Nip and Tuck Trade

Maurizio Viel cheerfully admits that he has had a nose job and gets regular botox injections to erase the wrinkles from his tanned face. But then Viel, 41, and his twin brother Roberto are plastic surgeons who operate the London Centre for Aesthetic Surgery. And while Maurizio is a walking advertisement for the benefits of modern cosmetic surgery, their clinic needs no promoting. Business, they say, has doubled since 1995.

Britain's cosmetic surgery industry seems to have been injected with a strong growth hormone. Even non-specialist doctors are routinely filling in unsightly wrinkles, puffing up thin lips and sucking out unwanted fat. The research firm Mintel estimates that 72,000 procedures were performed last year, up 31% since 1995, and that the value of the market has risen from $158 million to $216 million.

That's a trend being repeated across Europe, according to anecdotal evidence from doctors. Each month, the brothers Viel criss-cross Europe to work at clinics in Norway, Italy and Ireland. Corporación Dermoestetica, a Spanish group with 32 centers in Spain, this year will open clinics in Lisbon and Porto, Portugal. "There is no doubt that cosmetic surgery is growing in popularity," says Giulio Injianni, secretary of the German Association of Plastic Surgeons. "People are more confident about this kind of medicine because of media exposure." He says his own patient load has doubled in the past five years.

The boom is fueled in large part by new, less costly "quick fix" techniques that don't involve major surgery: botox injections that temporarily eradicate facial lines, derma-fills that smooth out wrinkles and scars and build up lips and cheeks, and laser beams that zap away lines. Liposuction, the process of vacuuming fat from the body, is gaining in popularity thanks to advances in keyhole surgery and other less intrusive techniques.

Cosmetic surgery is no longer the domain of middle-aged women, either. Britain's Transform Medical Group, which has 16 clinics, says two-thirds of its patients are under age 40, and half of those are under 30. Men are also increasingly seeking to enhance their looks by scalpel and syringe. The Viel twins and Corporación Dermoestetica say 30% of their patients are male. "We see more and more men around 50 coming in," says Yann Levet, who operates two clinics in France. "They say they are feeling strong competition from younger players at work." Sometimes they are simply lazy. Steven, 45, a retail display designer in Ireland, has twice had liposuction done to his chest and waist because he loathes exercise yet wants to look trim.

While technology has helped lower costs, cosmetic surgery remains a luxury. Various injections can cost from $180 in Germany to around $400 in Britain — and the effects wear off after several months. A face-lift fetches about $6,900 in France and as much as $10,000 in Britain.

Not all plastic surgeons are cheering the trend: some feel too many non-specialists are getting involved and also have doubts about the efficacy of some fad treatments. "A lot of these non-invasive techniques become fashionable, but it's a slightly dodgy market," says David Sharpe, a surgeon in Bradford, England. Some fills, he notes, can cause lumps, and lasers can scar if misused.

A major risk is that cosmetic surgery doesn't always work. Injianni is inundated by grossly overweight patients with unrealistic expectations about liposuction: "They want us to do things that are just not possible." Within limits, cosmetic surgery can temporarily mask the ravages of age and bad habits. That's clearly why demand remains high, at least until the next serious economic downturn. Given a choice between tight money and sagging skin, consumers may opt to live with the latter.