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Special Topic
The Economics of Plastic Surgery Practices:
Trends in Income, Procedure Mix, and
Volume
Lloyd M. Krieger, M.D., M.B.A., and Gordon K. Lee, M.D.
Beverly Hills, Calif.

Anecdotally, plastic surgeons have complained of working harder for the same or less income in recent years.
They also complain of falling fees for reconstructive surgery and increasing competition for cosmetic surgery.
This study examined these notions using the best available
data. To gain a better understanding of the current plastic
surgery market, plastic surgeon incomes, fees, volume,
and relative mix of cosmetic and reconstructive surgery
were analyzed between the years 1992 and 2002. To gain
a broader perspective, plastic surgeon income trends were
then compared with those of other medical specialties and
of nonmedical professions. The data show that in real
dollars, plastic surgeon incomes have remained essentially
steady in recent years, despite plastic surgeons increasing
their surgery load by an average of 41 percent over the past
10 years. The overall income trend is similar to that of
members of other medical specialties and other nonmedical professionals. The average practice percentage of cosmetic surgery was calculated and found to have increased
from 27 percent in 1992 to 58 percent in 2002. This most
likely can be explained by the findings that real dollar fees
collected for cosmetic surgery have decreased very slightly,
whereas those for reconstructive procedures have experienced sharp declines. This study demonstrates that plastic surgeons have adjusted their practice profiles in recent
years. They have increased their case loads and shifted
their practices toward cosmetic surgery, most likely with
the goal of maintaining their incomes. The strategy
appears to have been successful in the short term. However, with increasing competition and falling prices for
cosmetic surgery, it may represent a temporary bulwark
for plastic surgeon incomes unless other steps are
taken. (Plast. Reconstr. Surg. 114: 192, 2004.)

plastic surgeons have responded by changing
their practice mix to increase the amount of
cosmetic surgery performed and to curtail the
number of reconstructive procedures. Anecdotally, many plastic surgeons complain of declining overall incomes and the need to work
harder in their practices to remain economically viable.
This study was designed to substantiate or
refute these propositions with actual data. To
gain a better understanding of the current
plastic surgery market, this study examines
plastic surgeon incomes, fees, volume, and relative mix of cosmetic and reconstructive surgery between the years 1992 and 2002. To gain
a broader perspective, plastic surgeon income
trends are then compared with those of other
medical specialties and of nonmedical professions. Finally, the principles of economics are
used to explain these trends and offer insights
into possible future directions for the specialty.
PLASTIC SURGEON INCOMES
Methods

Data on plastic surgeon incomes were obtained from available sources. The best developed data came from Medical Economics magazine and the American Medical Group
Association. Medical Economics surveys thousands of physicians across various medical specialties every year and is able to obtain data
regarding annual income, practice profiles,
and variations among regions of the United

The nature of plastic surgery practice has
changed in recent years. Declining reimbursements from government and private payers
have increased the economic pressures faced
by plastic surgeons. It is widely believed that

From the Division of Plastic Surgery, University of California, Los Angeles Medical Center. Received for publication July 3, 2003; revised August
27, 2003.
DOI: 10.1097/01.PRS.0000128820.10811.0A

192

Vol. 114, No. 1 /

193

ECONOMICS OF PLASTIC SURGERY PRACTICES

States. Starting in 2000, Medical Economics began reporting data obtained from the American Medical Group Association as they cited
decreasing survey response rates and the high
reliability and consistency of the American
Medical Group Association data. It should be
noted that the American Medical Group Association only surveys groups, so solo practitioners are not included. Nevertheless, income
trends among group practice should reflect
economic trends among the plastic surgery industry as a whole. These income data are for
net income, after all practice expenses have
been deducted.
Annual income data were adjusted for inflation by using the consumer price index.1
This resulted in 2002 dollars being compared
across time periods to allow for accurate
comparisons.

ported by Medical Economics. Again, this disparity may reflect differences between solo and
group practices. However, the goal was to examine overall trends over time and not necessarily the absolute numbers themselves.
CHANGES

