ChangeWave Research: Cosmetic Medicine
April 15, 2005
ChangeWave Research Report:
Cosmetic Medicine
Cosmetic Procedures Market Still Skyrocketing
Overview
This report presents the latest ChangeWave Alliance survey on Cosmetic Medicine. Our
previous survey (May 2004) showed escalating interest in cosmetic procedures and a
growing perception that they are becoming routine.
To follow-up, we went back to our healthcare members to examine how the healthcare
industry and patients are dealing with cosmetic surgery issues – including those
procedures that have the most momentum. The survey was completed March 21, 2005,
and a total of 116 Alliance members participated, including 58 doctors.
Key Findings:

Surging Interest in Cosmetic Procedures. More than a third of responding doctors
(38%) report a “Significant Increase” in patient inquiries/requests for cosmetic
procedures over the past 12 months – a 14-point surge since our May 2004 survey.
Another 38% say they have seen a “Small Increase.”

Cosmetic Procedure Growth Rates. More than two-thirds of doctor respondents
(69%) say the growth rate for cosmetic procedures is faster than the average growth
rate for medical services generally, 14-points more than our May 2004 survey.

Consumers Increasingly Considering Cosmetic Procedures at Younger Ages.
Fifty-six percent (56%) of responding doctors say the average age of patients making
inquiries or requests about cosmetic procedures has decreased over the past year,
compared with 41% in May 2004.

More Patients are Viewing Cosmetic Procedures as Routine. Nearly nine-in-ten
doctors (89%) report that patients in their work locales increasingly view cosmetic
procedures as something routine, compared with 82% previously.

Procedures With Most Momentum – Last 12 Months. Doctors chose Botox
Procedures (Net Difference Score = +64) and Gastric Surgical Procedures to Limit
Eating (+39) as the cosmetic procedures that have increased most over the past 12
months, followed by ‘Surgical Procedures to Treat the Face’ (+35) and ‘Collagen and
other Dermal Filler Procedures to Treat the Face’ (+26).

Dysport Sticking it to Botox? Better than one-in-four doctors (28%) see Dysport – if
approved – capturing more than 25% of the Botox market in the first year it becomes
available. This is an 8-point increase over our May 2004 survey results.
Copyright ©2005 ChangeWave Research
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ChangeWave Research: Cosmetic Medicine

The Isolagen Process. If approved, one-third of responding doctors (34%) believe
that between 1 and 10% of patients that currently use Dermal Fillers/Botox treatments
would migrate to Isolagen. ChangeWave Research Director Michael Shulman finds
the projected market acceptance rate to be higher than current company estimates.

Hyaluronic Acid-Based Dermal Fillers. The survey results also suggest that
Hyaluronic Acid (HA) based dermal fillers could eventually be a competitive product. A
third of doctors (34%) believe that more than 20% of patients currently using Dermal
Fillers/Botox treatments will migrate to HA when it becomes available.
Bottom Line: The survey results show a continuing surge in patient interest and in the
overall growth rates for cosmetic procedures. Moreover, consumers are increasingly
considering cosmetic procedures at younger ages and viewing it as something routine.
Botox and Gastric Surgery are the cosmetic procedures that appear to have increased
most over the past 12 months. Dysport looks to be a serious competitor to Botox once it
becomes available. Hyaluronic Acid Based dermal fillers also could eventually become a
competitive product. Isolagen, if approved, looks to capture only a small percentage of
the current Botox market, but the Alliance findings suggest its market acceptance rate
could be higher than the Street currently estimates.
The ChangeWave Alliance is a group of 5,000 highly qualified business, technology, and medical professionals in
leading companies of select industries—credentialed professionals who spend their everyday lives working on the
frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, and converts the information into
proprietary quantitative and qualitative reports.
Helping You Profit From A Rapidly Changing World ™
www.ChangeWave.com
Copyright ©2005 ChangeWave Research
All rights reserved.
2
ChangeWave Research: Cosmetic Medicine
Table of Contents
Summary of Key Findings ............................................................................................ 4
The Findings .................................................................................................................. 5
ChangeWave Research Methodology ....................................................................... 13
About ChangeWave Research ................................................................................... 14
Copyright ©2005 ChangeWave Research
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3
ChangeWave Research: Cosmetic Medicine
I. Summary of Key Findings
Cosmetic Procedure Procedures with
Market Skyrocketing Most Momentum –
Last 12 Months
 38% of doctors see a

