Karen Russi was tired. She was tired of looking at herself in the mirror and seeing “an old prune” staring back. She was tired of looking tired. Tired of feeling tired.

“I needed to be rejuvenated,” said the 64-year-old special education teacher.

After contemplating a brow lift and CO2 treatment to erase the wrinkles from her face, Russi, who believes her job -- and her salary -- are “pretty safe and secure” in the current economy, took the plunge in the spring. The treatments cost $6,000.

That might seem surprising, given the recent surge of news reports on Americans who are increasing their savings and cutting back on spending. Indeed, the $12 billion to $20 billion cosmetic surgery industry had been tracking with the economy, taking a major hit last fall. Procedures in California declined even more than the national average -- they were off 30% to 40% between June and December 2008, compared with the previous year.


But the industry started making a comeback in the spring, spurred by doctors’ reduced rates and a sense that the economy’s death spiral may be slowing. And although they are not the only generation that has embraced cosmetic procedures, baby boomers -- who comprise that infamous demographic bulge in the population -- are helping to spur the trend.

“A lot of the economy moves with the baby boom,” said Mark Berman, an L.A. cosmetic surgeon who is president-elect of the American Academy of Cosmetic Surgery. “What I’ve been telling a lot of my colleagues who are somewhat disappointed and fearful of this down economy is: Sit tight.” The boomers, Berman said, are aging and “getting ugly.”

And aging is great for business.

Cosmetic surgery is a plastic surgery specialization designed to enhance the body’s appearance toward some aesthetic ideal. It covers scores of procedures, and demand for them is expected to grow 8.4% annually through 2012, with less invasive procedures such as Botox growing the most quickly, according to a September 2008 study from the Freedonia Group, an international research firm.

Getting a chemical peel or laser skin resurfacing requires less recovery time, less scarring and less money than so-called invasive procedures, such as a tummy tuck or breast augmentation. Many of those less expensive, less invasive undertakings -- including Botox and hyaluronic fillers (Restylane, Juvederm) -- are performed with a syringe or sponge instead of a knife.

Sheila Brown, 53, was concerned about recovery time and decided to have a laser face-lift to tighten up her neck area and the lower part of her face. Instead of cutting into her hairline, the laser face-lift required four small incisions -- one behind each ear and two in the crease of her chin.

“I was very attracted to the fact that it was a lot less invasive and the recovery time was a lot less than a regular face-lift,” said Brown, who works as a certified public accountant for a mutual fund business in Sacramento. She had the procedure done the Friday before Memorial Day weekend and was back on the job in a week.


One month later, she still had a little numbness and swelling, “but the stitches are out and I look completely normal. You’d have to have a discerning eye to see the swelling,” added Brown, who spent $2,500 on the procedure. Although her company has instituted a salary freeze and she is watching her expenses, Brown said the $3,500 discount she received from her doctor sweetened the deal.


Patient incentives

Many cosmetic surgeons have been offering discounts and specials to lure patients. They’ll throw in a free syringe of Botox, or perform a second, complementary procedure at no charge or for a reduced price.

“We used to give discounts on multiple procedures anyway, but we took it to the next level at the beginning of the year,” said Jacob Haiavy, a cosmetic surgeon and medical director of Inland Cosmetic Surgery in Rancho Cucamonga. “It’s tough because 90% of what we do is elective. People have been more scrutinizing and resistant to spending money.”

Haiavy’s own practice was down 40% between October and February compared with the same five-month period in 2007-08. These days, his business is still off, but only by 10%, thanks to the month-long specials he’s been offering, like those he ran earlier in the year. Patients who came in for a tummy tuck got a $1,750 liposuction treatment free; those who bought two syringes of Juvederm for $595 apiece got a third at no cost. Although Haiavy says he cannot continue the discounts forever, he hopes that today’s happy patients will result in returning patients later -- especially those who are putting off larger surgeries with “get-bys” such as Restylane.

The $1,000 discount Emma received was part of the reason she decided to get a breast augmentation, taking her from “a barely B” to a 34D. The 23-year-old USC student had been thinking about such an upgrade for years but finally decided to go through with it because “the economy being so poor, offices were willing to work with you.”

Emma, who asked that her last name not be used because she believes her decision might affect her job search once she graduates, got the discount because her mom was getting a breast reduction done by the same doctor. “Since my mom and I were together, it was more of a price break,” said Emma, who paid $6,700 for her enlargement -- $4,000 in cash, the rest financed.


When she graduates from USC next year with a degree in business administration, Emma will be $100,000 in debt from school loans. She said, “In the big picture, [my surgery] was not that much. I feel a lot more confident.”

“Once somebody decides they’re going to have cosmetic surgery, it’s something they’re going to do,” said Jean Loftus, a cosmetic surgeon based in the Cincinnati area and author of “The Smart Woman’s Guide to Plastic Surgery.”

“It’s not ‘if.’ It’s ‘when.’ Other discretionary things you sometimes go, ‘Gosh. I could live without that,’ ” she continued. But “the whole reason cosmetic surgery works is because people are willing to spend money to change something in their body that changes the way that they feel about themselves, that substantially and dramatically improves their own lives.”

That’s why Loftus believes cosmetic surgery “will pick up sooner than the rest of the economy.”

The numbers seem to support Loftus’ belief. There were 12.1 million cosmetic procedures performed in 2008, according to the American Society of Plastic Surgeons. That number reflects a 9% decline in surgical procedures but a 5% increase in minimally invasive procedures, such as Juvederm.

“We haven’t seen a dent in our skin-care and minor procedures, including lasers and peels,” said Loftus, who attributes the even keel to “people who might have otherwise had surgery turning to a less expensive alternative.”


That’s merely a rational consumer response, said Paul Albanese, an associate professor of marketing at Kent State University in Ohio. “Anything that’s a luxury, consumers tend to be more responsive to changes in price,” he said. “Luxury goods tend to have high price elasticity because it’s not something the person needs. . . . When prices are out of reach, they substitute lower-price products.”

They still want what they want, however, and if they have the means, they will get it.

“I understand it’s really bad out there and prices are going up on everything,” said Russi, who lives in north Fontana. “I thought maybe I should sit back, but I’m not going to live forever. I had to do what I felt is OK. I still have money. I’m not broke.”

Even better, her treatment has had the desired effect. “The reaction I get is what I’d hoped for. People say, ‘You look great. You look rested, without looking all stretched and pulled and fake,’ ” she said. “I like what I look like. I just wanted to freshen it up a little bit.”