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surgery performed or considered. Respondents were asked to identify training paths and specialties that could produce a cosmetic surgeon; options included surgeon, dentist, obstetrician/gynecologist, anesthesiologist, family practitioner, internist, and dermatologist. Subjects were then asked to identify the area of the body they would be most interested in having treatment for with plastic surgery, as well as the principal reason they would not have plastic surgery. Questions directed at surgeon selection included importance of advertisement, reputation, type of referral, board certification, surgeon age, training background, and quality of practice. For these questions, respondents were asked to rate the importance of each factor on a scale of 0 to 10, where 0 was least important and 10 was most important. Potential respondents were questioned on where they would prefer to undergo plastic surgery: at a private surgicenter, a community hospital, or a university medical center. Finally, respondents were asked to express their preference for a larger, more expensive procedure with longer lasting results or a shorter, less-expensive procedure with more temporary results. The full questionnaire is available in Appendix 1 at www.aestheticsurgeryjournal.com. Data Analysis Only responses with data available for all of the demographic variables were used; respondents who failed to choose at least 1 response for each question were excluded. Descriptive statistics were obtained for the demographic variables to describe the sample. Income was categorized in US dollars as $0 to 45 000 (low income), $45 000 to $100 000 (middle income), and >$100 000 (high income). An ordinal logistic regression model was then manually fit for the total for plastic surgery with age, sex, marital status, and income. Cross-tabulated frequencies were calculated and chi-square associations were computed among the association variables. A linear analysis of income was also employed to assess correlations with associated variables. Results Demographics Ninety-six subjects responded to the survey. Average respondent age was 34.5 years (range, 18-67 years). Eighty-one (84%) were women and 15 (16%) were men. Average annual household income of participants was $91 298 (range, $0 to $500 000). If we eliminated the participants who reported an annual income of $0, the average annual household income rose to $106 886 (±SE $9607). Forty-two participants were single and 54 (56.2%) were married. Sixteen respondents (16.7%) had previously undergone cosmetic surgery (Table 1). Defining a “Cosmetic” Surgeon Among participants, 32 (33.3%) did not draw a distinction between a plastic surgeon and a cosmetic surgeon (Figure 1A). Downloaded from https://academic.oup.com/asj/article/33/4/585/204723 by guest on 19 August 2022 Galanis et al 587 All respondents identified “surgeon” as a training path that could yield a cosmetic surgeon; 33 (34.4%) said that surgeon was the only training path that could yield a cosmetic surgeon. The remainder of subjects identified dermatologist (34%), dentist (22%), obstetrician/gynecologist (22%), anesthesiologist (12%), family practitioner (12%), and internist (10%) as training paths capable of yielding a cosmetic surgeon. Only 8 respondents (8.3%) selected all available training paths. There was no statistically significant correlation between these responses and age, sex, income, or marital status (Figure 1B). Interest in Plastic Surgery Nineteen subjects (19.8%) were considering cosmetic surgery at the time they completed the survey. Seventy-five subjects (78.1%) said they might consider cosmetic surgery in the future. Overall, surgery of the general face was identified most frequently (44.8%) as the surgery in which most individuals would be interested. Younger participants tended to be most interested in cosmetic breast surgery (mean age, 30.6 years), while older participants tended to be most interested in cosmetic surgery of the face (mean age, 35.4 years; P = .02). Subjects were least interested in cosmetic surgery for the extremity or neck (n = 0 and n = 4, respectively; Figure 2A). Fear of a poor result (51%) was the most common reason given for not undergoing plastic surgery. Other reasons were cost (40.6%), fear of the recovery process (25%), fear of anesthesia/surgery (14.6%), and no interest (20.8%). No respondents identified fear of what others might think as a reason not to pursue plastic surgery (Figure 2B). When compared with unmarried individuals, subjects who were married were more likely to choose a more expensive surgery with longer lasting results over a less invasive procedure offering more temporary benefits. There was no statistically significant correlation between preference for a permanent or temporary procedure and age, sex, or income. Factors Influencing Selection Average score for factors viewed by respondents as most important when considering a plastic surgeon are illustrated in Figure 3. Surgeon reputation (9.21 on a scale of 0-10) and board certification (9.20) were the most important factors indicated by subjects. Age (5.49) and advertisement (2.63) were identified as least important. Those with no history of prior surgery tended to value referral from a friend more highly than those with a history of prior
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