IN PRACTICE MIX: RECONSTRUCTIVE
VERSUS COSMETIC SURGERY

Methods

The American Society of Plastic Surgeons
has conducted detailed surveys of its members
on their practice parameters since 1992. Survey
data have been tabulated in the American Society of Plastic Surgeons National Plastic Surgery Statistics database, which provides information regarding total volume of cosmetic and
reconstructive surgery procedures, and is available only for the years 1992, 1996, 1998, 1999,
2000, 2001, and 2002.14

Results

According to Medical Economics data, plastic
surgery incomes were flat from 1992 to 1996,
took a drop in 1997, and then increased again
in 1998 and 1999.2– 8 The American Medical
Group Association data show that plastic surgeon incomes were $286,507 in 1999 and have
remained essentially unchanged since then9 –13
(Fig. 1). It was noted that reported incomes
from the American Medical Group Association
group practices were higher than incomes re-

Results

The total number of surgical procedures
(both reconstructive and cosmetic) performed
each year per surgeon went from 352 in 1992
to 496 in 2002, which represents an increase in
overall surgery load of 41 percent (Table I).
We stratified the data and calculated the average number of cosmetic versus reconstructive
surgical procedures per physician, and then
converted it to a percentage of total surgical

FIG. 1. Plastic surgery incomes over time. Mean incomes have been adjusted for inflation and
are plotted in 2002 dollars for accurate comparison between time periods. Medical Economics
survey data from 1992 to 1999 (1993 data not available) are shown. Starting in 2000, Medical
Economics began citing data from the American Society of Plastic Surgeons, whose income data
from 1997 to 2001 are shown. AMGA, American Medical Group Association.

194

PLASTIC AND RECONSTRUCTIVE SURGERY,

July 2004

TABLE I
Cosmetic, Reconstructive, and Total Surgical Procedures per Surgeon and as a Percentage of Average Plastic Surgeon
Practice*

Year

No. of Cosmetic
Operations
per Year

No. of
Reconstructive
Operations
per Year

Total No. of
Operations

No. of ASPS
Members

Average
Total No. of
Operations
Performed
per Year per
Physician

1992
1996
1998
1999
2000
2001
2002

412,901
696,912
1,045,815
1,008,140
1,355,793
1,917,139
2,036,794

1,125,232
1,239,209
1,167,934
1,242,993
1,341,192
1,472,145
1,504,341

1,538,133
1,936,121
2,213,749
2,251,133
2,696,985
3,389,284
3,541,135

4,363
5,826
6,394
6,574
6,837
7,073
7,145

352
332
346
342
394
479
496

Average
Percentage
of Cosmetic
Surgery per
Physician

Average
Percentage of
Reconstructive
Surgery per
Physician

27
36
47
45
50
57
58

73
64
53
55
50
43
42

ASPS, American Society of Plastic Surgeons.
* Calculations were based on data from the ASPS National Plastic Surgery Statistics database. These data do not include nonsurgical cases such as botulinum toxin
injections or chemical peels.

cases per physician. In 1992, the average plastic
surgeon’s total surgical volume consisted of 27
percent cosmetic and 73 percent reconstructive surgeries. By 2000, plastic surgeons were
performing approximately half cosmetic and
half reconstructive cases. By 2002, 58 percent
of all surgical procedures performed were cosmetic and only 42 percent were reconstructive.
Although the overall numbers indicate a
moderate increase in reconstructive surgery
and a large increase in cosmetic surgery across
the specialty, individual plastic surgeons
greatly decreased their percentage of reconstructive surgery and increased that of cosmetic
surgery. The trend toward an increased per-

centage of cosmetic surgery and decreased reconstructive surgery for individual plastic surgeons is shown in Figure 2.
CHANGES IN SURGEON FEES FOR COSMETIC
RECONSTRUCTIVE PROCEDURES

AND

Methods

To examine how cosmetic surgery fees have
changed over the past several years, data from
the American Society of Plastic Surgeons National Plastic Surgery Statistics on the six most
common cosmetic surgical procedures were
collated.14 These procedures included breast
augmentation, liposuction (single site), face

FIG. 2. Plastic surgeons’ practice mix over time. Average percentages of cosmetic versus
reconstructive procedures performed per plastic surgeon are plotted against time, using data
from the American Society of Plastic Surgeons’ National Plastic Surgery Statistics database.

