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More than 25 million people in the world undergo surgery or cosmetic treatment each year.
The most practiced are breast augmentation, liposuction and blepharoplasty to remove excess skin on the eyelids, as well as facial injections of botulinum toxin and hyaluronic acid.
Society's interest in these interventions has skyrocketed in recent years due to the cult of the image that social networks promote, to the point of exhaustion. Millions of people around the world seek to increase self-esteem, confidence and psychophysical health at the stroke of their checkbook. They resort to these practices, which can be more or less invasive, to improve their image, correct a physical defect and delay (or erase) the traces left by the years. It is difficult to calculate the value of such a colossal industry and, in fact, there are few statistics. Consulting firm Fortune Business Insights states that the global size of the cosmetic surgery market was $ 50.67 billion (€ 42.8 billion) in 2018 and is forecast to reach $ 66.96 billion (more than € 56.5 billion) in 2026.
Spaniards are no strangers to the fervor for surgeries (surgical) and aesthetic treatments (non-surgical).
There is more and more demand and at younger ages.
An example: a few years ago the age of entry to aesthetic medicine was 35 years.
Now 20-year-old girls are injecting hyaluronic acid to plump their lips and botulinum toxin to smooth their foreheads.
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The offer of treatments is extensive: hair grafts, knee and thigh stretching, buttock augmentation, intimate surgeries such as labiaplasty,
mommy makeover
(recovering muscle tone through operations such as abdominoplasty after giving birth), filled with fat ... Any part of the body that you imagine is susceptible to being improved or repaired. And you don't always have to undergo surgery.
Around 400,000 people contracted an intervention last year in Spain.
More than eight out of ten were women, although men now account for 15% and growing (very few years ago they only represented 2%).
Spanish women demand, above all, breast augmentation surgeries (also lifting and reduction) and liposuctions, practically the same as women in the rest of the world.
Men opt for correcting gynecomastia, high definition liposuction (marks the abdominals), hair grafting, blepharoplasty, otoplasty (correcting and reshaping the ears) and double chin removal.
The demand is not weak
The strength of the Spanish sector has been building for some years. The industry "has registered a growth of between 15% and 20% in the last decade", points out Francisco Gómez Bravo, plastic surgeon and president of the Spanish Association of Plastic Aesthetic Surgery (Aecep), an organization that brings together 155 surgeons from prestige.
But its robustness has been exposed precisely with the pandemic, which has barely impacted its accounts. Not on your demand. The sector's turnover (encompassing surgical procedures and aesthetic treatments) reached 2,660 million euros in 2020, only 5% less than in 2019, when it was 2,800 million euros, according to Aecep. If only aesthetic plastic surgery is taken into account —more expensive: between 3,000 and 6,000 euros on average—, "turnover fell by 30% in 2020," adds Nélida Grande, vice president of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (Secpre). These decreases are limited to the two and a half months of strict confinement in which the clinics remained closed. Thus, the sector, which generates around 100,000 jobs, passed the test with some ease: let's think that,for example, the income of textile fashion in Spain fell by 25%, that the restoration lost 42% of its turnover and that the cinema registered a decrease of 72%.
It could even be said that the pandemic has been a catalyst for this sector because, in addition to the accumulated demand of already convinced patients, it attracted new clients who had never set foot in a clinic, who for the first time approached this world of fillers, prosthetics , cannulas and syringes. In fact, in the spring of 2020 there was saturation in many beauty centers and long waiting lists. “Starting in June a boom started, it was a spectacular thing. The people operated on in a more cheerful way, money on this occasion was not the decisive factor in making the decision, which was the case in previous years ”, states César Casado, head of the Hospital's Plastic, Aesthetic and Reconstructive Surgery service Ruber International.
A plastic surgeon injects botulinum toxin into a patient at a clinic in Sant Cugat (Barcelona). Miquel Benitez / Getty Images
That in those months so complicated by contagions - even today they are - so many people went to aesthetic clinics is something that surprised even the doctors. "We had not foreseen that this could happen, that the patients after the first wave would be encouraged to take the step," argues Francisco Gómez Bravo. Surgeon Antonio de la Fuente, who has been performing plastic and cosmetic surgeries for 45 years, recalls that patients "came with the decision made, something that is not usual, since they usually visit several specialists before deciding." Although there is a very stable clientele in their practice, they did notice "a slight increase in young women, between 20 and 30 years old," he adds. Something that the Secpre corroborates: “Many more young patients who requested breast interventions were operated on”.
