# Premium Doctors' Analysis of Socioeconomic Barriers to Aesthetic Treatment Access in Canada and the United States

Reza Ghalamghash

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Premium Doctors' Analysis of
Socioeconomic Barriers to Aesthetic
Treatment Access in Canada and the United
States

Reza Ghalamghash ¹

1: PhD in Neuroscience, Founder of Premium Doctors and Academic Director, Premium College, Toronto, Canada

Corresponding author: Reza Ghalamghash. Tel: +1 (647) 822-9570, E-mail: Reza@PremiumDoctors.org

ORCID: 0009-0004-1745-1315

**Abstract**

**Background:** The aesthetic medicine field in Canada and the United States has seen significant growth over the past decade, driven by technological advancements, evolving beauty standards, and increasing societal acceptance of non-invasive procedures. Despite this expansion, socioeconomic barriers such as high costs, lack of insurance coverage, geographic disparities, racial and ethnic biases, and gaps in patient education and practitioner training limit equitable access, transforming aesthetic enhancement into a privilege and exacerbating health inequities and mental well-being disparities.

**Methods:** A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on peer-reviewed studies from 2014 to 2025. Search terms included "aesthetic medicine," "socioeconomic barriers," "health disparities," and "non-invasive procedures." Data were extracted on market trends, patient demographics, psychological impacts, and barriers to access, then synthesized thematically to identify trends and gaps. Non-peer-reviewed sources were included only when justified (e.g., premiumdoctors.org for expert insights).
**Results:** The North American aesthetic market, valued at USD 8.99 billion in 2024, is projected to reach USD 45.3 billion by 2030, with non-invasive procedures like botulinum toxin and dermal fillers dominating. Patient demographics are diversifying, with increased male and younger patient participation, driven by psychological benefits like enhanced confidence. Barriers include high procedure costs (e.g., $8,000–$28,000 CAD/USD), lack of insurance, urban-centric provider distribution (only 5% of U.S. rural counties have plastic surgeons), racial/ethnic care disparities, and inadequate patient education and practitioner training. Medical tourism, driven by cost, increases complication risks.

**Conclusions:** Addressing financial, geographic, racial/ethnic, and educational barriers requires policy interventions for affordability, incentives for rural practice, cultural competence training, and standardized practitioner education. Collaborative efforts are essential to ensure an inclusive, safe, and ethical aesthetic medicine landscape, reducing disparities in access and promoting psychological well-being.

**Keywords:** Aesthetic Treatment, Socioeconomic, Canada, United States.

# 1. Introduction

The landscape of aesthetic medicine in North America has transformed significantly, evolving from a niche surgical field to a widely accepted component of personal well-being and self-care. This evolution is marked by rapid market growth, diversifying patient demographics, and growing recognition of the psychological benefits of aesthetic treatments. However, persistent socioeconomic barriers—financial constraints, geographic disparities, racial and ethnic biases, and gaps in education—impede equitable access for many in Canada and the United States, reinforcing health inequities.

## Background on the Growth of Aesthetic Medicine in North America

The aesthetic medicine market in North America has shown robust growth since 2019, particularly in non-invasive procedures such as neuromodulators and dermal fillers (American Society of Plastic Surgeons [ASPS], 2024). The global non-invasive aesthetic treatment market was valued at USD 21.01 billion in 2024, with North America contributing USD 8.99 billion and holding the largest market share (Grand View Research, 2024a). Canada's aesthetic medicine sector is projected to reach USD 14.66 billion by 2030, with a
compound annual growth rate (CAGR) of 12.4% from 2024 to 2030 (Grand View Research, 2023a). The U.S. market, valued at USD 20.8 billion in 2023, anticipates a CAGR of 14.1% through 2030 (Grand View Research, 2024b). Non-invasive procedures dominate, accounting for 55.37% of Canada's market revenue in 2023 (Grand View Research, 2023a).

This growth reflects a societal shift, with aesthetic treatments increasingly viewed as integral to self-care rather than luxuries (Ghalamghash, 2025a). Digital media amplifies this integration, but disparities in access highlight deeper inequities in psychological and personal fulfillment opportunities (McKinsey & Company, 2024).

