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Dedication D R . V I S H WA S ( V I C ) N A R U R K A R 1968 - 2019 This report is dedicated to our beloved friend, mentor and colleague Dr. Vic Narurkar, who was one of the physician advisors who helped conduct this meaningful research. He was a man of honor and a great teacher. He will forever be missed, and his legacy will go on. We thank him and honor his significant contributions within the dermatology and aesthetic communities. His passion for patient care will forever be remembered. 2019 EDITION—BEYOND BEAUTY i
SPECIAL THANKS Allergan thanks the physician advisors who participated in and supported this research and ongoing analysis. In the years to come, this large far-reaching study is hoped to expose many truths about medical aesthetics and what we have yet to learn. M AC R E N E A L E X I A D E S S T E V E N DAYA N M A R VA S A FA M . D. , P H . D. , M . D. , U N I T E D S TAT E S A E S T H E T I C P H YS I C I A N , U N I T E D S TAT E S SW I T Z E R L A N D S A B R I N A FA B I JONQUILLE CHANTREY M . D. , U N I T E D S TAT E S GRANT STEVENS AESTHETIC SURGEON, M . D. , F. A .C . S , UNITED KINGDOM U N I T E D S TAT E S J U L I U S F E W, M . D. , U N I T E D S TAT E S VA N DA N A C H AT R AT H A R T H U R SW I F T M . D. , D E R M ATO LO G I S T, M . D. , F. A .C . S . , I ZO L DA H E Y D E N RYC H INDIA C A N A DA M.MED (DERM), H O N S B . S C N U C L M E D, LIGIA COLUCCI DIPL ANAESTH, R E H A YAV U Z E R D E R M ATO LO G I S T, SOUTH AFRICA PLASTIC SURGEON, BRAZIL TURKEY VIC NARURKAR M . D. , U N I T E D S TAT E S ii ALLERGAN 360° AESTHETICS REPORT
INTRODUCTION The popularity of medical aesthetic treatments continues to surge, fueled by fewer societal taboos, growing technological breakthroughs and millennials (consumers 21-35) and men entering the fray. The worldwide medical aesthetic market is projected to be worth approximately $26.53 billion by 2024, up from $10.12 billion in 2016.1 The demand for non-surgical procedures, particularly facial injectables, has been rising and 33% of health care providers think this demand will grow by more than 25% in the next year.2 With consumer interest in medical aesthetics at an all-time high, Allergan conducted one of the most far-reaching and authoritative studies ever on the subject. The Allergan 360 Aesthetics Report surveyed more than 14,500 “aesthetically conscious consumers” (those who self-identified as interested in looking better and willing to spend on it) and more than 1,300 physicians in 18 countries. The ultimate mission of the study? To more closely examine the diverse and evolving perspectives of people of varying ages, cultures and genders— as well as the physicians who treat them.3 However, the study is not a one-and-done deal. As a worldwide thought leader and driver of gold-standard care for the aesthetics market, Allergan plans to repeat the study regularly, as part of a greater listening exercise that will ultimately aid better understanding across physicians, patients and the industry as a whole. This understanding will help foster increased innovation, driving to better treatment outcomes and access. The goal of this report is to examine emerging trends based on all the data collected and launch an open resource intended to be shared. Here’s where we are at today. References 1 $26.53 Billion Growth of Medical Aesthetics Market 2018: Size, Drivers, Market Opportunities, Business Trends and Forecast to 2024, http://www. abnewswire.com/pressreleases/2653-billion-growth-of-medical-aesthetics-market-2018-size-drivers-market-opportunities-business-trends-and- forecast-to-2024_188799.html. April 2, 2019. 2 Consumer Interests Insight Engineers Global HCP Report. 2019. 3 Methodology Allergan 360 Aesthetics Report. 2019 EDITION—BEYOND BEAUTY iii
THE TIMES THEY ARE A-CHANGING “AESTHETICS TREATMENTS are BECOMING A GREATER PART of the OVER ALL WELLNESS and SELF-CARE CONVERSATION.” D R . S T E V E N DAYA N PLASTIC SURGEON, C H I C AG O, I L L I N O I S , U . S . 1 ALLERGAN 360° AESTHETICS REPORT