Vol. 114, No. 1 /

195

ECONOMICS OF PLASTIC SURGERY PRACTICES

lift, upper/lower blepharoplasty, tummy tuck,
and nose reshaping. Using these six cosmetic
procedures, average fees for each of the years
1994, 1996, 1998, 1999, 2000, 2001, and 2002
were calculated—the years for which data were
available from the National Plastic Surgery Statistics. These fees were then normalized to year
2002 dollars using the consumer price index to
adjust for inflation. Medicare fee schedules
were obtained to examine trends in reconstructive surgery fees and were also normalized
to 2002 dollars.
Results

The total number of cosmetic cases performed per year and the average number of
cosmetic procedures per surgeon were calculated and are shown in Table II. Average surgeon’s fees in 2002 dollars for these six common cosmetic procedures were $3596 in 1994.
They dropped to $3286 in 2000 and then returned toward close to 1994 levels at $3587 in
2002. In short, surgeon’s fees for cosmetic surgery, despite some modest fluctuations, are essentially stable to slightly decreased in real
terms. The average number of cosmetic procedures per surgeon per year was 52 in 1994 and
gradually increased to 105 cases by 2002. Thus,
the average plastic surgeon’s volume of cosmetic surgery procedures has increased by 102
percent. Graphic representations of these cosmetic fee and volume trends are shown in Figure 3.
Medicare fee schedules have traditionally set
the pace for insurance companies, health
maintenance organizations, and other health
care payers. Over the past several years, MediTABLE II
Average Fees and Volume of Cosmetic Procedures*

Year

Average
Fee per
Procedure
in 2002
Dollars

Total No. of
Cases per
Year

No. of
ASPS
Members

No. of Cases
per Year per
Physician

1994
1996
1998
1999
2000
2001
2002

$3596
$3549
$3754
$3718
$3286
$3351
$3587

226,196
406,946
597,955
714,582
769,549
712,871
747,980

4363
5826
6394
6574
6837
7073
7145

52
70
94
109
113
101
105

ASPS, American Society of Plastic Surgeons.
* Six representative cosmetic surgical procedures were chosen for analysis:
breast augmentation, liposuction (single site), face lift, upper/lower blepharoplasty, tummy tuck, and nose reshaping. On the basis of these six operations,
average surgeon’s fee in 2002 dollars and number of cases for all six procedures
per surgeon per year are shown.

care reimbursements for noncosmetic and reconstructive surgical procedures have decreased when adjusted to 2002 dollars, and are
expected to continue to decrease over the next
several years. As can be seen, for the five sample procedures chosen (breast reconstruction
with free flap, breast reconstruction with implant, repair of laceration, tumor removal, and
breast reduction), there has been an overall 7
percent decrease in reimbursement fees from
2001 to 2003 (Table III).15
PLASTIC SURGEON INCOMES VERSUS OTHER
MEDICAL SPECIALTIES AND NONMEDICAL
PROFESSIONS
Methods

Annual net incomes for orthopedic surgeons, cardiothoracic surgeons, and pediatricians were obtained from the American Medical Group Association for the years 1997 to
2002.9 –13 These income data were normalized
to 2002 dollars using the consumer price index
to see changes in real incomes (Table IV).
Income data for other professions including
teachers, attorneys, engineers, and computer
analysts were obtained from the American Federation for Teachers’ Department of Research
for the years 1992 to 2001 and converted to
2002 dollars using the consumer price index.16
Results

