Southern and Rural U.S. Markets Exhibit the Highest Unmet Demand for Aesthetic Surgery: Insights from Google Search Data and Plastic Surgeon Distribution Across Designated Market Areas.

Abstract

Optimizing plastic surgeon distribution is essential to meeting rising consumer demand for aesthetic operations. This study aimed to identify aesthetic surgery demand-supply mismatches across U.S. Designated Market Areas (DMAs) and quantify regional demand changes from pre- to post-COVID periods. This cross-sectional ecological analysis used Google Trends (Google LLC, Mountain View, CA, USA) Relative Search Volume (RSV) averaged for nine aesthetic operations as a proxy for demand across 210 DMAs from August 2024-2025. Surgeon concentration was calculated as board-certified plastic surgeons per 10,000 residents. Demand-Supply Ratio (DSR) was defined as RSV divided by surgeon concentration. DMAs were grouped into quintiles (Tiers 1-5, highest to lowest DSR). Median RSV was 45.03 (Interquartile Range [IQR] 39.52-54.90) and median surgeon density was 0.10 (IQR 0.06-0.17). Seventeen DMAs (8.1%) were "plastic surgery deserts," with search activity but no surgeons, clustering in the South, Midwest, and West. Median DSR was 426.16 (IQR 307.35-565.08), with highest DSRs concentrated in Southern and rural/interior DMAs, whereas coastal hubs were saturated. While surgeon concentration increased across DSR Tiers 1-5, RSV did not significantly differ. Nationally, median RSV increased 22.54% (IQR 16.65%-32.34%) from 2018-2019 to 2024-2025, with rising RSV in 95.2% of DMAs and highest growth in the Midwest (+32.58%, IQR 24.90%-47.55%). Southern and rural DMAs are disproportionately represented among underserved aesthetic markets and plastic surgery deserts. Aesthetic demand is rising nationwide, particularly in the American interior, underscoring high-growth regions where strategic expansion of aesthetic services by board-certified plastic surgeons may improve patient access and safety.