“Significant Increase” in
patient inquiries for
cosmetic procedures over
past 12 months – a 14point surge since May ’04
Another 38% see a “Small
Increase”
Cosmetic Procedure
Growth Rates


69% of doctors say the
growth rate for cosmetic
procedures is faster than
the average growth rate
for medical services
generally
56% say the average age
of patients making
cosmetic procedure
inquiries has decreased
over the past year – a
15-pt increase since May
 Botox Procedures (+64)
 Gastric Surgical
Procedures to Limit
Eating (+39)
 Surgical Procedures to
Treat Face (+35)
 Collagen and other
Dermal Filler Procedures
to Treat Face (+26)
Least Momentum
 Varicose Vein
Procedures (+4)
Bottom Line:
Continuing Surge in
Cosmetic Procedures
 The survey results show a
continuing surge in patient
interest and in the overall
growth rates for cosmetic
procedures. Moreover,
consumers are
increasingly considering
cosmetic procedures at
younger ages and viewing
it as something routine.
 Botox and Gastric
Surgery are the
procedures that appear to
have increased most over
the past 12 months.
 Dysport looks to be a
serious competitor to
Botox once available.
 Hyaluronic Acid Based
dermal fillers may also
eventually become a
competitive product.
Introduction
This report presents the latest ChangeWave Alliance survey on Cosmetic Medicine. Our
previous survey (May 2004) showed escalating interest in cosmetic procedures and a
growing perception that they are becoming routine.
To follow-up, we went back to our healthcare members to examine how the healthcare
industry and patients are dealing with cosmetic surgery issues – including those
procedures that have the most momentum. The survey was completed March 21, 2005,
and a total of 116 Alliance members participated, including 58 doctors.
Copyright ©2005 ChangeWave Research
All rights reserved.
4
ChangeWave Research: Cosmetic Medicine
II. The Findings
Total Respondents (n = 116)
Doctor Respondents (n = 58)
All Other Respondents (n = 58)
(1) Question Asked: Based upon what you are seeing in your work locale, has
there been an increase, decrease, or no change over the past 12 months in patient
inquiries or requests for cosmetic procedures?
A Significant Increase Over Past 12 Months (10% or More)
A Small Increase Over Past 12 Months (Less Than 10%)
No Change Over Past 12 Months*
A Decrease Over Past 12 Months
Don't Know
Other
Doctors
Current
Survey
Mar ‘05
38%
38%
22%
0%
2%
0%
Doctors
Previous
Survey
May ‘04
24%
51%
20%
0%
4%
0%
*Note that in the previous May 2004 survey this choice was “No Increase Over Past 12 Months”, whereas
in the current survey it is “No Change Over Past 12 Months”.
Surging Interest in Cosmetic Procedures. More than a third of responding doctors
(38%) report a “Significant Increase” in patient inquiries/requests for cosmetic procedures
over the past 12 months – a 14-point surge since our May 2004 survey. Another 38% say
they have seen a “Small Increase.”
(1A) Question Asked: Year over year consumption of medical services in general
is increasing by double digits. How would you characterize the growth rate for
cosmetic procedures?
Growth rate for cosmetic procedures is faster than the
average growth rate for medical services generally
Growth rate for cosmetic procedures is similar to the average
growth rate for medical services generally
Growth rate for cosmetic procedures is slower than the
average growth rate for medical services generally
Don't Know
Doctors
Current
Survey
Mar ‘05
69%
Doctors
Previous
Survey
May ‘04
55%
22%
37%
7%
2%
2%
6%
Cosmetic Procedure Growth Rates. More than two-thirds of doctor respondents (69%)
say the growth rate for cosmetic procedures is faster than the average growth rate for