Several were the reasons for this boom of tinkering amid continuous waves of infections.
The main one was the savings buffer accumulated by Spanish households: the rate shot up to 14.8% in 2020, the highest in the historical series, according to the INE.
"Although many people were economically affected during this pandemic crisis, many others kept their payroll without being able to spend on social life, so they had the resources to face surgery," says Gómez Bravo.
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The reduction in business trips by executive patients, who had more time for recovery and postoperative, also had an influence. In addition, the mask allowed to hide scars and inflammation. And teleworking made it easy not to have to give explanations to the curious.
Another cause was the dysmorphic effect that video calls produce on the perception of oneself.
"The perspective and shape of the camera lens deforms faces and bodies with unflattering effects, which meant an increase in the demand for facial interventions," confirms the president of Aecep.
In short, "we have been more aware of the effects of aging," adds Grande.
And from pandemic fatigue.
There was a growing need to look and feel better - at this point it should be remembered that, although surgery seeks the psychophysical health of patients, especially when there are physical abnormalities that reduce self-esteem, not in all cases the solution is through a clinic esthetic-.
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Eyelid surgery, the most demanded facial plastic operation
In those pandemic months, one of the most requested surgeries, both by men and women, was blepharoplasty, which grew by around 30%, according to Aecep. "It is the surgery to correct excess skin on the eyelids and the reduction of eye bags because patients focused more on the facial area and, above all, on the eyes," says Grande. At the Guilarte clinic they point out another star operation: rhinoplasty. “Wearing a mask generates relative respiratory failure. If you add to this that you don't breathe well through your nose, this makes you study a possible nasal obstruction and undergo a rhinoplasty ”, says plastic surgeon Rubén Guilarte. And in aesthetic medicine, the undisputed queens were injections of botulinum toxin (popularly known as botox,a commercial name) and hyaluronic acid in the upper facial third - which exposes the mask - to achieve a rejuvenation of the look.
It cannot be said that this boom to improve the exterior appearance is only a consequence of the pandemic lockdown. The good rhythm has not stopped this year. In fact, "in 2021 the demand has already increased by approximately 10% compared to the precovid period", they calculate in the Aecep. This is reported by some clinics. "The demand continues and we are fortunate to have the 2021 agenda already closed," says Rubén Guilarte. In his clinic they have detected that the average cost per client has gone from 7,000 euros in 2019 to 8,000 in 2020. This year it is already around 10,000 euros.
More of the same at the Brussels clinic: "This year we have already increased demand by 12% compared to precovid levels," says Christopher Oyola, medical director of this center who, since 2000, has performed more than 12,000 surgeries and he puts 70 Elipse gastric balloon implants a month - it consists of swallowing a capsule - for weight loss.
And Cesar Casado, from the Ruber International Hospital, believes that "new clients who approached aesthetic medicine for the first time will do so again."
World leaders
For all this, the experts do not rule out that this year Spain will be able to advance positions in the world rankings. It ranks 17th in the
ranking
of the countries that perform the most surgeries, according to data from the International Society for Aesthetic Plastic Surgery (Isaps) for 2019. In the breast augmentation category, it ranks eight. Not bad at all, considering that it is measured against giants like Brazil and the United States. US citizens alone spent more than $ 9 billion on cosmetic plastic surgery in 2020, according to data from the American Society for Cosmetic Surgery. They are followed by Japan, Mexico, Italy, Germany, Turkey, France, India and Russia.
The Spanish sector began to gain size thanks to two milestones. A few years ago, cosmetic surgeries and treatments were a minority, available only to characters on coated paper. The cost was high and there were few professionals. In the long expansion phase of the Spanish economy (from the 1990s to 2008), banks began to finance cosmetic surgery treatments, something unthinkable until then. And, on the other hand, the opening to the European common market allowed plastic surgeons from other parts of Europe to arrive in Spain with the approved title. And thus, a larger segment of the population began to access interventions at a more affordable price.
Today you don't need to have an excessively buoyant checking account to get a touch up. "The idea of being able to undergo surgery or treatment has become normalized among society," says Olaya, from the Brussels clinic. In this center they say they have noticed a slight increase in the payment in cash of amounts less than a thousand euros, although 60% of their patients finance the interventions.
