This report examines the market for cosmetic surgery in the UK. Cosmetic surgery refers to surgery undertaken exclusively to improve appearance and should not be confused with plastic surgery, which often refers to the correction of congenital defects (such as cleft palates) and for reconstruction after injury or illness. Minimally invasive cosmetic procedures (such as Botox and other dermal fillers, laser skin resurfacing, chemical peels and microdermabrasion) are also covered in this report under non-surgical cosmetic procedures. Procedures provided on the National Health Service (NHS) are excluded from this report as they usually relate to the restoration of appearance and function as a result of trauma, disease or deformity. As such, the report focuses wholly on the provision of cosmetic surgery by the private sector.
For the purpose of this report, the UK cosmetic surgery market is split into four main sectors based on the type of procedure. They are as follows:
- face/neck area
- breast area
- body area
- non-surgical procedures
It should be noted that the definitions used for the sectors reflect those used by the British Association of Aesthetic Plastic Surgeons (BAAPS), which provides the most reliable annual audit for the cosmetic surgical industry.
Surgical Cosmetic Procedures
Face Lift (Rhytidectomy)
Face lift (or rhytidectomy) is a cosmetic procedure which involves the repositioning of subcutaneous fat and the tightening of muscles in order to give a more youthful appearance. However, less invasive techniques are now increasingly being offered to patients and used as effective alternatives. For example, younger patients who have minimal baggy skin can find an endoscopic procedure, which involves small incisions beyond the hairline, to be extremely successful. In addition, clinics are now increasingly recommending contour thread lifts, which involve the insertion of tiny threads into lax areas of the skin in order to tighten it. This procedure does not leave scarring and recovery time is only a few days. Patients may also opt for a brow lift, for which there is an endoscopic alternative as well.
Eyelid Surgery (Blepharoplasdty)
Blepharoplasty involves the removal of excess skin, fat, wrinkles and puffiness from either one or both of the lower and upper eyelids. This procedure can visibly improve a person’s appearance through the elimination of ‘hooded’ eyelids, and is the most popular facial surgery procedure in the UK. The popularity of this procedure has been driven by the UK’s rapidly ageing population and the rising attraction of cosmetic surgery.
Nose Surgery (Rhinoplasty)
Rhinoplasty involves decreasing or increasing the size of the nose, changing the shape of the bridge and/or narrowing the span of the nostrils. Some clinics now offer a non-surgical alternative to traditional surgery in which injectable fillers and Botox (botulinum toxin) are used to reshape the nose.
Ear Correction (Otoplasty)
Otoplasty is most commonly performed on children aged between 4 and 14 in a paediatric unit and is undertaken to reshape uncommonly large ears or to enable the ears to lie more closely to the head. Problems often arise because of an under-developed middle fold in the ear, while other deformities may require more than one procedure.
Breast Augmentation (Augmentation Mammoplasty)
An important driver for the breast surgery sector in recent years has been the increasing desire for breast augmentations among young women. Aesthetic breast surgery is increasingly used to restore volume after pregnancy and to balance differences in breast size. Private clinics also offer reconstructive surgery for women who have had mastectomies.
There are several kinds of breast implant available, including natural tissue and different synthetic implants. The use of natural tissue for cosmetic implants has become more popular in the past few years. There are two types of synthetic breast implant available in the UK, they are silicone gel and saline.
Silicone continues to be the most widely used implant for breast surgery. A silicone rubber shell is filled with medical grade silicone, which has been proven to be the least reactive substance of any man-made material and is therefore safer to implant into the human body. The implant is sometimes filled with a saline solution, mimicking the fluid that accounts for 80% of a woman’s body weight.
Breast Reduction (Mammoplasty)
Breast reductions (mammoplasty) are usually carried out on women for whom having large breasts is either uncomfortable or painful. The reduction is performed by removing fat, glandular tissue and skin from the breast. It can also involve reducing the size of the areola (the dark skin surrounding the nipple).
Breast Lift (Mastopexy)
Often carried out in conjunction with augmentation surgery, mastopexy can raise or reshape breasts that have lost suppleness through age or pregnancy/breastfeeding. This procedure cannot permanently delay natural changes to the breast shape.
Pectoral (Male Chest) Augmentation
Pectoral augmentation is an operation that enhances the appearance of the male pectoral muscles. A solid silicone implant is chosen based on the measurements of the patient’s chest prior to surgery. The implant, which is soft and flexible, is inserted through an incision in the armpit and placed directly beneath the pectoral muscle.
Men are increasingly opting for cosmetic procedures in order to improve their appearance. Liposuction and rhinoplasty are popular, and there is also some demand for muscle-enhancing procedures. Calf implants are sometimes used and men are also offered abdominal ‘etching’, a new liposuction technique that creates a muscular, rippled effect on the abdominal area.
