The Looming Future of Private Equity in Plastic Surgery.

Private equity acquisition of independent private practices has grown dramatically in the last decade, with private equity firms increasingly investing in surgical specialties that practice in outpatient ambulatory centers. This trend has slowly started to creep into plastic surgery; therefore, understanding the concepts of private equity ownership in healthcare and its benefits and risks is critical. This article provides a fundamental economic background on private equity, describes its current state in healthcare, including trends in plastic surgery, and provides recommendations for plastic surgeons considering private equity acquisition.

Objective Residency Applicant Assessment Using a Linear Rank Model.

OBJECTIVES: Residency applicant assessment is imperfect, with little objectivity built into the process, which, unfortunately, impacts recruitment diversity. Linear rank modeling (LRM) is an algorithm that standardizes applicant assessment to model expert judgment. Over the last 5 years, we have used LRM to assist with screening and ranking integrated plastic surgery (PRS) residency applicants. This study's primary objective was to determine if LRM scores are predictive of match success and, secondarily, to compare LRM scores between gender and self-identified race categories. DESIGN: Data was collected on applicant demographics, traditional application metrics, global intuition rank, and match success. LRM scores were calculated for screened and interviewed applicants, and scores were compared by demographic groups. Univariate logistic regression was used to evaluate the association of LRM scores and traditional application metrics with match success. SETTING: University of Wisconsin, Division of Plastic and Reconstructive Surgery. Academic institution. PARTICIPANTS: Six hundred seventeen candidates who applied to a single institution over 4 application cycles (2019-2022). RESULTS: Using area under the curve modeling, LRM score was the most predictive indicator for match success. With every one-point increase in LRM score, there was an 11% and 8.3% increase in the likelihood of screened and interviewed applicant match success (p < 0.001). An algorithm was developed to estimate the probability of match success based on LRM score. No significant differences in LRM scores were appreciated for interviewed applicant gender or self-identified race groups. CONCLUSIONS: LRM score is the most predictive indicator of match success for PRS applicants and can be used to estimate an applicant's probability of successfully matching into an integrated PRS residency. Furthermore, it provides a holistic evaluation of the applicant that can streamline the application process and improve recruitment diversity. In the future, this model could be applied to assist in the match process for other specialties.

Offering No-Cost Cosmetic Revisions: The Experience of an Academic Cosmetic Surgery Program.

Background: The financial principles of a no-cost revision policy and their implications for revision rates are not well understood. Objectives: Therefore, the primary objective of this retrospective study is to report our no-cost revision rates and, secondarily, to survey the cosmetic revision policies of other cosmetic surgery practices and detail the financial principles underpinning no-cost revisions. Methods: All aesthetic surgeries and no-cost revisions performed by the plastic surgeons, oculoplastic surgeons, and facial plastic and reconstructive surgeons at our academic outpatient cosmetic surgery center from January 1, 2016 to June 30, 2022 were identified using procedural codes. Data on the number of surgeries, number of revisions, operative minutes, and time intervals between initial and revision surgeries were collected. A survey was administered to assess the revision policies of similar cosmetic surgery practices. Results: A total of 1491 aesthetic surgeries and minimally invasive procedures were included, and 125 revision procedures were performed (8.4%). Thigh lifts (3, 13.6%), rhinoplasties or septoplasties (25, 15.8%), and otoplasties (3, 27.3%) had the highest revision rates. Three practices (15%) offered cosmetic revisions at no cost, 9 (45%) did not apply a surgeon's fee, 5 (25%) evaluated fees on a case-by-case basis, 1 (5%) offered revisions with an insurance policy, and 2 (10%) cosmetic surgery practices did not offer revisions at a reduced rate. Conclusions: Despite offering revisions at no cost, our revision rates are reasonable for an academic cosmetic surgery practice. The revision policies offered to patients on the private market are varied, but most surveyed practices offer revisions at either a reduced rate or no cost.

The Price Is Right? An Economic Analysis of Factors Influencing Cosmetic Surgery Prices.

BACKGROUND: Cosmetic surgery is a large portion of practice revenue for many plastic surgeons, and therefore understanding the economic principles of pricing is critical. Although national averages provide a starting point for price determination, they may not reflect specific economic factors. Over the last decade, publicly reported pricing for cosmetic surgery has increased in prevalence, improving price transparency for patients and surgeons alike. OBJECTIVES: This study aims to compare publicly reported prices to national cosmetic surgery averages and identify variables that have the greatest impact on price determination. METHODS: An Internet search was performed with the term "cosmetic surgery, price" for practices that publicly reported cosmetic surgery prices. Publicly reported prices were compared to national averages generated from The Aesthetic Society's Aesthetic Society Plastic Surgery National Databank Statistics. The impact of regional prices, practice type, and surgeon accreditation were analyzed for the most popular cosmetic surgery procedures. RESULTS: Sixty-six practices were identified that reported cosmetic surgery pricing information. Publicly reported prices were significantly higher for all surgical procedures except nipple procedures, excision of (excess) skin, fat grafting, fat harvest, and lip enhancement. Facility/operating room fees (n = 38) and anesthesia fees (n = 34) were the most common components included in a price, after surgeons' fees (n = 66). A significant price difference was appreciated when separating practices by region for all procedures except breast augmentation (P = .074) and liposuction (P = .088). CONCLUSIONS: Publicly reported prices provide greater insight than national averages into specific pricing factors and strategies that can be employed when setting surgical prices.