The total number of cosmetic procedures performed in the United States by plastic surgeons has nearly doubled since 2000. Surgeries are on the decline, but minimally invasive procedures — such as Botox injections and chemical peels — are on the rise, up more than 120% over the same period.

Read The Most Popular Plastic Surgeries in America

Last week, the American Society of Plastic Surgeons (ASPS) released its annual report on cosmetic procedures in 2011. 24/7 Wall St. reviewed the report to identify the most commonly performed plastic surgeries in America.

In the past year, plastic surgeons performed nearly 14 million cosmetic procedures, including over 1.5 million surgeries, with total surgeon fees exceeding $10 billion. Though minimally invasive procedures account for nearly 90% of the procedures, surgical procedures cost significantly more and, as a result, account for more than half of surgical fees.

The average surgical procedure costs $3,694, while the average minimally invasive procedure costs $376. And the difference may be informing patients’ decisions.

Overall, cosmetic surgeries have become safer, more efficient and relatively cheaper. Generally done in an outpatient setting — in a doctor’s office or surgical center — they frequently require no overnight stays in the hospital.

Despite improved care and savings, minimally invasive procedures, which are usually temporary fixes, are replacing them. In 2000, surgeries represented one in five of all cosmetic procedures. Today, only one in nine of all procedures are surgical. Facial cosmetic surgeries decreased by 31% since 2000, likely due to a rise in these minimally invasive procedures.

The most frequently performed cosmetic procedures are not surgeries at all. The most common, the botulinum toxin type A injection — best known as Botox – is used to smooth skin by relaxing facial muscles. These injections were performed more than 5 million times in 2011, up from less than 800,000 in 2000. The second most common procedure uses products like Restylane, hyaluronic gel injections which “plump” and “fill” wrinkles, and was performed 1.9 million times, up from 650,000 in 2000.

In an email interview with 24/7 Wall St., ASPS President Malcolm Z. Roth MD explained that minimally invasive procedures provide an alternative to patients who may not be candidates for face-lifts or liposuction. “Patients want quick fixes with minimal or no down time,” he said. Using fillers like Restylane and neurotoxins like Botox, plastic surgeons “can offer dramatic improvement for many with less risk, cost and down time.”

While some surgical procedures are down, surgeries performed to “lift” or “tighten” a certain area of the body have risen dramatically since 2000. Upper arm and lower body lifts, two surgeries that are not in the top 10, increased approximately 4,000% in frequency. Similarly, breast lifts and tummy tucks increased by roughly 75% over the same time period. These rises are, according to Dr. Roth, largely due to the increased prevalence of bariatric, or weight loss, surgery over the past decade.

Almost every cosmetic surgery experienced a major dip during the first two years of the recession, and only a few have recovered to their prerecession numbers. “While the rate of economic recovery in the U.S. is still uncertain, 2011 proved to be a good year for plastic surgery,” said Dr. Roth. “Consumer confidence was up, auto sales rose 10 percent, so it is not surprising that we would also see increased demand for plastic surgery procedures.”

These are America’s most popular plastic surgeries.

10. Ear Surgery
> No. of procedures: 26,433
> Total expenditure: $83.2 million
> Average surgeon’s fee: $3,148
> Change in prevalence since 2000: -27%

Ear surgery is performed to reshape ears that are too small, too large, too far out from the head or deformed in some other way. As with plastic surgery overall, there has been a large decline in the number of ear surgery procedures since 2000, decreasing 27% over the 12-year period. While ear surgery was not in the top 10 in 2000, its rise to the tenth spot is rather the result of the decline in popularity of two other procedures, hair transplantation and breast implant removal, than an increase in its own popularity.

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9. Forehead Lift
> No. of procedures: 46,931
> Total expenditure:$155.3 million
> Average surgeon’s fee: $3,309
> Change in prevalence since 2000: -61%

Forehead lifts are generally performed to remove wrinkles due to the loss of collagen in aging skin. With the rise of nonsurgical procedures, most specifically Botox and hyaluronic acid injections, there has been a dramatic 61% decrease in the number of procedures performed since 2000. Botox injections, a treatment derived from a bacterial neurotoxin, are now performed more than 5 million times per year, an increase of more than 600% since 2000. Procedures like the forehead lift are likely to continue to decline as minimally invasive techniques continue to improve.

8. Dermabrasion
> No. of procedures: 73,433
> Total expenditure:$89.4 million
> Average surgeon’s fee: $1,218
> Change in prevalence since 2000: +74%

Dermabrasion is a surgical procedure that removes layers of skin — usually on the face — to repair damage. Over the past 12 years, this technique has actually increased in usage by 74%. While minimally invasive procedures, specifically chemical peels and laser skin resurfacing, are performed much more frequently, evidence has shown dermabrasion to be more appropriate for treating acne and traumatic facial scars, as well as localized cosmetic facial resurfacing.

