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Consumers can find money for makeovers
Cosmetic surgery spending gains show business is recession-proof
By Jeff Swiatek, January 26, 2003
Undeterred by the sluggish economy, Judy Nolan is ready to shell out several thousand dollars for laser eye surgery next month to fix her poor vision.
"I've been saving up for this for about a year," she said, her eyes dilated after a preoperative visit to TLC Laser Eye Centers of Indianapolis last week.
While consumers have reduced spending on many goods and services in the recession that began in March 2001, spending on elective cosmetic surgeries remains robust.
"So far we have not seen a drop in the number of cases because of the economy," said Dr. Kimberly Short, an Indianapolis plastic surgeon whose Southside practice is called the Gillian Institute. "Last year was the busiest year we've had."
Nolan's eagerness to pay for enhanced vision and Short's busy waiting room point up the medical truism: Cosmetic surgery is about as recession-proof a niche as you can find.
From nose jobs and eyelid lifts to making breasts bustier and varicose veins go away, business is good. Very good.
From 2000 to 2001, U.S. doctors saw a 48 percent increase in the 30 most popular cosmetic procedures, including 32 percent more breast lifts, 23 percent more upper arm lifts and 116 percent more chemical peels for smoother skin, according to the American Society for Aesthetic Plastic Surgery
"Things have never been busier. It's just one (patient) after another. There are no empty days," said Dr. Malcolm D. Paul, a plastic surgeon in Newport Beach, Calif., who was fresh from performing a five-hour facelift.
Paul is not surprised. In 2001, while serving as president of the 1,600-member American Society for Aesthetic Plastic Surgery, he studied the history of cosmetic procedures over the past 100 years and found no lasting dips in business during economic downturns.
In fact, during tough economic times, more people tend to opt for cosmetic enhancements to their bodies. "The incentive," Paul said, "is to feel good by looking good."
Technology feeds the boom in cosmetic procedures, as medical firms and doctor-tinkerers discover new techniques to make aging bodies look more youthful.
The rapid acceptance of laser eye surgery, commercialized about nine years ago, has made it the most common surgery in the United States, with 1.7 million procedures done in 2001. Eye surgeons use a laser to reshape the cornea of the eye to improve a patient's vision.
Nolan, 44, who has worn glasses since age 7, decided to seek laser surgery after taking up horse-riding competition, where good peripheral vision is an asset and glasses get specked with dust and mud.
"It's absolutely something I'm doing for my personal life, for my pleasure," said Nolan, a market researcher for Roche Diagnostics Corp. in Indianapolis.
Price competition has helped sell the laser procedure, with prices as low as $299 an eye advertised in Indianapolis by the local offices of Florida-based Lasik Vision Institute.
Competitor TLC, which ranks as the nation's largest laser vision company, hasn't lowered its $2,400-per-eye price for several years, although it offers periodic discounts, said Jetta Kinzer, executive director of TLC's Indianapolis office.
About 60 percent of the local TLC office's customers pay for their surgeries with payroll money set aside on a pre-tax basis in federally regulated flexible spending accounts, she said.
With TLC's higher prices comes a lifetime guarantee of free enhancements for customers whose vision worsens again and requires further laser surgery.
But TLC, which has about 52 laser eye centers in the United States, may not be around to back up its guarantee if the publicly traded Canadian company doesn't turn profitable. It lost money every year from 1998 to 2001 and is expected to post another loss for 2002.
So far, TLC's close relations with optometrists, who benefit in referring patients to TLC by getting paid to do their pre- and post-operative care, has kept many patients from turning to low-cost rivals.
Darren Evans, 37, a Greensburg accountant who was getting an eye exam at TLC to see if he was a candidate for vision surgery, said he didn't bother checking with competitors.
"I'm not price-shopping this one. I'm going off my personal doctor's reference," said Evans, who said he has grown tired of the inconveniences of wearing contact lenses.
Cosmetic surgery to improve appearance relies on better medical techniques, such as the discovery that injections with the chemical Botox can improve sagging facial muscles.
Marketing also drives the demand for medical enhancements. "These services have become quite similar to retail businesses, including financing plans," said Mike Erler, a health care consultant at BKD LLC in Indianapolis.
Cosmetic procedures can be a more profitable line of work than treating the sick, infirm or injured.
The Noblesville plastic surgery practice of Sando Jones Aker now derives half or more of its revenue from cosmetic surgery, compared with 90 percent of revenue coming from reconstructive surgery four years ago, said practice partner Dr. Christopher S. Jones.
"More and more of it (reconstructive plastic surgery) has become a charity type of practice" because of low reimbursements from private insurers and Medicare, the federal health plan for the elderly, Jones said.
Doing more cosmetic procedures, such as lip augmentations and tummy tucks, helped the practice boost its revenue 50 percent from 2001 to 2002, he said.
Insurance seldom pays for cosmetic procedures, which easily can generate bills of several thousand dollars.
Cosmetic surgery has benefited not only from consumers' willingness to pick up the medical tab themselves, but by society's greater acceptance of going under the knife for the sake of aesthetics.
"It's not something you hide," said Short, who in the past two years has increased her office staff from six to nine people. Customers who opt for a procedure to make them look younger or fitter "are less inhibited about it. They're proud of it," she said.
Look-better medical procedures increasingly are seen as a business advantage, especially among salespeople looking for "a competitive edge," Short said.
And in larger cities such as Indianapolis, she said, plenty of plastic surgeons, vascular specialists and other physicians are eager to cater to them
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