The economic impact is even bigger when the expected decline in the rest of the "luxury healthcare sector" is factored in, including such procedures as Lasik surgery to correct vision problems.
"While healthcare 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 saw 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%, so "2007 was still a good year for most folks," D'Amico said.
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 bathroom upgrades as common symbols of the good life and 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, 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% in January and February. He has heard some doctors are off by 30% to 40%.
Many doctors are trying to diversify into less costly -- and less invasive -- procedures or into reconstructive surgery for cancer patients and others that is covered by insurance.
