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Issue Date: July 2009


What's Hot Now

It was a tough 2008 for the cosmetic surgery industry, with the overall number of procedures seeing the first double-digit percentage drop in a decade. But a growing interest in smaller, more affordable options and a tough job market in which people are seeking any advantage has helped the industry in '09.
Lynne Thompson
editorial@clevelandmagazine.com
Late last year, Dr. Bahman Guyuron started noticing more patients telling him they could no longer afford the surgical procedures they inquired about during their initial consultations.

“They were saying, ‘Can you offer me another option that would buy me time, or can you do a less invasive procedure?’ ” recalls Guyuron, the chairman of the department of plastic surgery at University Hospitals and Case Western Reserve University.

He and his staff never asked why, but Guyuron says the reasons were obvious: Decimated stock portfolios, plummeting 401(k) accounts and dipping real estate values have everyone reconsidering big-ticket expenditures.

“Even people who have a significant amount of funds would not do the surgery because they were unsure of the future,” says Guyuron, who currently serves as president of the American Association of Plastic Surgeons and just finished his term as president of the Aesthetic Surgery Education and Research Foundation.

Guyuron’s experience is one shared to varying extents by many Northeast Ohio cosmetic surgeons.

Their numbers support statistics compiled by the American Society for Aesthetic Plastic Surgery that show a more than 12 percent decrease in the total number of cosmetic procedures between 2007 and 2008 — the second significant decrease since 1997, when the society began collecting such data. Surgical procedures alone declined by an even steeper 15 percent in 2008.

But Westlake surgeon Dr. Edward Levy notes that cosmetic surgeons haven’t taken as big a financial hit as those in other businesses.

“In my experience, things have been holding up better than expected,” he says.

Dr. Mark Foglietti, director of the Cosmetic Surgery Institute in Beachwood, says his business has remained relatively the same — a “positive,” he says, given the current economic climate. And at the Facial Plastic & Aesthetic Laser Centers in Garfield Heights, Fairlawn and Boardman, Dr. Richard Gentile has actually seen an increase in demand for the minimally invasive facial rejuvenation procedures in which he specializes.

“In tough economic times, you might see someone opt out of a $10,000 [or] $15,000 facelift and opt for a $2,000 laser procedure,” he says. “People don’t discontinue their interest in self-improvement. They just simply choose a less expensive treatment.”

Likewise, Dr. Michael Wojtanowski of the Ohio Clinic for Aesthetic and Plastic Surgery in Westlake and Dr. Bryan Michelow of Contemporary Cosmetic Surgery in Beachwood also report a spike in requests for nonsurgical procedures such as Botox and fillers such as Juvederm and Restylane.

Both women and men are seeking these services. The tightening job market has created a new group of patients who are interested in looking their best for their employers and for clients.

Dr. Janet Blanchard of Dr. Blanchard’s Plastic Surgery Center in Mentor gives the example of a 60-year-old customer service representative who came into her office to discuss a facelift.

“She said, ‘I sound very young over the phone. But when people come in to see me, they’re very disappointed, because they think I’m a lot younger than I am,’ ” Blanchard recalls. “Two or three weeks after the surgery, she looked like her daughter. Obviously, she could relate better to other people because she felt better about herself.”

Given this boost in popularity of less invasive or nonsurgical alternatives — even in the wake of a tough year for the industry overall — we asked Northeast Ohio specialists to give us the scoop on which procedures are hot right now.

Botox

This perennially popular injectable, which softens or eradicates frown lines and crows’ feet by temporarily paralyzing the muscles that cause them, was the first thing most Northeast Ohio cosmetic surgeons listed when asked about their most-requested procedures. It’s a common response, one that mirrors those of member physicians surveyed by the American Society for Aesthetic Plastic Surgery in compiling its 2008 statistics.

“It’s affordable, it’s quick, and there’s instant gratification,” Foglietti says of the procedure’s appeal.

Wojtanowski notes that a few well-placed shots to those aforementioned vertical lines between the brows and horizontal lines radiating from the corners of the eyes can be a fitting alternative to a brow lift or upper facelift for some patients. And unlike surgeries, Botox injections require absolutely no downtime. “People think more about taking time off from work now than they did a year ago,” Wojtanowski points out.

