Trends in Cosmetic Surgery … as measured in Units of Real Housewives (Data Visualization Assignment)

In research for an NPR series on women and image last year I came across data from the American Society of Plastic Surgeons that charts changes in cosmetic surgery procedures since 2000 – both surgical and “minimally-invasive” — generally fillers like Botox.

In 2013 Americans spent $12.6 billion on such procedures, almost all elective.  (The ASPS keeps separate data for medically-necessary procedures including reconstruction after cancer or injury.)

As you can imagine, this is pretty rich fodder.  There are numerous ways to compare or slice the data – some of which the ASPS does itself (by region, gender, age etc).  Below are some surprising discoveries, two of which we attempted to represent.

– Some procedures have seen dramatic changes in 13 years.

For example: there has been a 4,565% increase in “Upper Arm Lift Surgery” – a category or procedure that practically didn’t exist in 2000.

“Lower Body Lifts” are up 3,417% – a procedure the ASPS clarifies as “improv(ing) the shape and tone of the underlying tissue that supports fat and skin.” Basically, get rid of your sagging butt, your flabby belly, your dimpled thighs – all in one go!  Amazing, right?  If you like that kind of thing and are willing to spend some time in recovery.

– In the non-invasive sphere, “injectables” like Botox, and “soft-fillers” like Restylene show triple-digit increases.   These new substances have largely appeared since 2000, and are increasingly advertised in women’s publications and in the waiting rooms of dermatologists’ offices.   This stuff has become, in some cities, the “new normal” for women in certain industries, age groups or in the public eye.

There’s some good reporting to be done about how these chemicals have been created or repurposed, approved and brought to market as material that can be injected, absorbed and broken down by the body.

– There are also declines – nose jobs and liposuction are down.

I encourage anyone curious to simply look over the data, with a critical eye – as some things show dramatic growth by virtue of being new; and others –  like nose jobs, eye lifts and breast augmentation – still accounting for the lion’s share of these elective surgeries.

I simply wanted to show some of these dramatic changes.  I could say this is “value-neutral” but obviously, I have some thoughts here about how we are reshaping the norms of female appearance (the vast majority of the procedures are done by women).   Thanks to classmate Celeste LeCompte, I wandered my way into exporting data to Excel and making charts, and then to Photoshop, to illustrate them.

We originally tried to render some of these comparisons in Excel charts but they were both visually boring and confusing when we tried to compare rates of growth in procedures.

So, we settled on some icons who’ve helped introduce America to the Brave New World of Surgical Enhancement:  the Real Housewives.

Below are two procedures:  the lower body lift, as represented by Real Housewives of New Jersey’s Jacqueline Laurita jacqueline-laurita-rhonj-reunion-finale

And the nose job as visualized here by Atlanta’s own Real Housewife Kim Zolciak.   article-2130709-12A07CED000005DC-489_306x423-2

Several caveats apply:   Data is available in 2000, not from 2001-2004, and picks up again in 2005-2013.  It’s self-reported, by the ASPS, not by any government agency (which classmate Gideon Gil says is not required).  The Photoshopped images are – to scale, sort of.  And probably a hundred other things that make this scientifically squishy.

Let’s start with what’s NOT happening as often:  nose jobs.


“Nose reshaping surgery” has fallen off from 389,155 performed in 2000 to only 221,053 in 2013 – a drop of 43% — or, only about half the Kim Zolciaks as once took place.  (The Reality Star has denied having rhinoplasty – as recently as last week).

Since there a few years of missing data, it’s hard to pinpoint when the decline started.  As to the why? That’s entirely speculative.  People happier with the noses God gave them? Who nose?

Let’s turn, instead, to a growth industry: the Lower Body Lift.


As you can (sort of) see, in 2000, it was almost non-existent – some 207 procedures.

By 2013, 7,281 people had this done in a year.  Interesting to note a drop from 2006 to 2007, a bump in 2010, then drops.   RHONJ Ms. Laurita has publicly discussed her several procedures, so we’re not casting aspersions by using her image.

There is so much value-laden here, and so many, many possible interpretations.  Among our questions:  did the economic meltdown of 2008 have an impact (it seemed to in some instances) given that these are essentially discretionary purchases? Could any tool show a predictive association? Is there a way to cross-reference around a marketing push by the pharmaceutical industry?  Will Joan Rivers’ death at a medical day surgery center have an impact on the safety of this kind of thing?

I’ve treated this as a light-hearted exercise simply to get practice in working with new tools (Thanks, Celeste!) like basic manipulation of tables, and Photoshopping.  But there are myriad possibilities for some serious news gathering here and some even more serious discussion of what we make normative.   Women have been enhancing their appearances at least since Cleopatra; so who am I to judge whether using surgery or fillers is somehow less acceptable than, say, wearing lipstick?  But I am left uneasy, seeing this data, and hope it’s something we as a society can consider.