Like plastic surgeons, the incomes of orthopedic surgeons and pediatricians have remained essentially flat during this period. In
stark contrast, cardiothoracic surgeons have
seen their incomes fall by 18 percent—from
$495,168 in 1997, to $407,787 in 2001 (Fig. 4).
Income data for teachers, attorneys, engineers, and computer analysts are shown in Table V. The trend for these highly trained specialists also was flat during the study period
(Fig. 5).
DISCUSSION

Perhaps even more than other medical specialties, plastic surgery has a unique dependence on economic forces. Because plastic surgery includes cash-based cosmetic surgery, the
classic economic principles of supply and demand and market competition have the same
effects on plastic surgery as on other service
industries.17 Plastic surgeons are also very susceptible to the rather twisted economic forces
of health care reimbursement, as they have

196

PLASTIC AND RECONSTRUCTIVE SURGERY,

July 2004

FIG. 3. Cosmetic surgery fee and volume trends. For the six representative cosmetic surgery
procedures (breast augmentation, liposuction, face lift, upper/lower blepharoplasty, tummy
tuck, and nose reshaping), the number of annual operations performed per surgeon is plotted
over time. Simultaneously, the average fee (in 2002 dollars) per procedure is plotted.
TABLE III
Medicare Fee Schedules Adjusted in 2002 Dollars for Five
Reconstructive Surgical Procedures for Los Angeles
County*

Year

Procedure

Breast reconstruction
with free flap
Breast reconstruction
with implant
Repair of laceration
Tumor removal
Breast reduction

2001

2002

2003

Percent Change
from 2001 to
2003

$2883

$2795

$2786

–3

$ 496
$ 172
$ 160
$1212

$ 407
$ 169
$ 140
$1094

$ 403
$ 171
$ 148
$1157

–19
–0.6
–8
–5

* Percent change is shown from 2001 to 2003. Average decrease in fees for
this group of procedures is 7 percent.

seen a steady decline in fees for reconstructive
procedures. The result is that plastic surgeons
are truly economic creatures who must adapt
to their complex financial environment ruled
by both the classic laws of supply and demand
and the often perverse effects of third-party
reimbursement.
These concepts were borne out by the findings in this study (Fig. 6). When examining
Medicare fee schedules for the past several
years, reimbursements for reconstructive surgery have declined. Almost certainly as a result,
plastic surgeons have increased the percentage
of cash-paying cosmetic surgery procedures in
their practices while performing a smaller per-

centage of reconstructive surgery. They also
have increased their overall surgical volume.
Several forces then come into play. The number of plastic surgeons has increased. Although
outside the scope of this study, the number of
nonplastic surgeons performing cosmetic surgery certainly has also increased. The result is
that fees for cosmetic surgery procedures have
remained essentially flat to slightly decreased
despite increasing consumer demand. Plastic
surgeon incomes, despite the switch in practice
mix toward cosmetic surgery and an overall
increase in surgical volume, also have remained essentially stable. In short, plastic surgeons have taken aggressive steps to change
their practice patterns to cope with economic
realities on the ground, and the result has been
the mere maintenance of the financial status
quo.
Some of these trends raise warning flags and
questions about the future economics of the
specialty. If cosmetic surgery is the main economic engine of overall plastic surgeon income, what happens when plastic surgeons
eventually fully switch their practices over to
this area and they can no longer use change in
practice mix as a means of maintaining income? With more competition from plastic surgeons and nonplastic surgeons alike for cosmetic surgery patients, fees likely will decline,
further limiting cosmetic surgery’s ability to
buffer plastic surgeons’ incomes.18 Another im-

Vol. 114, No. 1 /

197

ECONOMICS OF PLASTIC SURGERY PRACTICES

TABLE IV
Average Annual Income in 2002 Dollars across Medical Specialties*

Year

Plastic
Surgeons

Orthopedic
Surgeons

Cardiothoracic
Surgeons

Pediatricians

General
Surgeons

1997
1998
1999
2000
2001

$300,266
$304,653
$286,506
$287,443
$285,883

$256,787
$337,604
$337,193
$327,736
$338,970

$495,168
$484,569
$420,566
$447,276
$407,787

$158,580
$161,706
$150,428
$157,694
$151,792

$279,636
$288,887
$262,790
$268,637
$259,340

* Data were obtained from the Medical Group Compensation and Productivity Survey, 1998 –2002.

