In the fall season opener of “Nip/Tuck,” the sleek Los Angeles office of McNamara/Troy sat forlorn and empty, a voice-over reminding that when times are tough, one of the first things to go is the luxury of elective cosmetic surgery.

That same scene could be played out in plastic surgeons’ offices all over, as people seem to be passing up big-ticket beauty procedures — face-lifts, liposuction, breast augmentation — and seeking less expensive ways to achieve beauty ideals.

According to both the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, the number of cosmetic surgical procedures done in 2008 was lower than in 2007 — by 9%, according to the ASPS, and 15%, according to the ASAPS. And although 2009 figures will not be available until late February or early March, plastic surgeons say, anecdotally, that business for the year was down at least 20% from 2008.

As a result, cosmetic surgery practices are finding themselves acting somewhat as financial consultants to their patients, helping them work out payment plans, negotiating fees and making out lists of priorities — a Brazilian butt lift can wait, but those wrinkles under the eyes need to be dealt with right away. In addition, plastic surgeons who previously only focused on the expensive and invasive procedures have had to turn their hands to the quick fixes — fillers, peels, laser treatments — which are increasingly in demand now.

Nonetheless, and partly because of an increasingly competitive job market, people still want to get work done, Mayer said, but they need cheaper options. Among them: Botox, Restylane and other injectibles that minimize wrinkles are proving especially popular and, at about $1,000 a treatment, are more affordable than the average $10,000 for a face-lift.

Experts are seeing trends across the board that are providing an insight into how people are choosing to spend their beauty dollars: Injectibles are holding their own, expensive products are not. The time between haircuts and mani/pedis is being stretched out, and massages and other body treatments are being postponed. But while fewer people are signing up for pricey liposuction surgeries, treatments such as laser liposculpture are proving popular.

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Laser Clinic MD: High Cost Treatments Taking a Backseat

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as those that send heat deep into the skin, can be used to suppress the oil glands in an effort to stop the breakout cycle.

Smoothbeam is the most popular diode laser used to shrink the size of the oil glands and suppress their activity. It heats the outer layer of the gland and creates a mild thermal injury that decreases sebum production. In addition to reducing active lesions and preventing new ones from forming, the nonablative resurfacing effect of collagen remodeling also helps reduce scarring.

Patients usually see a 40% to 50% improvement after the first treatment, but three to six are normal, with severe acne and scarring requiring up to 12 treatments.

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Lasers can shrink oil glands

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Caution for those with darker skin before you try laser hair removal….

The best candidate for light-based hair removal is someone with fair skin and dark hair.  Dark hair absorbs light more effectively, but the light can’t tell the difference between brown hair and brown skin. This can be tricky for those with darker skin types, like African-Americans, Hispanics, and some Asians.

A doctor could under-treat and get no response, or he or she may over-treat, stopping hair growth, but damaging the pigment-producing cells in the surrounding skin, leaving white spots.

Try to find a dermatologist who performs a lot of laser hair removal and also treats people with your skin color and type on a regular basis. Be sure to ask if he or she has treated others with your skin type with a fair amount of success, and what the complication rate has been.

It is also recommended that you ask how old the doctor’s technology is, since devices manufactured before 1999 emit pulses that are too short to address darker skin. Using these older machines could leave serious blistering and permanent discoloration.

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Laser hair removal on darker skin

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A study in the Journal of the American Academy of Dermatology says if you want to see a skin doctor about a changing mole, get ready to wait. The average wait time is 26 days. But if you want a Botox shot, it’s just eight days, two-and-half weeks shorter. Here in mid-Missouri, two dermatologists say that’s not true.

“There’s a shortage of dermatologists nationally,” dermatologist John Despain said. ”Also, patients have direct access to dermatologists for skin care.”

Dr. John Despain owns Despain Dermatology Center and Skintuition Medical Spa in Columbia, focusing on cosmetic dermatology like Botox. He says at his practice, clinical appointments always come before cosmetics.

