In the fall season opener of "Nip/Tuck," the sleek Los Angeles office of McNamara/Troy sat forlorn and empty, a voice-over reminding that when times are tough, one of the first things to go is the luxury of elective cosmetic surgery.
That same scene could be played out in plastic surgeons' offices all over, as people seem to be passing up big-ticket beauty procedures -- face-lifts, liposuction, breast augmentation -- and seeking less expensive ways to achieve beauty ideals.
According to both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, the number of cosmetic surgical procedures done in 2008 was lower than in 2007 -- by 9%, according to the ASPS, and 15%, according to the ASAPS. And although 2009 figures will not be available until late February or early March, plastic surgeons say, anecdotally, that business for the year was down at least 20% from 2008.
As a result, cosmetic surgery practices are finding themselves acting somewhat as financial consultants to their patients, helping them work out payment plans, negotiating fees and making out lists of priorities -- a Brazilian butt lift can wait, but those wrinkles under the eyes need to be dealt with right away. In addition, plastic surgeons who previously only focused on the expensive and invasive procedures have had to turn their hands to the quick fixes -- fillers, peels, laser treatments -- which are increasingly in demand now.
"We thought we'd be insulated better," said Dr. Toby Mayer, a Beverly Hills cosmetic surgeon. "But even though we have a large percentage base of Hollywood clients who are not affected by these economic conditions, for the large majority of our patients, the big procedures are out of the question for now."
Nonetheless, and partly because of an increasingly competitive job market, people still want to get work done, Mayer said, but they need cheaper options. Among them: Botox, Restylane and other injectibles that minimize wrinkles are proving especially popular and, at about $1,000 a treatment, are more affordable than the average $10,000 for a face-lift.
It's not just cosmetic surgeons who are having to play to the demands of the market. Dermatologists, hairstylists and all manner of beauty professionals are having to tailor their businesses to a marketplace now focused much more on the bottom line. In effect, luxurious and indulgent treatments are out; quick fixes with immediate results are in.
"Two years ago, it wasn't unusual for a patient to request a laser treatment, Botox and Restylane all on the same visit," said Dr. Jessica Wu, a Westwood dermatologist. "Nowadays, they're more likely to ask me which treatment they should do first, and which ones can wait till the next visit . . . so that we can prioritize what treatments we should do first."
Despite L.A.'s reputation as a body-conscious town, beauty practitioners say patients and clients are forgoing work on their bodies and concentrating primarily on the face. With the job market skewing younger, beauty professionals say, people come in saying they need to look more youthful, and quickly.
"If I look at my practice now compared to 15 years ago, the motivations are different," said Dr. Brent Moelleken, a plastic surgeon who has practices in Beverly Hills, Santa Barbara and Bakersfield. "Before, women would come in after they got divorced or widowed. Today, it's seen almost as a necessity to remain competitive in the business world. But while they're still concerned about a pot belly or their breasts, they are much more economically minded. They don't just walk into a plastic surgeon's office and get the most expensive procedure: They shop around, go to many doctors, look at prices and negotiate. In the heyday, even five years ago, they would be embarrassed to negotiate. Today, it's the rule."
Experts are seeing trends across the board that are providing an insight into how people are choosing to spend their beauty dollars: Injectibles are holding their own, expensive products are not. The time between haircuts and mani/pedis is being stretched out, and massages and other body treatments are being postponed. But while fewer people are signing up for pricey liposuction surgeries, treatments such as laser liposculpture are proving popular.
"The economy has not really impacted us," said Dr. Anh Ngo, medical director of Final Inches, a facility that offers laser liposculpture at its three L.A.-area branches. "We have a four- to six-week waiting list." The treatment is a cheaper and less invasive form of liposuction. It costs about $3,000 per area, about half of what liposuction costs, with almost no downtime for the patient.
"We're a better deal for the same results," said Ngo. "We see patients who have thought about it for years. Even if they haven't saved up for it, they seem to see the value in it for them. They want to see the quick results, so they can look and feel good on those job interviews."