An Assessment of Gender Differences in Plastic Surgery Patient Education and Information in the United States: Are We Neglecting Our Male Patients?

Abstract

Background

The number of total cosmetic procedures performed yearly has increased by more than 274% between 1997 and 2014, according to the American Society for Aesthetic Plastic Surgery. However, the vast majority of plastic surgery procedures are still targeted toward women, with little attention toward men.

Objectives

This study sought to quantify the extent of gender discrepancies observed in online plastic surgery marketing in this country.

Methods

For the 48 contiguous United States, a systematic Google (Mountain View, CA) search was performed for “[state] plastic surgeon.” The first 10 solo or group practice websites in each state were analyzed for the gender of the first 10 images featured, presence of a male services section, and which procedures were offered to men. The results were statistically analyzed using SPSS Software (IBM Corporation, Armonk, NY).

Results

A total of 453 websites were analyzed, as 5 states did not have 10 unique solo or group practice websites. Of the 4239 images reviewed, 94.1% were of females, 5.0% were of males, and 0.9% were of a male and female together. A male services page was present in 22% of websites. The most common procedures marketed toward men were gynecomastia reduction (58%), liposuction (17%), blepharoplasty (13%), and facelift (10%). Less than 10% of all websites offered other procedures to males, with a total of 15 other aesthetic procedures identified.

Conclusions

Many plastic surgeons choose to ignore or minimize male patients in their online marketing efforts. However, as the number of men seeking cosmetic procedures continues to grow, plastic surgeons will benefit from incorporating male patients into their practice model.

Cosmetic surgery has been and will remain a robust and growing industry in the United States. More than 10 million cosmetic procedures were performed in the United States in 2014, reflecting a 274% increase in the number of cosmetic procedures performed since 1997, according to the American Society for Aesthetic Plastic Surgery (ASAPS).¹ In 2013 alone, there was a 12% overall increase in cosmetic procedures in the United States, and American consumers spent more than 12 billion dollars on these services: the largest amount spent since the economic recession of 2008.² Not surprisingly, a record number of consumers conducted online research for cosmetic surgery in the same year.²

While men still represent a smaller fraction of the cosmetic surgery industry, there is clearly a significant growth in the demand for male cosmetic services. From 1997 to 2014, the total number of cosmetic procedures performed on male patients increased by more than 273% (Figure 1).^1,3 The number of facelifts performed on male patients increased by 44% and the number of blepharoplasty procedures increased by 34% from 2010 to 2014.⁴ In 2014, men accounted for 11.8% of liposuction procedures, 11.9% of facelifts, and 4.6% of tummy tucks.¹ The top 5 surgical procedures for men in 2014 were: liposuction, rhinoplasty, blepharoplasty, male breast reduction, and facelift.¹

Figure 1.

Number of male procedures in 1997 and 2014.¹

The goal of this study was to quantify the extent to which gender differences are seen in online plastic surgery marketing in this country.

METHODS

A systematic search was performed using the top internet search engine, Google (Mountain View, CA), in October 2014. For all 48 contiguous US states, the principal search term of “[state] plastic surgeon” was entered, and the websites of the first 10 solo practices located in that state were analyzed. If fewer than 10 solo practice websites were found, group practice websites were included in order to achieve a total of 10 websites. Multidisciplinary group practices were excluded. Some states had a combined total of less than 10 solo and group practice websites, and analyses were performed on as many websites as could be found.

Each website was analyzed for the gender of the first 10 images to appear on the website. Within each website, webpages were viewed in the order of: (1) homepage; (2) procedures page; (3) image gallery page (if available); and (4) any remaining pages, in order of the location of links on the homepage (from left to right and/or top to bottom). All photographs of patients and models were included, while images of drawings, paintings, or sculptures were excluded. In the image gallery page, before-and-after images of abdominal and facial procedures were counted before images of breast procedures to avoid skewing the data towards a female predominance. To broaden the data set, each before-and-after image pair was counted as 1 image instead of 2 images.

Each website was also analyzed for a male services section: a clearly titled section (eg, “Just for Men” or “Male Procedures”) demonstrating a procedure or set of procedures specifically intended to appeal to male patients. Sections showing gender-changing surgeries were excluded. If a male services section existed, the types of procedures offered to men were also noted. Because treatment of gynecomastia is a common male-specific procedure, websites were examined for offerings of this service, regardless of whether a male services section was present.

