Racial/Ethnic Disparities in Cosmetic Procedure Utilization: A Microeconomic Spending Analysis

ACC 

Purpose
Cosmetic plastic surgery has been growing in demand and popularity, with a 22% increase in total surgical volume since 2000.[1] However, the racial demographic makeup of cosmetic surgery utilization does not proportionally represent that of the United States population, with underrepresentation found in African Americans and Hispanics.[2] This study evaluates whether microeconomic spending traits as a representation of financial stability can inform trends in cosmetic surgical and minimally invasive procedure volumes by racial group.

Methods
Annual volumes for the top five cosmetic surgical procedures (breast augmentation, rhinoplasty, blepharoplasty, liposuction, and abdominoplasty) and top five cosmetic minimally invasive procedures (Botulinum toxin type A, soft tissue fillers, chemical peel, laser hair removal, and microdermabrasion) by racial/ethnic group from 2012-2020 were collected from the American Society of Plastic Surgeons' annual reports on plastic surgery statistics.[3] Using factor analysis to determine the consumer expenditure categories that shared the most common variation with other expenditures from the U.S. Bureau of Labor Statistics' (BLS) expenditure and income data by racial/ethnic groupings (White/Asian/Other, African American, Hispanic), food/medical services and entertainment were selected as proxies for the following microeconomic traits, inflexible and flexible consumer spending, respectively.[4] Additionally, average rates in both types of consumer spending, cosmetic surgical procedure volume, and minimally invasive procedure volume were calculated across the three BLS-defined racial/ethnic groupings and standardized so they could be interpreted relative to each other, with larger numbers indicating a larger mean difference.

Results
Compared to the other groups, the White/Asian/Other grouping spent significantly more on average for inflexible consumer spending (estimate = 1.33, p = 0.0097), flexible consumer spending (4.38, p < 0.0001), cosmetic surgical procedures (6.36, p < 0.0001), and cosmetic minimally invasive procedures (2.58, p = 0.0006). In contrast, African Americans spent significantly less on average for inflexible consumer spending (-2.95, p = 0.0069), flexible consumer spending (-6.32, p < 0.0001), cosmetic surgical procedures (-10.04, p < 0.0001), and cosmetic minimally invasive procedures (-6.31, p = 0.0003). For Hispanics, values were significantly less on average for flexible consumer spending (-2.68, p = 0.0023), cosmetic surgical procedures (-6.86, p < 0.0001), and cosmetic minimally invasive procedures (-5.11, p = 0.0002).

Conclusions
This study demonstrates that inflexible and flexible consumer spending follow trends in utilization of cosmetic surgical and minimally invasive procedures by racial/ethnic groups, with African Americans and Hispanics tending to spend less on consumer expenditures and having fewer cosmetic procedures done compared to their White and Asian counterparts. These microeconomic spending inequities may help further contextualize the racial/ethnic variation in access to cosmetic surgery.

References
1. Ullrich PJ, Garg S, Reddy N, et al. The Racial Representation of Cosmetic Surgery Patients and Physicians on Social Media. Aesthet Surg J. 2022;42(8):956-963.
2. American Society of Plastic Surgeons. Plastic Surgery Statistics Report: 2020. https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf. (n.d.). Accessed March 1, 2023.
3. Plastic Surgery Statistics. American Society of Plastic Surgeons. Updated April 27, 2021. Accessed December 20, 2022. https://www.plasticsurgery.org/news/plastic-surgery-statistics.
4. Consumer Expenditure Surveys. U.S. Bureau of Labor Statistics. Updated February 15, 2023. Accessed December 20, 2022. https://www.bls.gov/cex/tables.htm.

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