In 2013, the American Academy of Facial and Reconstructive Plastic Surgery reported that more than 70 percent of its members' work in 2012 was cosmetic rather than reconstructive. That year, about 14 percent of plastic surgeons earned $500,000 or more, according to Nine out of 10 earned more than $100,000. Aesthetic procedures have long been part of plastic surgeons' revenue streams. Now, other physicians are in the business as well.

More Services for More Revenue

To the extent that procedures are elective, cosmetic surgery is all business -- and that business is growing along with social media. AAFPRS members said that almost a third of requests for surgery arose from photo sharing on social media sites. The American Academy for Aesthetic Plastic Surgery reported in 2013 that the number of cosmetic procedures in the United States had risen some 250 percent from 1997 to 2012. More than $4 billion of the $11 billion that Americans paid for cosmetic procedures in 2012 went for low-tech services such as Botox and Restylane injections, hair removal and laser skin resurfacing.

The Appeal of Offering Peels

Noninvasive cosmetic services, usually included in industry statistics along with all kinds of cosmetic surgery, have long been the bread and butter of plastic surgeons' revenues. According to the ASAPS, the manpower alone for such procedures, some of which require only a skilled technician, was billed at $350 to $850 for injectable substances, $588 for chemical peels and $1,555 for microdermabrasion to smooth patients' facial skin. That's why many private-practice physicians who are not surgeons are offering cosmetic procedures to increase revenue in their practices.

A Modest Cost of Entry

The investment for a typical stand-alone medical spa can run from $700,000 to $1 million, with up to half going to procure up-to-date laser machines. A physician with a single room to spare, however, can buy a basic microdermabrasion machine for $4,000 to $10,000, and laser equipment can be bought second-hand. A two-week course is enough for a staffer to learn laser resurfacing techniques. For doctors, training even offers continuing medical education credit. If the doctor is on-site at all times, patients are safer than in many medical spas -- though this depends on the state, because regulations vary.

Marketing Cosmetic Services

Doctors sometimes promote cosmetic services by mentioning them to patients. To some extent, even the most dignified physicians can market these services in the local community. There are plenty of opportunities for spa promotions. AAFPRS physicians said many women patients used surgery as a bonding experience, coming in as mother-daughter and sister-sister pairs to brave the knife together. Medical spas already make use of the same trend, offering girls'-night-out packages -- and pointing out how much better patients will look in their Instagram and Facebook photos.