Educated, married, mothers, women who are older than their husbands - that's not necessarily the image of the typical cosmetic surgery patient, but a couple of chance comments from patients led three generations of a family of researchers to combine forces to create a prospective study of cosmetic patients that yielded interesting, and unexpected, results.
Joel Schlessinger, M.D., has had a busy cosmetic practice in Omaha, Neb., for 19 years. He picked up on a trend when chatting with his patients.
"A couple of women told me that they were older than their husbands and wanted to keep looking as good as possible. I suspected that might be a subset of my patients, but I never suspected it was as stunning a number as it turned out to be."
"With all of the studies I've seen so far, I realized the methodology was flawed, in that they were retrospective studies and the data was accumulated from corporations and surgeons who didn't necessarily have direct knowledge of the actual data," Dr. Schlessinger says. "Retrospective data tends to be extraordinarily unreliable. Some questions won't generate good answers unless the data is collected in a prospective manner from the subject themselves."
Starting the study
With the assistance of his father, Bernard Schlessinger, Ph.D., who has a background in survey development - knowledge of the types of questions and number of subjects needed to achieve credible results - and son Daniel, who has experience in statistical analysis, Dr. Schlessinger furnished the patients, and a prospective demographic study of cosmetic surgery patients was developed.
The study included 336 patients from a private, nonacademic dermatology practice. The results showed that Dr. Schlessinger's average cosmetic patient has similarities to the national average, but with significant differences.
In addition to the major difference in educational status of cosmetic patients, the number of women who are older than their husbands is much higher than Dr. Schlessinger anticipated, he says.
Nationally, according to the 2008 census, 53 percent of women reported being younger than their husbands and 31.9 percent were the same age, compared to Dr. Schlessinger's patients, with 61.7 percent younger - a significant difference - and only 16.7 percent who were the same age.
Dr. Schlessinger says he didn't expect initial results to hold.
"The first 50 survey results showed skewed results, and we thought the figures were an anomaly," he says. "We continued collecting another 100 patients, then another hundred. In time we ended up with 400 patients and the data stayed true throughout."
Dr. Schlessinger says he finds the results provocative.
"It is an interesting sign that certain types of women gravitate toward cosmetic surgery. I think there's a general misconception that cosmetic surgery patients tend to be somewhat younger and less savvy customers, that she is an unmarried woman looking to be a trophy wife. This data contradicts that.
"It makes me more comfortable about approaching an educated individual when I realize the filler and neurotoxin patient is significantly more educated than the general population," he says. "She is a married woman with children who is educated and has a higher level of productivity than what might be assumed by the common perception."
Dr. Schlessinger says the study is obviously limited at this point.
"This is one patient population from an established, well-known practice, as opposed to the medspa in the mall," he says. "There may be a much younger, less-educated population that is accessing that type of procedure there.
"There may also be differences in a plastic surgery practice, because a younger patient may be less comfortable going to a plastic surgeon, whereas they will access a dermatology practice at a younger age for a multitude of reasons."
Further studies in this area would be helpful, Dr. Schlessinger says.
"The survey respondents may be a homogeneous class of cosmetic patients in one Midwestern city," he says. "I think the results indicate it would be a good study to expand to other parts of the country, and to academic and other types of dermatology practices."
The study results could also enable cosmetic practices and possibly product manufacturers to focus their marketing efforts, Dr. Schlessinger says.
"Pharmaceutical companies probably have the ability to tease out that woman who is older than her husband by advertising on certain TV shows," he says. "'Cougar Town' may be a fertile area for them to advertise something like Restylane or Radiesse. It might be a subset they can actually target."
Disclosures: Dr. Schlessinger is a researcher for Medicis, Allergan, Merz and Mentor.