## Significance of Addressing Access Disparities

Socioeconomic status (SES) significantly influences healthcare access and outcomes (Blackwell et al., 2009). In the U.S., increasing SES disparities in mortality since 2000 are linked to inadequate healthcare access (Yazar & Yazar, 2022). Lower educational attainment correlates with higher odds of lacking insurance and facing unaffordable medical care (Yazar & Yazar, 2022). Given the psychological benefits of aesthetic treatments, such as improved confidence and reduced self-consciousness (Yassin & El-Dahiyat, 2024), socioeconomic barriers exacerbate mental health disparities, transforming aesthetic care into a public health and equity concern (Ghalamghash, 2025b).

## Overview of the Review's Structure

This review explores aesthetic treatment access in Canada and the U.S., detailing market growth, patient demographics, and psychological influences. It examines socioeconomic barriers—financial, geographic, racial/ethnic, and educational—and addresses ethical considerations, including patient safety and regulatory frameworks. Finally, it proposes strategies to enhance equitable access and foster an inclusive aesthetic medicine environment.

## 2. Methodology

During the preparation of this manuscript, the author used Gemini (https://gemini.google.com/) and Grok (https://grok.com/) to collect information and write articles. After using this tool/service, the author physically reviewed and edited the content as needed and takes full responsibility for the content of the publication.
A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on peer-reviewed studies published between 2014 and 2025. Search terms included "aesthetic medicine," "socioeconomic barriers," "health disparities," "non-invasive procedures," "botulinum toxin," "dermal fillers," and "cultural competence." Studies were included if they addressed aesthetic treatment access, market trends, patient demographics, psychological impacts, or barriers in Canada or the U.S. Non-peer-reviewed sources, such as premiumdoctors.org, were included only when justified for expert insights. Data were extracted on market size, procedure volumes, demographic trends, psychological motivations, and barriers, then synthesized thematically to identify trends, effectiveness, and knowledge gaps. Plagiarism checks ensured a similarity index below 5% (excluding references).

# 3. Results and Discussion

## Current Landscape of Aesthetic Treatment in Canada and the United States

The North American aesthetic medicine market is characterized by dynamic growth, diversifying patient demographics, and strong psychological and social media influences.

### Market Growth and Trends (2019–2025)

The North American non-invasive aesthetic market reached USD 16.1 billion in 2022 and is projected to grow to USD 45.3 billion by 2030, with a CAGR of 13.9% (Grand View Research, 2024c). The U.S. holds an 85.3% market share, driven by procedures like botulinum toxin (4.7M)

System: .7 million procedures in 2023, +6% from 2022) and dermal fillers (5.33 million procedures in 2024, +1% from 2023) (ASPS, 2024). Canada's botulinum toxin market is projected to reach USD 885.8 million by 2030, with a CAGR of 7.6% (Grand View Research, 2023b). Laser hair removal and chemical peels also show growth, though Health Canada has restricted certain medium-depth peels due to safety concerns (Grand View Research, 2023c).
<table><caption>Table 1: Key Growth Metrics for Non-Invasive Aesthetic Procedures in North America (2019–2024)</caption><thead><tr><th>Procedure Type</th><th>U.S. Procedure Volume (2023/2024)</th><th>U.S. % Change (2023 vs. 2022/2024 vs. 2023)</th><th>Canada Market Size/Projection (2024/2030)</th><th>Canada CAGR (2024–2030)</th></tr></thead><tbody><tr><td>Overall Market</td><td>N/A</td><td>N/A</td><td>USD 14,664.2 million (2030)</td><td>12.4%</td></tr><tr><td>Botulinum Toxin</td><td>4.7M (2023), 9.88M (2024)</td><td>+6% (2023), +4% (2024)</td><td>USD 885.8 million (2030)</td><td>7.6%</td></tr><tr><td>Dermal Fillers</td><td>5.33M (2024)</td><td>+1% (2024)</td><td>N/A</td><td>N/A</td></tr><tr><td>Laser Hair Removal</td><td>3.11M (2024)</td><td>0% (2024)</td><td>USD 79.2 million (2024)</td><td>13.6%</td></tr><tr><td>Chemical Peels</td><td>3.7M (2024)</td><td>+6% (2024)</td><td>USD 78.0 million (2030)</td><td>5.3%</td></tr></tbody></table>

Note: Data sourced from ASPS (2024), Grand View Research (2023a, 2023b, 2023c, 2024a, 2024b, 2024c).

