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People Go to the Doctor Less During the Holidays, With One Exception

Kelsey Tyler

Zocdoc has a lot of interesting data on patient booking behavior. Zoctrends is a new series where we’ll explore data points that are timely or relevant to larger healthcare conversations. In each story, we’ll highlight and explain a few facts and figures, with accompanying insight from doctors, statisticians, psychologists and other experts. The data we share is anonymized from the start, so nothing can ever be traced back to you, and the conclusions we draw only apply to Zocdoc patients, who may not be representative of the general population. For more information on Zocdoc’s privacy policy, check out our Terms of Service.

The holidays can be overwhelming even if you love them. During the final stretch of the calendar year, it’s easy to let activities like vegging in your childhood bedroom, chugging eggnog and obligatorily double-tapping #shesaidyes photos consume all your time and emotional bandwidth. As a result, healthy habits may fall by the wayside: Between Thanksgiving and New Year’s, research shows, we go hard on treats, light on exercise and heavy on erratic sleep patterns. Perhaps unsurprisingly, we don’t really make time for doctor’s appointments either. An analysis of Zocdoc data revealed that medical appointment volume falls in general during the holiday season, with one exception: Botox.

Botulism toxin type A injections, better known as Botox, have proven to be more than a passing beauty fad. Since securing FDA approval for cosmetic use in 1989, the wrinkle-reducing neurotoxin has steadily found its way into more crow’s feet and frown lines across the country each year. In 2017, Americans had 7.26 million procedures performed, a 2-percent increase over the previous year. According to the American Society of Plastic Surgeons, Botox is the most popular minimally invasive cosmetic treatment in the U.S., and has been for the past few years. 

We discovered the holiday Botox bump while analyzing seasonal fluctuations in different types of doctor’s appointments. We wanted to know how healthcare habits change when the days get short and the vibe gets merry: Do most of us take a break from blood draws and paper gowns? Or do we make an effort to squeeze in certain appointments before the year is over?

To find out, we teamed up with Priceonomics, a data storytelling company, and looked at a year’s worth of anonymized booking data (April 2017 through March 2018). Specifically, we zeroed in on appointments for every medical specialty, as well as 10 visit reasons that we surmised might spike during the holidays. These visit reasons included acne, depression, weight loss, STD testing and gastroenterology consultations.

For the most part, bookings either fell or held steady once Thanksgiving week rolled around. The only spikes we saw were for Botox. On the days surrounding Thanksgiving and Christmas, Botox booking rates were 35 to 45 percent higher than average. Twelve of the year’s 15 busiest days for Botox occurred in November and December. Nov. 20 came in at No.1 during this period, with booking rates 79 percent above average, while Dec. 4 and 21 followed close behind.

holiday botox

Surprisingly, these dates weren’t peak periods full stop: The most popular day of the year for Botox was actually in early January. Still, that’s a time when volume surges for many types of medical care. From late November through December, Botox is the only visit reason where bookings reach considerably above-average rates.

holiday botox

Our next question: Who gives themselves the gift of anti-aging botulism? A lot of middle-aged Chicagoans, it turns out.

We broke down booking stats by age and city and found that people between 40 and 59 years old were at least twice as likely as those in any other age group to get Botox around the holidays. It’s worth noting that 40- and- 50-somethings were no more likely than anyone else to book holiday appointments for other, non-Botox-related reasons.

Directly before and after Thanksgiving, Chicago saw the greatest Botox surge in the country, with booking rates 50 percent higher than average. The Windy City, the ninth most popular city for Botox in general, also came in second at Christmastime, trailing Seattle. San Jose, California, the city where Botox accounts for the greatest share of total appointment bookings during the rest of the year (54 percent of all San Jose bookings are for Botox) didn’t crack the top six during the holiday season.

holiday botox

We don’t know why so many Zocdoc patients get Botox during the holidays, or even if the uptick represents a meaningful behavior shift. For some cosmetic procedures, seasonal spikes happen consistently and for identifiable reasons, says Dr. Alan Matarasso, a New York City plastic surgeon and president of the ASPS. In his view, Botox isn’t one of them.

“You can explain why there’s a surge in liposuction in the spring, and then concomitantly explain why there may be less in the winter,” says Matarasso. “Or, with laser [treatments], patients might say, ‘I don’t want it in the summer because there’s too much sun.’ But Botox is one of those chronic treatments you do again and again, all year round, and I can’t say I see much seasonal variation in my patients.”

It’s fun to dig around for surprises like this, but it’s also important to understand the limitations of Zocdoc data.

Zocdoc patients are not a nationally representative sample, so we can’t be sure the trends we observe would bear out in the general population. On Zocdoc, for example, patients can only Botox appointments with doctors; they can choose dermatologists, cosmetic dermatologists or plastic surgeons. Outside the Zocdoc universe, people might get Botox from facilities that aren’t healthcare practices, like medi-spas. Do procedures performed by doctors and aestheticians peak at the same times of year? That we can’t answer right now.

We’re also assuming that all or most holiday-season Botox appointments are for cosmetic Botox. Zocdoc patients can choose among three Botox-related visit reasons when booking an appointment: Botox, Botox follow-up or Botox trigger-point injection (for migraines). We excluded the third visit reason from our analysis, so we know that the holiday bump doesn’t reflect the use of Botox as a neurological treatment. But it’s possible that some Zocdoc patients do book “Botox” or “Botox follow-up” appointments for other non-cosmetic issues like excessive sweating, rather than to fill in their forehead grooves. Our booking data isn’t granular enough to tell us when patients choose visit reasons that don’t perfectly reflect their needs.

Regardless, with the holidays approaching, we can see if the Botox bump bears out again. And if you’re coming up short on ideas for presents, consider this: In a 2017 survey by the ASPS, 27 percent of women and 20 percent of men said they’d want to receive plastic surgery as a holiday gift. Fourth on the list, after liposuction, tummy tucks and facelifts? Botox.

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The Paper Gown, a Zocdoc-powered blog, strives to tell stories that help patients feel informed, empowered and understood. Views and opinions expressed on The Paper Gown do not necessarily reflect those of Zocdoc, Inc. Learn more.