The battle against wrinkles is moving from the operating room to the office as many men and women are forgoing facelifts in favor of injectable wrinkle fillers like Botox (search), according to a new report on plastic surgery trends (search).

The American Society of Plastic Surgeons (ASPS) report shows the number of surgical cosmetic procedures has dropped by 8 percent from 2000 to 2004, while the number of nonsurgical cosmetic procedures has risen by 36 percent during the same time period.

In 2004, 9.2 million cosmetic procedures were performed, a 5 percent increase from 2003. That adds up to $8.4 billion spent annually on procedures ranging from chemical peels to breast augmentation.

Researchers say those figures show that reality TV shows are creating a greater awareness of cosmetic procedures, but they are not necessarily creating a stampede to the plastic surgeon’s office.

“These statistics show a strong, continued, and healthy increase in cosmetic surgery that mirrors the 4.4 percent economic growth of the United States,” says ASPS president Scott Spear, MD, in a news release. “However, there is no evidence in the statistics to support that TV programs have led to a dramatic surge in the amount of cosmetic surgery procedures.”

In contrast, a report released last month by the American Society for Aesthetic and Plastic Surgery credited increased media coverage for a recent surge in surgical and nonsurgical cosmetic procedures performed in 2004.

But both organizations say the biggest growth has been in nonsurgical cosmetic procedures, which they attribute largely to new injectable wrinkle fillers like Botox, Restylane (search), and Hylaform (search).

2004 Trends in Cosmetic Procedures

Overall, the report shows there’s been a 24 percent increase in the number of cosmetic plastic surgery and nonsurgical procedures over the last four years.

The top five surgical procedures in 2004 were:

Liposuction (325,000 procedures); Nose reshaping (305,000); Breast augmentation (264,000); Eyelid surgery (233,000); Facelift (114,000)

Among the 7.5 million minimally invasive or nonsurgical cosmetic procedures, the top five were:

Botox (3 million); Chemical peel (1.1 million); Microdermabrasion (859,000); Laser hair removal (574,000); Sclerotherapy (a procedure to treat varicose veins, 545,000)

Researchers say the demand for Restylane and Hylaform jumped 927 percent in 2004. Restylane was approved by the FDA for use in December 2003, and Hylaform was approved in April 2004.

The report shows use of the first FDA-approved wrinkle eraser, Botox, increased by 4% in 2004 and has increased by a whopping 280 percent since 2000.

Body Contouring on the Rise

Although less invasive procedures are becoming more popular for fighting wrinkles, researchers say people are opting for more drastic measures to fight fat.

Rather than using liposuction to contour, lower body lifts are up 72 percent in 2004 vs. 2003. The report also shows that procedures like thigh lifts are up 45 percent in 2004 vs. 2003

Researchers say people who have experienced major weight loss accounted for nearly 56,000 of the more than 106,000 body contouring procedures performed last year.

The report shows the most popular body contouring procedures in 2004 included:

—Breast lifts (76,000 procedures, up 14 percent since 2003)

—Buttock lift (4,000, up 45 percent since 2003)

—Lower body lifts (9,000, up 72 percent since 2003)

—Thigh lifts(8,000, up 45 percent since 2003)

—Upper arm lifts (10,000, up 44 percent since 2003)

Minority Plastic Surgery Trends

The report also shows a dramatic rise in the number of Hispanics opting for cosmetic plastic surgery procedures. Hispanics had nearly 553,000 cosmetic procedures in 2004, an increase of 49 percent from 2000.

“This tremendous growth shows that Hispanics have adopted and adapted to many U.S. cultural norms,” says James Wells, MD, a plastic surgeon and past ASPS president, in a news release. “Hispanics are the fastest growing ethnic group in America and body image is increasingly important to them as they move up the socio-economic ladder.”

Hispanics led all minority groups in the number of cosmetic procedures performed, accounting for 6 percent of all procedures, followed by African-Americans (5 percent), and Asians (3 percent).

The most common surgical cosmetic procedures requested by Hispanics in 2004 were nose reshaping, breast augmentation, and liposuction. The most common nonsurgical or minimally invasive cosmetic procedures for Hispanics were Botox, microdermabrasion, and injectable wrinkle fillers.

In addition, the most common cosmetic surgical procedures requested by African-Americans in 2004 were nose reshaping, breast reduction, and liposuction. Among Asians, the most popular were nose reshaping, eyelid surgery, and breast augmentation.

The ASPS report is based on information collected by an online database for plastic surgery procedures as well as an annual survey of more than 17,000 board-certified plastic surgeons.

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCES: “2005 Report on the 2004 Statistics, National Clearinghouse of Plastic Surgery Statistics.” News releases, American Society of Plastic Surgeons.