The International Society of Aesthetic Plastic Surgery (ISAPS) released its survey of aesthetic procedures performed in 2025 on September 29, 2026. Estimated calcium hydroxyapatite (CaHA) procedures performed by plastic surgeons fell from 418,173 in 2024 to 310,525 in 2025, a decrease of 25.7%. Poly-L-lactic acid (PLLA), hyaluronic acid (HA), and botulinum toxin procedures also declined, while non-surgical skin tightening increased by 23.3%. CaHA should therefore be compared with other categories in the same year. This places its decline in context and helps distinguish the overall change from differences between individual procedure categories.
These figures deserve attention from upstream material suppliers. However, survey coverage and the basis for extrapolation affect global totals, and several steps separate procedure counts from product sales and microsphere purchases. Reading the report requires attention to both the numerical changes and the survey methodology. For supply-chain analysis, the first step is to separate what the report measures from commercial questions that require other evidence. The statistics can identify questions to investigate; order and inventory data are needed to answer them.
The survey counts procedures, not material sales
The full title is 2026 ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025: a survey published in 2026 covering procedures performed in 2025. According to the methodology on page 4, ISAPS invited approximately 17,000 plastic surgeons from its database to participate, obtained data from 2,900 surgeons, and extrapolated the results using estimates of actively practicing plastic surgeons in each location. The survey focuses on board-certified plastic surgeons or their national equivalents. It does not capture every procedure performed by dermatologists and other professionals worldwide. Worldwide totals are therefore estimates based on a physician sample, rather than a complete register of procedures at every facility. The number of participating surgeons and the extrapolated number of procedures represent different levels of measurement.
The number of locations reported individually increased from 32 in the previous report to 51. ISAPS explicitly states that the broader basis for location-level extrapolation influenced some worldwide procedure totals. Newly added procedures may also affect comparisons across years. The report describes adjustments to outliers and some location-specific data, while reported percentage changes are limited to procedure categories that remained consistent across years. Comparisons should check both the definitions of the procedures and changes in the sample and regional composition. Consistent category definitions improve comparability, but they do not establish that the respondents and conditions for extrapolation were identical in both years.
The reported year-on-year changes therefore cannot be attributed entirely to changes in procedures within an unchanged set of markets and surgeons. The survey is also not a longitudinal study of the same patients or facilities. It provides no figures for syringes used per procedure, CaHA content per formulation, brand sales, or raw-material consumption, so its results cannot be converted directly into upstream material demand. Procedure counts, finished-product use, and upstream material consumption represent separate levels of measurement. Establishing a numerical relationship between them requires product and usage data, rather than multiplying procedure counts by a fixed conversion factor.
All four injectable categories declined; CaHA fell by 25.7%
Pages 10 and 12 of the report present the following annual comparison of worldwide non-surgical procedures: The four injectable categories and non-surgical skin tightening are listed separately to make their different directions visible. Both estimated volumes and percentage changes matter; the injectable subtotal should be kept distinct from other non-surgical categories.
| Procedure category | 2024 estimated procedures | 2025 estimated procedures | Year-on-year change |
|---|---|---|---|
| CaHA (calcium hydroxyapatite) | 418,173 | 310,525 | −25.7% |
| PLLA (poly-L-lactic acid) | 642,566 | 426,019 | −33.7% |
| HA (hyaluronic acid) | 6,338,184 | 4,737,957 | −25.2% |
| Botulinum toxin | 7,887,955 | 7,333,647 | −7.0% |
| Total for the four injectable categories | 15,286,878 | 12,808,147 | −16.2% |
| Non-surgical skin tightening (separate category) | 1,239,306 | 1,528,552 | +23.3% |
Source: ISAPS Global Survey 2025, pages 10 and 12. Totals and percentage changes are reproduced from the report. The four displayed injectable counts for 2025 sum to 12,808,148, one procedure more than the published total; the report does not explain this difference.
The decline was not confined to CaHA, but its magnitude varied by category. PLLA fell by 33.7%, CaHA and HA by 25.7% and 25.2%, respectively, and botulinum toxin by 7.0%. A single description such as “injectable aesthetics declined” can obscure these differences. A percentage change describes movement relative to a category's previous-year volume, while the absolute decrease depends on that starting volume. Similar percentage declines therefore need not represent similar numbers of procedures or arise from the same cause.
The estimated total for surgical and non-surgical procedures in 2025 was 35,204,030, including 17,320,420 non-surgical procedures. Because the published percentage changes use categories that are consistent across years, simply dividing the displayed annual totals does not necessarily reproduce the official change rates. Checking a change in the total requires identifying the set of procedures being compared and reviewing the report's cross-year calculation method. The total provides scale, while changes for consistent categories support annual comparisons; the two measures serve different analytical purposes.
One year's decline does not establish a long-term downturn
The report lists 290,095 CaHA procedures in 2021, 418,173 in 2024, and 310,525 in 2025. The 2025 estimate was 25.7% below 2024 but remained 7.0% above 2021. These estimates provide useful points of comparison; they do not constitute a continuous trend study based on a fixed sample. Comparisons with 2024 and 2021 answer questions over different periods. The annual comparison describes the most recent decline, while the earlier year provides a longer-term reference. Neither reference point can replace observations from the intervening and subsequent years.
