From extreme to mainstream: The future of aesthetics injectables

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The aesthetics injectables market has historically grown by more than 10 percent a year.1 Expanded access to services (primarily via aesthetics clinic chains, med spas, and beauty bars) and growing consumer purchasing power have accelerated global penetration, especially in emerging markets.2 Shifting consumer attitudes about wellness, beauty, and healthy aging have increased awareness and acceptance of aesthetics, generating demand from new patient segments, including men and millennials.

Meanwhile, next-generation products and procedures are continually expanding the range of offerings and making greater inroads into demographic groups that value aesthetics. New indications and an expanded portfolio of dermal fillers and biostimulators are helping to expand the market as well. Analysts’ consensus revenue growth estimate is no less than 12 percent a year for the next five years (Exhibit 1).3 Annual growth could be as high as 14 percent, according to an October 2021 McKinsey survey of 10,000 consumers and 500 health care practitioners (HCPs) in the world’s main aesthetics markets, supplemented by in-depth interviews, social-media listening, investment scans, and intellectual-property (IP) analyses.4

Analyst consensus is that the global injectables market has the potential to grow at an annual rate of 12 percent over the next five years.

The COVID-19 pandemic underscored the resilience of the aesthetics injectables market, which had already been evident in a previous crisis: during the 2008 recession it lost only 2.4 percent of its sales and less than 20 percent of its market capitalization while the S&P 500 Index contracted by 50 percent.5 After contracting by a moderate 7 percent in 2020, the aesthetics market rebounded swiftly in 2021, aided by a post Covid increased consciousness and focus on aesthetics procedures.6 We believe that fundamental trends and elevated concerns about aging and health were responsible for the bounce-back.

In most large markets, the core consumer base for aesthetics injectables continues to be affluent women over 40 seeking facial treatments. But there are variations between regions; for example, the core demographic is much younger in China.7 Even in the longer-established geographical markets, such as North America, the pool of potential patients is steadily expanding.

Our survey analyzed the utilization of neuromodulators, dermal fillers and biostimulators by age group, income level, and gender (Exhibit 2). Averaged across the globe, people with annual incomes exceeding $100,000 are the most active users. But 30- to 50-year-olds with incomes from $50,000 to $100,000 are also a substantial segment. Patients from 20 to 30 with middle to high incomes represent a sizable portion of the market as well, with penetration of more than 10 percent among the highest earners.

The typical primary customers of aesthetic products worldwide are young to middle-aged and earn high incomes.

Although men still account for a minority of customers in most markets, the proportion of men utilizing aesthetics services is growing, especially in North America and Europe and in affluent social groups. Men made up 10 percent of the neuromodulator market in 2018, jumping to 15 percent in 2021. Likewise, 5 percent of all dermal filler and biostimulator users were men in 2018, rising to 7 percent in 2021. Today, overall market penetration is around 5 percent for neuromodulators and 4 percent for dermal fillers and biostimulators.

Poised for sustained double-digit growth

Whether the market will track along the expected trajectory of 10 to 12 percent or capture its upside potential will depend on how effectively the industry can harness tailwinds from growth trends and meet the emerging needs of potential new patients. Reaching 14 percent growth would require many, if not all, of these trends to materialize. In our October survey, 15 to 20 percent of respondents were considering a first-time aesthetics injectable treatment in the next five years; we refer to these as fence-sitters.

The gap between users and fence-sitters is most pronounced among 20- to 50-year-olds earning $50,000 to $100,000 a year. Men, projected to double their use of injectables over the next five years, make up a substantial proportion of this fence-sitter group. Our in-depth interviews suggest that about one-third of fence-sitters may convert, especially in geographies where the concentration of aesthetics chain stores and clinics makes services more accessible and affordable (Exhibit 3).

The projected conversion rate of consumers who are unsure about aesthetics injectables could accelerate growth significantly.