Male Breast Reduction (Gynaecomastia)
Occasionally, accumulation of fat on the male chest can give the appearance of prominent breasts. This can be removed by liposuction, liposculpture or by cutting out excess glandular tissue. Demand for this procedure increased significantly over the 5-year period between 2008 and 2012; a total of 642 breast reduction procedures were carried out by BAAPS members in 2012, up from 323 in 2008.
An increasing number of younger consumers and men are investing in liposuction, a procedure that is most effective on more youthful, flexible skin. Liposuction is a sculpting technique that reshapes and smoothes the contours of the body. It involves inserting a hollow metal tube (cannula) through an incision in order to remove fat by suction. Liposuction techniques have improved significantly since 2000, and developments include ultrasound-assisted lipoplasty and the tumescent technique, which allows the operation to be performed using a local anaesthetic, thus eliminating surgical blood loss and potentially fatal complications. One of the newer treatments in recent years is lipotripsy, a cellulite treatment that involves using advanced radial wave therapy to significantly reduce the effects of cellulite.
Tummy Tuck (Abdominoplasty)
This type of major surgery involves removing excess fat and skin for the purpose of tightening muscles. Techniques for abdominoplasty have improved significantly and recovery times are now becoming much shorter. Some procedures can be carried out without the need for a general anaesthetic.
Buttock Implants (Gluteal Augmentation)
Gluteal augmentation involves the implantation of very soft silicone implants into the buttocks to give them a better shape.
Bariatric Surgery (Weight-Loss Surgery)
Bariatric surgery has become much more widespread in recent years in terms of the surgical procedures offered by surgeons, and some clinics even specialise in it. Laparoscopic (lapband) surgery involves the placement of a band to create a small pouch at the top of the stomach. This pouch quickly fills with food and the passage of food from the top to the bottom of the stomach is slowed as a result. As the upper part of the stomach becomes full, it sends this message to the brain, which helps the person to eat smaller portions and thus lose weight.
An alternative procedure is endoscopic intra-gastric balloon (IGB) surgery, which involves swallowing a gastric balloon (via a long tube) made of elastic, durable, high-quality silicone, which is then inflated with saline. This partially fills the stomach and induces the feeling of fullness in the patient. This procedure does not require an overnight stay in hospital, as only a local anaesthetic is required. It should be noted that weight-loss surgery is not included in BAAPS’s procedure data and is therefore not included in the market size figures provided by this report.
Other Surgical Cosmetic Procedures
Upper Arm Lift (Brachioplasty)
This type of surgery involves the removal of sagging skin, often caused by weight loss, but also due to the natural ageing process.
Female Genital Surgery
Genital surgery is becoming more available to women who require it either because of congenital deformity or childbirth, or because they have suffered from cervical cancer. Vaginal tightening is carried out either under total intravenous anaesthesia (TIVA) or under a general anaesthetic. Labial reductions, usually carried out to correct a perceived congenital deformity, are also available. Vaginal surgery is becoming more widely available in the UK and cosmetic surgery clinics have experienced greater demand since 2008.
Non-Surgical Cosmetic Procedures
Laser treatments are an area of non-surgical cosmetic procedures that have experienced rapid technological advancements in recent years, particularly since the mid-2000s. Laser treatments are used to reduce uneven skin pigmentation, rough skin, acne scars and even sun-damaged skin, as well as to curtail the appearance of facial lines and wrinkles.
Laser beams can be directed at specific areas of damage or at certain tissues within the skin. These beams are produced in one wavelength or colour at a time, a process known as selective photothermolysis. Two types of laser treatments are commonly used in the UK - ablative and non-ablative.
Ablative lasers work by heating water within the surface layers of the skin, causing both the water and the tissue layers to vaporise. This is performed in a precise and controlled manner and allows for new layers of collagen to be produced as part of the healing process, resulting in improvements to the texture and appearance of the skin. These lasers can also be used on sensitive areas of the skin, such as around the lips, eyes and even the eyelids. Among the more progressive clinics in the UK, ablative lasers are becoming less common in usage as a result of a move towards less invasive laser treatments.
Non-ablative lasers aim to reduce the recovery time after treatment by targeting the dermal layer of skin below the outer epidermis. These types of lasers use lower energy levels than other lasers and claim to destroy tissue without significantly affecting the surface layers. Many new forms of lasers are now used by cosmetic clinics in order to attain shorter recovery times and greater flexibility. Other non-ablative lasers include intense pulsed light (IPL); light-heat energy (LHE); and light-emitting diode (LED) systems. IPL can deliver hundreds of wavelengths or colours in each burst of light. LHE is similar to IPL, but works by delivering controlled levels of both low-level light and heat.
