Bryn Collins paid nearly $10,000 for a facelift and eyelid surgery 10 years ago. Now, at age 65, she could have another, but opted instead for "facial fillers" -- at $1,500 injections that smooth eye wrinkles and marionette mouth lines for 18 months.
Though Collins' psychology practice was still smarting from the recession, she found a way to finance the shots. She quit shopping, hoarded the change in her pockets, and set aside the first $20 of every ATM withdrawal until she had saved enough.
"Psychologically, it's healthy for us to feel good about how we look," Collins said. "When I look in the mirror and see my grandmother's lips and all, I say, 'No!'"
Collins' willingness to part with hard-earned cash resonates with cosmetic clinicians who say demand for Botox, fillers, chemical peels, breast enlargements, nose jobs, Lasik eye surgeries and other out-of-pocket procedures are creeping back after a dismal three years in the elective surgery business.
"We have heard some recent rumblings that things are on the upswing," said Brian Hugins, a spokesman for the American Society of Plastic Surgeons. Although hard numbers for 2010 are hard to come by, anecdotes and industry surveys suggest a mild comeback.
And economists are keeping a close eye.
"We saw one of the biggest pullbacks in consumer spending and confidence in 50 years," said Wells Fargo senior economist Scott Anderson. "So the fact that this demand (for elective surgery) might be coming back is the first sign that the consumer is starting to come out of its deep freeze."
As printing, manufacturing and retail were smacked by the recession, so were medical procedures that patients elected to pay for on their own. Cosmetic surgeries plummeted 9 percent in 2008 and another 9 percent in 2009, according to the 6,000-member plastic surgeons group.
And more expensive procedures such as liposuctions, tummy tucks and breast augmentation surgeries dropped dramatically. Breast augmentations, for example, dropped 12 percent in 2008 and 6 percent in 2009. Liposuctions dropped 19 percent in 2008 and 2009.
Practitioners blame layoffs, stock market declines, underwater mortgages and tightened home-equity and other loans for throttling the $10 billion industry.
But the siege may be easing. An ASPS survey this year found that 15 to 29 percent of respondents nationwide acknowledged wanting a beauty procedure that was not covered by insurance. Another ASPS survey of physicians found that minimally invasive procedures, such as the facial filler injections that Collins received, rose 6 percent this year after climbing just 1 percent in 2009.
Several Minnesota surgeons now report that more patients are pairing insurance-covered procedures, such as deviated septum surgery, with out-of pocket cosmetic work like rhinoplasty or liposuction. Others find patients forgoing vacations, new cars and clothes or working extra shifts to pay for the quick-fix surgery of their dreams.
The entire industry is coming back "a little bit by little bit," said Dr. Joe Gryskiewicz, who performs about 500 breast surgeries, tummy tucks, rhinoplasties and injections a year at the Minnesota Valley Surgery Center in Burnsville. "We are seeing more people go for the cheaper procedures. In the last two years, I would say business has tripled (for) lower-level entry procedures."
To keep his revenues level throughout the recession, Gryskiewicz booked more shots and more patient consults. Before the recession, most of his clients qualified for surgery loans. Today five out of 10 discover just before the operation that they can't get the loan because of poor credit or tighter lending guidelines, he said.
Still, some determined patients find a way to finance their procedures.
At the University of Minnesota Medical Center, plastic surgery chief Dr. Bruce Cunningham said he's seeing more cosmetic patients because the economy's improving and people finally feel comfortable taking sick leave again.
"Early this summer suddenly we had a lot of people who came in. (They) were putting off health care that they thought was elective," Cunningham said. "They noticed a lump in their breast but put off doing anything about it because they were working overtime, people were getting laid off and they felt insecure about their jobs. They just didn't want to take the time off. But now we suddenly have a lot more breast" surgery patients opting for out-of-pocket breast surgeries as well as insured procedures such as lumpectomies, and post-cancer reconstruction.
Steve Parente, a health economics professor at the University of Minnesota's Carlson School of Management, said he is not surprised that several types of cosmetic surgeries appear to be improving.
"There is probably a little bit of pent-up demand in the market for that type of element," Parente said. "It's not unlike a kitchen makeover. Once people have discretionary cash again, they may say, 'It's time to get tuned up.' "
LCA Vision Inc., one of the largest Lasik eye surgery centers in the country, sees pockets of growth and signs of stability nationwide after two years of pure misery.
The company shut 17 of 78 LasikPlus Vision Centers as recession-weary workers stuck with eyeglasses in lieu of corrective laser surgery that can run $2,100 an eye.
"Procedures at all of our vision centers declined throughout this recession. But now we do see signs of stabilization," said CFO Michael Celebrezze. "We are just not sure it has been long enough for us to call it permanent."