 India 553,420 5.8% 593,640 6.5% 1,147,060 6.2% 4 6 Mexico 437,351 4.6% 479,749 5.3% 917,100 4.9% 5 7 Italy 396,750 4.2% 418,995 4.6% 815,745 4.4% 9 8 Korea,South 361,988 3.8% 408,925 4.5% 770,913 4.2% 7 9 France 261,198 2.8% 249,943 2.7% 511,142 2.8% 14 10 Colombia 319,305 3.4% 173,822 1.9% 493,126 2.7% 17 11 Germany 229,273 2.4% 218,615 2.4% 447,888 2.4% 8 12 Turkey 205,114 2.2% 224,196 2.5% 429,310 2.3% 11 13 Spain 150,459 1.6% 154,190 1.7% 304,649 1.6% 12 14 Russia 138,854 1.5% 135,728 1.5% 274,583 1.5% 10 15 Canada 117,164 1.2% 138,559 1.5% 255,723 1.4% 16 16 UnitedKingdom 118,467 1.3% 116,645 1.3% 235,112 1.3% 18 17 Taiwan 102,708 1.1% 118,409 1.3% 221,116 1.2% 19 18 Venezuela 130,595 1.4% 79,848 0.9% 210,443 1.1% 20 19 Argentina 117,140 1.2% 76,954 0.8% 194,094 1.0% 13 20 Thailand 77,417 0.8% 85,205 0.9% 162,623 0.9% 21 21 Greece 76,471 0.8% 82,531 0.9% 159,002 0.9% * 22 SaudiArabia 66,310 0.7% 74,702 0.8% 141,012 0.8% 25 23 Australia 61,364 0.6% 78,662 0.9% 140,026 0.8% 22 24 Netherlands 57,358 0.6% 55,163 0.6% 112,520 0.6% * 25 Romania 52,854 0.6% 52,232 0.6% 105,086 0.6% * NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin2010comparedtothe figureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffectrankingcomparisons,since2009rankingswere notrecomputed. *DidnotplaceinTop25in20 10.Hungary,Portugal,andBelgiumfellfromtheTop25listin2011. NumberofProceduresandPlasticSurgeonsbyContinent Rank Co ntinent TotalProcedures PercentofTotal Procedures PlasticSurgeons PercentofTotal PlasticSurgeons Rankin 2009 1 Asia 5,879,349 31.7% 9,512 28.8% 1 2 NorthAmerica 4,566,581 24.6% 8,042 24.3% 2 3 Europe 3,980,135 21.4% 7,469 22.6% 3 4 SouthAmerica 3,645,758 19.6% 7,137 21.6% 4 5 Africa 320,006 1.7% 594 1.8% 5 6 Oceania 165,997 0.9% 273 0.8% 6 Total 18,557,82533,027 NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin2010comparedtothe figureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffectrankingcomparisons,since2009rankingswere notrecomputed. 4 NumberofWorld‐WideSurgicalProceduresPerformedbyPlasticSurgeons Rank SurgicalProcedure Total PercentofTotal SurgicalProcedures Rankin 2009 1 Lipoplasty 2,174,803 23.0% 1 2 Breastaugmentation 1,506,475 15.9% 2 3 Blepharoplasty 1,085,153 11.5% 3 4 Rhinoplasty 985,325 10.4% 4 5 Abdominoplasty 681,344 7.2% 5 6 Breastreduction(women) 549,994 5.8% 6 7 Breastlift 543,848 5.7% 7 8 Facelift 421,029 4.4% 8 9 Otoplasty 242,271 2.6% 10 10 Gynecomastia,treatmentof(malebreastreduction) 235,947 2.5% 9 11 Lipaugmentation(otherthaninje ctablematerials) 221,703 2.3% 11 12 Foreheadlift 135,242 1.4% 13 13 Buttockaugmentation 119,007 1.3% 14 14 Chinaugmentation 108,178 1.1% 16 15 Upperarmlift 94,026 1.0% 15 16 Hairtransplantation 77,480 0.8% 12 17 Thighlift 70,558 0.7% 17 18 Vaginalrejuvenation 67,665 0.7% 18 19 Lowerbodylift 64,475 0.7% 19 20 Cheekimplants 40,891 0.4% 21 21 Buttocklift 36,977 0.4% 20 TotalSurgicalProcedures 9,462,391 NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin2010comparedto thefigureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffectrankingcomparisons,since2009 rankingswerenotrecomputed. 