T H E T I M E S T H E Y A R E A- C H A N G I N G When Consumers Around the World Were Asked... 69% say looking my best is important for my daily activities (such as career, 64% say looking fit and volunteering, and healthy, and being on running errands)1 trend with fashion and beauty contributes to my confidence2 1 Percentage of the Total Global Aesthetic Conscious Consumers (n=1,447) who say looking my best is important for my daily activities (e.g. career, school, volunteering, errands). 2 Percentage of the Total Global Aesthetic Conscious Consumers (n=1,447) who say maintaining a healthy lifestyle contributes to my confidence. 2019 EDITION—BEYOND BEAUTY 2
T H E T I M E S T H E Y A R E A- C H A N G I N G DESCRIBING BEAUTY The most commonly used terms to describe beauty include natural, healthy, strong, and curvy. 1 1 U.S. Aesthetic Conscious Consumers (n=2,122) who described beauty as natural, healthy, strong, and curvy. 3 ALLERGAN 360° AESTHETICS REPORT
T H E T I M E S T H E Y A R E A- C H A N G I N G In the U.S., specifically, younger women (ages 21-35) are more apt to describe “curvy” as beautiful than their older counter- parts (ages 56-65). The older women get, the more apt they are to use the word “fit” to describe beautiful. 1 AG E S 2 1 — 3 5 AG E S 3 6 — 5 5 AG E S 5 6 — 6 5 SOFT NATUR AL HEALTHY SMOOTH SMOOTH NATUR AL CURVY SOFT SMOOTH NATUR AL HEALTHY SOFT BEAUTIFUL CURVY CLEAN STRONG BEAUTIFUL GLOWING CLEAN CONFIDENT CONFIDENT PRETTY GLOWING TONED HEALTHY PRETTY CURVY CONFIDENT TONED FIT FIT FIT BEAUTIFUL GLOWING STRONG STRONG “The body-positivity movement has broadened our definitions of beauty, especially among younger generations.” DR. GRANT STEVENS PLASTIC SURGEON, M A R I N A D E L R E Y, C A L I F O R N I A , U . S . 1 U.S. Female Aesthetic Conscious Consumers (n=2,122) phrases to describe female beauty. 2019 EDITION—BEYOND BEAUTY 4
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T H E T I M E S T H E Y A R E A- C H A N G I N G DRIVING INFLUENCE Worldwide, consumers look to celebrities most often (50%) 1 to help define beauty, but in the U.S., Canada, and India, women’s definitions of attractiveness are derived more from their friends and family than from celebrities. 2 TOP BEAUTY SOURCES IN THE U.S., CANADA, AND INDIA 48%FRIENDS 43% 42% FA M I LY CELEBRITIES 1 Percentage of the Total Global Aesthetic Conscious Consumers (n=14,584) who say they look to celebrities to define beauty. 2 Percentage of the Total U.S., Canada and India Aesthetic Conscious Consumers (n=2,970) who say their definitions of attractiveness are derived more from their friends than from celebrities. 2019 EDITION—BEYOND BEAUTY 6
"The ALLERGAN 360° AESTHETICS REPORT ƒound that AESTHETIC TREATMENTS are MUCH MORE SOCIALLY ACCEPTABLE than THEY WERE JUST FIVE YEARS AGO." D R . A R T H U R SW I F T PLASTIC SURGEON, M O N T R E A L , Q U E B E C , C A N A DA 7 ALLERGAN 360° AESTHETICS REPORT
THE TABOO HAS LIFTED! We’ve ushered in a new era of openness about medical aesthetics. Worldwide, consumers no longer shy away from pursuing the look they want with the help of their physician. 62% of consumers in the U.S. want to 83% of consumers worldwide revitalize the way they look or look like are willing to invest in their a refreshed version of themselves.1 appearance2 63% of consumers worldwide consider 71% of consumers worldwide spending money worthwhile to are willing to see a improve the way their face looks3 professional4 1 Percentage of the Total U.S. Aesthetic Conscious Consumers (n=3,028) who say they want to revitalize the way they look or look like a refreshed version of themselves. 2 Percentage of the Total Global Aesthetic Conscious Consumers (n=14,584) who say they are willing to invest in their appearance. 3 Percentage of the Total Global Aesthetic Conscious Consumers (n=14,584) who consider it worthwhile spending money to improve the way their face looks. 4 Percentage of the Total Global Aesthetic Conscious Consumers (n=10,384) willing to see a professional. 2019 EDITION—BEYOND BEAUTY 8