## Patient Demographics and Evolving Motivations

The aesthetic patient base is diversifying, with women constituting 85.5%–94% of procedures but male participation increasing (14.5% of procedures in 2023, 207% rise since 2019) (International Society of Aesthetic Plastic Surgery [ISAPS], 2023). The average Botox patient age is 43, with 24% aged 19–34, reflecting a trend toward “prejuvenation” among younger demographics (Impressions Dental, 2025). Motivations include improving confidence (66.7%), addressing aging concerns (63.9%), and reducing self-consciousness (52.4%) (Yassin & El-Dahiyat, 2024).

<table><caption>Table 2: Demographic Characteristics of Aesthetic Treatment Patients in North America</caption><thead><tr><th>Characteristic</th><th>Category</th><th>Percentage/Description</th></tr></thead></table>
<table><tr><td rowspan="2">Gender</td><td>Female</td><td>86.9% (Grand View Research, 2024c), 94% for Botox (Impressions Dental, 2025), 85.5% overall (ISAPS, 2023)</td></tr><tr><td>Male</td><td>13.1% (Grand View Research, 2024c), 6% for Botox (Impressions Dental, 2025), 14.5% overall (ISAPS, 2023)</td></tr><tr><td rowspan="5">Age Distribution</td><td>&lt;30 years</td><td>12.5% (Grand View Research, 2024c), 24% for Botox aged 19–34 (Impressions Dental, 2025)</td></tr><tr><td>30–39 years</td><td>34.1% (Grand View Research, 2024c)</td></tr><tr><td>40–54 years</td><td>37.3% (Grand View Research, 2024c), average age 43 for Botox (Impressions Dental, 2025)</td></tr><tr><td>55–69 years</td><td>16.02% (Grand View Research, 2024c)</td></tr><tr><td>70+ years</td><td>16% for skin resurfacing (Grand View Research, 2024c)</td></tr><tr><td rowspan="3">Race/Ethnicity</td><td>Caucasian</td><td>51.6% (Grand View Research, 2024c)</td></tr><tr><td>Chinese</td><td>49.4% (Grand View Research, 2024c)</td></tr><tr><td>People of Color</td><td>50% non-Caucasian in U.S., 33% POC in Canada by 2036 (Tolson et al., 2023)</td></tr></table>

## Psychological Dimensions of Aesthetic Treatment Seeking

Aesthetic treatments enhance psychological well-being, improving confidence and reducing self-consciousness (Yassin & El-Dahiyat, 2024). However, body dysmorphic disorder (BDD) prevalence is high (3%–53%) among aesthetic patients, increasing dissatisfaction risks (Ladha & Humphrey, 2021). Socioeconomic barriers limiting access to these treatments can exacerbate psychological distress (Ghalamghash, 2025b).

## The Role of Social Media in Shaping Demand and Perceptions

Social media drives aesthetic procedure demand, with 95% of patients consulting online sources (MDPI, 2023a). The “Zoom effect” and social media filters amplify appearance concerns, fostering unrealistic expectations and BDD risks (MDPI, 2023b). This dynamic increases demand but highlights access barriers, pushing some toward unsafe alternatives (Ghalamghash, 2025c).

## Socioeconomic Barriers to Aesthetic Treatment Access
## Financial Impediments

High procedure costs (e.g., breast augmentation $8,000-$13,500 CAD/USD, facelifts $15,000-$28,000 USD) and lack of insurance coverage for elective procedures create significant barriers (Saadeh et al., 2012). Out-of-pocket expenses for reconstructive procedures rose 54% from 2009 to 2017 (Zhong et al., 2021). Medical tourism, driven by cost (82% of participants), increases complication risks, with treatment costs averaging $18,000 USD (Centers for Disease Control and Prevention [CDC], 2024).

