The non-invasive aesthetic treatment market in North America is expected to expand at a compound annual growth rate of 13.2% through 2028, according to a market analysis report led by Grand View Research. People are becoming more and more interested in what the industry has to offer as procedures become increasingly effective with more pain management options and better provider training. While the market as a whole is growing throughout the United States, there are regional differences in which procedures people are seeking out. The most recent statistics from the American Society of Plastic Surgery provide useful insights on the popular procedures in each region. The U.S. regions are broken up as follows:  

• New England/Middle Atlantic: CT, ME, MA, NH, RI, VT, NJ, NY, PA
• East & West North Central: IL, IN, MI, OH, WI, IA, KS, MN, MO, NE, ND, SD
• South Atlantic: DE, DC, FL, GA, MD, NC, SC, VA, WV
• East & West South Central: AL, KY, MS, TN, AR, LA, OK, TX
• Mountain/Pacific: AZ, CO, ID, MT, NV, NM, UT, WY, AK, CA, HI, OR, WA

Neurotoxins

Neurotoxins, such as Botox®, Dysport®, and XEOMIN®, are widely used to diminish and prevent fine lines and wrinkles. Common treatments areas for these injectables include the forehead, glabellar lines, crow’s feet, and around the lips. In 2020 alone, there were more than 4.4 million Botulinum Toxin Type A procedures performed. Nearly 30% of these were performed in the South Atlantic region, which includes the medical aesthetic hot spot of Miami, FL. Another 21% of these procedures were performed in the Mountain/Pacific region, encompassing the large aesthetic markets in the state of California.

Soft Tissue Fillers

Fillers came in as second most popular, with a total of more than 3.4 million procedures being performed in the same year. Dermal fillers are medical volumizers that work by stimulating the natural matrix-bulking components in the skin, notably collagen. They help fill in fine lines, facial folds, and hollowing by replacing lost volume for a smoother, plumper, refreshed look. The soft tissue filler category encompasses a wider range of procedures, including

• Acellular Dermal Matrix (ADMs): When combined with oxidized regenerated cellulose, ADM can be used as an aid to yield better cosmetic results in breast reconstructions.
• Allograft Adipose Matrix (Renuva®): This product contains the same growth factors, proteins, and collagen found in autologous fat, and can be injected into any area where fat naturally exists. After injection, the body will repopulate the area with its own adipocytes, therefore volumizing the area.
• Calcium hydroxylapatite (RADIESSE®): This active ingredient works to add volume and stimulate collagen production. RADIESSE® is FDA-approved for use in the jawline but is also frequently used off-label for building structure in the cheeks and hyperdiluted for collagen stimulation for skin and hands.  ‍
• Fat-face: Used in a process called fat grafting, where fat is removed from one area of the body and injected into another. The harvested fat is purified and injected into the face to plump areas with lost volume.‍
• Hyaluronic acid (Juvéderm® Ultra, Juvéderm ®Ultra Plus™, Perlane®, Restylane®, Belotero®): Naturally existing in the skin, HA is a key component in the skin’s ability to retain water, resulting in a plump, hydrated complexion. Commonly used all over the face, the filler attracts more water upon injection. ‍
• Polylactic acid (Sculptra®): Once injected, PLLA gradually induces collagen production that is significant enough to fill out hollowness, folds, fat loss, and other signs of aging.‍
• Polymethyl-methacrylate microspheres (Bellafill®): Comprised of bovine collagen, this injectable was approved by the FDA in 2006 to treat smile lines and acne scars. Injectable polymethylmethacrylate (PMMA) also stimulates collagen production in the skin.

Within the United States, filler procedures are most popular in the South Atlantic and Mountain/Pacific regions, making up for 24% and 23% of treatments respectively. Specifically in Miami, dermal fillers are popular for patients who want a more full and plump pout. Lip filler treatments are one of the most popular treatments in the Los Angeles & Beverly Hills areas as well. These major cities contribute significantly to the filler procedure counts in their region.

Chemical Peels

During chemical peel treatments, a light to deep chemical solution is applied to the skin to remove the top layers of skin, which are usually damaged or wrinkled. The peels are used to treat wrinkles, discoloration, and help improve any scarring on the face. The depth of the peel determines how frequent the treatment is recommended and how long recovery for the skin will take. Chemical peels result in the skin’s improved ability to absorb moisture better, stay more hydrated, and have a brighter, more youthful-looking complexion.

These peels are most popular in the Mountain/Pacific region, including the sunny states of California, New Mexico, and Arizona, to name a few. Overall, 28% of chemical peel procedures are performed in this region. This number is more than double in comparison to the New England/Mid Atlantic region, encompassing NY and other states with more harsh winters. The South Atlantic region, also known for the sunshine year-round, makes up for 20% of these treatments in total.

Intense Pulsed Light (IPL) Treatment

During an Intense Pulsed Light therapy treatment, also referred to as a “photofacial”, pulses of broad-spectrum lights are administered across the skin’s surface using a handheld device. The broadband light used helps improve the appearance of dark spots, sunspots, rosacea, age spots, and unwanted skin texture. Photofacials can also be used to help minimize conditions such as acne.

Though not as popular as the previously mentioned treatments, there were over 800,000 IPL treatments in the year 2020 alone. A quarter of these procedures were performed in the Mountain/Pacific region. Aside from this stand-out region, the remainder of the United States came in relatively even, with approximately 20% of treatments in each area.

Microdermabrasion

Microdermabrasion treatments exfoliate your skin, correcting dull complexion, uneven skin tone or texture, age spots, dark spots, and melasma, leaving a refreshed, more youthful look. Through this process, the outer layer of skin cells, typically dull/dead, are broken up using tiny crystals to reveal smoother, softer skin underneath. Results from this microdermabrasion include reduced wrinkles, decreased pore size, minimized acne scars, and treated hyperpigmentation.

The Mountain/Pacific region is responsible for 27% of the over 500,000 procedures administered in the United States in 2020. The East & West North Central region is a close second in this category, with 23% of treatments occurring in the area. This is 10% more than their South Central counterpart, responsible for just 13% of the overall microdermabrasion procedures.

Sclerotherapy

Sclerotherapy is used to treat small varicose veins, which are enlarged veins that sit close to the skin’s surface, and spider veins, a more mild variation of varicose veins. Some choose this treatment for cosmetic concerns, while others experience pain & discomfort as a result of the varicose vein. During sclerotherapy, a solution is injected into the vein, causing it to scar and eventually fade by being absorbed into local tissue.

Nearly a third of all sclerotherapy treatments in 2020 were performed in the South Atlantic region, including popular beach destinations like Florida. Since sclerotherapy is most commonly performed on the legs, it makes sense that treatments would be higher in an area where bathing suits are frequently worn. The East/West South Central region, encompassing TX and other notoriously warm southern states, makes up for an additional 23% of these treatments.

Conclusion

As a whole, dermal filler, and IPL treatments are the most evenly distributed across US regions, with only an 8% differential between the highest and lowest performing areas. Chemical peels and Sclerotherapy treatments are the least consistent, showing a 16% gap between regions with the most and least procedures administered. Many factors influence the treatments that patients invest in across the United State, and location is certainly one of them. As the industry continues to explode, it will be interesting to see how the popularity of these procedures evolves in each region.

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