“They are seen on a priority basis within a few days,” Despain said. ”If they’re a new patient, if there’s the ability to put them in a new patient slot, they priority over anyone calling for cosmetic concerns, of course.”

At Dr. Lindall Perry’s practice in Columbia, they treat all appointment requests the same.

“We don’t have, quote, ‘cosmetic appointments,’” he said.

Although Perry is booked through January, he says patients with skin problems can get appointments.

“We have open appointments in two weeks with our newer staff and they would take both a cosmetic patient, an acne patient, a wart patient,” Perry said.

Perry says it can be a challenge juggling business and patient care.

“I like to think I have sound business practices,” she said. ”I do schedule myself very fully. My staff would say too full. My patients would say too full. We pay attention though to the frustration of long waits.”

With a heavy focus on clinical treatments, Perry says he tries to see as many patients as possible. Often leaving the Botox appointments for after hours. He says money is a benefit of his practice, not the motivator.

“My desire everyday is to find every melanoma that’s in front of me and not to miss that,” he said. 

As for Despain, he likes biopsies just as much as Botox.

“I view them as a compliment to each other,” he said. ”If I had to choose how to spend my time out of enjoyment or profitability, they’re probably equal.”

Both doctors say there’s certainly a demand in mid-Missouri for cosmetic dermatology, but most of their patients and profits stem from clinical work. In the meantime, if you want to see a dermatologist, the best idea is to plan ahead.

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Cosmetic Dermatology: No wait for Botox or Photofacials.

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An estimated 100,000 cosmetic surgical procedures are performed in Britain each year, many by doctors who have had no specialist training in cosmetic surgery. In addition, hundreds of thousands of non-surgical procedures are done, including Botox for wrinkles and laser treatments to rejuvenate skin, many by non-medical staff with little or no training.

The 200-member Baaps represents the top surgeons in the business who performed 34,187 surgical procedures in 2008, twice the number in 2004. More than 90 per cent of them were on women. The most popular procedure was breast augmentation, demand for which rose 30 per cent last year.

But Mr Mercer, who combines private practice as a cosmetic surgeon specializing in facelifts with his work as an NHS consultant in reconstructive surgery for cancer patients, said the market for cosmetic surgery, of which Baaps surgeons account for less than one third, was an “unregulated mess”.

He added: “There has been a massive increase in plastic surgery marketing, including discount vouchers, two-for-one offers and holidays with surgery. In no other area of medicine is there such an unregulated mess. What is worse is that national governments would not allow it to happen in other areas of medicine. Imagine a two-for-one advert for general surgery. That way lies madness.”

Mr Mercer, in the journal Clinical Risk, which publishes articles on cosmetic surgery today, he warns that “the doctor’s first duty to protect the patient” has been forgotten in the headlong rush to cash in. “The motive for performing any procedure must never be financial gain … if we cannot self-regulate then regulation will eventually be imposed.”

Citing experience in France, where all advertising of cosmetic procedures is banned, he says: “Perhaps, like tobacco, there should be a Europe-wide ban on advertising all cosmetic surgical procedures, including on the internet search engines.”

Among those who can testify to the dangers is Jill Saward, the former lead singer of 1980s group Shakatak, who last year agreed to a facelift in the hope of reviving her career after her divorce. But she suffered complications aggravated by her high blood pressure and bitterly regretted the decision. Three months after the operation she still did not have full feeling and was warned full recovery could take a year.

“Surgery is not a quick-fix solution,” she said. “The simple truth is that I could have died. I was an idiot, I should have thought much more carefully about the operation and its dangers. It was pure vanity.”

Foad Nahai, president of the International Society of Aesthetic Plastic Surgeons, backed Mr Mercer’s warning, and called for tougher regulations to prevent doctors practising without specialist training. A code of practice backed by self-regulation of cosmetic clinics was announced by the Government in 2007. Clinics are also subject to inspection by the Care Quality Commission. But Baaps says the measures do not go far enough.

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Cosmetic surgeons demand ban on advertising… cosmetic surgery!