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AESTHETICS ASCENDING “The popularity of aesthetic treatments is on the rise.” M A R VA S A FA A E S T H E T I C M E D I C I N E S P E C I A L I S T O. R . , SWITZERLAND CONSUMERS PHYSICIANS More than 73% of consumers worldwide expect to 62% of physicians around the world spend money on a physician–administered aesthetic expect the volume of their patients treatment in the next year,1 compared to 50% who seeking aesthetic procedures to reported spending money in the past year. 2 increase in the next year.3 50% 73% PA S T Y E A R 62% O F P H YS I C I A N S IN THE NEXT YEAR 1 Percentage of the Total Global Aesthetic Conscious Consumers (n=10,694) who say they expect to spend money on a physician-administered aesthetic treatment this year. 2 Percentage of the Total Global Aesthetic Conscious Consumers (n=7,326) who say they spent money on a physician-administered aesthetic treatment in the past year. 3 Percentage of the Total Global Aesthetic Physicians (n=1,315) who say they expect the volume of patients seeking aesthetic treatments to increase in the next year. 2019 EDITION—BEYOND BEAUTY 10
MILLENNIALS are HAVING A MOMENT. “There’s no doubt that coming of age around social media has greatly impacted the way millennials view themselves. They aren’t thinking about if they will have aesthetic treatments, it’s when to start.” D R . S A B R I N A FA B I D E R M ATO LO G I S T, S A N D I E G O, C A L I F O R N I A , U . S . 11 ALLERGAN 360° AESTHETICS REPORT
M I L L E N N I A L S A R E H AV I N G A M O M E N T When Consumers Around the World Aged 21-35 Were Asked... 98% of consumers worldwide would say, in general, people 63% 52% consider professional treatment at some point in their lives1 of consumers of consumers worldwide feel overall worldwide would appearance impacts consider dermal filler how successful they injections at some 82% are in life2 point in their lives3 of consumers worldwide believe 34% injectable treatments of U.S. consumers say are socially acceptable4 60% of U.S. consumers they ‘always use apps would consider to modify or erase wrinkle relaxing something on my face injections at some 36% before posting a photo point in their lives7 on social media’5 of U.S. consumers say they ‘always use apps to modify or erase something on my body before posting a photo on social media’6 1 Percentage of the Total Global Aesthetic Conscious Consumers ages 21-35 (n=5,975) who were asked about considering a facial injectable treatment. 2 Percentage of the Total Global Aesthetic Conscious Consumers ages 21-35 (n=6,099) feel overall appearance impacts how successful they are in life. 3 Percentage of the Total Global Aesthetic Conscious Consumers ages 21-35 (n=6,099) who would consider dermal filler injections at some point in their lives. 4 Percentage of the Total Global Aesthetic Conscious Consumers ages 21-35 (n=4,890) who believe injectable treatments are socially acceptable. 5 Percentage of the Total U.S. Aesthetic Conscious Consumers ages 21-35 (n=2,076) say they ‘always use apps to modify or erase something on my face before posting a photo on social media. 6 Percentage of the Total U.S. Aesthetic Conscious Consumers ages 21-35 (n=2,165) say they ‘always use apps to modify or erase something on my body before posting a photo on social media. 7 Percentage of the Total U.S. Aesthetic Conscious Consumers ages 21-35 (n=4815) who were asked about considering a facial injectable treatment. 2019 EDITION—BEYOND BEAUTY 12