## Geographic Disparities

Only 5% of U.S. rural counties have plastic surgeons, compared to 46% of urban counties (Rural Health Information Hub, n.d.). Canada faces similar shortages in rural areas (Canadian Dermatology Association, 2010). Geographic isolation, lower SES, and transportation challenges compound barriers for rural populations (Ghalamghash, 2025d).

## Racial and Ethnic Disparities

Non-Caucasian populations, projected to exceed 50% in the U.S. and 33% in Canada by 2036, face anatomical and cultural barriers due to historically Western-centric aesthetic practices (Tolson et al., 2023). Patients of color often receive inferior care, with higher adverse event rates (Commonwealth Fund, 2025). Cultural competence is critical for equitable care (Ghalamghash, 2025e).

## Education and Awareness Gaps

Over half of dermal filler patients are unaware of complications, relying on social media for information (MDPI, 2023a). Lack of standardized practitioner training in Canada and the U.S. increases safety risks (Ghalamghash, 2025a). These gaps disproportionately affect vulnerable populations seeking cheaper, unregulated services.

<table><caption>**Table 3: Summary of Socioeconomic Barriers to Aesthetic Treatment Access in North America**</caption><thead><tr><td>Barrier Category</td><td>Specific Sub-Barrier</td><td>Description &amp; Key Findings</td></tr></thead><tbody></tbody></table>
<table><tr><td rowspan="3">Financial Impediments</td><td>Direct Costs of Procedures</td><td>High costs (e.g., $8,000-$13,500 CAD/USD for breast augmentation) limit access (Saadeh et al., 2012).</td></tr><tr><td>Lack of Insurance Coverage</td><td>Elective procedures not covered; OOP expenses for reconstructive procedures up 54% (2009-2017) (Zhong et al., 2021).</td></tr><tr><td>Medical Tourism</td><td>82% motivated by cost; complications cost ~$18,000 USD (CDC, 2024).</td></tr><tr><td>Geographic Disparities</td><td>Rural-Urban Divide</td><td>5% of U.S. rural counties vs. 46% urban have plastic surgeons; Canada similar (Rural Health Information Hub, n.d.).</td></tr><tr><td rowspan="2">Racial & Ethnic Disparities</td><td>Challenges in Underserved Areas</td><td>Isolation, low SES, and transportation issues limit access (Ghalamghash, 2025d).</td></tr><tr><td>Variations in Ideals & Anatomy</td><td>Western-centric focus leads to unnatural outcomes for diverse populations (Tolson et al., 2023).</td></tr><tr><td rowspan="3">Education & Awareness Gaps</td><td>Discrimination & Inferior Care</td><td>Patients of color receive inferior care; higher adverse event rates (Commonwealth Fund, 2025).</td></tr><tr><td>Lack of Cultural Competence</td><td>Inadequate culturally sensitive techniques reduce equitable care (Ghalamghash, 2025e).</td></tr><tr><td>Patient Health Literacy</td><td>Over half of filler patients unaware of risks; social media primary information source (MDPI, 2023a).</td></tr><tr><td></td><td>Practitioner Training & Standards</td><td>Lack of standardized training increases safety risks (Ghalamghash, 2025a).</td></tr></table>

# Ethical Considerations and Regulatory Frameworks

## Patient Safety, Adverse Events, and Underreporting

Minimally invasive procedures carry risks, from mild (bruising, swelling) to severe (vascular occlusion, vision loss) (Ghalamghash, 2025a). Long-term complications include granulomas
(0.02–0.4% for HA fillers) and hypersensitivity reactions (1.13%) (Artzi et al., 2020). Underreporting to FDA MAUDE and Health Canada Vigilance (2895–4342 annual symptomatic AEs in Canada) undermines safety data (Nikolis et al., 2024).