We also investigated cutting-edge micromarkets that could provide signs of future norms. While interviewing practitioners in Los Angeles neighborhoods, for example, we encountered atypical patient populations: some practices have a client base of 30 to 50 percent men, and teenage girls seeking lip injections and prejuvenation “to prevent the loss of youth.”8 These nontraditional patients suggest that social stigmas around injectables may be receding and even that inaction may be regarded as self-neglect. This may also reflect how social trends are changing around the world as well as signal the conversion of fence-sitters.

Five trends expanding the patient base

Our survey and research revealed five growth trends in aesthetics aligned with the expanding needs of patients:

1. Social media is driving awareness and acceptance, especially for new patient segments

Social-media coverage of neuromodulators grew fivefold from 2010 to 2020 and eightfold for dermal fillers and biostimulators.9 Digital messaging resonates with novel patient groups; for example, 60 percent of Twitter mentions are from people under 25, and 60 percent are from men. Existing and potential patients increasingly engage digitally, and aesthetics manufacturers and providers meet them where they are, either directly or through influencers who are normalizing aesthetics procedures.

2. Aesthetics service outlets are proliferating

Access to aesthetics procedures is expanding rapidly across the globe (Exhibit 4). Two forces are pulling channels in opposite directions: consolidation and expansion. On the one hand, aesthetics clinic chains are consolidating, so that they are better positioned to grow. On the other, many new medical professionals are entering the market to provide aesthetics services, such as adjunct services in dental surgeries or nurse-administered therapies in large aesthetics-focused practices. This multiplication of providers of aesthetics services gives patients more options to access treatment. Over the past five years, more than 400 aesthetics clinics and care centers raised $3.1 billion from investors, making them the fastest growing segment of the aesthetics industry.10

Investments in the aesthetics injectables industry support the development of new technologies, expanded patient access, and the rise of adjacencies.

In the United States, patients have better access to injectables via new treatment options such as large aesthetics clinic chains and the emergence of wellness and beauty bars specializing in cosmetic microtreatments. (These are nonsurgical procedures, from lasers to medical-grade skincare products, applied over time to make people look younger.) We discovered 60 points of sale in Santa Monica alone while researching the greater Los Angeles area.

A similar trend exists in Brazil with the expansion of high-volume injection chains backed by private equity (PE) investment. In China, chains of private aesthetics clinics are growing fast: large digital platforms providing first time access to patients in largely untapped third- and fourth-tier cities. New models have also emerged in Europe: high-volume clinic chains.

3. New indications are gaining traction

Upper-face indications remain common for neuromodulators, but other use cases on the face and body also become frequent. For example, dermal fillers are increasingly used in lip, chin, and cheek indications, while biostimulators are used for buttock lifts . Some preferences are country specific, such as the desire for sharper face features in China (Exhibit 5). Some marginal indications (for instance, jawline revision) are overrepresented in trendsetting locations, like Los Angeles.

The relative popularity of different aesthetics procedures varies by region.

4. Providers are meeting patient needs

Doctors we surveyed said they intend to adopt near-term technological improvements for neuromodulators,dermal fillers and biostimulators:

  • Longer-acting neuromodulators are in the development pipeline. More than 80 percent of HCPs say they would use such neuromodulators for at least 20 percent of their patients, and levels of adoption are even higher in Brazil and Mexico. High-volume practices believe that long-acting treatments could enable physicians to keep up with an increase in patient demand. Training and comfort will be essential to expand the use of longer-acting neuromodulators beyond advanced practitioners.
  • Ready-to-use liquid formulations of neuromodulators are launching now. About 90 percent of HCPs say they will adopt these new formulations, and high-volume practices are the most interested. However, the most sophisticated providers of aesthetics treatments, such as plastic surgeons, like the ability to tailor concentrations.
  • Innovation in the dermal-fillers and biostimulators market includes new indication launches. That’s especially true in the United States and China: by 2025, 10+ are expected for China, subject to clinical trials. Also, next-generation technologies, such as biostimulators and silk-based technologies, are emerging.11 HCPs in our survey intend to continue adopting these technologies in coming years. Patents filed for new dermal fillers and biostimulators outpace those filed for neuromodulators and devices by a factor of four.12

