By RHONDA L. RUNDLE
Vanity appears to be trumping frugality in a looks-conscious society.Despite the dismal economic climate, most women -- and men -- who undergo appearance-enhancing treatments such as Botox injections are spending hundreds or even thousands of dollars a year to maintain the regimen, aesthetic physicians say. Meanwhile, some older patients who are putting off or forgoing expensive facelifts are instead opting for less-costly injections and laser treatments.[Keeping Up Appearances In a Downturn] Ben Baker/Redux PicturesDoctors say a weak economy hasn't curtailed demand for Botox injections.Maralyn Burr of Omaha, Neb., in June lost her job as a district sales manager for bookstore chain Borders Group Inc. Ms. Burr, who is $140,000 in debt from her 22-year-old daughter's musical education, says she has slashed spending and all but stopped eating out. But she hasn't given up her Restylane and Botox injections. "It's like comfort food," she says.Nearly three out of four plastic surgeons who responded to a survey this fall reported that demand has increased or held steady for minimally invasive procedures, including Allergan Inc.'s Botox antiwrinkle drug, dermal fillers used to plump up lips and smile lines, and skin-smoothing chemical peels, according to the American Society of Plastic Surgeons, a professional group representing 6,700 surgeons. The survey also found a steep drop in demand for plastic surgeries ranging from breast augmentation to nose reshaping.To be sure, makers of aesthetic medical treatments are bracing for a challenging year ahead. While many established patients are sticking to their beauty regimens, it's tough to entice new patients in the current economic environment. In late October, Allergan said that dermal-filler sales were up 18% through September, but the company reduced its 2008 Botox sales guidance, citing overall "subdued demand." Medicis Pharmaceutical Corp. recently has been offering a $100 consumer rebate on its Restylane family of products.Most of the products used for so-called facial rejuvenation weren't available in the U.S. when the last downturn hit, so there's no historical precedent to estimate their sales performance in the current economic environment. While Botox has been on the market for nearly 20 years, it didn't receive regulatory approval for cosmetic use until 2002, at the tail end of the dotcom-led stock-market bust. Allergan's dermal filler, Juvéderm, which competes with Restylane, has been on the market for about two years.Joel Schlessinger, Ms. Burr's dermatologist in Omaha, says the number of his patients seeking dermal fillers began to increase on a year-over-year basis in the last few months, after posting declines earlier in the year. "Things are so bad [in financial markets] that investments aren't even worthwhile anymore, so people are investing in themselves," he suggests.[Keeping Up Appearances in a Downturn]Malcolm Z. Roth, a plastic surgeon in New York City, says that even people with good jobs and robust savings are worried about the future and are afraid to miss work for surgery. They come in, he says, knowing that they need a facelift but asking if there's "something I can do to tide them over." Botox and fillers, he responds. "I think that's probably something we'll be seeing more of next year," he adds.Pay as You GoPatients also like the idea that with aesthetic treatments, they can pay as they go, Dr. Roth says. The treatments cost his patients between $500 and $2,000 for a visit, rather than perhaps $15,000 for a facelift. "Botox lasts about four months, but if you can't afford to come back, you don't have to," he says. By contrast, patients are reluctant to run up credit-card debt on a big ticket item like surgery.Increasingly, many aesthetic patients view their treatments as professional self-preservation rather than as a personal indulgence. Appearances make a difference, says Kathleen Hudson, a 57-year-old marketing consultant in Falls Church, Va. "If you're in the business world and you want to be competitive with the younger people, you need to stay on top of your game," she says.Ms. Hudson says it costs her between $300 and $400 every six months to have a syringe of Restylane or Juvéderm injected in a few places around her mouth and smile lines. She says she considers the injections "maintenance" and compares them to the $300 cost of hair styling with color highlights. Her plastic surgeon, Roberta Gartside in Reston, Va., says she is remodeling her office and adding staff to accommodate more patients like Ms. Hudson who are seeking minimally invasive treatments rather than surgery.Media and political consultant Julie Buckner says that looking good gives her confidence to focus on her message when she appears on television. Now that the election season has passed, business is slowing and she expects money to be tight next year. The 41-year-old single mom, who lives in Los Angeles, is cutting spending and delaying a home remodeling project, but she isn't skipping her beauty injections. It's "part of my cost of doing business," she says. She says she is trying to stretch out the interval between visits to her injecting physician, Robert Kotler, who charges about $1,000 for her regimen of Botox, Restylane and Juvéderm shots.Aggressive promotions and discounts, mostly by retailers, are common in some regions, especially Southern California and Florida. A sandwich board outside the entrance to Pure Med Spa in Sherman Oaks, Calif.'s Fashion Square mall, for instance, promotes Botox for the highly competitive price of $9 a unit, based on a minimum purchase. The Anushka Cosmedical Centre Spa & Salon in West Palm Beach, Fla., is offering a "Buy 2 get 2 free Restylane package." According to the shop's Internet ad: "You and a friend receive four syringes of Restylane to share for the price of two."Wendy Lewis, a plastic-surgery consultant who sees clients in New York, London, and West Palm Beach, says she also advises physicians to adopt some of the same sales-promotion strategies as retailers. This holiday season, for the first time in over 11 years in business, she is offering her consumer clients a complimentary additional consultation if they purchase one between now and Valentine's Day.Client IncentivesIf high-end stores "can send out gift certificates the week before Christmas, Ritz Carlton has deals all over, and B.R. Guest restaurants offer 20%-off gift cards, it seems only reasonable that our clients deserve a bonus, too," she tells physicians.Doctors typically shun discussions of price cuts, but many offer them to longtime patients in a pinch. Dr. Schlessinger says he recently helped a local "news person" after she was laid off and was about to interview for a new job. He also gave Ms. Burr, the 61-year-old former sales manager in Omaha, a Botox discount. She has since landed a new job in sales for Verizon Wireless.Write to Rhonda L. Rundle at rhonda.rundle@wsj.com
