Cosmetic Institute co-founder, David Segal.image

This preschool drop-out has built a $15m breast enlargement business by slashing the cost of surgery.

David Segal wasn’t a naughty child. He just didn’t want to do what everyone else was doing in the playground.

The Cosmetic Institute co-founder recounts how his parents “were politely asked to find alternate early childhood education” for their bright but uninterested son.

“I was expelled from a number of kindergartens,” he jokes.
Surgeon Dr Laith Barnouti from Plastic Surgery Sydney..

Surgeon Dr Laith Barnouti from Plastic Surgery Sydney..

“I just really struggled to find things that engaged me all the way through to high school when sometimes I didn’t even turn up to exams.”

The Sydneysider scraped into a business degree at Macquarie University but dropped out within six months.

Odd jobs washing cars and selling door-to-door home alarm systems followed.

boobs measure tape image (6)

“During those years I really just felt quite lost. I knew there was something out there for me but just hadn’t found my groove …”

Then he had a serious car accident.

His recovery demanded Segal get physically fit, which led to a job with Fitness First, then a job as general manager of a Sydney cosmetic surgeon’s laser clinic.

It was here he flicked his entrepreneurial switch.

Watching the price of cosmetic procedures, including breast enlargement, rise annually and thousands of Aussie women travel abroad to have surgeries for half what they paid at home, he “saw there was a discernible gap in the local market for a high-quality cosmetic surgery practice that could offer affordable breast augmentations without sacrificing patient care or surgical outcomes.”

“It was a business model I could see could work right here in Australia.”

Selling “everything” including his home unit and a laser clinic franchise, he got a private loan from a big four bank and pooled $2 million to start The Cosmetic Institute in partnership with the company’s surgical director and plastic surgeon Dr Eddy Dona.

Surgeon Dr Laith Barnouti from Plastic Surgery Sydney.image

The business launched in August 2012. Its mantra is “half the price; double the service”. Business immediately boomed. It has two custom facilities – in Bondi Junction and Parramatta – and plans to expand to Brisbane and Melbourne next year.

The size of the Australian breast enlargement industry is unknown. No public or private body yet captures statistics showing the number of local women undergoing cosmetic breast surgery domestically and abroad each year.

Breast implant companies are reluctant to share sale figures for privacy reasons, says Dr Tim Papadopoulos of the Australasian Society for Aesthetic Plastic Surgeons.

According to a Deloitte report, between 12,000 and 13,000 cosmetic surgeries took place in 2011 and research by the University of Technology’s Dr Meredith Jones in 2012 shows about 15,000 Australians go overseas for cosmetic surgeries annually, Dr Papadopoulos says.

There is a glaring lack of meaningful public data.

Still, Segal says his business has 40 per cent to 60 per cent of the local breast augmentation market.

Every week about 200 women pay $5,990 for surgery by one its nine surgeons; a radical departure from the status quo, according to the 34-year-old, who says it used to be standard practice for Aussie surgeons to charge $10,000 to $14,000 for a breast augmentation.

In September alone TCI turned over $4 million and in 2013/2014 about $15.5 million.

Its projected turnover for this financial year is $35 million to $40 million.

“The radical drop in price [we offer] has seen more than 5,000 patients come through our doors in just over 24 months.

“I think as consumers, we have been led to believe that if you pay less, you get less, and I wanted to prove the opposite.”

Surgeon Dr Laith Barnouti from Australia Plastic Surgery in Sydney agrees there have been massive price cuts in Australia’s breast enlargement sector this year.

Cheaper implants, more variety of implants, and more GPs performing breast augmentations are contributing factors.

In Australia, a graduate of a Bachelor of Medicine and Bachelor of Surgery (BMBS) can perform cosmetic surgery.

Worryingly, post-graduate specialist training is optional, he says.

“I have performed about 1000 breast augmentations since 2009 and know over the past six months there has been change as prices have dropped,” Dr Barnouti says.

