Margee Ferris is not trying to stay young forever. “I’m 52,” she said. “I just want to look like a good 52.” That’s why the consultant at Associates in Dermatology in Louisville has undergone multiple cosmetic procedures at the office where she works. The last five years have been busy ones for her skin: Botox injections to correct wrinkles between her eyes, a Blepharopasty surgery to lift her eyelids, a laser light facelift called “Thermage” to lift her cheeks and jowls and liposuction to tighten up her tummy, among others.

“People tend to think of having a cosmetic procedure done as being drastic. But most of the procedures we do here are really not invasive, and there’s not much downtime,” Ferris said. “With procedures like these, it’s really not about trying to avoid your age. It’s about taking care of your skin, taking care of yourself and looking your best.”

Television shows like Nip/Tuck, Miami Slice and The Swan portray extensive plastic surgery as the norm for the rich and glamorous. But Ferris is part of a subtle trend, where a growing number of Kentuckians from all walks of life are turning to cosmetic surgery to improve themselves. That’s in part because the procedures are becoming less invasive, less expensive and more effective. In 2003, more than 8.7 million procedures were done nationally – a 32 percent jump over the number done just one year before, according to the American Society of Plastic Surgeons (ASPS). For minimally invasive procedures like laser peels and Botox, the increase was even higher – 41 percent, to 6.9 million procedures.

It’s a trend that isn’t just confining itself to fashion-forward cities like New York, Los Angeles or Miami, either. “As for my business, I’d say it’s gone up by about 300 percent over the last five years,” said Dr. Mark Salzman, a Louisville-based plastic surgeon. “Louisville, with our great community of hospitals and medical professionals, is really a hotbed of plastic surgery. Kentucky is the gateway to the South, and the South has always been good for plastic surgery.” Chalk it up to the warmer weather or the South’s distinctive mix of cultures. Whatever the reason, doctors say plastic surgery rates are cooler in Northern states like Vermont and Michigan.

Dr. Michael McCall, of Associates in Dermatology in Louisville, has seen steady growth in his practice for non-invasive cosmetic procedures. He’s also noticed a change in his patients’ attitudes toward their appearance. “Twenty years ago, people tended to be very concerned about appearance until they hit 30, and they after that, it wasn’t such an issue,” McCall said. “Now people consider it very important to look vibrant and healthy throughout middle age and beyond.”

And the drive to look healthier and younger has spurred another sector out of hiding and into cosmetic surgeons’ offices – professionals. “I have more and more professional people coming into this practice saying they want to improve their image to be more competitive with the younger folks at work,” McCall said.

Ageless beauty
The evidence suggests plastic surgery is not just for the middle-aged and affluent anymore. Physicians in Kentucky report they are seeing more young patients than ever before. Dr. Lee Pu, plastic surgeon and assistant professor of plastic and reconstructive surgery at the University of Kentucky, has a three-month waiting list for cosmetic enhancement surgeries like breast augmentations and tummy tucks.

According to the ASPS, younger patients between ages 19 and 34 made up 26 percent of total cosmetic procedures done in the United States last year. Patients between 35 and 50 made up 40 percent, and the 51 to 64 year olds comprised 24 percent.

“When they get into their 30s and 40s, many professional women are looking at Botox, brow lifts, facelifts, collagen injections, eyelid surgery and tummy tucks,” Pu said.

It’s not only women who want to look and feel better. Men are opting for cosmetic procedures in record numbers. Nationally, men represented 18 percent of all cosmetic surgery patients, and 14 percent of the patients for non-invasive procedures. Though women still account for 90 percent of their practice, both McCall and Salzman say that they have twice as many male patients as they did a just a few years ago. Most men ask for liposuction of excess fat in the chest – a type of male breast reduction – as well as more standard eyelid surgery, facelifts, and liposuction of the belly.

“I’m seeing a lot of men in my practice for chemical peels, which has the benefit of smoothing out fine lines and taking care of uneven pigment or precancerous lesions,” McCall said. “But we still have a way to go to get men to pay attention to the upkeep with skin products. In this area of the country, most men just don’t want to mess with that,” he said.

