Cosmetic-surgery business sagging

LOS ANGELES — It used to be a high point of Goldy Anthony's life. Every six weeks or so, as a morale booster, she and her girlfriends would make appointments to see a Beverly Hills plastic surgeon for touch-ups: plumping the lips and smoothing the frown lines on the forehead. He was "an artist," Anthony said, with Botox and Juvéderm.

Afterward, the ladies would dine at a popular restaurant on the Sunset Strip.

No more.

The subprime loan crisis, the housing slump and the general decline of the economy have claimed another covey of victims. Anthony is in the real-estate business, and the cosmetic treatments — at $1,800 or more a pop — can no longer be squeezed into her budget.

It's the same with others in the group.

"We used to make appointments together," she said. "Then they started saying, 'I can't go next week.' People didn't have the money, but they were ashamed to tell you."

Anthony, 41, is looking for a job since her career in the mortgage business went sour. She has not had the facial treatments in months.

What's been happening in Beverly Hills is apparently happening around the country. After years of steady growth, the cosmetic-surgery business seems to be going through a rough patch. Doctors don't like to talk about it, but plastic surgeons from Southern California to South Florida said some colleagues are struggling to stay in business.

"I think we're going to feel it," said Dr. Richard D'Amico, president of the American Society of Plastic Surgeons, who practices in New Jersey and teaches at a New York medical school. "When people get concerned about the economy, they tend to cut back on the discretionary items."

Economic impact

At a time when several million families face the loss of their homes and possible ruin, the financial problems of relatively prosperous women — and, increasingly, men — is not the stuff of tragedy.

But in 2007, cosmetic surgery was a multibillion-dollar industry, so a slowdown is a blow to more than vanity. Doctors collected more than $12 billion in fees for such procedures and nearly that much more went for nurses, anesthetists, operating rooms, materials and other things.

The economic impact is even bigger when the expected decline in the rest of the "luxury health-care sector" is factored in, including such procedures as eye surgery to correct vision problems.

"While health-care spending as a whole has traditionally moved independently of the economy — a safe haven — that really isn't the case with plastic surgery," said Jeff Viksjo, a Morningstar analyst. "Consumer confidence is at multiyear lows, and it's clear to us that patients, as a whole, will cut back."

The American Society of Plastic Surgeons does not compile monthly statistics. Last year, there was a slight drop in more complicated procedures such as face lifts, while cheaper procedures such as Botox increased. The overall number of procedures increased 7 percent, so "2007 was still a good year for most folks," D'Amico said.

Symbol of the good life

Beyond the economics, there is another dimension: Once largely confined to movie stars and rich socialites, cosmetic surgery has been democratized, thanks in part to the popularity of "makeover" television shows and decades of prosperity that have put such treatments within reach of large numbers of people.

Botox, breast enhancement and "body sculpting" have joined designer clothes, upscale cars, and kitchen and bath upgrades as common symbols of the good life and material success.

"No one can have a practice built on the ultra-wealthy because there aren't enough of those people to go around," said Dr. Robert Kotler, a Beverly Hills surgeon who specializes in the face. "The reality is that cosmetic surgery became popular when the middle class became enamored of it: flight attendants, professional people, businesswomen; people whose appearance is important to them."

In Los Angeles, a world capital for plastic surgery, established doctors are hoping that globalization will provide a cushion. Some are looking to European patients, who can capitalize on the weak dollar and combine their plastic surgery with a Hollywood vacation.

"This is a Mecca," said Dr. Stuart Linder, who specializes in breast augmentation. "I have women flying in from all over the world because this is Beverly Hills."

But Linder said his surgeries were off by about 5 percent in January and February. He has heard some doctors are off by 30 percent to 40 percent.

Kotler, who helped promote the cosmetic-surgery boom on television and with a book, said he has also seen a dip in his practice.

"What we do is strictly a choice made by the patient," Kotler said. "There is no medical urgency."

Wanting to be beautiful

Nonetheless, for patients, the emotional pull to be beautiful can be strong.

Judy Wade, who divorced in 2005 after 35 years of marriage, has put off a face lift she had hoped would spark her social life.

A Las Vegas businesswoman, Wade, 66, owns rental property. A few years ago, a Florida investment had seemed like a sure thing; real estate in the Panama City area was appreciating briskly. But rents have since come down and her costs have not.

"I can't allow myself the luxury of thinking about something that I can't have," she said of the $29,000 facial procedure she had planned to undergo. "It's one of those nonproductive emotions, so I don't allow myself to do that."