Business is down at many plastic surgery practices in San Diego County, according to several surgeons in the area. Appointments at some offices have dropped by more than 50 percent, they said.The most pain is being felt by practices that depend on advertising rather than referrals to drive business. Many of those businesses tend to cater to a younger, less-affluent clientele that favors breast enlargement surgery and liposuction.
"We're seeing fewer consultations," said Dr. Robert Singer of San Diego's upscale La Jolla area. "During a time of downturn in the economy, practices see fewer shoppers."
Consumers are tightening their belts as they worry about job security and try to cope with skyrocketing prices for gasoline and food. One area of discretionary spending that some are cutting is elective medical procedures.
Because most cosmetic surgery isn't covered by insurance, putting off the purchase could save a bundle. One plastic surgery practice in the La Jolla area lists breast enlargement at $5,950, liposuction at $5,600 to $8,800, and a face-lift at $9,000 to $10,000.
The downturn, which took hold early this year, marks a stumble for the multibillion-dollar industry. It's the first slump for the sector since the dot-com bust in 2000, which was short-lived thanks to the surging popularity of nonsurgical treatments such as Botox, wrinkle fillers and laser skin resurfacing.
In the first three months of this year, cosmetic procedures at the Scripps Mercy Surgery Pavilion in San Diego dropped 30 percent compared with the same period in 2007, said Steve Green, executive director of the outpatient center.
Perhaps the doctors best positioned to weather the decline are those whose businesses include a substantial amount of nonsurgical cosmetic services or reconstructive plastic surgery, which aren't as greatly affected by the economy's undulations.
Doctors say the slowdown didn't show up in the statistics reported in February by the American Society for Aesthetic Plastic Surgery because the downturn didn't emerge until late last year.
The number of cosmetic procedures performed in the United States actually increased 2.4 percent in 2007, according to the society's report. Physician fees, which can account for as little as half of the total fees charged for a procedure, totaled $13 billion.
The organization reports industry statistics only on an annual basis, so figures from 2008 won't be released until early next year.
Dr. Barry Handler said a fellow San Diego plastic surgeon who claimed to be busy with work a couple of months ago admitted several weeks later that he had cut back on his schedule because of a lack of business.
"Anybody who won't admit that they have been affected is lying," Handler said.
Dr. Ervin Wheeler said business at his cosmetic surgery practice in San Diego County has fallen off to levels reminiscent of the slump that hit the industry after the dot-com bust and the terrorist attacks of Sept. 11, 2001.
Consultations with new patients are down 10 percent and procedures are down as much as 20 percent, Wheeler said. In turn, income has fallen about 20 percent at the practice.
Wheeler hasn't reduced his office hours or cut back on his staff, and he's hoping things will turn around this summer.
Long-term demographic shifts seem to be magnifying the industry's troubles. Plastic surgery was once the exclusive realm of wealthy celebrities and social elites. Over the years, many cosmetic services came within reach of the middle class as lower-priced procedures became available and lenders started financing more costly work.
But those same middle-class consumers are the ones most likely to feel the pinch of inflation, job security concerns and tighter borrowing standards. Several plastic surgeons said business remains strong among older, better-heeled patients.
Beverly Douglas, 55, said she never considered putting off the eyelid-lift surgery she recently underwent. The retired school behavioral specialist said she wanted to finish the procedure before the summer, when she and her husband - the vice president of a biotech firm - will move to Arizona.
"I have a family history of those very droopy eyelids that interfere with sight," Douglas said. "I just decided that rather than waiting till I was 70 or 80, I would do it (when I was) younger. I was also pretty frustrated by people telling me that I looked tired when I actually felt pretty good."
Douglas paid cash for the operation. "We are in a very fortunate position, being young and being able to afford that," she said.