THE EYES HAVE IT “Eye contact is the first step towards empathy and trust, therefore eyes are one of the primary features we notice in others. It is not surprising that we are aware of how our own eyes look.” D R . I ZO L DA H E Y D R E N RYC H M . M E D ( D E R M ) , H O N S B . S C N U C L M E D, D I P L A N A E S T H , C E N T U R Y C I T Y, C A P E TOW N , S O U T H A F R I C A CONSUMER EXPERIENCE WITH PROCEDURES 41% DERMAL INJECTIONS 36% WRINKLE RELAXERS 13% 15% 9% 11% SAUDI ARABIA UNITED STATES GLOBAL 36% of Saudi millennials have tried dermal injections and 41% have tried wrinkle relaxers,1 compared to 13% and 15% worldwide.2 US millennials are also low users with 9% and 11%.3 1 Percentage of the Total Saudi Aesthetic Conscious Consumers (n=304, n=302) who say they have tried dermal filler injections, wrinkle relaxers. 2 Percentage of the Total Global Aesthetic Conscious Consumers (n=3,451, n=8,323) who say they have tried dermal filler injections, wrinkle relaxers. 3 Percentage of the Total U.S. Aesthetic Conscious Consumers (n=1,462, n=1,387) who say they have tried dermal filler injections, wrinkle relaxers. 13 ALLERGAN 360° AESTHETICS REPORT
T H E E Y E S H AV E I T 32% of consumers Top concerns worldwide worldwide are considering are upper facial a facial injectable treatment lines and wrinkles— in the next year1 regardless of age2 36% of women 54% of women worldwide state worldwide consider wrinkles around under-eye bags a their eyes are a top concern3 top concern2 1 Percentage of the Total Global Aesthetic Conscious Consumer (n= 14,584) who are considering a facial injectable treatment. 2 Percentage of the Total Global Aesthetic Conscious Consumers (n=13,363) who say their top five biggest concerns include upper facial lines and wrinkles. 3 Percentage of the Total Global Aesthetic Conscious Consumer (n=6,097) who state wrinkles around their eyes and under-eye bags are a top concern. 2019 EDITION—BEYOND BEAUTY 14
#BODYGOALS "The growing acceptance of aesthetic treatments has empowered women and men around the world to consider these options as part of the process to realising one’s potential." DR. JONQUILLE CHANTREY AESTHETIC SURGEON, UNITED KINGDOM HOW BODY PERCEPTIONS ARE SHAPED THROUGHOUT THE WORLD USA CANADA UK ITALY TURKEY RUSSIA SAUDI ARABIA INDIA CHINA SOUTH KOREA WO M E N MEN AV E R AG E Men and women in the U.S., Canada, U.K., Italy, Turkey, Saudi Arabia, India and China met or exceeded the average scores for caring about the shape of their body,1 whereas in Russia and South Korea both genders score well below the average on this front.2 1 Total US, Canada, UK, Italy, Turkey, Saudi Arabia, India and China Aesthetic Conscious Consumers (n=8,491) who exceeded the average scores for caring about the shape. 2 Total Russia and South Korea Aesthetic Conscious Consumers (n=1,222) who scored below average for caring about the shape. 15 ALLERGAN 360° AESTHETICS REPORT
# B O DYG OA L S Satisfaction vs. Consideration 53% of consumers worldwide would consider a non–invasive body contouring treatment1 32% of consumers worldwide are satisfied with their body shape1 19% 34% of consumers worldwide would consider it within of consumers worldwide the next year1 would consider it beyond next year1 1 Percentage of the Total Global Aesthetic Conscious Consumers (n=14,584) who would consider a non-invasive body contouring treatment, satisfied with their body shape, would consider a body contouring treatment beyond the next year, would consider a body contouring treatment in the next year. 2019 EDITION—BEYOND BEAUTY 16
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# B O DYG OA L S Top 3 Beauty Agreements Worldwide 57% Of consumers worldwide agree there are solutions that exist to address some of their body issues1 55% Of consumers worldwide are concerned about unnatural results from surgical or non–surgical enhancement/treatment/procedures1 54% Of consumers worldwide report they will keep trying to achieve the vision they have for their body1 1 Percentage of the Total Global Aesthetic Conscious Consumers (n=14,447) who say solutions exist to address some of their body issues, who say they are concerned about unnatural results from surgical on non-surgical enhancement/treatment/procedures, and who report not being willing to give up trying to achieve the vision they have for their body. 2019 EDITION—BEYOND BEAUTY 18
