Cosmetic Procedures on the Rise Again

What price vanity? Try $12.2 billion.

That's the amount Americans spent last year improving their appearances with the help of cosmetic surgery, wrinkle fillers, facelifts, fat suctioning and other beautifying options.

About 11.5 million cosmetic procedures were performed overall in the United States in 2006, according to the latest survey released by the American Society for Aesthetic Plastic Surgery.

The number of procedures increased by 1 percent over the previous year, with most of the rise due to a surge in nonsurgical procedures, such as Botox injections and facial "fillers," said Dr. James Stuzin, a plastic surgeon in Miami and president of the society.

"The total is up by 1 percent," Stuzin said, even though surgical procedures actually declined by 9 percent.

For the latest survey, the society worked with an independent research firm and mailed out 14,000 questionnaires nationwide -- not only to plastic surgeons but to facial plastic surgeons and dermatologists, specialists who also often perform cosmetic procedures. "The survey is more comprehensive than in past years," Stuzin said.

So, what's the latest? "Botox is becoming fairly common in men," Stuzin said. Interest in the injectable treatment used to smooth out facial wrinkles such as crow's feet and that between-eyebrow furrow really began to boom in 2002, Stuzin said, when the U.S. Food and Drug Administration approved it for wrinkle relief.

Previously, Botox had been used "off-label," meaning many doctors used it for wrinkle relief, although it was not officially approved for that purpose but is common and legal practice.

In 2006, the top surgical procedures for both men and women were (in order of popularity) liposuction, breast augmentation, eyelid surgery, abdominoplasty ("tummy tucks"), and female breast reduction. For women, breast augmentation was the most popular surgical procedure, with almost 384,000 procedures done in the United States in 2006.

For men, liposuction was the most popular surgical procedures, with more than 53,000 such procedures done on men last year.

Botox was the most popular non-surgical procedure for both men and women, although the number of procedures on women -- 2.8 million -- was far greater than the number of procedures on men, 300,472.

Other popular non-surgical procedures included the use of hyaluronic acid (brand named Restylane and Juvederm); fillers used to plump up the face and reduce wrinkles; laser hair removal and skin resurfacing.

"The non-surgical procedures have opened up cosmetic enhancement either to people who were afraid or financially couldn't afford the surgery," Stuzin said.

He pointed to other patterns, as well. People are going in for cosmetic procedures at an earlier age, he said, picking non-surgical options such as skin peels and injectables first and delaying more major work (such as face-lifts) until they are older.

Not everyone thinks the rise in cosmetic surgery is a good thing.

"These numbers make me sad," said Joan Chrisler, a professor of psychology at Connecticut College in New London who has researched the topic of self-image. "It suggests people are so dissatisfied with themselves, they are willing to take risks and subject their bodies to all kinds of damage."

Chrisler points to a statistic in the survey that the number of cosmetic procedures has jumped 446 percent since 1997. "That's a big jump in 10 years," she said.

Those who decide to have a cosmetic procedure, she added, should "check into the side effects of what could go wrong and make sure it is worth the risk."

In agreement with that advice are officials from the American Society of Plastic Surgeons, another professional organization of physicians who perform cosmetic procedures. In a survey by the group released this month, pollsters found that nearly 40 percent of cosmetic surgery patients said they should have been more proactive in learning about side effects and potential complications before the surgery.

The survey, conducted by a market research firm and funded by a grant from pharmaceutical giant Merck & Co., polled 301 patients who had cosmetic surgery and 316 who had surgery that was medically necessary.

While 80 percent of the cosmetic surgery patients were pleased with the experience, about a third encountered "difficult to manage" side effects or complications after surgery, and 40 percent said they wished they had researched the surgery more extensively.

Among the suggested questions to ask a doctor, according to the Society: What are your credentials and training? How many of these procedures have you performed? What are the risks? Where will you do the procedure? What type of anesthesia will you use? What are the potential complications and side effects? How long is the recovery period? What can I, and can't I, do during the recovery time?

Chrisler suggested people also have realistic expectations should they decide to have cosmetic surgery.

"People often think they are going to be happier," she said. "And they are often not." To boost happiness, she tells them, "You have to work on the inside as well as the outside."