Nonsurgical Aesthetic Treatment Conversion to Surgery: Implications for Patient Selection and Practice Modeling

Nonsurgical treatments for facial aging have become a mainstay in plastic surgery practices. Two practice models exist, one in which the plastic surgeon provides both the nonsurgical and surgical treatments and the other in which an advanced practice provider (APP) performs the nonsurgical treatment.

This study aims to provide objective data on the practice model in which APPs provide nonsurgical treatments.

A retrospective chart review was conducted on patients treated with either botulinum toxin or dermal fillers at our division between 2015 and 2021. Patients who had cosmetic surgery at our institution before nonsurgical treatments were excluded.

Of the 737 patients included, 39 underwent surgical treatment, for an overall conversion rate of 5.3%. Patients with a history of prior cosmetic surgery had a higher conversion rate than those without (12.5% vs 4.1%, P < 0.0004). Patients undergoing surgical treatment were more likely to have had prior aesthetic surgery (P < 0.0004), received fillers (P < 0.0009), and were older at the time of the first filler visit (P < 0.0098). The most common surgical procedures were facelifts and liposuction.

Due to the low conversion to surgical procedures, the results of this study support the practice model in which APPs perform the chemodenervation and dermal filler treatment. Additionally, patients who are older and are treated with fillers are more likely to have surgical procedures, indicating a potential provider focus on treatment counseling and optimization of outcomes. These findings also indicate that nonsurgical aesthetic treatments remain a mainstay in the plastic surgery practice.