medical services generally, 14-points more than our May 2004 survey. Another 7% say
the growth rate for cosmetic procedures is slower, and 22% say the rates are similar.
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ChangeWave Research: Cosmetic Medicine
(2) Question Asked: Which of the following statements best reflects what you have
personally observed in your work locale over the past year?
(a) Patient Age
The average age of patients making inquiries or requests about
cosmetic procedures is increasing
The average age of patients making inquiries or requests about
cosmetic procedures is decreasing
The average age of patients making inquiries or requests about
cosmetic procedures has not changed
Don't Know
Doctors
Current
Survey
Mar ‘05
27%
Doctors
Previous
Survey
May ‘04
27%
56%
41%
16%
24%
2%
8%
Consumers Increasingly Considering Cosmetic Procedures at Younger Ages. Fiftysix percent (56%) of responding doctors say the average age of patients making inquiries
or requests about cosmetic procedures has decreased over the past year, compared with
41% in May 2004.
(b) Patient Attitudes
Patients are increasingly viewing cosmetic procedures as
something routine
Patients are increasingly becoming more reluctant to undergo
cosmetic procedures
Patients attitudes have not changed about the use of cosmetic
procedures
Don't Know
Doctors
Current
Survey
Mar ‘05
89%
Doctors
Previous
Survey
May ‘04
82%
0%
2%
7%
12%
4%
4%
More Patients are Viewing Cosmetic Procedures as Routine. Nearly nine-in-ten
doctors (89%) report that patients in their work locales increasingly view cosmetic
procedures as something routine, compared with 82% previously.
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ChangeWave Research: Cosmetic Medicine
(3A) Question Asked: Based upon the number of patient requests or inquiries you
are seeing in your work locale, which of the following cosmetic procedures would
you say have increased the most over the past 12 months? (Check All That Apply)
Botox Procedures to Treat the Face/Facial Area*
Gastric Surgical Procedures to Limit Eating**
Collagen and other Dermal Filler procedures to Treat the
Face/Facial Area
Surgical Procedures to Treat the Face/Facial Area***
Liposuction Procedures to Reduce Body Fat****
Hair Removal Procedures
Breast Cosmetic Surgical Procedures*****
Varicose Vein Procedures******
Procedures to Eliminate Scars/Tattoos/Blemishes
None of the Above
Don't Know
Other
Doctors
Current
Survey
Mar ‘05
71%
53%
40%
Doctors
Previous
Survey
May ‘04
67%
39%
NA
40%
36%
31%
31%
28%
26%
0%
3%
7%
47%
41%
NA
33%
39%
37%
NA
6%
4%
(3B) Question Asked: And which cosmetic procedures would you say have
increased the least over the past 12 months? (Check All That Apply)
Varicose Vein Procedures******
Liposuction Procedures to Reduce Body Fat****
Procedures to Eliminate Scars/Tattoos/Blemishes
Hair Removal Procedures
Collagen and other Dermal Filler procedures to Treat the
Face/Facial Area
Gastric Surgical Procedures to Limit Eating**
Breast Cosmetic Surgical Procedures*****
Botox Procedures to Treat the Face/Facial Area*
Surgical Procedures to Treat the Face/Facial Area***
None of the Above
Don't Know
Other
Doctors
Current
Survey
Mar ‘05
24%
19%
19%
17%
14%
Doctors
Previous
Survey
May ‘04
24%
22%
20%
NA
NA
14%
14%
7%
5%
2%
26%
2%
27%
22%
10%
8%
NA
20%
0%
* In the previous survey, the response was “Procedures to treat aging of the face/facial area through
injections/implants.”
** In the previous survey, the response was “Procedures to limit the ability of the body to eat (e.g. gastric
bypass). “
*** In the previous survey, the response was “Procedures to treat aging of the face/facial area through
surgery.”
