Cosmetic enhancements were once the exclusive indulgence of celebrities, but minimally invasive procedures and moderate prices are drawing people from a wide swath of age and income brackets.

"There isn't one particular group that is seeking cosmetic surgery or cosmetic procedures," says cosmetic surgeon Dr. Mark Mandell-Brown, owner of the Mandell-Brown Plastic Surgery Center. His patients include teachers, business leaders and homemakers, and 25 percent are male.

Rather than an austere and sudden surgical procedure, a gradual and more natural change over a longer period of time is becoming more popular.

"We want a softer look in cosmetic procedures than we used to have. We're using more volume-type procedures, where rather than cutting, you actually put fillers and products under the skin that defy gravity and bring that natural look to your face," says Don Holmes, vice president of marketing and business development at Cincinnati Eye Institute.

At the CEI's Face & Eye Aesthetic Center, skin care experts use the VISIA Complexion Analysis System to assess five different skin issues "” wrinkles, spots, pores, skin tone and sun damage. They use the information to develop a customized skin care regimen to fit an individual's skin type.

This regimen can be combined with other cosmetic procedures for a holistic transformation, rather than focusing on only one facial area such as eyelids.

"You don't want to have a forehead that looks like you are 65 and eyelids that looks like you are 30," Holmes explains.

Affordability Key

Since 2008, many Americans may have been more cautious about their discretionary spending. But in 2010 they still opened their wallets to spend an estimated $11 billion on more than 13 million cosmetic enhancements, both surgical and nonsurgical, according to the American Society of Plastic Surgeons.

The cost of most nonsurgical procedures falls beneath the $1,000 threshold, save for some involving lasers.

"We are using lasers now that have a much quicker turnaround or recovery time, where there would be prolonged redness and (slower) recovery and now it's much quicker," Dr. Mandell-Brown says.

In Cincinnati, a Botox procedure to one facial area, such as the crow's feet around both eyes, costs between $200 to $300, according to Dr. Mandell-Brown.

Growing Popularity

Noninvasive procedures such as Botox injections, soft tissue fillers, chemical peels, laser hair removal and microdermabrasion are the top five nonsurgical procedures in the U.S.

Botox dominates the U.S. marketplace, accounting for 5.4 million of the 11.5 million total noninvasive procedures, according to the ASPS. Botox injections eliminate furrows and wrinkles by blocking communication between nerve and muscle cells, which makes the skin relax.

Another popular procedure is the chemical peel, which removes top layers of skin and improves the appearance of age spots, acne scars, fine wrinkles and sun damage. This procedure can also be applied over a period of time to gradually achieve a desired effect.

Surgical procedures have also increased by nine percent from 2009 to 2010, with the favorites being breast augmentation, nose reshaping, eyelid surgery, liposuction and tummy tucks.

"The Midwest has become a bit more accepting of the whole idea of cosmetic surgery and there are more people having it done than ever before. Most people here in the Midwest don't talk about it as much as they do say in California and Florida," says Dr. Peter J. McKenna, a plastic surgeon with the Cincinnati Institute of Plastic Surgery.

A new trend is younger patients in their 20s and 30s starting cosmetic procedures as a preventative measure to stay ahead of the aging curve, according to Dr. McKenna.

"One of the nice things about the Midwest is they really have good values," Dr. Mandell-Brown says. "They're not doing it to keep up with their neighbor. They're doing it (for) themselves."

Growing New Cells

Promising new technology involving stem cells might lead to advances in the future for cosmetic surgery, such as growing new tissues or increasing skin turnover to give people a more youthful appearance. These stem cells don't necessarily come from embryos, but can be taken from living siblings and even cadavers.

"We're seeing more interest in stem cell fat research, where they can harvest fat from different areas and then transfer that, and when you harvest the stem cells they will actually grow and multiply," Dr. Mandell-Brown says. "It's used for both cosmetic and reconstructive, but eventually it may be that instead of doing breast implants you're going to do fat transfer, which is your own tissue."

Deeper Motives

The growing cosmetic enhancement trend can partially be attributed to the aging baby boomer population, the same generation that shunned sun block and might want to correct the damage. People ages 55 and older had 3.3 million cosmetic procedures in 2010.

"A lot of people are planning on staying in the workforce a lot longer. In doing that, they want to have a more youthful look to be competitive," Holmes says.

Though some people might want to fit into their clothes better or compete with their junior coworkers, physical appearance is also an emotional issue.

"Men will sometimes develop breast tissue during adolescence and it doesn't go away. In which case, they will not go swimming, they will not go to the beach, and they will wear a couple of shirts and hide it for decades. They don't know that there's something that can be done to improve that. There [are] women "¢ who will not undress in front of husbands under any circumstances without the lights being off," explains Dr. McKenna.

"I think helping those people really is a rewarding part of what I do because it changes what they do and the way they really feel about themselves," he says.

Picking the Right Surgeon
Cosmetic surgery is elective, but surgery nonetheless, and choosing the right surgeon for your procedure is critical. Some things to consider:

Verify the surgeon's certification with the American Society of Plastic Surgeons, the American Board of Otolaryngology and the American Board of Cosmetic Surgery.

Check the surgeon's hospital privileges and the accreditation of the facility where the surgery will take place.

Visit at least three surgeons. Multiple consultations allow you to become more educated about options and procedures.

Develop rapport. It's important to be comfortable speaking with your surgeon about what to expect.

Check references. Your family doctor, friends, family, and previous patients can be great resources.

Compare costs to national and regional averages, but don't settle for a procedure
because it's cheapest.

View before/after photos. Make sure the surgeon you choose has performed your specific procedure before and that you are satisfied with the results experienced by other patients.

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