Finally, plastic surgeon gender and membership with the American Society for Plastic Surgeons (ASPS) and ASAPS were noted.

The results were analyzed using Microsoft Excel (Microsoft Corporation, Redman, Washington) and SPSS software (IBM Corporation, Armonk, NY).

RESULTS

A total of 453 individual websites were analyzed in this study, as 5 states (North Dakota, South Dakota, Wyoming, Vermont, and West Virginia) did not have 10 unique solo or group practice websites for plastic surgeons. Of these, 443 belonged to solo practice plastic surgeons, while 10 of the websites belonged to group practices. Among the plastic surgeons analyzed, 403 (89%) were male, 360 (79%) were members of ASPS, and 193 (43%) were members of ASAPS.

In total, 4239 images were reviewed, as some websites had fewer than 10 images of patients or models. Of these images, 3989 (94.1%) were pictures of female patients or models, 212 (5.0%) were pictures of male patients or models, and 38 (0.9%) were pictures of a female and male model together. There were no images of female and male patients together in the same picture.

A male services section was found in 99 (22%) of the websites, and the most common procedures offered in these sections were gynecomastia (90%), followed by liposuction (78%), blepharoplasty (60%), facelift (45%), abdominoplasty (40%), rhinoplasty (39%), Botox (28%), neck lift (27%), and fillers (25%); 9 other aesthetic procedures were presented to males by <25% of websites with a male plastics section (Table 1).

Table 1.

Procedures Offered in 99 Websites With Male Services Sections

Procedure	Number Offering Procedure (%)
Gynecomastia	89 (90%)
Liposuction	77 (78%)
Blepharoplasty	59 (60%)
Facelift	45 (45%)
Abdominoplasty	40 (40%)
Rhinoplasty	39 (39%)
Botox	28 (28%)
Neck Lift	27 (27%)
Fillers	25 (25%)
Brow Lift	22 (22%)
Chin/Jaw Implants	21 (21%)
Otoplasty	13 (13%)
Hair Restoration	12 (12%)
Pectoral Implants	11 (11%)
Other Implants (ie, Bicep, Calf, Cheek)	10 (10%)
Laser Hair Removal	10 (10%)
Facial Fat Grafting	9 (9%)
Gluteal Implants	5 (5%)

The number of websites offering male plastics sections varied by state. The states with the greatest proportion of websites featuring male plastics sections were Pennsylvania and Virginia, where 5 of 10 websites had sections relating to men; Colorado, Maryland, North Carolina, New Jersey, and Tennessee followed, with 4 of 10 websites featuring male plastic sections; while 10 states had no websites with male plastic sections (Table 2).

Table 2.

Websites With Male Services Section by State

Number of Websites	States
5	PA, VA
4	CO, MD, NC, NJ, TN
3	AZ, CT, DE, FL, GA, IL, KY, ME, MO, NY, OH, TX, WA
2	IA, IN, MA, MI, MN, MT, ND, NM, NV, OK, RI, SC
1	CA, KS, NE, NH, OR, WI
0	AL, AR, ID, LA, MS, SD, UT, VT, WV, WY

Of the 354 websites which did not have a specific section aimed at appealing to male patients, 174 (49.2%) still offered treatment of gynecomastia. When a male services section was not present, this procedure was either listed alongside female-targeted procedures such as breast augmentation, or within the body procedures section alongside procedures such as abdominoplasty.

DISCUSSION

Since 1997, the number of cosmetic procedures performed yearly in the United States has increased by more than 274%.¹ Although the recession of 2008 had a negative effect on the popularity of cosmetic procedures, the numbers have once again been on the rise since mid-2009.⁵ While males are traditionally an underrepresented group in the cosmetic surgery realm, they are increasingly seeking out these services. In fact, in an 18-year period concluding in 2014, there was a 273% increase in male cosmetic plastic surgery procedures.¹ Men are investing more and more in their appearances every year, and several factors drive this desire for cosmetic enhancement. American men spent 5 billion dollars on grooming products in 2012, more than double the 2.4 billion dollars they spent in 1997.⁶ In 2011, men accounted for nearly half of the volume of health and beauty products used.⁵ A high percentage of men indicate their reason as being “work-related,” to improve competiveness.⁷ In this age of technology start-ups, older men are competing with and working for CEOs and executives in their mid-20s. Another driving factor is a change in men's fashion trends, as men are wearing more tight-fitting clothing as compared to a decade ago.⁸

