Cosmetic surgery feels knife of economy

As the economy goes, so go liposuctions, brow lifts, Botox and nose jobs. The American Society for Aesthetic and Plastic Surgery said last week that after growing at a breakneck pace for 10 years, business was down more than 11 percent in 2008. Surgical procedures, such as tummy tucks and eyelid surgeries, are down 15 percent, while noninvasive procedures such as chemical peels and injected fillings are down 11 percent.

“People are having fewer procedures, period,” says Alan Gold, a New York plastic surgeon and president of the Aesthetic Society. “People are being more cautious about where they are spending.”

Actually, compared to the downturn in the rest of the economy, cosmetic surgery is holding its own, Dr. Gold says.

“Look at the stock market, which is down 35 or 40 percent,” he says. “Our stats are not as dismal.”

That’s because if cosmetic surgery is something someone has been coveting, he or she likely will do it eventually, many doctors say.

“For people who are thinking about cosmetic surgery, it is never as trivial as people make it out to be,” says Robert Sigal, a plastic surgeon with the Austin-Weston Center for Cosmetic Surgery in Reston. “It is very important to them. Ninety percent of our practice is women, and women know what they want. They know how to save and make it happen.”

In the Washington area, business has been holding a bit steadier than in the United States overall, Dr. Sigal says. Surgical procedures are down, but injectables and other noninvasive procedures are about even or slightly up from where they were a year ago at Austin-Weston.

For one thing, the noninvasive procedures cost considerably less. Dr. Sigal says combining several facial procedures, such as injectable filling, Botox and facial resurfacing, can do as good a job as a full surgical facial rejuvenation - at one-third the price.

“Some patients are downgrading,” he says. “They are coming up with other things that may not be the gold standard, but it is going to be cheaper and still good.”

Eric Desman, a cosmetic surgeon in Alexandria, says the demand for noninvasive treatments in his office is up as well. These treatments - which include fillers such as Restylane and Juvederm, laser treatment and chemical peels - “have gone a long way to solve people’s problems,” Dr. Desman says.

“We can do this at an earlier point,” he says. “Rather than waiting until someone is 70 and saying, ‘Gosh, I need a full face-lift.’ ”

Regular use of fillers can even have a permanent effect, Dr. Desman says. He says some patients who came to him for injections to reduce the appearance of nasal-labial folds (the “marionette” lines that form from the sides of the nose downward toward the corners of the mouth) started out needing two syringes of filler.

A year or two later, they may need only a half to one syringe and eventually might not need any filler.

Many patients are still finding a way to fund the big procedures, though. The Aesthetics Society reports that more than 355,000 women had breast augmentation in 2008. This makes it the most popular cosmetic surgery procedure in America, surpassing liposuction for the first time.

Dr. Desman says breast augmentation has been his top procedure for years and runs around $5,800 in the Washington area.

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