Surgery and aesthetic medicine have crept onto the Spanish shopping list. "We can say that it has become a
commodity
, that is, something that people usually look for, which they no longer give up," says Cristina Sánchez, deputy general director of Dorsia clinics, where demand in 2020 increased by 20 % year-on-year. Only in breast surgery, Dorsia has a 30% market share in Spain.
This brand, which works with the franchise model and is present even in shopping centers, is a sample of the pull of the sector. “We expect to end 2021 with 130 clinics throughout Spain, in addition to starting the international journey with openings in France and Portugal. The demand grows every year, ”says Sánchez. Their prices are cheaper than those that can be found in the private consultations of surgeons, but they do not like to talk about
low cost
, but about "affordable luxury," says Sánchez. The average cost per patient was 2,000 euros in 2020, 10% more than in 2019. So far in 2021 the average ticket has increased by 15%.
The huge demand for all kinds of aesthetic treatments, those that do not use major surgical techniques or require general anesthesia, has contributed much to the boom of this millionaire business.
In fact, the number of centers has grown by 30% in less than three years, reaching 5,244 establishments, according to the Spanish Society of Aesthetic Medicine (Seme).
How to pay for the gym
“For many people, aesthetic touch-ups are already considered a basic expense.
For example, for many patients, botulinum toxin and hyaluronic acid are comparable to subscribing to the gym or paying for the hairdresser, they see it as one more annual expense ”, says plastic surgeon Isabel de Benito, from the Porcuna & De clinic. Benedict.
The impulse of aesthetic treatments is due to several factors.
The first is its cost: it is much lower - on average between 300 and 500 euros - than that of cosmetic plastic surgery and, above all, it is reversible.
In fact, it is what many women and men cling to to delay entry into an operating room.
The boom in this branch is due to “technological improvements, with much more effective and safer treatments.
And we cannot forget the importance that the image has been acquiring in the well-being of people, both due to an increase in longevity (also work life) and because of social networks ”, says Petra Vega, president of Seme.
Four out of ten Spaniards already go to aesthetic medicine. "There are about 100,000 different treatments done each year," says Vega. Keep in mind that many of them need several sessions, one to three a year. What is most requested are injections of botulinum toxin and hyaluronic acid to rejuvenate the face. “Sales of these two treatments have grown by over 10% in recent years. Botulinum toxin was the most in demand, followed by lip filling, despite the use of masks, ”says Galderma Laboratories, which markets Restylane hyaluronic acid and Azzalure botulinum toxin. From Restylane alone, which is 25 years old since its launch, 50 million treatments have been sold worldwide.
Now that masks are not mandatory outdoors, the lower part of the face has gained importance.
“The demand for treatments for the lips and surroundings has increased, when before the absolute protagonists were the eyes,” confirms Mar Mira, co-director of the Mira + Cueto aesthetic medicine clinic.
The eyelid operation has been one of the most demanded interventions in recent months.Raúl Caro / EFE
It may be said less or, directly, not said, but more and more men succumb to aesthetic medicine.
The global male market is estimated to grow at an annual rate of 7% until 2024, according to Seme.
"Men now think differently, and on an aesthetic level, they want to look good, just like women," says Cristina Sánchez.
Graft Revolution
Proof of this is the revolution in hair grafts, especially in men in their 30s.
Spain has become in a few years a world reference in hair transplantation and more so now that trips to countries like Turkey have been reduced.
In Spain, more than 2,000 hair grafts are performed per month, calculates the specialist Jaime Tufet.
At its International Hair Surgery center, about 60 interventions are performed per month.
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In this field, women have always been a minority: they represent between 5% and 10% of patients.
Although in the Svenson centers women are 52%, compared to 48% of men.
"Hair problems and alopecia are no longer a taboo subject for them," they point out in this company, which was established in Spain 50 years ago and has 40 own centers in which more than 120,000 hair treatments are applied per year .
The pandemic did not stop the desire of many Spaniards to have a new hair, an intervention that is around 4,500 euros, although it can reach almost 6,000 euros.
"2020 has been the year of the maximum growth peak, making all hair clinics 100% occupied", says Tufet.
