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to some interpretation. At the very least, “reputation” emphasizes the advantage of established practitioners over new cosmetic surgeons. Board certification in plastic surgery was the second most important factor. We did not investigate the general public’s understanding of what it meant to be a board-certified plastic surgeon in this study. For example, cosmetic surgeons may rightfully state they are board-certified practitioners when, in fact, they are board-certified in a field other than plastic surgery. Just as with the distinction between a plastic surgeon and a cosmetic surgeon, the distinction between American Board of Plastic Surgery certification and other nonaccredited certifications must be clear to the general population. Our data suggest this is not currently the case. Interestingly, at a time when cosmetic surgeons are dedicating increasingly more resources to marketing, the results of our study indicated that advertising was the least important factor in surgeon selection. These results are somewhat difficult to interpret, however. Certainly, making one’s presence known to potential patients is the first step toward being selected as their provider. Nonetheless, it is safe to say that a surgeon should not rely too heavily on a strong advertising campaign in lieu of many of the other factors mentioned in our survey. In fact, our results might indicate that if he or she has developed a good reputation through successful treatment of a group of patients, a board-certified surgeon may be unnecessarily draining resources by investing in expensive advertising campaigns. Patients cited fear of a poor result, cost, and fear of the recovery process as the principal reasons for refusing cosmetic surgery. We know that thorough preoperative consultation with the patient is often effective in addressing concerns regarding results and the recovery process, but concerns over cost are not surprising in today’s economic climate, and they have been shown to affect aesthetic surgery decision making.13 However, the continued increase in nonsurgical procedure rates suggests that patients will continue to undergo aesthetic procedures that are more affordable, even if the expected benefit is more short lived. Nonetheless, presenting the prospective patient with payment plan options such as monthly or deferred payments might address these concerns. Patients who had previously undergone plastic surgery were more likely than those who had not undergone a previous procedure to choose a private practice surgicenter over a university medical center. There are 2 possible explanations for this finding. First, if these patients had already received their treatment from private surgicenters, they likely experienced high-level personal care and attention, which is a certain advantage of these lowvolume centers. Such “patient-centric” practices would only reinforce the patient’s desire to return to these settings. Second, if patients had previously undergone surgery at a different type of location, the opposite effect may have occurred, and these patients may crave the increased anonymity and attention of private surgicenters. Another interesting finding of our study evaluates patient interest in a more expensive, longer lasting surgery (eg, facelift) versus a less expensive, more temporary procedure (eg, botulinum toxin injection). In 2011, Kurkjian et al13 found respondents to be less interested in longlasting but expensive treatments when more affordable and temporary options existed. Furthermore, data from the American Society for Aesthetic Plastic Surgery illustrated growing interest in less expensive, nonsurgical modalities, with less percentage growth in surgical procedures in 2010.1 In this study, the responses to this question showed no correlation with age, sex, or household income. However, married respondents were more likely to select a facelift. This could be explained by the fact that married respondents tended to be older and wealthier. Although age and wealth did not show individual links with a preference for surgical modalities, marriage essentially brought both factors to bear on this question. It would seem logical that older patients would more strongly consider procedures to the face and wealthier patients would select the more expensive option. This study has other limitations. First, the sample size is small and therefore prone to sampling error. Second, this cohort is not a faithful representation of the general public, as it is geographically confined to Southern California, where, as the survey indicates, the average annual household income ($91 298) is well above that of the national median ($60 088 in 2010).14 However, it should also be noted that in 2010, the income group with the largest number of members in the US census data was the $100 000 to $149 999 group (14.9%). It could also be argued that the population most interested in cosmetic surgery belongs to a higher income bracket than what would be represented by the national median income. Nonetheless, the geographic and income limitations of this study could be addressed with a larger sample size, which would capture a more diverse and therefore more representative survey population. As the demand for cosmetic surgery continues to rise, additional investigation into this unique patient population is warranted. Defining the demographics of this group as well as those factors
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