Fractional photothermolysis (also known as fractional laser skin treatment) is a form of laser technology that can be achieved through both ablative and non-ablative skin-resurfacing techniques and, as the name suggests, refers to the treatment of certain zones (tiny dot or pixel-like areas in the skin) that leaves the area around these zones intact. The treatment is therefore fractional and the skin heals much faster than if the whole area was treated. Fractional photothermolysis is one of the most recent areas of laser treatment and is becoming more widely available in non-surgical clinics.
Laser lipolysis, which offers a less invasive and aggressive alternative to traditional liposuction, is a relatively new laser treatment available in some clinics in the UK. Laser lipolysis is used for removing fatty tissue in areas that are normally resistant to dieting and exercise through the selective interaction of a laser beam with fat cells. SmartLipo, a brand of laser lipolysis, claims to promote the breaking up of the walls of fat cells, transforming them into a substance that can be absorbed and eliminated by the body’s own natural processes. It is particularly effective in areas such as the inner and outer thigh, stomach, jaw line and jowls. Results are evident at 6 weeks, with the full effects expected at around 4 months. As such, laser lipolysis offers a faster treatment time than conventional liposuction.
Another brand, VASER, which was introduced in the US in 2002 and offers VASERshape and VASERlipo machines, uses ultrasonic energy to selectively liquefy fat while preserving tissue structures vital to natural skin tightening. By preserving nerves, blood vessels and collagen, patients are less likely to experience pain and bruising post-operation, allowing for a faster return to normal activities.
Laser Hair Removal/Hair Reduction
Laser hair removal undertaken through small independent clinics has witnessed strong expansion since the mid-2000s. The procedure involves a laser being directed onto the skin for a fraction of a second using the photothermolysis process. The energy of the laser is absorbed by melanin in the skin, which is then transmitted down to the root of the hair shaft, disrupting growth. Newer and more sophisticated technology for hair removal has been developed in recent years, to target lighter-coloured hairs that were previously difficult to eradicate.
The only recognised truly effective method for permanent hair removal is electrolysis. Advancements in techniques in electrolysis have made this process an even more effective method. The diathermy process (the use of heat to destroy the hair follicle) is the most widely adopted method used by cosmetic clinics and beauty salons.
Botulinum toxin is a naturally occurring protein produced by the bacterium Clostriduim botulinum. There are currently two types of Botulinum toxin that are commercially available in the UK: Type A toxin (which includes Botox [Vistabel], Dysport [Azzalure] and Xeomin [Bocouture]), and Type B toxin (Neurobloc). Type A toxin is used commercially to reduce lines and wrinkles. Botox is the trade name for Botulinum toxin A. It causes temporary paralysis and, since the mid- to late-1990s, it has been used to immobilise the muscles in the brow and around the eyes to temporarily reduce the appearance of frown and laughter lines.
Botulinum toxin acts by blocking acetylcholine (a chemical that is responsible for transmitting electrical impulses), which causes muscle contraction. Botox is injected directly into the muscles that cause wrinkles using a very small needle, resulting in temporary muscle paralysis. The effects generally last for around 3 to 4 months and the treatment gives the face a more relaxed and smoother appearance. When the gradual fading of the effect is noticed, another treatment is required.
Allergan Pharmaceuticals is the major manufacturer of Botox. Botox is currently the most popular form of non-surgical treatment for the face, owing to the ease of the treatment and its fast and visible results.
Collagen and Other Injectable Treatments
Many methods and substances beyond Botox are now being used to treat facial wrinkles and to conceal the effects of ageing on the face. In fact, non-surgical procedures are developing at a spectacularly fast rate in terms of treatment possibilities. For example, a widening number of biocompatible dermal fillers are now available that can be injected. These products have a good safety record and normally last for between 6 months to 1 year. The usage of these types of treatments has increased significantly in recent years, since they are recognised as efficient and cost effective.
Collagen is used to replenish the skin by filling in wrinkles and grooves, including those around the mouth, nose and eyes. Collagen is lost naturally from the skin as part of the ageing process. The collagen synthesis process and treatment is lengthier compared with that of Botox; however, the results can be more effective and last for a longer period of time. Collagen injections were first used in 1976 and remain widely used today. Dermal fillers containing hyaluronic acid, such as Restylane, Perlane, Juvederm, Belotero and many others, have also become highly popular in recent years.
