Cosmetic surgery dominated by lipoplasty, breast augmentation

By comparison to reconstructive surgery, which is overwhelmingly dominated by one type (reconstruction associated with tumor removal), the global distribution of cosmetic surgery procedures is very fragmented, with more than a dozen different surgeries performed over 100,000 times annually. The dominant procedures remain lipoplasty and breast augmentation:

Worldwide Distribution of Cosmetic Surgery By Type

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Source: MedMarket Diligence, LLC; Report #S710.

Reconstructive surgery is increasingly aesthetic

Given the volume of the non-clinically-indicated aesthetic procedures, and their increasingly sophisticated techniques and technologies, reconstructive surgery specialists have integrated aesthetics advances and can now achieve spectacular results that go well beyond the simple reconstructive procedures of the past, which were much less effective in concealing the trace evidence of disease and trauma.

Reconstructive surgery is the subset of “plastic” surgery focused on correcting the anatomy, aesthetics, or both, for patients who have been treated for disease or trauma, which sets it apart from purely aesthetic procedures performed for people wishing to improve their appearance above and beyond what they were given by birth (excluding congenital defects) or to reduce the signs of aging.

Given the volume of the non-clinically-indicated aesthetic procedures, and their increasingly sophisticated techniques and technologies, reconstructive surgery specialists have integrated aesthetics advances and can now achieve spectacular results that go well beyond the simple reconstructive procedures of the past, which were much less effective in concealing the trace evidence of disease and trauma.

By far, the most common reconstructive procedures are to address the physical appearance resulting from the removal of tumors. In the U.S. alone, reconstruction for tumor removal is performed over 4 million times annually. The remainder of reconstructive procedures covers a gamut of major and minor trauma and diseases.

Below is the distribution of non-aesthetic (only) reconstructive procedures in the U.S.

reconstructive-pie

Source: MedMarket Diligence, LLC; Report #S710.

Through 2018, the global medical reconstructive and aesthetic products market is expected to reach a value of about $10.7 billion. Energy-based products such as lasers will experience the highest growth level. In most geographical regions and particularly in the U.S. and Europe, there is a growing consumer demand for medical cosmetic procedures and through 2020, even the lower income groups are likely to demand for more procedures, as the treatments become increasingly main stream. During the past few years, practitioners in the U.S. were rather forced to implement discounts and now with the revival of the economy, the total fee growth is likely to rebound. Successful companies in the sector mostly rely on a formula for continued research and development, pursuing additional, new business opportunities to increase expertise and product offerings. These companies remain solidly active in the eyes of high-end dermatologists, plastic and cosmetic surgeons.  As the aesthetic market is all about new products, the companies will be left behind, if they do not come up a new product every now and then.


This post is drawn from, “Global Markets for Products and Technologies in Aesthetic and Reconstructive Surgery, 2013-2018”, Report #S710, published by MedMarket Diligence, LLC.  For details, see link/a>.

Aesthetic and Reconstructive Markets

Aesthetic and reconstructive medicine, encompassing medical and surgical procedures and physician-administered products, is a dynamic area as a result of the overlap of medically reimbursed therapeutic procedures and out-of-pocket, cosmetic or purely aesthetic procedures. While there is a difference financially between the two areas of medicine, the medical and surgical procedures, as well as products, find overlapping benefits that blur the differences clinically. Physicians and medical product manufacturers have developed approaches to address post-traumatic or post-disease reconstruction that have demonstrated clear aesthetic benefits even in the absence of trauma or disease (in other words, more purely cosmetic).

Below is the distribution of product revenues in aesthetic and reconstructive medicine as the balance will change between from 2013 to 2018.

aesthetics-growth-segments

*Neuromodulators in aesthetic/reconstructive applications include Botox, Dysport, Xeomin, etc.

Source: MedMarket Diligence, LLC; Report #S710, “Global Markets for Aesthetic and Reconstructive Medicine, 2013-2018.”

