The healthy recession in cosmetic surgery.

Science, technology, and life.
April 8 2008 7:52 AM

Tuck Off

The healthy recession in cosmetic surgery.

Surgeon with a scalpel
What's cutting into the cosmetic-surgery market?

If your local real estate agent's face is hanging low these days, it might be more than sadness. The recession's latest victim is cosmetic surgery. "Plastic surgeons from the Southland to South Florida said some colleagues are struggling to stay in business," Ricardo Alonso-Zaldivar reports in the Los Angeles Times. A breast implant company disclosed a decline in surgeries late last year; a laser eye-surgery firm has lowered its forecast based on a similar trend early this year. A professional breast augmenter frets that in January and February, business for some of his colleagues was off 30 percent to 40 percent.

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

Excuse me while I celebrate.

It's not the suffering that gratifies me. It's the reaffirmation of the distinction between necessary and unnecessary procedures. People have always practiced medicine, albeit clumsily. And they've always adorned themselves, to the point of reshaping their heads and bodies, as the Mayans and Chinese did. (Even the Bush administration has yielded to nipple rings.) But despite the occasional overlap, medicine and body art remained two different things. One aimed at health, the other at beauty. One was necessary, the other elective. If your treatment looked really cool but all the patients died, it was a failure.

Modern cosmetic surgery has challenged that distinction. It has done so not in theory but in practice, by making aesthetic procedures so safe and lucrative that people who would otherwise have devoted their careers to medicine turned instead to cosmetic work.

Depending on how you count it, on an annual basis, the cosmetic-surgery industry—subset of the "luxury healthcare sector" and parent of the "facial aesthetics market"—is now worth $12 billion to $20 billion a year. Two weeks ago, the New York Times reported that last year, among 18 medical specialty fields, the three that attracted med-school seniors with the highest medical-board test scores were the most cosmetically oriented: plastic surgery, dermatology, and otolaryngology.

Cheerleaders hail the industry's expansion as a manifestation of upward mobility. First it was "democratized," as it became affordable to the middle class. Now it's being "globalized," with Europeans touted as the new clients whose influx will take up any slack in U.S. demand. I'm a big fan of capitalism, always glad to see it praised for the wealth it creates and spreads on the way up. But in this case, I prefer the discipline it imposes on the way down.

A month or two ago, the industry seemed invincible. "For a growing number of Americans, Botox is no longer a luxury, it's a necessity," the Associated Press declared. Despite the recession, doctors, companies, and financial analysts were projecting double-digit growth, and not just in lips and bust lines. Their confidence was based on several theories. One was that people valued bodily appearance more than jewelry, fancy handbags, and other luxuries. Another was that social pressure to look young would force us to keep shelling out. A third was that cosmetic procedures were "addictive," largely because patients feared regressing to their previous appearance. "You get used to the way you look," one analyst observed. "It's an incredibly effective dynamic."

Some people do seem addicted. "I would rather have Botox than go out to dinner," one woman tells the Los Angeles Times. But her addiction seems to have found its limits. The real-estate bust has forced her to give up her four-figure treatments. Another woman has put off a tummy tuck. A third has postponed a face lift. "I can't allow myself the luxury of thinking about something that I can't have," she explains.

More effectively than any bioethicist, the recession is reminding people that cosmetic work isn't medicine. "While healthcare spending as a whole has traditionally moved independently of the economy—a safe haven—that really isn't the case with plastic surgery," a financial analyst tells the Times. In the new, sobered economy, the paper reports, some cosmetic doctors are diversifying into "reconstructive surgery for cancer patients and others that is covered by insurance." Insurance!

Say what you will about coverage-denying bean counters, but they do enforce the essential priority of urgent procedures over elective ones. In a health-care industry controlled by tight budgets and insurers, you might even see the cream of the med-school crop shift back to the kind of work that keeps people alive. I hope they're well-paid for it, and I hope the next rising tide lifts millions more families into the ranks of the insured. But let's never forget what the bad times taught us about what matters and what doesn't.

TODAY IN SLATE

War Stories

The Right Target

Why Obama’s airstrikes against ISIS may be more effective than people expect.

Why Is This Mother in Prison for Helping Her Daughter Get an Abortion?

The XX Factor
Sept. 23 2014 11:13 AM Why Is This Mother in Prison for Helping Her Daughter Get an Abortion?

Divestment Is Fine but Mostly Symbolic. There’s a Better Way for Universities to Fight Climate Change.

I Stand With Emma Watson on Women’s Rights

Even though I know I’m going to get flak for it.

It Is Very Stupid to Compare Hope Solo to Ray Rice

Building a Better Workplace

In Defense of HR

Startups and small businesses shouldn’t skip over a human resources department.

It’s Legal for Obama to Bomb Syria Because He Says It Is

How Ted Cruz and Scott Brown Misunderstand What It Means to Be an American Citizen

  News & Politics
War Stories
Sept. 23 2014 4:04 PM The Right Target Why Obama’s airstrikes against ISIS may be more effective than people expect.
  Business
Moneybox
Sept. 23 2014 2:08 PM Home Depot’s Former Lead Security Engineer Had a Legacy of Sabotage
  Life
Outward
Sept. 23 2014 1:57 PM Would a Second Sarkozy Presidency End Marriage Equality in France?
  Double X
The XX Factor
Sept. 23 2014 2:32 PM Politico Asks: Why Is Gabby Giffords So “Ruthless” on Gun Control?
  Slate Plus
Political Gabfest
Sept. 23 2014 3:04 PM Chicago Gabfest How to get your tickets before anyone else.
  Arts
Brow Beat
Sept. 23 2014 4:45 PM Why Is Autumn the Only Season With Two Names?
  Technology
Future Tense
Sept. 23 2014 1:50 PM Oh, the Futility! Frogs Try to Catch Worms off of an iPhone Video.
  Health & Science
Science
Sept. 23 2014 4:33 PM Who Deserves Those 4 Inches of Airplane Seat Space? An investigation into the economics of reclining.
  Sports
Sports Nut
Sept. 18 2014 11:42 AM Grandmaster Clash One of the most amazing feats in chess history just happened, and no one noticed.