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Updated: Jan 31, 2026

Principles of Rodent Surgery for the New Surgeon
Published on: January 6, 2011
Southern and Rural U.S. Markets Exhibit the Highest Unmet Demand for Aesthetic Surgery: Insights from Google Search
Scott R Levin1, Nina Yu1, Granger B Wong1
1Division of Plastic and Reconstructive Surgery, University of California Davis Medical Center, Sacramento, CA.
Background:
Optimizing plastic surgeon distribution is essential to meeting rising consumer demand for aesthetic operations.
Objectives:
This study aimed to identify aesthetic surgery demand-supply mismatches across U.S. Designated Market Areas (DMAs) and quantify regional demand changes from pre- to post-COVID periods.
Methods:
This cross-sectional ecological analysis used Google Trends (Google LLC, Mountain View, CA, USA) Relative Search Volume (RSV) averaged for nine aesthetic operations as a proxy for demand across 210 DMAs from August 2024-2025. Surgeon concentration was calculated as board-certified plastic surgeons per 10,000 residents. Demand-Supply Ratio (DSR) was defined as RSV divided by surgeon concentration. DMAs were grouped into quintiles (Tiers 1-5, highest to lowest DSR).
Results:
Median RSV was 45.03 (Interquartile Range [IQR] 39.52-54.90) and median surgeon density was 0.10 (IQR 0.06-0.17). Seventeen DMAs (8.1%) were "plastic surgery deserts," with search activity but no surgeons, clustering in the South, Midwest, and West. Median DSR was 426.16 (IQR 307.35-565.08), with highest DSRs concentrated in Southern and rural/interior DMAs, whereas coastal hubs were saturated. While surgeon concentration increased across DSR Tiers 1-5, RSV did not significantly differ. Nationally, median RSV increased 22.54% (IQR 16.65%-32.34%) from 2018-2019 to 2024-2025, with rising RSV in 95.2% of DMAs and highest growth in the Midwest (+32.58%, IQR 24.90%-47.55%).
Conclusions:
Southern and rural DMAs are disproportionately represented among underserved aesthetic markets and plastic surgery deserts. Aesthetic demand is rising nationwide, particularly in the American interior, underscoring high-growth regions where strategic expansion of aesthetic services by board-certified plastic surgeons may improve patient access and safety.
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