The data support the statement that estimated CaHA procedures decreased from the previous year within the ISAPS survey framework. They do not establish that demand for CaHA materials has entered a prolonged contraction. Equally, the comparison with 2021 does not negate the decline recorded for 2025. Establishing a sustained trend requires more years of comparable data and examination of specific regions and products. Extending a single-year decline into a long-term forecast leaves unanswered whether the pattern persists and whether it is consistent across markets.
The report offers no causal model for the decrease. Consumer budgets, treatment choices, the distribution of procedures across medical specialties, regional composition, and uncertainty in the estimates are all possible subjects for further research. None should be presented as a confirmed cause without corresponding evidence. Each explanation needs its own evidence, such as comparable regional time series or changes in a facility's procedure mix. Even a cause confirmed in one region must be assessed for its relevance to the worldwide estimate; a local finding cannot automatically explain every market.
Growth in skin tightening does not prove substitution for CaHA
Non-surgical skin tightening increased from 1,239,306 procedures in 2024 to 1,528,552 in 2025, a rise of 23.3%. Its direction differs from that of several injectable categories, but opposing changes in these categories do not establish that patients switched from CaHA injections to a particular device-based treatment. Growth in skin tightening alongside a decline in CaHA is an observation worth examining. The survey does not track the same patients' choices over time, so it cannot identify whether the increase involved people who previously received CaHA procedures.
Assessing substitution requires evidence about individual patients' choices, replacement of one treatment plan by another, or continuous operating data from facilities. The survey does not provide that tracking. It shows a change in the procedure mix within its framework; any substitution relationship requires additional evidence. Even if one facility records both changes, assessing substitution would require checking whether they involved the same patients, comparable treatment needs, and the same observation period. Connecting these conditions would be necessary before evaluating whether one treatment replaced another.
Global figures cannot replace local market analysis
The 2025 CaHA estimates on pages 16–20 include 32,485 procedures in Brazil, 30,046 in South Korea, 30,000 in China, and 23,247 in the United States. These figures describe regional distribution within the survey's coverage. They are not complete national sales figures, nor do they show that every country experienced the same decline. The figures allow comparison of reported procedure volumes within one year. Revenue also requires price data, penetration requires an appropriate denominator, and growth requires comparable figures across years. The selected country estimates do not provide that complete set of information.
Evaluating a particular market requires checking local coverage, comparable historical figures, regulatory access, product sales, and clinical use. The global decline of 25.7% cannot be applied directly to China, South Korea, or Brazil, or used alone to set production and inventory plans for upstream suppliers in China. Analysis of CaHA internationalization and supply chains also requires checking where products have entered commercial use and how their local distribution operates. A worldwide percentage cannot replace evidence on differences in market access and commercialization stage.
The relationship between procedure counts and upstream CaHA demand
ISAPS estimates CaHA procedure counts within its survey coverage. The figure does not include corresponding injectable sales or purchase volumes for CaHA microspheres. The 25.7% decline therefore describes a decrease in the estimated procedure count; it cannot be converted directly into an equivalent decline in upstream raw-material demand. Product use and inventory changes are among the steps between these measures. Data on the actual use and consumption of corresponding products are needed before assessing the extent to which lower procedure activity affects raw-material demand.
Analysis of CaHA microsphere procurement requires linking procedure counts to specific products and regions, then considering CaHA content in the formulation, product use per procedure, channel inventory, and production plans. These factors affect the relationship between clinical use and raw-material purchases. Procedure counts alone do not provide enough information for that calculation. For example, assessing lower clinical use requires checking whether distributors are drawing down existing inventory or changing replenishment plans. Whether manufacturers have adjusted production also affects when raw-material purchasing changes. These are possible transmission mechanisms to investigate, not market conditions confirmed by the survey.
Raw-material purchases for commercial products are related to clinical use, while purchases for development and registration projects require separate analysis of project progress. Product sales, inventory, production, and actual purchasing data are still needed to determine whether upstream demand has fallen, by how much, and when any change reaches orders. The ISAPS survey is a starting point for observing changes in procedure activity; it cannot answer these questions on its own. Commercial supply can be examined through purchasing records over time; development and registration projects require checking validation batches and project milestones rather than assuming proportionality to procedure counts. Separating these types of demand helps avoid interpreting a change in project stage as a uniform movement across the material market.
Take the decline seriously and respect the survey's scope
The 25.7% decrease in CaHA procedures, declines across all four injectable categories, and growth in non-surgical skin tightening are results worth tracking. Material suppliers can treat them as signals to examine alongside regional markets, finished-product developments, and customer purchasing data. Subsequent observations can follow the same sequence: check statistical comparability, examine regions and categories, then test consistency with finished-product sales and raw-material purchasing. This retains the information conveyed by the annual decline while reducing the risk of drawing too much from a single indicator.
This article discusses estimated procedures within a defined physician survey and their relevance to upstream demand assessment. It does not compare clinical efficacy or provide a commercial forecast. Demand changes and substitution relationships that lack supporting evidence remain questions for further verification. Observed statistical changes can be stated directly, while any industry conclusions drawn from them need an explanation of their evidence and scope.
Original sources and attachment
International Society of Aesthetic Plastic Surgery (ISAPS). 2026 ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025. Original English report, 118 pages, released September 29, 2026.
ISAPS original PDF · ISAPS report release page. The complete original PDF can also be saved using the attachment download on the right (below the article on narrow screens). The attachment preserves the original official file; the report cover and statistics are sourced from ISAPS.