    Doctors want not only to deliver individual procedures but also to better address unmet needs, such as cellulite, skin laxity, acne scarring, and fat reduction.13 To do so, they need to combine treatments from a broader portfolio. The industry is investing in new technologies, such as cell therapies and energy-based devices (EBDs), including at-home blue-light devices. A scan of innovation and aesthetic-based investment hotspots indicates the possible rise of adjacencies and a race to understand and use new technologies, devices, and regenerative medicines.14

5. Patient preferences increasingly influence channel behavior

Our survey found that patients increasingly come to their first aesthetics procedure well informed. Web searches are the number-one source of information in North America, ahead of recommendations by physicians. Traditional media remains more influential than the internet in emerging markets. Younger patients reinforce these trends: only 5 percent of patients under 40 have no product preference, compared with more than a quarter of those over 50. More than 40 percent of patients make a final product selection in line with a physician’s recommendation. But the level varies between markets—younger patients in China tend to be attached to brands and are less likely to switch in response to a physician’s or beauty consultant’s recommendation.

Meanwhile, channels are aligning with the preferences of the various patient segments. Beauty bars act as an entry gate for much of the younger market segments; patients over 60 prefer dermatologists and dentists; and in the United States, MedSpas attract a more affluent patient segment.

Opportunities for players in the aesthetics space

The aesthetics industry is ripe for growth, but in this still young industry there are considerations to bear in mind.

Rapid adoption. As access to aesthetics procedures continues to expand rapidly, demand for aestheticians and physicians who can provide aesthetics procedures grows as well. Many new injectables continue to enter the market. However, when patients select a practice, they list the reputation of the providers and their expertise as the most important consideration.15 Manufacturers may benefit from proactively selecting and providing ongoing training and support for a priorized group of specialized aestheticians and physicians, to ensure that they are up to date on new products and injectables. This will help ensure that all of a manufacturer’s injectables are being used for optimal indications, so that patients have positive experience. These positive experiences in turn will ensure that aestheticians and physicians have confidence in the manufacturer and its offerings of injectables. Another possible risk is concern about the “frozen” (or unnatural) look that can sometimes result from certain procedures, especially if not applied by skilled professionals. Product innovation could provide new options for achieving more natural aesthetics results.

Regulatory compliance. As the aesthetics industry evolves, regulations for certain treatments may change in some countries. Manufacturers will need to sharpen their regulatory-compliance function for global scalability.

Patient-centric solutions. Manufacturers could help create a continuum of care beyond the injection site and in this way embrace the aspirations of doctors to advance from individual procedures to comprehensive aesthetics solutions that can improve outcomes. Combinations of regenerative treatments could help. In addition, injections clinics could be complemented by pre- or postprocedure skin care, as well as at-home (but scientifically backed) devices using, for example, blue-light or microcurrent technologies. A scan of investment hotspots shows rising interest in adjacencies and a race to harness new technologies and devices.16 Manufacturers can also help providers maintain their relationships with their patients beyond the care site by providing digital platforms, subscription programs, and e-commerce tools.

Provider engagement. Manufacturers should consider segmenting the ways they go to market. They can approach an increasingly diverse provider base with well priced segment-based offerings, such as tailored education programs and B2B and business-to-business-to-consumer (B2B2C) loyalty programs. Manufacturers could also reconfigure their sales force to better reach customers by account type, tailoring their engagement model for single-location clinics all the way up to corporate accounts. Technology-enabled engagement could help manufacturers improve the provider experience with services beyond product training—for example, virtual reality–enabled telemedicine, workflow optimization, and 3-D–printed device parts for responsive customer support. Finally, manufacturers could become more connected to aesthetics data ecosystems, such as search and patient engagement platforms.

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