Patients choosing less-expensive options in plastic surgery

The economic downturn means that patients are less apt to have major plastic surgery but more likely to take advantage of increasingly available, minimally invasive cosmetic procedures.

The American Society of Plastic Surgeons surmises that because of rising unemployment, fewer people are willing or able to pay for major procedures. But people are willing to pay for Botox injections or other procedures they think would make them look more attractive to employers.

"If a patient is interested in getting a more youthful appearance, there are so many more options," said Malcolm Z. Roth, MD, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y., and vice president of health policy and advocacy for the American Society of Plastic Surgeons. "They don't have to worry about taking time off of work or a job hunt. If they're in the market for a job or hoping to maintain [a] job, having a more youthful appearance and feeling better about [their] appearance is an advantage."

Plastic surgeons also say that because minimally invasive procedures are more accessible, patients are coming in younger.

"They're not waiting for a face lift. They're coming in years earlier doing maintenance," Dr. Roth said.

Approximately 12.1 million cosmetic plastic surgery procedures were performed in 2008, according to a report issued by the American Society of Plastic Surgeons March 25. This represents an increase of 3% compared with 2007 and is primarily from an expansion in the number of minimally invasive procedures, which increased by 5%. Major procedures went down 9%, the first decrease since 2004.

Office-based cosmetic procedures increased by 13%, and the number of patients getting more than one procedure at the same time grew by 9%. When broken down by specific procedure, laser skin resurfacing was up by 15%, and the use of various soft tissue fillers rose by 5%. The use of Botox and various chemical peels both grew by 6%.

More expensive procedures experienced significant declines. The number of breast augmentations went down 12%, and breast lifts, 22%. Tummy tucks went down 18%. Liposuction decreased 19%, and eyelid surgery, 8%.

The society said growth also is being driven by the aging of the population. The use of minimally invasive procedures by those older than 55 grew 5% to 2.8 million. The use by those ages 40 to 54 increased 6% to 5.1 million.