Part 1 of 3
CLEVELAND, March 22 (UPI) -- Two weeks ago, Sue O'Donnell, age 54, celebrated the coming of spring by doing some sprucing up -- on her face.
She received Botox injections to smooth crinkly lines around her eyes. She also received shots of a collagen-like filler to remove fine lines around her lips and smooth out her cheeks. Like millions of others, she is seeking a better, tighter, younger face.
O'Donnell, who lives in the suburban town of Glenties in County Donegal, Ireland, is just like baby boomers living in every corner of the developed world who are using modern medicine to address the anxiety conveyed in the Beatles' query, "Will you still need me, will you still feed me, when I'm 64?"
In the United States alone, 8.7 million cosmetic surgery procedures -- such as liposuctions, removing love handles and saddlebags, breast augmentations and full face-lifts -- were performed in 2003, a 32 percent increase over the previous year.
In the United Kingdom, 24,336 surgeries -- not including Botox or filler injections or liposuctioning to remove fat -- were performed in 2000, the most recent year for which data are available.
Cosmetic surgery is a huge growth industry, said Dr. Patrick Hudson, a plastic surgeon in Albuquerque, N.M. Moreover, Hudson said, a great deal of the growth over the last decade has come from the expansion of cosmetic surgery to a non-traditional market: middle-income patients.
"I had a patient come to me six or seven years ago saying that she needed a face lift because she was in the public eye so much and it was important that she look her best," Hudson told United Press International. "I looked at her and she didn't seem familiar. I didn't recognize her from television or from government -- people that we usually think of as in the public eye. So, I asked her what she did for living. She said, 'I collect the money at the gas station downtown. I sit in a little glass box and everybody looks at me.' What she said was true -- everybody did look at her all the time and she didn't want to look old."
O'Donnell puts it this way: "I say thank God for Botox and Restylane."
Her March 3 injections are her third go-round on Botox and she has had two treatments with Restylane, a synthetic gel similar to collagen, the naturally occurring substance that makes young skin fuller and more subtle but disappears with age. Botox is made from botulinium toxin type A, a powerful and dangerous neurochemical that paralyzes muscles -- but if a brow can't move, it can't wrinkle.
In the rural Irish countryside where O'Donnell lives, she receives her treatments at her daughter's beauty salon in nearby Ballyshannon. An Irish physician, who was trained in England to do injections of Botox as well as cosmetic filler -- visits the salon a few times a year, working as sort of a circuit-riding plastic surgeon.
O'Donnell said the Botox treatments cost her the equivalent of about $245, while the Restylane treatments cost between about $850 and $980.
Although U.S. physicians advertise their cosmetic surgery practices on television, radio and online as well as in print and on billboards, physicians in Ireland must rely on word-of-mouth, O'Donnell explained. "So, it's a bit odd really because if someone tells you about Botox you think, 'Oh, dear I must look like I need it.'"
Hudson said he is not a fan of billboard ads or television commercials, but he does have a Web site that features before and after photos, brief descriptions of available procedures, and a price list. He also includes information about procedures he claims are dangerous -- penis enlargement, for example -- that he does not perform.
In Savannah, Ga., plastic surgeon Dr. Richard Greco, said he, too, relies heavily on Internet-based advertising, but said he also uses word-of-mouth as a major marketing tool in his practice. He said in the last "10 to 15 years we have seen a definite change in the pattern of surgery patients -- we have more middle class and more men."
Fifteen or 20 years ago, Greco told UPI, women were having procedures done but were not talking about it. "Now women have become quite open about it, but men are where women used to be: They have procedures, but they don't talk about it."
The most popular procedure for men, according to Greco and other plastic surgeons, is liposuction -- the suctioning out of fat cells from specific areas of the body. Men usually have liposuction for "the abdomen and chest," Greco said. In the chest men often develop fat deposits around the breasts, a condition called gynecomastia.
The price tag for liposuction runs from about $2,000 to $2,500 for one body area, but that includes only the surgeon's fees. Most procedures are done in freestanding surgery centers, which adds about another $1,200 for supplies, anesthesia and so on.
Although men middle class members of both sexes constitute the new patients for cosmetic surgery, the other growth area is among the young, said Dr. Ronald Iverson, who practices in Pleasanton, Calif., a suburb of San Francisco.
Noting that he practices in the "dot-com area, which is very competitive," Iverson said his typical patient is a person in his or her late 30s or early 40s who wants to be "refreshed and younger looking." He told UPI his typical patient is "10 to 20 years younger than (the typical patient) when I started practice 31 years ago."
Iverson's scheduling assistant, Kris Dixon, is a good example of the so-called new cosmetic surgery patient.
Dixon had breast augmentation when she was 23. Her inspiration, she said, was her father, who "had his eyes done when he was in his 40s." Her first procedure was completed after the first of her first two children "left me with no breasts." So, she received silicone implants to "get a full B-cup." Then, 10 years later, after the birth of two more children, she decided to have surgery again.
"I had developed a condition called capsular contracture, but I was still very pleased with the silicone implants," Dixon told UPI. "This time I went larger -- to a full 36-D."
Breast augmentation typically costs $3500 to $4000, plus the cost of anesthesia and supplies, but by the time Dixon had her second procedure she was working for Iverson, which made her eligible for a generous employee discount. Dixon, along with her mother -- who does not approve of cosmetic surgery -- recently appeared on the "Dr. Phil" television talk show, with Dr. Phil McGraw, to discuss the growing acceptance of cosmetic surgery.
Cost can be a barrier for the procedures, because they are not covered by insurance, but financing has emerged as a common option over the past decade.
Greco said about 5 percent of his patients finance their surgeries, but many more pay using credit cards.
Next: Financing perfection
Peggy Peck covers medical research and women's health issues for UPI Science News. E-mail firstname.lastname@example.org