September 10, 2026 | Plastic Surgery News
Every August we publish our numbers. This year, for the largest category in aesthetic medicine, there are no numbers.
No count for neuromodulators. No count for fillers. The report gives their reason directly: because of “the dynamic nature of the minimally invasive treatment market, ASPS is seeking a data source that aligns with its cosmetic and reconstructive data sets before estimating treatment counts.”
They ranked by share instead. Neuromodulators about half of all minimally invasive treatments. HA fillers 30 percent. Then lasers, then hair removal and IPL and tattoo removal, then non-HA fillers.
What I said when I saw it
“I am surprised that they weren’t able to give us exact numbers from the numbers reported by surgeons, but still had a percentage.”
“Again, I’m surprised that we couldn’t get an exact count of the amount of fillers when we could still get an exact count of the amount of botulinum toxin and many other procedures.”
“I think the truth is that fillers have decreased considerably compared to other procedures, botulinum toxin still being number one. In my practice, I’ve seen more than a twenty to thirty percent decrease in the use of fillers, and a shift toward biostimulators and donor fat grafts instead.”
Twenty to thirty percent, in one practice, in a category with no official count.
Who this makes nervous
“Really, what I think is that there has been a huge tendency to overfill faces with fillers, and maybe that’s why it’s difficult to count. But truly, what I feel is that there has been such a decrease in the use of fillers that manufacturers and even med spas have become worried, as this is really the only thing they provide, since they do not have a way to provide surgical procedures, which are becoming far more common than hyaluronic acid fillers.”
That is about business models, not about individuals. If injectables are the only thing on the menu, injectables are the recommendation. My own MedSpa sits inside a surgical practice precisely so the recommendation can be something else, including nothing yet. There is more on how we handle it on the practice site.
On botulinum toxin, which is not going anywhere
“Yes, botulinum toxin is half of all minimally invasive treatments. I think it’s probably more than half in reality in our practice. This doesn’t mean that it’s the safest bet; it means that it’s something that’s tried and proven. It really is a maintenance therapy.”
“I myself get botulinum toxin in the forehead, crow’s feet, and glabella lines every three to four months, just to maintain the wrinkle free appearance with a dose that still lets me express my face without looking abnormal.”
“I believe the skin quality in these areas is also maintained with the use of botulinum toxin. And although there are other uses, I think these are the most common. Patients really like the results, and that’s why they keep coming back to get the botulinum toxin injections.”
A dose that still lets you express your face. That is the entire brief.
Why an uncounted market matters
A market too fast-moving to count is also a market too fast-moving to regulate. These estimates cover only board-certified plastic surgeons, so whatever is being injected outside that group is invisible here.
For a ranking, that is a footnote. For the question of who is allowed to hold the syringe, it is the whole thing.
Ready to talk?
Call my office at (915) 590-7900, text 1-866-814-0038, or request a consultation.
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Source: ASPS 2025 Procedural Statistics Report, minimally invasive section. Commentary from Dr. Agullo’s 2026-09-07 dictation, Q&A Transcriptions/Filler-Decline-Botulinum-Commentary.md.
