Cosmetic surgery sags as purse strings tighten

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

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

Nonetheless, for patients, the emotional pull can be strong. Judy Wade, who divorced in 2005 after 35 years of marriage, has put off a face-lift that she had hoped would help spark her social life.

A Las Vegas businesswoman, Wade, 66, owns rental property in that city and in the Florida Panhandle. A few years ago, the 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 procedure she had planned to undergo. "It's one of those nonproductive emotions, so I don't allow myself to do that."

Cathy Hollingsworth is not in the real estate business; she manages a clothing store. But the 42-year-old mother of two from San Jacinto said she is holding off on $20,000 worth of surgery because she doesn't think it would be fair to her family in a shaky economy.

Hollingsworth, who once weighed more than 300 pounds, had gastric bypass surgery and shed 170 pounds. "Unfortunately, I was left with all the skin," she said.

A tummy tuck and breast augmentation were supposed to deal with the problem, but now they're on hold.

Her husband's job with an engineering firm appears to be secure, but the four-bedroom home the family bought 2 1/2 years ago has lost value. On their street in a brand-new subdivision, four or five houses now sit empty.

"If we weren't upside-down in the house, I probably would take the money out and have it done," said Hollingsworth, but "I don't want to make my family do without.

"I'll have to see how long I can tolerate wearing a girdle."

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ricardo.alonso-zaldivar @latimes.com