"We're FINALLY SEEING MORE PEOPLE INVESTING in PREVENTATIVE CARE MEASURES, WHICH MEANS that AS A SOCIETY WE'LL BE LOOKING BETTER for LONGER." D R . M AC R E N E A L E X I A D E S D E R M ATO LO G I S T, N E W YO R K , N E W YO R K , U . S . 19 ALLERGAN 360° AESTHETICS REPORT
AN OUNCE OF PREVENTION Globally, millennials are... U.S. G LO B A L More likely to consider AG E S 29% 2 1 -35 treatment preventatively 33% before older cohorts1 AG E S 23% 36 - 55 24% AG E S 12% 56 - 6 5 13% 0 5 10 15 20 25 30 35 L I K E L I H O O D O F CO N S I D E R I N G P R E V E N TATI V E TR E ATME N T ( % ) More likely than other AG E S 32% 2 1 -35 age groups to consider 39% treatment as soon as AG E S 26% 36 - 55 they notice a concern 2 32% AG E S 15% 56 - 6 5 21% 0 5 10 15 20 25 30 35 40 L I K E L I H O O D O F CO N S I DE R I N G TR E ATME N T N OW ( % ) Conversely, 53% of physicians around the world believe they should start seeing females in their 20s, and 38% believe they should start seeing males in their 20s, even if only for skincare.3 1 Percentage of the Total Global Aesthetic Conscious Consumer 21-35 (n=2,001), 36-55 (n=1,490), 56-65 (n=314) who are aware of preventative treatment. 2 Percentage of the Total U.S. Aesthetic Conscious Consumer 21-35 (n=2,364), 36-54 (n=1,961), 55-65 (n=501) who are more likely to think now is the time to consider a professional aesthetic treatment. 3 Percentage of the Total Global Aesthetic Physician (Female - n= 687, Male - n = 498) who believe that consumers should start seeing them in their 20’s. 2019 EDITION—BEYOND BEAUTY 20
IN DOCTORS WE TRUST "Although aesthetic treatment is more socially acceptable than ever, we’re still educating consumers on the basics every day." DR. JULIUS FEW PLASTIC SURGEON, C H I C AG O, I L L I N O I S , U . S . CONSUMERS WORLDWIDE WHO CONSULTED WITH A PHYSICIAN OR PROFESSIONAL 17% 24% PLASTIC SURGEON D E R M ATO LO G I S T 6% P R I M A RY C A R E P H YS I C I A N Most of the time, the first stop a consumer will make on their medical aesthetics journey is with a dermatologist (24%) or plastic surgeon (17%).1 1 Percentage of the Total Global Aesthetic Conscious Consumer (n=14,584) who start their medical aesthetics journey with a primary care physician, plastic surgeon, or dermatologist. 21 ALLERGAN 360° AESTHETICS REPORT
I N D O C TO R S W E T R U S T The Most Common Questions at the First Appointment Are: 1 COST 2 EFFECTIVENESS OF TREATMENT 3 SAFETY * 52%, 46%, 43% Percentages of the Total Global Aesthetic Conscious Consumer (n=14,584) who discuss cost, effectiveness of treatment, and safety at their first appointment. 2019 EDITION—BEYOND BEAUTY 22
I N D O C TO R S W E T R U S T HOW IMPORTANT IS TRUST? “The trust my patients place in me is a sacred bond. So it’s important that any product I recommend is not only safe but delivers reliable results." D R . R E H A YAV U Z E R PLASTIC SURGEON, 75% TURKEY OF CONSUMERS say trust in a product is important to them when considering an injectable toxin1 treatment2 61% O F P H YS I C I A N S G LO B A L LY believe having trust in a medical aesthetics brand allows them to consistently achieve the best result when considering an injectable treatment3 1 Allergan Presents Results From Global Survey Highlighting the Importance of Trust in Medical Aesthetics, PRNewswire, April 8, 2018. 2 Percentage of the Total Global Aesthetic Conscious Consumer (n=13,186) who say trust is important when considering an injectable toxin treatment. 3 Percentage of the Total Global Aesthetic Physicians (n=360) who say trust in a product is important when considering an injectable treatment. 23 ALLERGAN 360° AESTHETICS REPORT
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WHAT GIVES CONSUMERS PAUSE? "Understandably, consumers want to ensure that the outcome of treatment will be worth the cost." LIGIA COLUCCI D E R M ATO LO G I S T, B E LO H O R I ZO N T E – M G , B R A Z I L 25 ALLERGAN 360° AESTHETICS REPORT
