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http://www.nytimes.com/2009/05/07/us/07plastic.html?_r=1&ref=health

 

Hurt by Economy, Plastic Surgeons Find Hope in New Products

Isaac Brekken for The New York Times

A display of liposuction needles at the convention of the American Society for Aesthetic Plastic Surgery. More Photos > 

By STEVE FRIESS

May 6, 2009

LAS VEGAS — They can lift breasts and firm up thighs, but the nation’s cosmetic surgeons admit they are powerless over a sagging economy.

And yet, hope is rising, along with the Dow, what with the first competitor to Botox just approved last week and potentially revolutionary new treatments on the horizon, including stem cell injections and a cream that can remove unwanted facial lines.

“Business has definitely been flat,” Dr. Brian Kinney, a Los Angeles surgeon, said at the annual meeting of the American Society for Aesthetic Plastic Surgery, which concludes here Thursday. “I can think of a particular woman who said in October she wanted a facelift but she said, ‘Well, I need to sell a house because I want to make sure I’m secure.’ And then she told me in March she was still waiting, the real estate market’s down.”

The number of cosmetic procedures in the United States last year fell 12.3 percent from 2007, to just over 10.2 million, according to the organization. That is a setback for a business that had seen unabated growth since 1997, when about two million procedures took place.

The biggest growth area has been nonsurgical procedures, owing largely to the success of Botox, a botulinum toxin that works by numbing and relaxing facial muscles that create wrinkles. Yet the company that markets Botox, Allergan Inc., is bracing for new competition now that the Food and Drug Administration has approved the second botulinum toxin for similar use, Dysport, produced by the French drugmaker Ipsen Biopharm Ltd.

“Everybody is excited about it because it’s the first competitor to Botox in seven years,” said Dr. Z. Paul Lorenc, who practices in Manhattan and who views Dysport as a faster-acting, longer-lasting and potentially less-expensive option. “It’s also a softer look.”

Also pending are studies into topical versions of these muscle-numbing medications, although none are expected to come to market for years. Already, though, doctors here are debating how useful or practical it might be.

“There’s a concern that if you were to give the patient the cream to take home, they’d just keep putting more and more and more on, and you’d have a dosing problem,” Dr. Kinney said. “And patients might start putting it on other places, like around the mouth, and then they might not be able to move their mouths properly.”

Stem cell treatments were on the minds of many as well, although the potential applications are vague. The thinking seems to be that doctors may some day be able to extract stem cells from a patient’s own fat and use them in lieu of breast implants to produce self-regenerative tissue that would provide a more natural feel than silicon-gel or saline, now the standard. No one is sure yet if it will work and several doctors voiced concern as to whether it is safe and how they would be able to regulate the tissue growth.

Another potential growth area is in nonwhite patients, who have long been underserved, said Dr. Julius W. Few, a surgeon from Chicago who lectured at the conference on how to provide nose jobs for non-Caucasian patients while preserving their ethnicity.

“We know by our statistics that this is a growing group by interest in plastic surgery,” said Dr. Few, who performs as many as 40 nose jobs a year on nonwhite patients. “Being African-American, when I was growing up, it was said at my house and a lot of other houses that plastic surgery was only for wealthy white people. That seemed unfair to me.”

The four-day event was a serious medical conference of nearly 2,500 practitioners and exhibitors attending live demonstrations, listening to debates over newer techniques and browsing countless models of implants and needles that were on display.

Still, the convention offered provocative sessions like “137 Rhinoplasties in 20 Patients: What Went Wrong?” “The Weird Smile After Facelift Surgery: A Dynamic Investigation” and “The Role of Chin Augmentation in Achieving Facial Harmony.”

Doctors at the conference hoped to get out the message that they were far from the stereotypes of predatory practitioners who take advantage of patients’ insecurities. They resent portrayals like that from a “Sex and the City” episode in which Samantha Jones, played by Kim Cattrall, is worried about aging and wants a small operation but is told by a physician that she ought to consider several other procedures. She eventually decides on “aging gracefully.”

Of the fictional surgeon’s behavior, Dr. Robert Singer of San Diego said, “That never happens.” Dr. Singer added: “I generally will turn that question in a different way when a patient asks me what I think she needs done. It’s not a matter of what I say. It’s what bothers you.”

Dr. Singer said that part of the challenge was managing patient expectations.

“The public wants something that has essentially no down time, that has maximum improvement, that is non-invasive, that has no discomfort and that has no cost,” Dr. Singer said. “They want magic. That magic pill doesn’t exist.”

 





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