Andie Gauna didn't flinch as a local plastic surgeon administered shots of Botox around her eyes to reduce the appearance of wrinkles.
Gauna, who works with Dr. William Brender at Adirondack Aesthetic Arts in Glens Falls, N.Y., has also had filler injections to smooth her chin, correct what she described as a "gummy" smile and even out a bump on her nose.
"I wasn't so concerned that I wanted to go under the knife," she said, adding that she's been thrilled with the results, even if they are temporary.
Gauna is among a growing number of people opting for less invasive procedures to improve their appearance -- a trend spurred in part by the growth of in-office options and also by the economic downturn.
"Everything is going toward less and less invasive procedures," said Brender, who opened Adirondack Aesthetic Arts in 2006 to focus primarily on Botox, fillers and laser treatments. He had spent the previous 20 years running a practice dedicated to cosmetic and reconstructive surgeries.
So far business has been slow, but Brender believes there is a market in Glens Falls.
Other surgeons in the region agree that in-office procedures have been more popular than major cosmetic surgeries due to the economy.
"Instead of the big procedures, patients are going for laser surgery," said Dr. Mohan Sadana, also a longtime Glens Falls plastic surgeon.
According to the most recent data from the American Society of Plastic Surgeons, minimally invasive cosmetic procedures were up 5 percent from 2007 to 2008, while cosmetic surgical procedures declined 9 percent for the same period. "The shift has been due to economics," said Alan Matarasso, a spokesperson for the American Society of Plastic Surgeons and a practicing doctor in Manhattan. "People can spend less but still look good." But even before the recession hit, the industry had begun a major shift toward in-office options, which in turn has broadened the customer base to include a younger and more middle-class demographic. Dr. Juan Garcia, a plastic surgeon in Glens Falls, said patients who can't afford to take two weeks off for recovery from surgery are looking for less disruptive alternatives. And Garcia, like other surgeons, is now seeing patients in their 30s who may not need or want a permanent surgical procedure. Some lawmakers have taken note of the growth, too. Last month, Senate Democrats added a tax on cosmetic procedures to their health care reform bill. The 5 percent excise tax on everything from liposuction to teeth whitening is expected to generate $5.8 billion over the next 10 years to help fund the $850 billion overhaul.
Industry groups have railed against the tax, saying it discriminates against primarily middle-class women who are paying out-of-pocket for these services. According to the American Society of Plastic Surgeons and its sister organization, the American Society for Aesthetic Plastic Surgery, 86 percent of cosmetic surgery patients are women, while 60 percent have a household income of $30,000 to $90,000 a year. "This tax is effectively a 'soccer mom' tax that will adversely impact mainstream American wives and mothers, who are the majority of plastic surgery patients," said Dr. Renato Saltz, president of American Society for Aesthetic Plastic Surgery. "As doctors, we understand and appreciate the need for health care reform, but taxing physicians and cosmetic surgery procedures to pay for the reform is not realistic or beneficial." Allergan, Inc., which makes Botox and Juvederm, has also criticized the proposal. "Taxing medical procedures -- any medical procedure -- is a dangerous precedent," said Allergan CEO David Pyott. The Senate has said the tax wouldn't impact surgeries for congenital abnormalities, personal injuries resulting from an accident or trauma, or disfiguring diseases. But local plastic surgeons say they are worried about how officials will determine what's reconstructive and what's cosmetic, as that's been a battle they've waged with insurance companies for decades.
"We already have arguments with insurance companies that call everything cosmetic so they don't have to pay for it," Sadana said. Some doctors have gone a step further, saying there is a risk that such disputes could lead to IRS audits of medical practices, which could compromise medical records. "It's a problem for our patients," Garcia said. While the fate of the cosmetic tax remains uncertain, Gauna at Adirondack Aesthetic Arts is sure that she'll be back for more of the filler that gave her a new nose, chin and smile. "I'm hooked," she said.