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7. Breast Lift
> No. of procedures: 90,679
> Total expenditure: $388.7 million
> Average surgeon’s fee: $4,286
> Change in prevalence since 2000: +72%

Breast lifts are performed to raise and firm the breasts by removing excess skin and tightening the tissue around the breast, which usually occurs due to breast feeding or heavy weight loss. There has been a 72% increase in the number of breast lifts since 2000, most likely due to the increased frequency of bariatric, or obesity, surgery. Bariatric surgery causes massive weight loss and frequently requires several plastic surgeries afterwards, including breast lifts and the removal of excess skin in other areas, including tummy tucks, upper arm lifts and lower body lifts. After experiencing a small decline during the first two years of the economic recession, breast lift procedures have continued to increase in popularity.

6. Tummy Tuck
> No. of procedures: 115,902
> Total expenditure: $611.8 million
> Average surgeon’s fee: $5,279
> Change in prevalence since 2000: +85%

A tummy tuck, or abdominoplasty, removes excess skin and fat from a patient’s abdomen when it remains loose after significant weight loss, pregnancy, aging or previous surgery. Since 2000, there has been an 85% increase in the prevalence of this procedure. As with breast lifts, this is likely due to the increase in bariatric surgery and other successful, significant weight loss techniques over the same time. After an incredibly rapid rise over the first part of the decade, the number of tummy tuck procedures declined roughly 20% in the first year of the recession and has remained stable since then.

5. Face-Lift
> No. of procedures: 119,026
> Total expenditure: $764.9 million
> Average surgeon’s fee: $6,426
> Change in prevalence since 2000: -11%

While the number of face-lift procedures has declined by 11% over the past decade, other facial cosmetic surgeries have declined even more over the same time frame. Likely impacted by the success of minimally invasive injections, a face-lift continues to be the best option to remove deep sagging of the skin in the neck and face. Despite the decline, face-lifts have remained the number three plastic surgery in terms of total patient expenditure, and they are the second most expensive plastic surgery procedure overall.

4. Eyelid Surgery
> No. of procedures: 196,286
> Total expenditure: $538.0 million
> Average surgeon’s fee: $2,741
> Change in prevalence since 2000: -40%

Cosmetic eyelid surgery rejuvenates the appearance of the area around the eyes and can make people look more well-rested and alert. However, several minimally invasive procedures can produce the same results for a much cheaper price, including Botox and hyaluronic acid injections. Likely due to availability of these alternatives, eyelid surgery declined by 40% between 2000 and 2011, with a roughly 25% drop between 2000 and 2002, when Botox was approved by the FDA to treat frown lines around eyes.

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3. Liposuction
> No. of procedures: 204,702
> Total expenditure: $585.2 million
> Average surgeon’s fee: $2,859
> Change in prevalence since 2000: -42%

Liposuction is the process of removing excess fat deposit from almost any part of the body. In 2000, liposuction was the second-most frequently performed cosmetic surgery, but it has since been passed by breast augmentation. While the procedure is great for removing fat, it frequently leaves behind excess skin and is therefore being replaced with surgeries that remove both skin and fat tissue in some body parts, including the upper arms, lower legs and thighs. These procedures have become much more prevalent in the past 12 years, with upper arm and lower body lifts increasing from 595 total procedures in 2000 to 22,613 total procedures in 2011.

2. Nose Reshaping
> No. of procedures: 243,772
> Total expenditure: $1,078.0 million
> Average surgeon’s fee: $4,422
> Change in prevalence since 2000: -37%

Nose reshaping, or rhinoplasty, was the most commonly performed plastic surgery until 2004, when it was briefly exceeded by liposuction. As plastic surgeons continue to refine minimal invasive injections to reshape and smooth out facial contours, surgical reshaping becomes less necessary. While previously the only option for reducing a prominent bump on the nose was to physically shave it down, surgeons can now inject small amounts of gels to smooth the appearance of the nose. Nose reshaping is likely to remain one of the most common plastic surgeries, as there is still no other way to reduce the overall size of a nose.

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1. Breast Augmentation
> No. of procedures: 307,180
> Total expenditure: $1,040.1 million
> Average surgeon’s fee: $3,388
> Change in prevalence since 2000: +45%

While most other plastic surgery procedures have become less common since 2000, breast augmentation has risen to the top. Between 2000 and 2007, the procedure was performed 64% more frequently. It dipped nearly 30% over the first two years of the recession, but has been on the rise since 2009. After the introduction of semi-solid silicone gel implants in the late 1990s, complications due to implant rupture virtually disappeared. Additionally, improved techniques have made the surgery an almost exclusively outpatient procedure. Likely related to these improvements, patient satisfaction has increased and reversal, or breast implant removal, has decreased by nearly 50% over the same time period. As of 2011, 5% of women in America had breast implants, including those placed for reconstructive rather than cosmetic purposes.

Baxter B. Allen

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