Non-surgical Aesthetic Treatment Conversion to Surgery: Implications for Patient Selection and Practice Modeling

Introduction: Non-surgical treatment for facial aging is a mainstay in plastic surgical practices most commonly employing chemomodulation with botulinum toxin and/or use of dermal fillers. Good objective data indicating the transition from non-surgery to surgery treatment does not exist. The purpose of this study is to identify surgical conversion from non-surgical care which will guide overall care of these patients. Methods: An IRB-approved retrospective chart review was conducted analyzing patients treated with either Botox® or fillers in a single plastic surgery office. All treatments were provided by two experienced physician assistants. The end-point of surgical treatment with the same practice was comparatively analyzed. Results: 737 patients were treated of which 612 had no previous aesthetic surgery, and 104 had previous surgery. 604 patients were treated with Botox, 385 with filler (304 had both). Patients had an average of 5.4 office visits for Botox treatments and 2 visits for filler treatment. Only 39 patients had surgical procedures (5.3%; Figure 1). The conversion from non-surgical to surgical treatment was significantly higher in patients with prior aesthetic surgery (12.5% vs 4.1%, p<0.001) (Table 1). Conclusions: The conversion from non-surgical to surgical care was only 5.3%. However, patients with a previous history of aesthetic surgery have a higher conversion rate, indicating a targeted patient demographic for early plastic surgeon involvement. These findings provide objective data that patients undergoing nonsurgical care are unlikely to convert to surgical care. This supports a practice model in which physician extenders provide Botox and fillers.