**** In the previous survey, the response was “Procedures to reduce body fat (i.e. liposuction). “
***** In the previous survey, the response was “Procedures to increase breast size.”
****** In the previous survey, the response was “Procedures to eliminate/reduce varicose veins. “
Copyright ©2005 ChangeWave Research
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ChangeWave Research: Cosmetic Medicine
Net Difference Score – Doctors
Botox Procedures to Treat the Face/Facial Area
Gastric Surgical Procedures to Limit Eating
Surgical Procedures to Treat the Face/Facial Area
Collagen and other Dermal Filler Procedures to Treat
the Face/Facial Area
Liposuction Procedures to Reduce Body Fat
Breast Cosmetic Surgical Procedures
Hair Removal Procedures
Procedures to Eliminate Scars/Tattoos/Blemishes
Varicose Vein Procedures
Increased
the Most
71%
53%
40%
40%
Increased
the Least
7%
14%
5%
14%
36%
31%
31%
26%
28%
19%
14%
17%
19%
24%
Net
Difference
+64
+39
+35
+26
+17
+17
+14
+7
+4
Procedures With Most Momentum – Last 12 Months. Doctors chose Botox
Procedures (Net Difference Score = +64) and Gastric Surgical Procedures to Limit Eating
(+39) as the cosmetic procedures that have increased most over the past 12 months,
followed by Surgical Procedures to Treat the Face (+35) and Collagen and other Dermal
Filler Procedures to Treat the Face (+26).
(4) Question Asked: Historically, insurers/payors have not reimbursed for cosmetic
procedures other than those directly related to a patient's health (e.g., gastric
bypass) or to correct a major disfigurement (e.g., repair of cleft palate). Are
insurers/payors exhibiting an increased willingness or a decreased willingness to
pay for cosmetic procedures?
Insurers/payors exhibit an increased willingness to pay for
what was previously considered elective cosmetic procedures
Insurers/payors exhibit a decreased willingness to pay for
what was previously considered elective cosmetic procedures
No change in insurer/payor willingness to pay for what was
previously considered elective cosmetic procedures
Don't Know
Doctors
Current
Survey
Mar ‘05
7%
Doctors
Previous
Survey
May ‘04
2%
19%
22%
71%
67%
3%
8%
Slight Increase in Cosmetic Procedure Reimbursement. Seven percent (7%) of
doctors now say Insurers/payors exhibit an increased willingness to pay for elective
cosmetic procedures compared to 2% in May 2004. Also, fewer doctors in the current
survey report seeing a decreased willingness to pay for these procedures than in May
(19% currently vs. 22% previously).
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ChangeWave Research: Cosmetic Medicine
(5) Question Asked: A Botox competitor called Dysport, manufactured by Inamed,
is currently in trial. Dysport requires fewer injections for the same results as
Botox. If approved, what percent of the Botox market do you think it would
command in its first year on the market?
0-5%
5-10%
11-25%
26-50%
Over 50%
Don't Know
Doctors
Current
Survey
Mar ‘05
3%
19%
17%
21%
7%
33%
Doctors
Previous
Survey
May ‘04
2%
12%
35%
10%
10%
31%
Dysport Sticking it to Botox? Better than one-in-four doctors (28%) see Dysport – if
approved – capturing more than 25% of the Botox market in the first year it becomes
available. This is an 8-point increase over our May 2004 survey results.
(6) Question Asked: Which of the following vendors do you think will gain the most
traction in the marketplace over the next 12 months and why? (n = 15)
Candela
Laserscope
Syneron
Palomar Medical
Cutera
47%
33%
13%
13%
0%
Candela (47%) is the top choice of respondents for vendors likely to gain the most
traction in the marketplace over the next 12 months, followed by Laserscope (33%).
Sample of Alliance Member Responses:
(a) Candela