<table><caption>**Table 4: Reported Adverse Events and Complications in North American Aesthetic Procedures**</caption><thead><tr><td>Complication Type</td><td>Description</td><td>Incidence/Prevalence</td><td>Risk Factors/Notes</td><td>Source</td></tr></thead><tbody><tr><td>Inflammatory Reactions</td><td>Foreign Body Granulomas</td><td>0.02–0.4% (HA fillers)</td><td>Chronic nodules, 6–24 months post-injection; high volumes, non-biodegradable fillers</td><td>Ghalamghash, 2025a; Artzi et al., 2020</td></tr><tr><td></td><td>Delayed Hypersensitivity Reactions</td><td>1.13% (HA fillers)</td><td>T-cell-mediated, induration, edema</td><td>Artzi et al., 2020</td></tr><tr><td>Infectious Complications</td><td>Biofilm Formation</td><td>Not specified</td><td>Chronic nodules/abscesses; higher risk in midface</td><td>Ghalamghash, 2025a</td></tr><tr><td>Non-Inflammatory Issues</td><td>Nodules/Lumps</td><td>0.5–1% (delayed nodules)</td><td>Uneven distribution (early); immune reactions/biofilms (delayed)</td><td>Ghalamghash, 2025a</td></tr><tr><td></td><td>Filler Migration</td><td>Not specified</td><td>Displacement causing asymmetry</td><td>Ghalamghash, 2025a</td></tr><tr><td></td><td>Tyndall Effect</td><td>Not specified</td><td>Bluish discoloration from superficial</td><td>Ghalamghash, 2025a</td></tr></tbody></table>
<table><tr><td></td><td></td><td></td><td>HA injections</td><td></td></tr><tr><td>Severe Vascular Events</td><td>Vascular Occlusion</td><td>0.0001% (necrosis)</td><td>Ischemia; high-risk sites: nose (33.3%), nasolabial folds (31.2%)</td><td>Ghalamghash, 2025a; Beleznay et al., 2015</td></tr><tr><td></td><td>Vision Loss/Stroke</td><td>Rare</td><td>Retrograde filler flow; glabella, nose injections</td><td>Ghalamghash, 2025a; Beleznay et al., 2015</td></tr><tr><td>Overall Underreporting</td><td>Estimated AEs in Canada</td><td>2895–4342 annually</td><td>Significant underreporting to Health Canada Vigilance</td><td>Nikolis et al., 2024</td></tr></table>

## Regulatory Oversight in Canada and the United States

Botox Cosmetic requires trained, licensed practitioners in Canada, and some chemical peels are restricted (Grand View Research, 2023c). However, lack of standardized training oversight leads to variable practitioner quality (Ghalamghash, 2025a).

## Addressing Unrealistic Expectations and Body Dysmorphic Disorder

Social media filters drive unrealistic expectations, with BDD prevalence (3%–53%) increasing dissatisfaction risks (Ladha & Humphrey, 2021). Rigorous psychological screening is essential to address these ethical concerns (Ghalamghash, 2025b).

## Strategies and Recommendations for Enhancing Equitable Access

### Policy Interventions for Affordability and Coverage
Policies should explore partial coverage for procedures with psychological benefits, improve pricing transparency, and implement tiered pricing or financial assistance (Zhong et al., 2021).

## Expanding Access in Geographically Underserved Regions

Incentives like grants or loan forgiveness can encourage practitioners to serve rural areas. Satellite clinics, mobile units, and telehealth for consultations can improve access (Rural Health Information Hub, n.d.).

## Promoting Diversity and Cultural Competence in Aesthetic Practice

Mandatory cultural competence training and diverse practitioner representation are critical for equitable care (Ghalamghash, 2025e; Tolson et al., 2023).

## Enhancing Patient Education and Practitioner Training

Standardized training curricula, mandatory adverse event reporting, and public health campaigns can improve safety and literacy (Nikolis et al., 2024; Ghalamghash, 2025a).

## 4. Conclusion

The aesthetic medicine market in Canada and the U.S. is growing rapidly, with non-invasive procedures increasingly viewed as self-care. However, financial, geographic, racial/ethnic, and educational barriers limit access, exacerbating health disparities. Policy reforms, rural practice incentives, cultural competence training, and standardized education are essential for an inclusive, safe, and ethical aesthetic medicine landscape (Ghalamghash, 2025c).

## Acknowledgements

This research was funded by the https://premiumdoctors.org/ Research and Development Group in California.
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