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IT'S A DIGITAL WORLD 27 ALLERGAN 360° AESTHETICS REPORT
I T ' S A D I G I TA L WO R L D “Social media isn’t just for posting photos, it’s for research.” D R . VA N DA N A C H AT R AT H , M . D. D E R M ATO LO G I S T, INDIA 37% 20% of consumers worldwide use the Internet to search of consumers about specific problem worldwide follow areas or treatments2 a physician on social media1 32% 28% of consumers worldwide of consumers worldwide start searching online to use social media to search find a physician who can about specific problem administer aesthetic areas or treatments3 treatments1 1 Percentage of the Total Global Aesthetic Conscious Consumer (n=14,584) who start searching online to find a physician who can administer aesthetic treatments and who follow a physician on social media. 2 Percentage of the Total Global Aesthetic Conscious Consumer (n=5,445) who use the Internet to search about specific problem areas or treatments. 3 Percentage of the Total Global Aesthetic Conscious Consumer (n=4,613) who use social media to search about specific problem areas or treatments. 2019 EDITION—BEYOND BEAUTY 28
I T ' S A D I G I TA L WO R L D Top 3 Sources Global Consumers Look to for Treatment Information 37% Receive a recommendation from friend/family/coworker1 33% Receive a recommendation from their current physician1 37% Search online1 1 Percentage of the Total Global Aesthetic Conscious Consumer (n=14,457) whose top 3 information sources for treatments includes recommendations from friend/family/coworker, online search, and recommendation from current physician. 29 ALLERGAN 360° AESTHETICS REPORT
I T ' S A D I G I TA L WO R L D Social Savvy U.S. Millennials Turn to Their Apps for Information 93% FAC E B O O K 82% I N S TAG R A M 56% S N A P C H AT * Percentage of the Total U.S. Aesthetic Conscious Consumer Aged 21-35 (n=351) who use Snapchat, Instagram, and Facebook as a leading source of information. 2019 EDITION—BEYOND BEAUTY 30
Conclusion The medical aesthetics field is growing—as is consumer interest in looking better, healthier, and more vital. This confluence of events is feeding the desire for increasing knowledge about skincare, as well as facial injectables and body treatments. With information comes understanding and improvement, so Allergan plans to continue to track the feedback of its consumers and doctors for years to come and continue to share growing trends.
APPENDIX METHODOLOGY The study was conducted by Ipsos and fielded October 25 – December 17, 2018. The sample included of 14,584 adults ages 21 to 65 (US) / 75 (OUS) from eighteen countries (U.S., Canada, Mexico, Brazil, U.K., Spain, France, Germany, Italy, Turkey, Russia, Saudi Arabia, India, China, Japan, South Korea, Taiwan, Australia). Respondents completed an online survey, in the language appropriate for each country. In order to qualify for the survey, respondents had to strongly agree/agree that looking good at any age is important to them, at least slightly agree that they are open to going to a professional to improve their appearance, and strongly agree/agree with at least one more statement about caring about overall appearance, willing to invest money in their appearance or prepared to invest money in their appearance. Consumers were asked a broad range of questions on aesthetics including the following topics: perceptions of beauty/appearance; beauty routines/aesthetic goals; aesthetic concerns and treatment awareness/experience/ future consideration; motivator, barriers and triggers; aesthetic purchasing process. A separate survey among physicians was also conducted. In order to qualify for the survey, physicians had to have a primary medical specialty of plastic surgeon, dermatologist, or non-core physicians and see aesthetic patients in a private setting. A total of 1,315 Physicians were surveyed. © 2019 ALLERGAN. ALL RIGHTS RESERVED. 2019 EDITION—BEYOND BEAUTY 32
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