The U.S. market continues to represent the biggest contributor to the global market for these products, as illustrated below.

aesthetics-regionals

Source: MedMarket Diligence, LLC; Report #S710, “Global Markets for Aesthetic and Reconstructive Medicine, 2013-2018.”

Growth of High Strength Medical Adhesives

See the 2016 published report #S290, “Worldwide Surgical Sealants, Glues, Hemostats, 2016-2022” and 2018 published report #S254,”Wound Management to 2026.”

The market for high strength medical adhesives is growing, and is expected to continue to grow due to regulatory approvals and steady ongoing research and development. Active programs are currently under development in three areas for high strength surgical adhesives:

  • The use of cyanoacrylate adhesives and new application devices for new internal surgical procedures
  • New adhesive products based on existing biomaterial adhesives such as fibrin and albumin compounds
  • New polymer adhesives based on entirely new chemistries (e.g., polyurethanes, proteins from living organisms).

The global market for high-strength medical adhesives is forecast to show strong double-digit growth during the forecast period, growing from roughly $713 million in 2011 to $1.72 billion by 2017. The USA represents, by far, the largest share of the global high strength medical adhesives market, and this is not expected to change during the forecast period.

Worldwide Market for High Strength Medical Adhesives, 2010-2017

Source: MedMarket Diligence Report #S190, “Worldwide Surgical Sealants, Glues, Wound Closure and Anti-Adhesion Markets, 2010-2017.”

Although some form of suturing wounds has been used for probably thousands of years due to their ease of use and strength of closure, but sutures’ simplicity can also be limiting. There are procedures in which sutures are too large or clumsy, and locations in which it is difficult for the surgeon to suture. They can lead to complications, such as intimal hyperplasia, in which cells respond to the trauma of the needle and thread by proliferating on the inside wall of the blood vessel, causing it to narrow at that point. This increases the risk of a blood clot getting stuck and obstructing blood flow. In addition, sutures may trigger an immune response, leading to inflamed tissue that also increases the risk of a blockage. These are some of the reasons why surgical adhesives are becoming increasingly popular.

As a logical derivative, surgeons want a product that is strong, easy-to-use and affordable, while being biocompatible and resorbable. TissuGlu (Cohera Medical), a urethane adhesive suited for plastic surgery procedures, is both biocompatible and resorbable, making it ideal for internal applications. It is also strong, user-friendly, and does not contain human/animal product derivatives. TissuGlu is currently only available for sale in Germany, but the company is rapidly preparing to sell in the other major markets of the EU.

One of the top five plastic surgery procedures performed in the United States is abdominoplasty, which has a reported post-operative complication rate of 15-52%. The most common complication is the formation of seroma. Usual methods to combat seroma formation include the placement of closed suction drains, use of compression garments around the tissue, use of progressive tension sutures, and use of fibrin sealants to reduce fluid accumulation. However, most of these methods can still lead to further complications such as leakage from drain sites, skin necrosis and inconsistent adhesion. High strength glues like TissuGlu and other products can solve this problem and garner significant caseload.

Dermal repair and market for securement products worldwide

Skin securement (sealing, closure, hemostasis, etc.) has always been an essential final step in surgical procedures. In early years, the skin surface was sutured; in recent years a number of advances have been made, including new tapes, sutures, staples, hemostats, and glues.

Treatments for skin or dermal repair by surgical securement products represent a worldwide caseload of over 20 million annually.  Burns represent the most serious of these cases, but roughly 25% of patients with burns die from them and overall are far fewer than ulcers.  Ulcers, which may be caused by inadequate circulation, biochemical deficience or other causes, are a high volume, high cost caseload worldwide and, as such, drive considerable interest in the development of improved treatments.  Nonetheless, the highest volume application in dermal repair in western civilization is plastic surgery.

Potential caseload is segmented by geography and skin repair type for the use of securement products, and is shown below:

ulcer-usa1

ulcer-europe

ulcer-row

Source:  MedMarket Diligence, LLC; Report #S175, "Worldwide Surgical Sealants, Glues and Wound Closure, 2009-2013,"