Nearly every kind of surgery rose in number of cases last year. One exception: The popularity of Botox treatment – propelled to the front pages by figures like Democratic presidential candidate John Kerry – has started to replace the standard surgical forehead lift, procedures of which dropped 24 percent. Ironically, even while the FDA debated the safety of silicone breast implants, the number of breast enlargement surgeries climbed seven percent, according to the ASPS report.

Doctors and demand
Any licensed physician can perform a cosmetic procedure. “An emergency room doctor or an obstetrician could start advertising themselves as a plastic surgeon tomorrow, and there is no one to stop them,” Pu said. Most of his practice is still reconstructive plastic surgery.

Pu is the secretary and treasurer of the Kentucky Society of Plastic Surgeons, part of a national group of more than 6,000 board-certified plastic surgeons in the United States. He said that while demand for plastic surgery continues to grow, plastic surgery residency programs only graduate about 150 or 200 students a year across the nation. And Kentucky has attracted more than its fair share of qualified surgeons. Generally, demand for plastic surgeons is one per 50,000 in population. But there are more than 18 board certified surgeons in Lexington alone, and in Louisville, more than 35.

If that seems like a glut, experts say the market for cosmetic procedures is still broadening, and more and more medical professionals are getting into the business. Chief among them are dermatologists, responding to their patient’s growing needs by offering a host of minimally invasive procedures.

The physicians at Associates in Dermatology in Louisville, for instance, have devoted a separate wing to dermatologists who specialize in cosmetic procedures, broadening the services they offer. Here, patients can consult a dermatologist for everything from glycolic peels to rejuvenate the skin, to Botox injections, to laser procedures to lighten and tighten the skin, to liposuction. Many of the procedures ring up at under $1,000. They can also visit the firm’s aesthetician for advice on how to use pharmaceutical-grade skin-care products.

“Patients today are bombarded with information about what’s available, and they come into the office much better educated about what we can do for them,” said Dr. Tim Brown, dermatologist with Associates in Dermatology and an associate clinical professor at the University of Louisville.

More than 50 percent of all cosmetic procedures are now being done in surgery centers built and operated by the surgeons themselves. They’re convenient, but also loosely regulated. According to another Associates in Dermatology doctor, Dr. Seema Doshi, not doing your homework before getting cosmetic procedures can be downright dangerous. “When you are shopping around, it is really important to seek out a board certified dermatologist or plastic surgeon who has completed formal fellowship training or a reputable residency program,” Doshi said. “You can go to a laser hair removal center at a shopping mall…the person doing your procedure could have no medical credentials whatsoever. The patient has to ask to look out for themselves.”

A better image, a smaller bill
“We often joke among ourselves that we do so many of these breast augmentations, we wonder if there’s anyone left in Kentucky who’s flat-chested,” Salzman said. But patients are lining up at his office for a reason. Salzman is one of only 15 surgeons nationally doing a clinical trial of an improved gel breast implant that is thick, less likely to leak, and looks more natural.

Innovations like these are attracting new patients across the state. Today, patients can get mini-tucks and mini-facelifts with tiny scars. Where once physicians could only choose collagen to fill in fine lines and wrinkles, now they are transplanting the patient’s own fat or choosing from an array of longer-lasting fillers like Restylane that are now on the market.

“The tools we have available to us are working better, lasting longer and becoming more versatile,” Brown said. “More procedures than ever before are having little to no down time for the patient,” he said.

Doshi noted that lasers are also gaining ground for hair removal as well as “resurfacing” – a process that uses carbon dioxide lasers and other kinder, gentler techniques to help smooth and rejuvenate aging or uneven skin.

Like many plastic surgeons, Salzman has for the last few years offered financing for people whose insurance doesn’t pay, but who can’t afford to write a check for the whole amount. Much like a car lot, patients can work through the doctor’s staff on site to secure a loan with a credit company specializing in surgical lending – at rates far lower than just swiping their credit card.

Doshi predicts that the industry’s increased customer friendliness – coupled with America’s appetite for appearances – will push cosmetic surgery to evolve from a celebrity-exclusive rite of passage to a street-level convenience.

“I think as technology improves and we’re able to offer patients more non-aggressive options, the demand will continue to increase,” Doshi said. “It’s not as taboo as it was before. After all, as long as you work, your looks matter.”