And from hair to teeth. Or rather to smile design. “The demand for dental aesthetics is booming. Digital technology has made veneer treatments less invasive and orthodontics with clear aligners faster and more comfortable. Teeth whitening is also in high demand, ”says Carlos Saiz, an expert dentist in dental aesthetics, whom some media has dubbed the famous dentist. He has treated more than 16,000 patients with the micro-veneer technique without carving the natural tooth, a treatment that costs from 650 euros per tooth. "After the confinement in March, we did not notice a recession in the number of aesthetic treatments, but rather a slight increase," says Saiz.
Much has happened since the first cosmetic rhinoplasty was performed in the United States in 1887. The sector has had to overcome the bad image caused by the abusive and unfortunate use of silicone. In fact, "it is rare that you do not see patients with these products," says Antonio de la Fuente. And the so-called
Michael Jackson effect —
so many operations disfigured his face.
He has achieved this by perfecting techniques, which are less and less invasive.
The challenge for the sector is to obtain increasingly natural results, despite the fact that in some cultures, such as Latin America, fashion is exuberance.
The president of the Aecep believes that Spain is experiencing the third technical innovation.
“There was a first phase in which the surgeries were very noticeable.
The second phase was based on avoiding the
operated
look
.
Now we move on to the next level: that a breast with a prosthesis not only looks good in the photo, but when you touch it, you do not realize that it is not a breast, ”says Gómez Bravo.
Naturalness in touch and movement.
Intrusion and social media
Surgeons and clinics are heavily exposed to the public eye. Many turn to social media and influencers to advertise their treatments and surgeries. It has its good part: "It has helped to have a surge in surgery", believes Francisco Gómez Bravo, president of the Aecep. And it has its bad part: that so-called professionals, who in reality are not, use social networks to advertise. “We have seen how misleading frames are used: from light effects that can alter the perception of the results, to the use of Photoshop selling a false result. There is no control and it is very dangerous. There are people who take advantage, false surgeons, without specialist titles ”, adds the plastic surgeon. "People are confused and end up creating unrealistic expectations, which generate frustration," says Mar Mira,from the Mira + Cueto aesthetic medicine clinic. Precisely Norway has just banned 'influencers' and brands from retouching photos without warning. The new law of the Nordic country seeks to fight against misleading advertising and unrealistic ideals of beauty. Instagram announced in 2019 that it would remove those filters that mimic cosmetic surgery, due to their effects on the mental health of the youngest.
It is an open door that enhances intrusion, one of the great ills of the sector.
“A kind of potpourri of many professionals who call themselves specialists in practices for which they are not trained has been opened,” they say from Aecep, which requires all its members, apart from the medical career and the specialty of Plastic Surgery, Aesthetics and Repairing, an experience practicing of at least five more years.
“The fact that a doctor, just by being one, can do everything is something from the last century.
We need to increase awareness among patients, so that they can and know how to inform themselves well, for their health ", they add in Sepcre.
Because, not going to the right hands has serious health risks, often irreversible.
It all started with a rhinoplasty
1. FIRST NOSE. Aesthetic plastic surgery is a fairly modern specialty compared to other medical-surgical disciplines. In 1887 the first aesthetic rhinoplasty was performed in the United States and in 1907 the first book on the subject was published, entitled 'The Correction of Featural Imperfections', by Charles Conrad Miller.
2. WARS. During the First World War the faces of thousands of soldiers were disfigured. Specialist camps dedicated to facial reconstruction were created, especially in England. In Spain, cosmetic surgery began to be performed with some normality after the Civil War, specifically in 1940. Foreign specialists trained Spanish military surgeons to help the wounded who needed facial reconstructions.
3. HOLLYWOOD. In the golden age of Hollywood, in the 20s of the last century, celebrity surgeries allowed society to know these types of interventions. One of the most popular operations was the rhinoplasty of the singer and actress Fanny Brice. Pioneers in Europe were the surgeon Suzanne Noël in Paris (France), known for her facelift technique, and the surgeon Joseph Lister in Germany.
4. PIUS XII. In the 50s the discipline spread throughout the world, it is the true boom of surgery. Pope Pius XII made a public recognition of the specialty in 1958 during the 10th Italian Congress of Plastic Surgeons, in which he defended the importance of plastic surgery to solve problems of psychological suffering that other specialties did not solve.
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