Temporary lip enhancement is another popular treatment in the UK and many substances are now being used for this type of procedure. These substances are primarily injected under the white hair-free line that outlines the vermilion (red mucosa) of the lip, creating the much-desired ‘bee stung’ look. The most common material used in this treatment is collagen, although, more recently, hyaluronic acid gel (e.g. Hylaform and Restylane) has been used. Permanent lip enhancement is also possible and a number of new products are being made available for this. Artecoll is popular in Europe and can be injected into clients without anaesthesia, as outpatients. Artecoll gives a softer result than a number of earlier injectables used for lip enhancement treatments.
Although temporary, fat injection is another means of lip enhancement, which has the advantage of being sourced from the patient’s own tissue, meaning that an allergic reaction will not occur. The fat is collected either as part of another liposuction procedure or harvested specifically for the purpose of lip augmentation.
Other Skin Resurfacing Techniques
Exfoliation treatments using mineral crystals to varying levels of penetration are offered by most non-surgical clinics. The minerals used include aluminium salts, sodium bicarbonate crystals and even sodium chloride (table salt). The movement of these crystals under pressure loosens and partially removes the outermost epidermal layer of the skin, which in turn stimulates the body’s own collagen and skin-cell production and improves skin texture. Specific treatments are available, for example, for use around the eyes, while the process is also used for combined treatments.
This type of procedure typically comprises peels using forms of acid that can be used to improve skin texture. Salycilic acid, trichloracetic acid (TCA) and glycolic acid are all used in different treatments. Brand names include Compositum, Cosmedix, Innovation Concept Peel (ICP), Mene & Moy, and Neostrata.
New techniques using both chemical-based and natural compounds have also been developed and are attracting greater demand. The Obagi Blue Peel, for example, uses TCA as an active ingredient mixed with the patented Blue Base from Obagi. A Green Peel is also available and is made from a mixture of herbs and natural ingredients. Treatments can also cover other parts of the body, such as the back and thighs, to improve skin texture and pigmentation.
Mesotherapy is now gaining wider acceptance worldwide as a non-invasive skin treatment. It involves the injection of compounds that benefit the skin, including vitamins, amino acids, enzymes, minerals, plant extracts, hormones and hormone blockers. These are placed millimetres under the skin in the particular area that is to be treated within the mesoderm (or the skin surface), hence the treatment’s name.
Another relatively new treatment involves increasing the levels of hyaluronic acid in the skin. This is achieved in a similar way to the dermal filler treatment detailed previously, with the exception that the injections are not in filler form. This procedure is recommended for maintaining skin firmness and texture. Originally practiced in France as a weight-loss technique, it has also become increasingly popular in the US and the UK in recent years. Non-injectable mesotherapy procedures have recently become available in some clinics in the US.
Micro Current Therapy
This type of therapy originated in its medical usage for people with facial muscles that had been paralysed by a stroke or due to illness. The introduction of the computer-aided cosmetology instrument (CACI) has also been called the non-surgical face lift, in the sense that similar effects are achieved through the use of micro currents to ‘lift’ the face. The most recent and innovative of these CACI machines claims to effectively plump out and soften lines and wrinkles, as well as tone the skin. This technology can also be used to treat acne scarring.
Radio Frequency Therapy
Radio frequency treatments involve the use of radio frequency energy, which is used to penetrate the skin at a deep level, resulting in skin tightening; the heating of fat cells and increased blood circulation for body contouring; and fat and cellulite reduction. Radio frequency is also used for facial rejuvenation, since it is able to affect the deeper dermis and subcutaneous layers. The treatment can also improve the underlying tissue structure.
Sclerotherapy and Microsclerotherapy
Sclerotherapy is used for treating varicose veins. Microsclerotherapy is a technique that involves injecting thread veins with a sclerosant that causes swelling in the vein’s wall, thus destroying it.
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1. Introduction & Definition
2. REPORT COVERAGE
3. MARKET SECTORS
Surgical Cosmetic Procedures
Non-Surgical Cosmetic Procedures
What’s KEY in the Market?
4. KEY DRIVERS
5. MARKET TRENDS
Demand for Cosmetic Surgery Falls
‘Selfies’ and Social Media Influences
Cosmetic Surgery Abroad
6. ECONOMIC TRENDS
7. MARKET POSITION
8. HOW ROBUST IS THE MARKET?
Market Size, Segmentation & Forecasts
9. MARKET SIZE & SEGMENTATION
The Total Market
10. BY MARKET SECTOR
The Face/Neck Area (including nose)
The Breast Area
The Body Area
Future Economic Trends
Forecast Total Market
12. MARKET GROWTH
14. THE US MARKET
Strengths, Weaknesses, Opportunities & Threats
Company Profiles Updated
League Tables Updated