FIG. 4. Plastic surgeon incomes compared with other medical specialties. Incomes are reported in 2002 dollars for accurate comparison. Data were obtained from American Medical
Group Association’s Medical Group Compensation and Productivity Survey, 1997 to 2001.
TABLE V
Average Annual Income in 2002 Dollars across Various Professions*

Year

Plastic Surgeons

Teachers

Attorneys

Engineers

Computer Analysts

1992
1993
1994
1995
1996
1997
1998
1999
2000
2001

$269,606
NA
$266,912
$268,964
$265,539
$245,987
$273,403
$286,506
$287,443
$285,883

$43,631
$43,579
$43,413
$43,400
$43,105
$43,082
$43,441
$43,706
$43,680
$43,633

$84,479
$85,387
$78,335
$76,667
$76,317
$76,197
$78,946
$74,621
$80,600
$84,019

$68,477
$68,882
$68,425
$70,529
$70,645
$69,784
$71,175
$73,746
$75,666
$76,104

$68,344
$68,344
$66,215
$66,215
$66,241
$66,166
$69,611
$72,113
$69,838
$72,279

NA, not available.
* For plastic surgeons, data were obtained from Medical Economics for 1992 to 1999 (1993 data not available) and the American Medical Group Association for
2000 to 2001. Data for teachers, attorneys, engineers, and computer analysts were from the American Federation of Teachers’ Department of Research.

portant question is, To what extent can plastic
surgeons expect to work harder by performing
more operations while getting paid less for
each procedure? Plastic surgeons have already
increased their surgery load by 41 percent over
the past 10 years. This rate of increase cannot
be sustained forever.
One possible solution to this dilemma would

be to regulate cosmetic surgery through legislature and governing medical boards such that
only qualified individuals of appropriate training and background are allowed to perform
cosmetic surgery. Plastic surgeons might also
move to limit the number of residency positions and thus control the flow of new competition into the marketplace. These subjects are

198

PLASTIC AND RECONSTRUCTIVE SURGERY,

July 2004

FIG. 5. Plastic surgeon income compared with other nonmedical professionals. Incomes are
reported in 2002 dollars for accurate comparison. Data were obtained from the American Medical
Group Association, Medical Economics, and the American Federation of Teachers’ Department of
Research, 1992 to 2001.

FIG. 6. Recent trends in the plastic surgery marketplace. See text for
discussion.

politically charged and controversial.19 Regulation of cosmetic surgery in general and curtailing plastic surgery training programs, although
likely effective in buttressing incomes, are unlikely to materialize and provide market protection for plastic surgeons.
If plastic surgeons become less willing to
perform reconstructive procedures because of
declining surgeon fees, who will shoulder the
responsibility of caring for those patients?
There is no question that there will always be a
need for reconstructive surgery, but the opportunity costs of performing reconstructive sur-

gery over cosmetic surgery are so great that
fewer and fewer plastic surgeons may be able to
resist the economic pressure for very long.
For now, plastic surgeons seem to be doing
as well as other medical specialties, and certainly are doing well when compared with
other professions. However, economic and political realities indicate that there likely will be
a continuing trend toward declining fees in
both reconstructive and cosmetic surgery.
Once plastic surgeons have completed the arc
of their switch in practice mix toward cosmetic
surgery, there will be few steps individual sur-