Additionally, more men are being introduced to cosmetic surgery procedures through their spouses. Studies suggest that woman tend to accept cosmetic surgery more readily than men because of higher expectations regarding their physical appearance.⁹ As a result, women are now introducing their men to the options and benefits. A significant percentage of men now report that their wives were the instigation for seeking a cosmetic surgeon.¹⁰ In the same vein, men are also requesting to undergo cosmetic surgery with their wives.¹⁰ Additionally, many men in relationships with other men elect to undergo aesthetic surgery together.¹⁰ This trend opens doors to new marketing tactics for male cosmetic procedures: practitioners might first introduce the idea of male cosmetic enhancement to the potential patient's spouse.

Despite the boom in popularity, male cosmetic surgery has been a neglected part of the field of plastic and reconstructive surgery. Only 5% of all pictures viewed for this study were of men. One reason for neglect is that cosmetic surgery has a stigma associated with woman and vanity. Men may also be able to achieve some of the results of cosmetic surgery through exercise, diet, and weightlifting. For instance, men can exercise to build larger calf muscles, making calf implant procedures a less popular option. On the other hand, women aren’t able to increase their breast size through these nonsurgical means.

Marketing trends are beginning to reflect the continued rise in interest and popularity of male cosmetic surgery. A male services section was found in about a quarter of all websites studied. However, for 10 states, none of the first 10 Google-generated plastic surgery websites had male plastic surgery sections. This may reflect that fact that most of these states also rank within the bottom 20% of population statistics in the United States.¹¹ Not surprisingly, the states with the most websites offering males services are ranked within the top 20% of population statistics within the United States.¹¹

Male breast reduction was the most popular procedure offered. Gynecomastia is a common problem in the male population, particularly in young adults, with a reported prevalence of up to 36%.¹² Our study found that half of all the websites without a male services section still offered treatment for gynecomastia. The next 4 most marketed procedures, in descending order, were liposuction, blepharoplasty, facelift, and abdominoplasty. This closely mirrors the top 5 cosmetic procedures for men in 2014: liposuction, rhinoplasty, blepharoplasty, male breast reduction, and facelift.¹

This study examined if and how male cosmetic surgery information was provided in medical practice websites throughout the contiguous 48 United States. We chose to use the gender-neutral search term “[state] plastic surgeon” instead of search terms such as “[state] plastic surgery for men” because we wanted to quantify the number of typical plastic surgery websites with pictures of men and with male services sections; using search terms including the words “male” or “men” would have skewed the results. However, one limitation of this study is that only the first 10 practices located in each state were analyzed. Another limitation is that Hawaii and Alaska were not included. Future studies might expand on these areas, and they could also include other forms of marketing such as print media, television commercials, and even office décor. Other interesting directions for future study would be a survey of practicing plastic surgeons to gather information about the differences in consultations and procedures between male and female patients, and to consider any differences between homosexually-oriented and heterosexually-oriented male patients. The benefit of this study is that it allows practitioners to refine their marketing strategies to their specific state and the types of procedures being offered, in order to increase their practice revenue. Of note, to the authors' knowledge, there are 5 practices in the US that capitalize on serving the otherwise underserved male population by having websites that cater exclusively to men: 3 practices were in California, 1 was in New York, and 1 was in Florida.

It continues to be an exciting time to be practicing cosmetic surgery. Men are continuing to enter the picture in larger and larger numbers as the options grow and the stigma fades. Despite the fact that we may face another recession, the projection scenarios generated in a study by Broer et al⁵ suggest a continued demand for aesthetic surgical procedures in the United States. There is no doubt men will be an important market in this evolving paradigm.

CONCLUSION

The male audience is not the focus of most plastic surgery websites. Many plastic surgeons elect to ignore or minimize male patients in their marketing efforts. As the number of men seeking a variety of plastic surgery procedures continues to grow, plastic surgeons will benefit from including this substantial population into their practice model.

Disclosures

The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The authors received no financial support for the research, authorship, and publication of this article.