5 NumberofWorld‐WideNonsurgicalProceduresPerformedbyPlasticSurgeons Rank NonsurgicalProcedure T Total PercentofTotal NonsurgicalProcedures T Rankin 2009 1 BotulinumToxinTypeA(BotoxDysport) 3,072,372 33.8% 1 2 HyaluronicAcidinjection 2,045,899 22.5% 2 3 Autologousfatinjection 836,864 9.2% 4 4 Laserhairremoval 796,192 8.8% 3 5 IPLLaserTreatment 583,536 6.4% 5 6 Microdermabrasion 394,148 4.3% 7 7 Chemicalpeel 305,585 3.4% 6 8 NoninvasiveTightening 285,074 3.1% 10 9 LaserSkinResurfacing 189,657 2.1% 8 10 CalciumHydroxylapatiteinjection 180,769 2.0% 12 11 Laser‐AssistedLipoplasty 176,800 1.9% * 12 Dermabrasion 109,198 1.2% 11 13 Sclerotherapy 99,220 1.1% 9 14 PenisEnlargements 20,121 0.2% * TotalNonsurgicalProcedures 9,095,434 *Itemswerenotsurveyedfor2009. T Collagen,Poly‐L‐LaticAcid,PolymethylMethacrylate,Fraxel,InjectionLipolysis,Lasertreatmentoflegveins,andOtherFillerswerenot reportedduetoaninsufficientnumberofplasticsurgeonsreportingtheyperformedtheprocedurein2010. Thoughsomemayconsiderthisasurgicalprocedure,itisclassifiedasanonsurgicalprocedureinthisstudysinceitsindicationsare approximatelythesameasfiller. 6 CountriesPerformingMostPopularSurgicalProcedures Rank Country NumberofProcedures PercentageofTotal Rankin2010 Lipoplasty 1 Brazil 436,887 20.1% 1 2 U.S. 402,259 18.5% 2 3 China 134,720 6.2% 3 4 India 130,480 6.0% 4 5 Japan 118,612 5.5% 5 Breastaugmentation 1 U.S. 336,648 22.3% 2 2 Brazil 254,214 16.9% 3 3 Mexico 85,099 5.6% 5 4 Italy 75,225 5.0% * 5 China 55,400 3.7% 1 *DidnotplaceinTop5for2009.Indiafellfromthetop5in2010. Blepharoplasty 1 Brazil 155,543 14.3% 3 2 U.S. 127,937 11.8% 2 3 China 73,480 6.8% 1 4 Japan 66,172 6.1% 5 5 Italy 63,330 5.8% * *DidnotplaceinTop5for2009.MexicofellfromtheTop5in2010. Rhinoplasty 1 Brazil 106,609 10.8% 3 2 U.S. 75,521 7.7% 1 3 China 125,700 12.8% 2 4 India 113,040 11.5% 4 5 Japan 112,497 11.4% * *DidnotplaceinTop5for2009.MexicofellfromTop5in2010. Abdominoplasty 1 U.S. 154,265 22.6% 1 2 Brazil 125,600 18.4% 3 3 Mexico 39,756 5.8% * 4 India 33,660 4.9% 4 5 China 33,480 4.9% 2 *DidnotplaceinTop5for2009.JapanfellfromTop5in2010. NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin 2010comparedtothefigureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffect rankingcomparison s,since2009rankingswerenotrecomputed. 7 CountriesPerformingMostPopularNonsurgicalProcedures Rank Country NumberofProcedures PercentageofTotal Rankin 2010 BotulinumToxinTypeA(BotoxDysport) 1 U.S. 579,739 18.9% 1 2 Brazil 268,131 8.7% 2 3 China 228,660 7.4% 3 4 Japan 213,659 7.0% 5 5 Mexico 195,883 6.4% 4 HyaluronicAcid 1 U.S. 256,048 12.5% 2 2 China 151,880 7.4% 3 3 Japan 149,648 7.3% * 4 Italy 143,040 7.0% * 5 Brazil 142,983 7.0% 1 *DidnotplaceinTop5for2009.MexicoandHungaryfellfromTop5in2010. Autologousfat 1 Brazil 148,208 17.7% 3 2 U.S. 121,430 14.5% 1 3 China 56,060 6.7% 2 4 Japan 51,616 6.2% 5 5 India 50,620 6.0% 4 Laserhairremoval 1 U.S. 146,086 18.3% 1 2 Brazil 104,348 13.1% 2 3 China 77,580 9.7% 3 4 Japan 76,371 9.6% 4 5 India 69,020 8.7% * *DidnotplaceinTop5for2009.SouthKoreafellfromTop5in2010. IPLLaserTreatment 1 U.S. 108,535 18.6% 2 2 Brazil 77,772 13.3% 1 3 Japan 54,600 9.4% * 4 China 45,240 7.8% 4 5 India 41,340 7.1% * *DidnotplaceinTop5for2009.MexicoandGermanyfellfromTop5in2010. NationalSocietiesofthefollowingcountriesmateriallyrestatedtheircountry’sestimatednumberofplasticsurgeonsin2010 comparedtothefigureusedin2009:Brazil;China;Colombia;France;Italy;andUnitedKingdom.Thismayaffectranking comparisons,since2009rankingswerenotrecomputed. Thoughsomemayconsiderthisasurgicalprocedure,itisclassifiedasanonsurgicalprocedureinthisstudysinceitsindicationsare approximatelythesameasfiller. 