Doctor DRM7263 writes, "Candela. Strong market presence & state-of-the-art
technology."

JOH9038 writes, "Candela. Largest player in cosmetic lasers. Margins tight and
others may not survive."

Doctor GUT8640 writes, “Candela and Laserscope have a very good marketing
plan.”
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ChangeWave Research: Cosmetic Medicine
(b) Laserscope

Doctor DRJ5952 writes, "Laserscope innovative technology."

Doctor STE3218 writes, "Laserscope, very aggressive sales staff."

HHA9729 writes, “Laserscope.”
(c) Palomar Medical

Doctor HER4689 writes, "Palomar. New products."

BJA2582 writes, “Palomar - Breadth of offerings.”
(d) Syneron

Doctor MIN9289 writes, "Syneron-non-invasive, few side effects."
(7) Question Asked: Are you familiar with the company Isolagen or the Isolagen
process?
Yes
No
Doctors
21%
79%
(7A) Question Asked: Isolagen has pioneered a process, available in England, that
extracts fibroblast cells from a patient and manufactures large quantities of them.
The duplicated cells are then re-injected into the patient. The treatment could last
up to a year and could cost between $7,000 and $10,000. The Isolagen process is
currently awaiting FDA approval in the US. Do you see a market for this cosmetic
procedure?
Yes, 1-5% of patients currently using Dermal Fillers/Botox
treatments would migrate to Isolagen
Yes, 6-10% of patients currently using Dermal Fillers/Botox
treatments would migrate to Isolagen
Yes, 11%-20% of patients currently using Dermal
Fillers/Botox treatments would migrate to Isolagen
More than 20% of patients currently using Dermal
Fillers/Botox treatments would migrate to Isolagen
Do not see a market for the Isolagen process
Don't Know
Copyright ©2005 ChangeWave Research
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Doctors
24%
10%
9%
0%
10%
47%
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ChangeWave Research: Cosmetic Medicine
The Isolagen Process. If approved, one-third of responding doctors (34%) believe that
between 1 and 10% of patients that currently use Dermal Fillers/Botox treatments would
migrate to Isolagen. We note that ChangeWave Research Director Michael Shulman
finds “this projected market acceptance rate is much higher than company estimates.”
(8) Question Asked: Several companies are working on HA (Hyaluronic Acid)
based dermal fillers and will eventually market them as a "natural alternative" to
animal based collagen fillers. If competitively priced (within 10% of current dermal
fillers) do you see a market for this product?
Yes, 1-5% of patients currently using dermal fillers/Botox treatments would
migrate to HA (Hyaluronic Acid) based dermal fillers
Yes, 6-10% of patients currently using dermal fillers/Botox treatments would
migrate to HA (Hyaluronic Acid) based dermal fillers
Yes, 11%-20% of patients currently using dermal fillers/Botox treatments
would migrate to HA (Hyaluronic Acid) based dermal fillers
More than 20% of patients currently using dermal fillers/Botox treatments
would migrate to HA (Hyaluronic Acid) based dermal fillers
Do not see a market for HA (Hyaluronic Acid) based dermal fillers
Don't Know
Doctors
7%
14%
16%
34%
2%
28%
Hyaluronic Acid-Based Dermal Fillers. The survey results also suggest that Hyaluronic
Acid (HA) based dermal fillers could eventually be a competitive product. A third of
doctors (34%) believe that more than 20% of patients currently using Dermal
Fillers/Botox treatments will migrate to HA when it becomes available.
(9) Question Asked: What would you say is the hottest new cosmetic procedure
that has not yet generated much discussion in the general media?

Doctor 8486810 writes, “Botox is still the hottie.”

Doctor DRJ5952 writes, “Dermal fillers for wrinkles.”

CRA1451 writes, “Men, men, men. Implants, chin tucks, eyes, etc.”

Doctor GUT8640 writes, “Mesotherapy.”

Doctor KJA2163 writes, “Mesotherapy for the reduction of fat and cellulite.”

Doctor MTA6607 writes, “Gastric banding; Gastric bypass.”

