title: Plastic Surgery Statistics in the US: Evidence and Implications.
abstract: BACKGROUND
  The American Society of Plastic Surgeons publishes yearly procedural statistics, collected through questionnaires and online via tracking operations and outcomes for plastic surgeons (TOPS). The statistics, disaggregated by U.S. region, leave two important factors unaccounted for: (1) the underlying base population and (2) the number of surgeons performing the procedures. The presented analysis puts the regional distribution of surgeries into perspective and contributes to fulfilling the TOPS legislation objectives.
  
  
  METHODS
  ASPS statistics from 2005 to 2013 were analyzed by geographic region in the U.S. Using population estimates from the 2010 U.S. Census Bureau, procedures were calculated per 100,000 population. Then, based on the ASPS member roster, the rate of surgeries per surgeon by region was calculated and the interaction of these two variables was related to each other.
  
  
  RESULTS
  In 2013, 1668,420 esthetic surgeries were performed in the U.S., resulting in the following ASPS ranking: 1st Mountain/Pacific (Region 5; 502,094 procedures, 30 % share), 2nd New England/Middle Atlantic (Region 1; 319,515, 19 %), 3rd South Atlantic (Region 3; 310,441, 19 %), 4th East/West South Central (Region 4; 274,282, 16 %), and 5th East/West North Central (Region 2; 262,088, 16 %). However, considering underlying populations, distribution and ranking appear to be different, displaying a smaller variance in surgical demand. Further, the number of surgeons and rate of procedures show great regional variation.
  
  
  CONCLUSIONS
  Demand for plastic surgery is influenced by patients' geographic background and varies among U.S. regions. While ASPS data provide important information, additional insight regarding the demand for surgical procedures can be gained by taking certain demographic factors into consideration.
  
  
  METHODS
  This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Englschalkingerstr. 77, 81925, Munich, Germany. paul@heidekrueger.net.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Heidekrueger
authors.affiliation: Population and Development Branch, Technical Division, United Nations Population Fund, New York, NY, USA.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Juran
authors.affiliation: Plastic Surgery, Yale University, New Haven, CT, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.affiliation: Plastic Surgery, North Shore LIJ Hospital, New York, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.affiliation: Department of Plastic, Reconstructive, Hand, and Burn Surgery, Klinikum Bogenhausen, Academic Teaching Hospital Technical University Munich, Englschalkingerstr. 77, 81925, Munich, Germany.
authors.forename: P Niclas
authors.initials: PN
authors.lastname: Broer
mesh_terms: D006801:Humans; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D013518:Surgery, Plastic / Q000706:statistics & numerical data*; D014481:United States
keywords: Cosmetic surgery; Data analysis; Esthetics; Geography; Plastic surgery; Regional distribution; Statistics; Surgical procedures