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Shopping Therapy
The latest cure for a sagging image

If you’re not quite ready for a visit to the surgeon but you still feel like you need an image overhaul, you’re not alone. You may be the ideal candidate for an image consultant – a growing type of professional who offers individual tips for full fashion makeovers, hair advice, clothing secrets and makeup help.

Marjorie Dunn, owner of Louisville-based Your New Image, LLC, has built a business by charging clients $35 an hour to take them through their closets, throw out the unflattering and shop for the fashion touches they need to update their look. She also recommends hairdressers, gyms, career counselors and yes, even plastic surgeons.

“Most people I see generally look fine. What they need is a boost of self-confidence. Maybe they are a stay-at-home mom who’s re-entering the workforce. Maybe they are just hitting middle age and feel like their look has gotten out of date,” Dunn said. “The most common thing I hear people say is they want to look how they feel inside. I can help them do that.”

Dunn has these tips to give anyone who is looking for an “image makeover.”

Don’t throw everything out. Throw away the clothes you feel are the most unflattering or out of date, but keep those basic pieces that can make for good building blocks like that navy sports coat or that pair of black dress pants that fit so well.

Avoid falling into the trend trap. While it’s nice to have a few chic pieces, don’t buy an entire outfit that has a short fashion shelf life. Instead, invest in basics and accessorize with trendy items like ties, purses, shoes, jewelry, etc.

Buy a few key pieces and build your wardrobe around them. Instead of having 10 suits in 10 different colors, have four or five and buy shirts, ties and accessories that will allow you to mix and match outfits from those pieces.

Does it fit? Your clothes should hug your body in the right places, giving you a sense of proportion and comfort. It may be time to ditch those pleated pants, stretched out web belts and floppy shoes.

Mix it up with color. If you have a few neutral colors in your outfit, you can afford to wear that bright red shirt or that unconventional tie.

Consider the rest of the package. Part of an image makeover is assessing the health and look of your skin and hair, and consulting qualified hairdressers or cosmetologists. It may be time to get that facial or manicure. It may be time, too, to assess your overall health and lifestyle, and adopt a healthy eating and exercise plan. Even getting enough sleep can be an important boost to your energy level.

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Health and Prosperity
The marketing arm of Louisville's health care industry

There’s no doubt in Tom McMahon’s mind that Louisville has become something of a health care mecca in-between Indianapolis and Nashville. He wants everyone to know it.

“We just need to tell people about it,” said McMahon, executive director of the Health Enterprises Network, a branch of Greater Louisville Inc. charged with marketing the health care industry in the Louisville region.

The organization is a relatively recent addition to the medical superstructure that’s grown up around Louisville’s burgeoning hospitals, clinics and research facilities. Need to find a list of area pharmaceutical researchers? How about a play-by-play of health-related patents? Interested in the stock performance of the area’s major medical corporations? McMahon’s group has done the homework.

“We had to put all these documents together and do all this research to be credible in what we said, to prove that it’s true,” McMahon said. Now the three-year-old organization is poised to barrage national media outlets with the results. And next year, they expect to have a record $400,000 budget to do so.

The region has plenty going for it. Eight of the top 20 employers in the metro area are health-related businesses. Area research groups, led by the University of Louisville, currently utilize between $40 and $50 million in federal medical research funding, compared to around $7 million in 1996-97, according to Dr. Paul Coomes, an economist at U of L. Coomes added that cutting-edge experimental surgeries like face transplants are drawing even more dollars into the local economy (see story on page 30).

“Such exotic surgeries would bring in perhaps 95 percent non-residents” willing to pay the price of expensive new procedures, Coomes said. “For every dollar spent in the Louisville market, it creates about another $1.20 in new sales for the hospitals and other local firms.”

Louisville has made a name for itself in transplant surgery research and development with the transplant of an artificial heart in 1984 and a hand transplant in 1999. Local health-related businesses employ 72,000 workers in Louisville and draw an annual payroll of $2.3 billion. Among them, of course, are giants like Kindred Healthcare and Humana.

— Andy Olsen and Ed Ford

Susan Gosselin is a staff writer for The Lane Report.
editorial@lanereport.com