Vol. 114, No. 1 /

ECONOMICS OF PLASTIC SURGERY PRACTICES

geons can take to maintain their incomes at
present levels.
Perhaps the best strategy for the specialty lies
in the larger educational, political, and technological arenas. If plastic surgeons successfully educate the public and lobby for increased fees for reconstructive surgery, the
economic dependence on cosmetic surgery
will be diminished. The trigger event that began the whole cycle toward less reconstructive
surgery, increased overall volume, and increased economic reliance on cosmetic surgery
will have been counteracted.
At the same time, if plastic surgeons increase
the size of the cosmetic surgery market such
that more people obtain these procedures, the
greater demand will help fees remain stable or
increase. The growing older population will
provide some help in this regard, as will technological advancement.20 Given these issues,
plastic surgeons’ main economic imperative
becomes clear. They must work to provide innovative services that more people desire, and
in a manner in which they want to receive
them, to increase the size of their market and
thus stabilize their individual incomes.
Lloyd M. Krieger, M.D., M.B.A.
Rodeo Drive Plastic Surgery
The Rodeo Collection
421 North Rodeo Drive
Beverly Hills, Calif. 90210
lkrieger@ucla.edu
REFERENCES
1. U.S. Department of Labor, Bureau of Labor Statistics.
Consumer price index. Available at: http://www.bls.
gov. Accessed May 15, 2003.
2. Crane, M. Is doctors’ hard work paying off? Med. Econ.
September 27, 1993.
3. Goldberg, J. Doctors’ earnings take a nosedive. Med.
Econ. September 12, 1994.
4. Goldberg, J. H. Doctors struggle to keep their earnings
up. Med. Econ. September 11, 1995.

199

5. Goldberg, J. H. Doctor’s earnings: An uphill struggle.
Med. Econ. September 9, 1996.
6. Goldberg, J. Are boom times over for primary care?
Med. Econ. September 8, 1997.
7. Crane, M. Charge what you will . . . reimbursements are
shrinking. Med. Econ. September 21, 1998.
8. Goldberg, J. Doctors’ earnings: You call this progress?
Med. Econ. September 20, 1999.
9. American Medical Group Association. 1998 Medical
Group Compensation and Productivity Survey–1998
Report Based on 1997 Data. Alexandria, Va.: American Medical Group Association, 1998.
10. American Medical Group Association. 1999 Medical
Group Compensation and Productivity Survey–1999
Report Based on 1998 Data. Alexandria, Va.: American Medical Group Association, 1999.
11. American Medical Group Association. 2000 Medical
Group Compensation and Productivity Survey–2000
Report Based on 1999 Data. Alexandria, Va.: American Medical Group Association, 2000.
12. American Medical Group Association. 2001 Medical
Group Compensation and Productivity Survey–2002
Report Based on 2000 Data. Alexandria, Va.: American Medical Group Association, 2001.
13. American Medical Group Association. 2002 Medical
Group Compensation and Productivity Survey–2002
Report Based on 2001 Data. Alexandria, Va.: American Medical Group Association, 2002.
14. American Society of Plastic Surgeons. National plastic surgery statistics. Available at: http://www.plasticsurgery.
org/psf. Accessed May 16, 2003.
15. Colorado Medical Society. Medicare Fee Schedule Report, Area 18, Los Angeles County. Available at:
http://www.cms.org. Accessed May 18, 2003.
16. American Federation of Teachers Department of Research. Survey and analysis of teacher salary trends.
Available at: http://www.aft.org/research/reports/
salarysv. Accessed May 22, 2003.
17. Krieger, L. M., and Shaw, W. W. Aesthetic surgery economics: Lessons from corporate boardrooms to plastic
surgery practices. Plast. Reconstr. Surg. 105: 1205, 2000.
18. Krieger, L. M., and Shaw, W. W. The effect of increased
plastic surgeon supply on fees for aesthetic surgery: An
economic analysis. Plast. Reconstr. Surg. 104: 559, 1999.
19. Krieger, L. M. Will the real plastic surgeon please stand
up? Plast. Reconstr. Surg. 100: 1059, 1997.
20. Krieger, L. M., and Shaw, W. W. The effect of increased
consumer demand on fees for aesthetic surgery: An
economic analysis. Plast. Reconstr. Surg. 104: 2312,
1999.


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