“The implants are getting cheaper, more GPs are entering the market and when I began my specialist training in 2000, there were only two medical-grade silicone implants; now there are more than 10.

“Women have tended to stay in Australia for tummy tucks and facelifts because they are larger cuts with longer recoveries but that is changing.

“[Since winter] we’ve seen 10 to 15 per cent of women who would have previously gone overseas for breast augmentations staying here for their surgeries because there is more competition in the market, more specialists and the surgery, which cost $14,000 about 15 years ago yesterday cost $9,900.”

Selling a product that polarises consumers is his business’s biggest challenge, Segal says.

“It is like anything; people used to put you in jail if you walked down the beach in a bikini but over time things change.

“I believe it [opposition to cosmetic breast surgery] boils down to lack of understanding and information.”

Segal is “pretty happy” with where his business sits in 2014 but wants to expand to 10 clinics by 2020.

He says the market appreciates TCI’s transparency. Surgery prices are posted online.

“We do expect others to follow us. I mean there are already copycats copying our approach but you cannot stop that and I don’t think you should try.

“I want us to be the Kleenex of cosmetic surgery.” (8)

Henry Sapiecha

Expert advice on anti-wrinkle injections here


Around 33,000 anti-wrinkle injections are administered each year in Australia. However, despite their popularity, some women still remain uninformed when it comes to the different brands on offer, the different results they achieve, and what product they have received.

To ensure you’re fully educated about anti-wrinkle injections, we asked Dr Joseph Ajaka, cosmetic surgeon at Cosmos Clinic, seven of the most imperative questions you’ll need answered to guarantee you’re getting the best treatment possible.


bh: Are all anti-wrinkle injections the same?

Dr Ajaka: When it comes to anti-wrinkle injections, each product is different and the risks and benefits vary between brands. People considering treatments should speak to their doctor regarding the possible side effects, the effect of the treatment and how long the results will last. Also, ask your doctor about the benefits and risks associated with the brand they recommend and ensure they are using a brand with a trusted heritage of quality that is supported by clinical data for safety and effectiveness.

bh: Around half of all anti-wrinkle injection patients in Australia do not know there are different types of anti-wrinkle injections available. Why do you think this is?

Dr Ajaka: Women are doing some research ahead of their treatments – such as searching online or talking to friends – but they shouldn’t stop once the appointment is booked. The most important thing a patient can do is come in prepared and ask the right questions before, during and after their treatment. This ensures there’s no mystery to the treatment and increases patient satisfaction.

bh: Why is it important for a patient to know what brand of anti-wrinkle injection is being used on them?

Dr Ajaka: Patients who are the most satisfied with their treatment are the ones who are informed, are asking the right questions and are ensuring the anti-wrinkle injection they’ve requested is indeed what they are receiving.

bh: How can a patient ensure they know what type of anti-wrinkle injection is being injected into their face?

Dr Ajaka: There are five specific questions people should ask their doctors during their consultation:

1. Which brand do you use and why?
2. Has this anti-wrinkle treatment been extensively tested and researched?
3. How quickly will I see the effects of the injection and how long will the results last?
4. Are side effects different between brands?
5. How satisfied are you with the results?

You can download this question checklist from to your phone and take it with you to your next appointment.

bh: What kinds of side effects are commonly associated with anti-wrinkle injections?

Dr Ajaka: When it comes to side effects, each brand is different. Ensure that you discuss the possible side effects with your doctor and understand the variations between the different brands.

bh: When will a patient see the results of the treatment and how long will they last?

Dr Ajaka: Effects of anti-wrinkle treatments can be seen within the first week following the treatment and last up to four months depending on the area being treated. However, results can vary from brand to brand.

bh: How does a patient know if their doctor is using the right product for them?

Dr Ajaka: The best way to decide if the treatment will meet your needs is by looking at real results. Ask your doctor to show you some before and after images, and explain the result you want to achieve. You’ll want to ensure your doctor can provide a product that has a long heritage of achieving results for patients and can do the same for you.

Henry Sapiecha