8 MostCommonProceduresByCountry NumberofProcedures Performed UnitedStates SurgicalProcedures Lipoplasty 402,259 Breastaugmentation 336,648 Abdominoplasty 154,265 Breastlift 128,295 Blepharoplasty 127,937 NonsurgicalProcedures BotulinumToxinTypeA(BotoxDysport) 579,739 HyaluronicAcid 256,048 Microdermabrasion 147,638 Laserhairremoval 146,086 Autologousfat 121,430 Brazil SurgicalProcedures Lipoplasty 436,887 Breastaugmentation 254,214 Blepharoplasty 155,543 Abdominoplasty 125,600 Rhinoplasty 106,609 NonsurgicalProcedures BotulinumToxinTypeA(BotoxDysport) 268,131 Autologousfat 148,208 HyaluronicAcid 142,983 Laserhairremoval 104,348 IPLLaserTreatment 77,772 China SurgicalProcedures Lipoplasty 134,720 Rhinoplasty 125,700 Blepharoplasty 73,480 Breastaugmentation 55,400 Abdominoplasty 33,480 NonsurgicalProcedures BotulinumToxinTypeA(BotoxDysport) 228,660 HyaluronicAcid 151,880 Laserhairremoval 77,580 Autologousfat 56,060 IPLLaserTreatment 45,240 Thoughsomemayconsiderthisasurgicalprocedure,itisclassifiedasanonsurgicalprocedureinthis studysinceitsindicationsareapproximatelythesameasfiller. 9 MostCommonProceduresByCountry (continued) NumberofProcedures Performed Japan SurgicalProcedures Lipoplasty 118,612 Rhinoplasty 112,497 Blepharoplasty 66,172 Breastaugmentation 50,114 Abdominoplasty 29,735 NonsurgicalProcedures BotulinumToxinTypeA(BotoxDysport) 213,659 HyaluronicAcid 149,648 Laserhairremoval 76,371 IPLLaserTreatment 54,600 Autologousfat 51,616 India SurgicalProcedures Lipoplasty 130,480 Rhinoplasty 113,040 Blepharoplasty 62,340 Breastaugmentation 51,000 Abdominoplasty 33,660 NonsurgicalProcedures BotulinumToxinTypeA(BotoxDysport) 193,100 HyaluronicAcid 127,800 Laserhairremoval 69,020 IPLLaserTreatment 41,340 Autologousfat 50,620 Thoughsomemayconsiderthisasurgicalprocedure,itisclassifiedasanonsurgicalprocedureinthis studysinceitsindicationsareapproximatelythesameasfiller. 10 Average Surgeon's Fee* (U.S. Dollars) Charged per Surgical Procedure Facelift $5,526 Abdominoplasty $4,150 Breastreduction(women) $3,924 Breastlift $3,684 Breastaugmentation $3,450 Lipoplasty $2,658 Rhinoplasty $2,609 Gynecomastia,treatmentof(malebreastreduction) $2,419 Otoplasty $2,039 Blepharoplasty $1,973 *Averagesareweightedbasedonnumberofproceduresperformedineachcountryand thecountry'saveragereportedfee. AverageSurgeon'sFee(U.S.Dollars)ChargedPerSurgicalProcedure— ByTop5Countries U.S. Brazil China Japan India Abdominoplasty $4,946 $3,731 $2,983 $3,048 $2,699 Blepharoplasty $2,429 $1,845 $1,292 $1,366 $1,191 Breastaugmentation $3,629 $2,921 $2,666 $2,794 $2,405 Breastlift $4,095 $3,109 $2,712 $2,971 $2,483 Breastreduction(women) $4,562 $3,230 $2,980 $3,128 $2,730 Facelift $6,442 $4,724 $4,009 $4,323 $3,689 Gynecomastia,treatmentof(malebreastreduction) $3,199 $2,305 $1,759 $1,837 $1,607 Lipoplasty $2,998 $2,789 $1,967 $2,034 $1,816 Otoplasty $2,745 $1,977 $1,519 $1,561 $1,412 Rhinoplasty $3,993 $3,031 $1,973 $2,053 $1,825