Doctor 799519 writes, “Laparoscopic gastric bending is more and more replaced by
laparoscopic gastric sleeve operation that costs less, requires no adaptation
afterwards, and less complications. Laparoscopic gastric bypass for severe obesity is
still rising in favor of open ga.”
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ChangeWave Research: Cosmetic Medicine

WPB8388 writes, “Neurostimulators that replace gastric by-pass.”

Doctor MIM3324 writes, “Laser therapy of all types especially for hair removal.”

Doctor FER6743 writes, “Neither hot nor new but micro-dermabrasion seems to me
capable of increasing use.”

Doctor SKR3776 writes, “Dermabrasion.”

Doctor RAV1272 writes, “Non Ablative Laser Resurfacing (Fraxel).”

Doctor WLU8236 writes, “Spray-on tanning - micro-powered devices for delivery of
skin care products.”

Doctor DON7620 writes, “Breast reduction surgery.”

AGI1147 writes, “Cosmetic acupuncture. Not much potential for huge new product
sales, but the procedures are becoming increasingly common. The risks are much
lower than other cosmetic procedures, so many patients may start here rather than
more aggressive treatment.”

Doctor HER4689 writes, “Non-surgical face lifts.”

WIL6687 writes, “LED Lights for acne and other facial blemishes and fine lines.”

Doctor ELB6765 writes, “I don't think any haven't reached the media.”
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ChangeWave Research: Cosmetic Medicine
III. ChangeWave Research Methodology
This report presents the findings of the latest ChangeWave Alliance survey on Cosmetic
Medicine. The survey was conducted between March 16 - March 21, 2005. A total of 116
Alliance members participated, including 58 doctors.
The Alliance’s proprietary research and business intelligence gathering system is based
upon the systematic gathering of valuable business and investment information directly
over the Internet from accredited members.
ChangeWave surveys its Alliance members on a range of business and investment
research and intelligence topics, collects feedback from them electronically, interprets
and reconciles the information in a cohesive manner and converts the information into
valuable quantitative and qualitative reports.
The Alliance has assembled its membership team from senior technology and business
executives in leading companies of select industries. Nearly 3 out of every 5 members
(58%) have advanced degrees (e.g., Master’s or Ph.D.) and 94% have at least a fouryear bachelor’s degree.
The business and investment intelligence provided by the Alliance provides a real-time
view of companies, technologies and business trends in key market sectors, along with
an in-depth perspective of the macro economy – well in advance of other available
sources.
Copyright ©2005 ChangeWave Research
All rights reserved.
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ChangeWave Research: Cosmetic Medicine
IV. About ChangeWave Research
ChangeWave Research, a subsidiary of Phillips Investment Resources, LLC, identifies
and quantifies "change" in industries and companies through surveying a network of
thousands of business executives and professionals working in more than 20 industries.
ChangeWave has a very unique asset in its 5,000-member Alliance. We have assembled
our membership team from a broad cross section of more than 20 vertical markets such
as telecom, semiconductors, data storage, and biotechnology, along with a wide range of
professional disciplines including CIOs, IT managers and programmers, executive
management, scientists, engineers and sales personnel.
The ChangeWave Alliance is composed of senior technology and business executives in
leading companies - credentialed professionals who spend their everyday lives working
on the frontline of technological change.
This proprietary research and business intelligence gathering system provides a real-time
view of companies, technologies and business trends in key market sectors along with an
in-depth perspective of the macro economy - well in advance of other available sources.
ChangeWave surveys its 5,000 Alliance members on a wide range of investment
research topics and converts the findings into valuable investment and business
intelligence reports. ChangeWave delivers its products and services on the Web at
www.ChangeWave.com.
ChangeWave Research does not make any warranties, express or implied, as to
results to be obtained from using the information in this report. Investors should
obtain individual financial advice based on their own particular circumstances
before making any investment decisions based upon information in this report.
For More Information:
ChangeWave Research
9420 Key West Avenue
Rockville, MD 20850
USA
Telephone: 301-279-4200
Fax: 301-610-5206
www.ChangeWave.com
service@changewave.com
Helping You Profit From A Rapidly Changing World ™
www.ChangeWave.com
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