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Skin laser treatments have gained increasing popularity. But what is a skin laser treatment?

Skin laser treatments are still relatively new procedures, but already it has been shown that laser skin procedures produce less bleeding, less bruising, and less postoperative discomfort and less down time than traditional cosmetic surgery procedures like face lifts.

Skin Laser Resurfacing

Laser skin resurfacing uses laser light to treat deeper layers than microdermabrasion, but not as deep as laser scar removal. These laser treatments lasts longer and produce less discomfort than many alternatives. Typical treatments are Fraxel, ActiveFX and DeepFX. (Thermage is not a laser but worth looking into.)

Laser Scar Removal

A variety of lasers can be used to treat different types of scars. CO2 laser resurfacing is a popular option when treating scars. If it’s unwanted pigment that’s the problem, IPL will be the treatment of choice.

Laser Tattoo Removal

Lasers are the most effective method for removing unwanted tattoos but it’s not easy. You’re going to need multiple treatments and it’s going to get expensive. (and painful). The lasers used to remove tatoos target the ink, basically blasting it apart inside the skin. Go easy on the tatoos in the first place.

Laser Hair Removal

A laser beam of light can free you from the tedium, frequency, expense, and pain of getting rid of unwanted hair. Laser hair removal is an attractive alternative to tweezers, shaving, and waxing. Bikini lines, underarms and lower legs are the most common choices.

Before you launch into laser treatments make sure you’ve found a reputable skin or laser clinic. (IE don’t get suckered into the mass market medical spa franchises that are popping up everywhere.) Find a local doc that you like. You’ll save money as well as your skin.

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Skin Laser

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Laser Treatment Classifications in Cosmetic Medicine

The invention of the laser has led to many advancements in the electronic and medical device industries. In the aesthetic arena, new and improved lasers are entering the market every few months. This rapid development is leaving the classification criterion to continually be redefined. Therefore, the following information is deemed to be a guideline and is not considered to be a definite and thorough description.

Lasers in use by medical practitioners typically have low outputs of energy and power, and are thus placed in ANSI (American National Standards Institute) Class 2 category. Another important organization is the LIA (Laser Institute of America). The majority of medical lasers fall into the ANSI Class 3 or 4 categories with most surgical lasers being in ANSI Class 4. Most medical and/or surgical lasers are classified by the FDA (Food and Drug administration) as Class II or Class III medical devices.

Class 1: These types of low power lasers are not considered to pose any hazards when operated according to normal conditions and includes lasers which are completely enclosed such as CD players, fiber-optics devices, and printers. These devices cannot have emissions exceeding the maximum permitted exposure (MPE) under any conditions are considered to be class 1 systems.

Potential dangers can occur during the repair of such devices since the laser is outside of the enclosure. Warning labels are required for this class inside the unit or underneath the cover.

Class 2a Lasers: Few lasers qualify for this class of low-power, visible light lasers. Lasers in this class do not pose a threat if the beam of light is directly viewed for periods of time less than 16 minutes or so. Visible light lasers with a total output power less than 1 milliwatt, but greater than a few microwatts.

Class 2: This class of lasers includes visible light lasers that are intense enough that viewing the beam into a human eye can cause the normal “aversion response”. An aversion response is when the eyelids close, or the head moves in order to avoid the light. It can occur within 0.25 seconds and includes the blink reflex time.

Class 3a: This includes those lasers emitting ultraviolet or infrared light as well as visible light. All devices within the Class 1 AEL (Allowed Exposure Level) with laser output between .18μm and 1mm fall in this class. (Common Laser pointers are class 3a laser devices.)

Class 3b: These include the same spectrum as class 3a, but increase the output levels to that of Class 2 AEL.

Class 4 Lasers: This class of lasers includes any that exceeds the Class 2 AEL. Most every laser that produces an excess of 0.5 watts is in this class. Laser hair removal, photofacials, laser resurfacing… these are all class 4 lasers and are classified as medical devices that must be used or overseen by a physician.

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Cosmetic Laser Clinic Classifications

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