Despite differences in training, plastic surgeons and otolaryngologists (ENT) often perform facial surgeries and rejuvenation procedures. With the increasing exposure of facial plastic surgery in otolaryngology residency programs, it remains unclear how common facial aesthetic procedures are distributed between the two surgical sub-specialties. This study evaluates the breakdown between ENT and plastic surgeons in common facial aesthetic procedures within the Medicare population. We hypothesize that plastic surgeons perform the majority of the facial aesthetic procedures, and foresee greater growth rates in such procedures within otolaryngology, when compared with plastic surgery, over time.
A retrospective review was performed for Medicare beneficiaries who underwent common facial surgical procedures. These procedures were determined from the 2019 American Society of Plastic Surgeons Plastic Surgery Statistics Report.1 Compound annual growth rates (CAGR) for the number of procedures and corresponding reimbursement values were calculated for both plastic and ENT surgeons from 2010 to 2018.
In 2018, ENT surgeons performed a greater percentage of rhinoplasties (71%) and botulinum toxin injections (68%), relative to plastic surgeons. In contrast, blepharoplasties (84%), dermabrasions (83%), soft tissue fillers (69%), intense pulsed light treatment (74%), and laser skin resurfacing (70%) were more commonly performed by plastic surgeons. ENT surgeons had growth in botulinum toxin injections (8.25%), soft tissue fillers (44.22%), and rhytidectomy (3.09%), relative to plastic surgeons whose CAGRs for the aforementioned procedures were 4.32%, 19.25%, and −5.45%, respectively. In terms of total Medicare payments amongst plastic surgeons, blepharoplasty contributed to the majority of dollar value ($16,281,914), while botulinum toxin type A comprised the greater amount of funding ($5,673,748) for ENT surgeons. A comprehensive summary of results is shown in Table 1.
Table 1.
Facial Aesthetic Procedures in Plastic Surgery and Otolaryngology in Medicare Beneficiaries from 2010 to 2018
| Characteristics | Overall | |
|---|---|---|
| Plastic Surgery | Otolaryngology | |
| Total services, n (2018) | ||
| Blepharoplasty | 5888 | 1114 |
| Rhinoplasty | 250 | 622 |
| Dermabrasion | 598 | 121 |
| Neck lift | 25 | 14 |
| Rhytidectomy | 76 | 74 |
| Botulinum toxin type A | 15,1581 | 31,4990 |
| Soft tissue fillers | 11,314 | 5109 |
| Chemical peel | 28 | 22 |
| Intense pulsed light (IPL) treatment | 7062 | 2535 |
| Laser skin resurfacing | 73,200 | 31,083 |
| CAGR of no. of services, % (2010–2018) | ||
| Total services, n (2018) | ||
| Blepharoplasty | −5.54% | −4.00% |
| Rhinoplasty | −1.58% | −0.98% |
| Dermabrasion | 12.44% | −0.89% |
| Neck lift | 2.20% | 4.30% |
| Rhytidectomy | −5.45% | 3.09% |
| Botulinum toxin type A | 4.32% | 8.25% |
| Soft tissue fillers | 19.25% | 44.22% |
| Chemical peel | −18.79% | −3.39% |
| IPL treatment | 7.77% | 5.66% |
| Laser skin resurfacing | 0.80% | −7.22% |
| Total medicare payments, $ (2018) | ||
| Blepharoplasty | $16,281,914 | $2,928,686 |
| Rhinoplasty | $985,821 | $2,587,381 |
| Dermabrasion | $646,149 | $182,857 |
| Neck lift | $120,379 | $83,350 |
| Rhytidectomy | $475,789 | $590,252 |
| Botulinum toxin type A | $3,027,821 | $5,673,748 |
| Soft tissue fillers | $286,047 | $164,294 |
| Chemical peel | $23,389 | $13,214 |
| IPL treatment | $2,708,725 | $1,149,316 |
| Laser skin resurfacing | $5,958,838 | $2,631,392 |
| CAGR of Medicare payments, % (2010–2018) | ||
| Blepharoplasty | 0.03% | −1.35% |
| Rhinoplasty | 0.22% | 1.74% |
| Dermabrasion | 12.40% | 3.84% |
| Neck lift | 14.15% | 11.40% |
| Rhytidectomy | 1.22% | 13.55% |
| Botulinum toxin type A | 4.43% | −0.71% |
| Soft tissue fillers | 0.86% | 16.95% |
| Chemical peel | −15.11% | −2.16% |
| IPL treatment | 9.89% | 10.44% |
| Laser skin resurfacing | 2.30% | −4.45% |
Our results reveal that plastic surgeons perform the majority of facial surgical interventions, as well as facial rejuvenation procedures, for Medicare beneficiaries. Nonetheless, ENT surgeons have a growing foothold in providing soft tissue fillers and botulinum toxins for such patients. Moreover, tissue fillers may restore defects caused by head and neck cancer resection, or alternatively, may be utilized for tracheoesophageal puncture site enlargement and nasal reconstruction.2–4 Botulinum toxin type A has unique applications within the field of otolaryngology, such as facial synkinesis and spasmodic dysphonia, in addition to cosmetic considerations.5
There are several limitations of this study that warrant consideration. First, we only included the top 10 highest volume aesthetic procedures in our analysis, thus excluding other aesthetic procedures. Second, we examined Medicare beneficiaries, a specific subset of patients; thus, our results may not be generalizable to younger and healthier patients. Third, the database does not include the indications for procedures, and therefore, cannot provide explanations for particular specialty involvement in a given operation.
Plastic surgeons perform the majority of facial surgical interventions and facial rejuvenation procedures. Nonetheless, there has been an increase in the proportion of certain procedures, namely botulinum toxin injections and soft tissue fillers, performed by ENT surgeons. This suggests the growing versatility of otolaryngology and increasing engagement in cosmetic procedures among Medicare beneficiaries.
Footnotes
Published online 23 August 2021.
Disclosure All authors have no financial interest to declare in relation to the content of this article. This study did not receive any funding.
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