The future of aesthetic surgery

Plastic surgery, aesthetic surgery, cosmetic surgery: the field has many different names. Yet despite its high profile today, many people even within the medical field have a limited understanding of it and the drastic changes it’s undergoing. From noninvasive procedures to patient education, aesthetic surgeons face a variety of new challenges. We sat down with Foad Nahai, editor of Aesthetic Surgery Journal‎, to learn more about developments in the field.

What encouraged you to pursue a career in aesthetic surgery?

My early career was at a time when very few plastic surgeons limited their practice to aesthetic surgery. Compared to today, there was far less demand for such procedures, and media coverage of aesthetic surgery was not extensive. Like most others of that era, I focused primarily on reconstructive surgery and was fortunate to have the opportunity to contribute to the many advances that have transformed the field. As my practice and reputation as a surgeon grew, coupled with increasing interest and demand for aesthetic procedures, more and more patients sought my services for aesthetic surgery. My background in reconstructive surgery, interest in art and anatomy, and my experience as a reconstructive microsurgeon prepared me well for the transition from a heavily reconstructive practice to one that eventually became exclusively aesthetic. The ultimate encouragement came from satisfied patients who continue to refer friends and family.

What do you think are the biggest challenges being faced in the field of aesthetic surgery today?

The field of aesthetic surgery is rapidly evolving. There continue to be many new and innovative surgical advances, but the most rapid area of growth is in the arena of noninvasive procedures. Most notable is the development of a wide array of injectable products as well as new mechanical devices for noninvasive skin tightening and elimination of unwanted fat. The challenge for the practitioner is not only to keep up with these new developments but also to determine, on a scientific basis, which products and devices can best serve patients, both immediately and long term. Aesthetic Surgery Journal (ASJ) has an important role in providing the most current evidence-based information to assist our readers in evaluating these emerging technologies.

By far the major challenge to the field, however, is education of the public as to who is competent or best qualified to undertake aesthetic procedures. Given the rapid growth of aesthetic surgery, coupled with cuts in medical reimbursements and other disincentives to the practice of traditional medicine, a wide range of physicians (and even non-physicians) are enticed to enter the field of aesthetic surgery despite having little or no relevant training. Plastic surgeons have long been among those who regard “scope of practice” as a significant public safety issue and not, as some have claimed, a “turf battle.” While all surgery has some risk, no patient should subject himself or herself to the inherently greater danger when a procedure is performed by an unqualified practitioner or in a facility that fails to meet accepted safety standards.

How has the field changed in the last 25 years?

Growth, growth, and more growth! Twenty-five years ago, all that aesthetic specialists could offer patients, with the exception of skin peels, were invasive surgical procedures. This has dramatically changed. Statistics from the American Society for Aesthetic Plastic Surgery (ASAPS), published as a July 2015 Aesthetic Surgery Journal supplement, show that since 1997 the number of surgical procedures has doubled while nonsurgical procedures have increased more than tenfold. This trend will continue.

Equally influential in changing the field has been innovation in electronic communication. Although there are many positive aspects to the Internet and social media, there are also many downsides when it comes to healthcare information. Patients may often obtain the “facts” about aesthetic surgery from websites that are unreliable and lack credibility. Any assertion of an individual surgeon’s superiority can be made with virtually no challenge. In the past, being well-trained, taking good care of patients, and providing them with excellent results was all a young surgeon needed to build a successful practice. Today, physicians feel pressured to devote a good deal of time and resources in developing an online presence.

The Internet is replete with questionable, misleading, and self-serving claims. Anonymous online evaluations of physicians have largely replaced word-of-mouth recommendations. All this can make it more difficult for a surgeon to establish that all-important relationship of trust, especially with new patients. Yet adapting to these challenges, while remaining ethical and placing patient welfare above all else, is a necessary part of developing a successful practice in a fiercely competitive healthcare environment.

What do you think will change the most in the field in the future?