Gentile says the recent U.S. Food and Drug Administration’s approval of Reloxin, a variant of botulinum toxin sold outside the United States for many years, will make the treatment even more appealing to budget-conscious patients moving forward.

“More competition in terms of sellers will mean lower prices,” he says.

Hyaluronic Acids

Often mentioned in the same breath as Botox, these synthetic versions of the gel-like substance found in human connective tissue finished third on the American Society for Aesthetic Plastic Surgery’s list of top 5 nonsurgical procedures.

The injectable fillers, which include the brand names Juvederm, Restylane/Perlane and Hylaform, are typically used to plump up and smooth the grooves between the corners of the nose and corners of the mouth, as well as to diminish fine vertical lines around the mouth. Foglietti says hyaluronic acid fillers offer the same benefits as Botox, and there is evidence that hyaluronic acids actually help prevent existing grooves and lines from getting deeper.

“They have some properties that prevent various enzymes from breaking down collagen,” he explains. “It just kind of slows the whole process.”

Chemical Peels

Along with Botox and fillers, chemical peels have become another popular option for freshening a face. Wojtanowski says peels are preferable for lessening the appearance of fine lines and diminishing pigment changes and discoloration.

The range of options consist of surgical peels — such as those Wojtanowski calls the “very aggressive” 35 percent trichloroacetic acid peels that require approximately two weeks at home — as well as lower-strength, nonsurgical counterparts such as glycolic acid and lactic acid peels. The latter involve two to three days of recovery but take repeated applications to achieve the same results as the surgical peels.

Smaller Surgeries
Want to know how much surgical procedures have tapered off in favor of less invasive options? Only eyelid surgery made the American Society for Aesthetic Plastic Surgery’s overall top 5 list of cosmetic procedures for 2008. When it comes to surgical procedures, smaller, less noticeable options are the ones most commonly sought.

Foglietti notes that many of his clients request brow and neck lifts, because they offer long-term results in targeted areas —without the time and expense of the more elaborate facelift. The same is true of the short-scar or limited facelift techniques performed by Guyuron and Blanchard.

Guyuron explains that with these procedures, the incisions are not as long and the undermining of the skin not as extensive. The deeper layers are “lifted” then folded back and sutured under the skin. Ideal candidates include previous facelift patients considering maintenance work and those noticing the first effects of gravity.

“It’s a sensible choice for somebody who has limited resources and limited time to recover from the surgery,” he says. “The operation is shorter and safer, but it has less of an effect.”

Breast Augmentation

While the American Society for Aesthetic Plastic Surgery’s data indicates an 11 percent reduction from 2007 to 2008 in the perennially popular breast augmentation, Foglietti and Michelow report a jump in recent inquires about breast implant surgeries — particularly, Foglietti says, in 20- to 30-year-old women.

“I equate breast augmentation surgery in a woman to hair transplantation in a man,” Foglietti says. “It’s very similar from a psychosocial standpoint.”

Michelow explains the appearance of this major cosmetic surgery option on his own short list of most-requested procedures by pointing to the younger demographic that most frequently requests it.

“The patients feel that they’re only young once, and they want to look good,” he says. “They’ll find a way, either through financing or saving up, to have the procedure done.”

This increase in breast augmentation surgeries could be evidence of an upswing in cosmetic surgeries overall. In fact, some plastic surgeons have reported performing more surgical procedures of late than during the previous 12 months. It’s an improvement that Guyuron attributes to recent rallies in the stock market and a feeling among consumers that the economic free fall may have ended.

“I’m actually seeing more and more patients who we saw eight months or a year ago and did not do surgery coming in and scheduling it,” Guyuron says. “In fact, I just came back from an American Society for Aesthetic Plastic Surgery meeting in Las Vegas. We had a good deal of discussion about this, and everyone is seeing more and more patients scheduling surgery.”

Dr. Steven Goldman of Beachwood Plastic Surgery & Medical Spa says his experience has been that “people are coming in for everything” — face-lifts, nose jobs, tummy tucks and breast augmentations as well as the increasingly popular nonsurgical procedures such as Botox and chemical peels. Overall, he says business this spring was comparable to what he enjoyed during the same period last year. He worries, however, that the slow times of the year — the very end of summer and after the holidays — may be even slower than normal due to the sluggish economy.

“Maybe we’ve reached bottom,” he says, “but we certainly haven’t come back up out of the pit.”

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