Economy Puts New Wrinkle In Plastic Surgery

These are times when the whole plastic surgery market could use a lift and expansion.

Affluent Caucasian women who have long been the bedrock of the plastic surgery market are feeling the effects of the economy and holding off on the most expensive procedures: face-lifts, breast augmentation and tummy tucks.

But rather than aging gracefully, more women are opting instead for what doctors call “tide you over” procedures - wrinkle relaxers, lip plumpers and other injectable elixirs - things that appeal to women such as Michelle Zitelli, a sales professional in Tampa. She works out in the gym every day, but says she feels so much younger than the image in the mirror.

“I’m out there competing with women in their 30s and 40s, and I just turned 50,“ Zitelli said. “Of course, the economy has gotten a lot scarier, and I lost money in the stock market like everyone else. ... But I want my clients to know I have energy and will be there tomorrow. Presenting a fresher face makes people feel like you’re awake at the wheel.“

In December, Zitelli signed up for one course of lip injections and wrinkle fillers around her mouth for about $700. Friends said she looked great, and she followed up with Botox treatments for another $700 in February.

Ultimately, she may consider a more extensive procedure such as a face-lift. But those can cost $6,000 or more, so she’s holding off until the economy improves.

Thinking like that has prompted a 9 percent slowdown in the $10 billion U.S. plastic surgery market, the first downturn since 2004.

“People are thinking differently about themselves because of the economy,“ said Daniel Greenwald, Zitelli’s doctor. “They’re asking ‘How long can I get away with something less invasive?‘“

What isn’t going away is the desire among women to look younger. A powerful mix of a down economy and image-obsessed pop culture is adding pressure to women’s mind-sets and self-image.

Doctors say some women coming to their offices have been laid off and think they need to better compete with younger-looking rivals for jobs. Others face new peer pressure from friends getting their first procedures. Even the rise of plastic surgery in pop culture is having an influence, with reality TV shows like “Dr. 90210” and dramas such as “Nip/Tuck.“

Economy

For now, economic forces appear to hold sway as all the big-ticket procedures are slowing.

Liposuctions, typically a $2,800 procedure, were down 19 percent in 2008. Tummy tucks, typically a $5,100 procedure, were down 18 percent. Breast augmentations, typically a $3,300 procedure, were down 12 percent.

For Florida, the trends hold extra significance as the Southeast is among the most lucrative regions in the U.S. field of plastic surgery. Anecdotally, doctors here say the Bay area is a popular spot for surgeries among women from Miami, Orlando and other cities, as they come here on a medical vacation and hide away from friends while they heal from incisions and bruising.

Consumers, meanwhile, are becoming more informed and frugal shoppers. RealSelf.com launched in 2006, offering a forum where women can trade their before-and-after photos and assign ratings on which procedure they found worth the money. Currently, the site lists eyelid-boosting injections and face-lifts as the best value; cellulite treatment ranked lowest.

Rise of tide-you-over

That kind of economic pressure has helped spawn an explosion of sales in less-intrusive and less-expensive items, marketed as temporary patches until patients are able or willing to spend more.

Botox injection sales rose 8 percent last year, along with wrinkle “fillers,“ laser treatments of leg veins and laser skin resurfacing. Botox treatments may last only a few months, but such procedures can cost a couple of hundred dollars, compared with a face-lift that averages $6,000 nationally.

“Some patients are really honest and say, ‘I just can’t spend the money today,‘“ said St. Petersburg plastic surgeon Randy Buckspan. “Some patients may really need a face-lift today. But they end up deciding on an injectable like Botox so they can do something, even if they probably need an ultimate solution down the road.“

The makers of injection drugs and fillers are developing a wider range of products. In years past, there might have been only one type of wrinkle-filler material derived from cow tissue, but now there are several competing manufacturers, each offering a half-dozen derivations of materials.

Even the longtime gold standard Botox brand could face a direct competitor. Reloxin, a muscle-relaxing derivative of the botulinum toxin - which in some forms is among the most poisonous substances known, but in other formulations, is used in medical procedures - is lining up for Food and Drug Administration approval.

Doctors expect the economy will eventually improve and unleash a wave of demand for big procedures. Until then, some doctors are pushing gift cards, “Mother’s Day specials” and something relatively new to lift the industry: coupons.