The changing culture of healthcare (depersonalization and lack of access to doctors) in the United States will have some effect on aesthetic surgery, though less than on many other fields since aesthetic procedures are largely elective and therefore not covered by insurance or Medicare. However, as I have alluded to earlier, more physicians without appropriate training can be expected to migrate from their own specialties into what they perceive as the more lucrative field of aesthetic surgery. This will increase competition and decrease patient safety.

Nonsurgical procedures, notably noninvasive skin tightening and fat reduction technologies, will be improved. The predictable and consistent results they achieve in the future will ultimately reduce the demand for surgical procedures. In particular, the combination of new and improved injectables and skin-tightening devices may well spell the end of surgical procedures for facial rejuvenation. In the wake of these advances, interest in and demand for nonsurgical aesthetic services will grow even more rapidly than the current pace.

What does your typical day as the Editor-in-Chief look like?

As an active aesthetic surgeon, my practice keeps me fairly busy, and the care and welfare of my patients is my top priority. After that come my many academic and professional responsibilities including Aesthetic Surgery Journal. I am up early every morning and on my computer for an hour or two, working on ASJ, before my clinical day starts at 7:30 in the operating room or 8:00 in the clinic. During the day, as my clinical schedule allows, I may tend to ASJ business, but I do most of this at the end of the day after all my clinical responsibilities have been met. As my running days are over, after two knee injuries, I exercise daily on a bicycle. Given Atlanta’s traffic and weather extremes, I “ride” a stationary bike for at least 45 minutes with iPad in hand. I read new manuscripts, assign reviewers, evaluate revised manuscripts, and make decisions on manuscripts which have completed peer review. On a typical day, including weekends, I spend two to four hours on ASJ. Beyond the peer review process, I spend time evaluating our website as well as the websites and print publications of sister journals in our own and related fields. Correspondence with authors, discussions with potential authors (many of which occur during my extensive travels to meetings and conferences around the world), and close interaction with my editorial staff also add significantly to my work hours.

How do you see the journal developing in the future?

Our plan is for Aesthetic Surgery Journal to continue to grow, both in terms of content and readership. Within the next year or so, we plan to publish ten issues per year (up from the current eight) and eventually on a monthly basis. The transition from print and online to online- only is inevitable but not imminent. Our mobile app, through RADAR, is state-of-the- art, offering innovative and unique reference and learning opportunities for our readers. Readership growth, especially internationally, will continue to accelerate as we offer enhanced accessibility options worldwide.

What do you think readers will take away from the journal?

My goal has been to build a scholarly journal serving the practicing aesthetic surgeon and the academic researcher. I am proud that Aesthetic Surgery Journal has, in a relatively short time, achieved an excellent impact factor, making this journal one in which academically-affiliated physicians and scientists choose to publish their clinically-significant research. Equally important are papers of immediate practical value to the practicing aesthetic surgeon, and we have made a concerted effort to elevate the quality of these practice-oriented manuscripts so that they reflect the evidence-based model to which we aspire. Aesthetic surgeons need both types of information: first, tried-and-true practices which they can immediately adopt and, second but no less important, research which in the longer term may impact the safety and efficacy of patient care.

What would you like to leave as your legacy to ASJ?

I have been fortunate to be surrounded by a talented and dedicated editorial board, editorial staff and to enjoy the support of the board and staff of the Journal’s sponsoring organization, the American Society for Aesthetic Plastic Surgery (ASAPS). Any legacy I leave behind is also theirs and was made possible through their efforts. Aesthetic Surgery Journal has the highest impact factor and largest circulation in its class of journals dedicated solely to aesthetic surgery. As a leading international journal, ASJ is increasingly becoming the “go to” journal for clinicians and researchers alike. I hope to build on our current success, with continued support from our readers, authors, ASAPS and the advertisers who help make all of this possible.

Featured Image Credit: Medical appointment. CC0 via Pixabay.