Plastic surgery boom

In a town of fake pharoahs, imitation pirates and faux French cafes, what's a little surgical facial artifice?

Booming business.

From the two to three plastic surgeons the area gains each year to a local clinic seeking to change the face of plastic surgery marketing worldwide, Las Vegas is becoming a hot spot for that tummy tuck or liposuction.

"There are a tremendous number of people who believe Las Vegas is the hottest place to do plastic surgery," Charles Vinnik, a local surgeon, said.

Vinnik recalls a time when Las Vegas had only two plastic surgeons. That was back in 1969, and he was one of them. Plastic surgeons' advertisements now span 15 pages in the Las Vegas Valley telephone book, covering at least twice as many pages as any other physician specialty.

Nationwide, plastic surgery for cosmetic, rather than traumatic, reasons increased from almost 2.1 million procedures in 1997 to 4.6 million last year, according to the American Society for Aesthetic Plastic Surgery.

"It's huge," said Daniel Morello, a New York surgeon and president of the elite professional society that, among other things, tracks industry trends.

"Liposuction increased as much as 33 percent in a year," Morello said. "There's a perception of a healthy economy. These are luxury spending-type things. And there seems to be increasing pressure to look well and to look healthy."

And people who can't get there one way certainly can pay to get there another. Morello says Las Vegas was for years considered "under-supplied" when it came to plastic surgery.

"The guys out there made it on a heck of a lot of breast augmentations in show girls and in noses," Morello said.

Locally, surgeons say times are changing.

"Within the last five to six years it's really opened up," Vinnik said. "They keep coming to wherever they think the grass is going to be green."

Green it is. With one of the nation's fastest-growing populations overall, a spiraling population of people age 50 and older and a host of entertainers, the Las Vegas patient base is fertile ground.

Barry Markman, a surgeon who left New York in 1986 and moved here to open his practice, said states with lots of sunshine typically have lots of plastic surgery business.

"Back in '86 this was an excellent market. And it still is. Any growing city like Orlando or Las Vegas -- in the Sun Belt -- is where cosmetic surgery is performed more," he said. "It's a growing population, and the disposable income is good."

High ratio

Nevada has one plastic surgeon for roughly every 37,500 residents, making it second only to the District of Columbia in the ratio of plastic surgeons to population, according to the most recent figures available from the American Society of Plastic Surgeons.

Liposuction was the most popular procedure nationally last year, the society's figures say, followed by breast augmentation, eyelid surgery, face lifts and tummy tucks. Buttock lifts rank, coincidentally, at the bottom. Las Vegas surgeons say their patients, like those nationally, are overwhelmingly women -- 80 to 85 percent. But men are increasingly being drawn to plastic surgeons' offices for laser hair removal, hair transplants and liposuction.

Locally, surgeons say breast augmentation definitely ranks right up there -- especially among teens who feel they look "uneven" or women who have had children.

Markman says he performs 500 to 600 of the procedures a year. And about 100 of those are for patients from other states. Markman says his out-of-towners come here because of his reputation.

But owners of the Las Vegas' Estetika Institute figure patients also come here for the same reasons people like to visit. That's why they chose Las Vegas for their first posh, one-stop shop for everything from laser hair removal and liposuction to breast implants, cosmetic dermatology and dental procedures.

Estetika opened about 18 months ago behind Desert Springs Hospital and offers just about any cosmetic procedure available, Naomi Barsilay, president, said.

Its staff includes three plastic surgeons, a dermatologist, a dentist and a ear-nose-throat surgeon who also is a dermatologist and a nutritionist. Putting that many physicians in a single center devoted to plastic surgery isn't common, Barsilay said, but it is the wave of the future.

"This enables us to have every one of the doctors specialize," she said. "With plastic surgeons, most do everything. We took plastic surgery a step further, enabling the physicians to specialize in whatever they're most comfortable with," Barsilay said.

People who want more than one procedure -- say a face lift and then some cosmetic dental work -- don't have to find a plastic surgeon, then start over on the process looking for a dentist. Everyone is there in one office, Barsilay said.

"Dermatologists work with surgeons who work with the dentists," she said. "And we have a file here. We know you. You don't have to go through everything again."

But the real difference in Estetika is presentation. The lobby looks like that of a posh day spa. The Internet site touts the concept of "rejuvenation vacations," where out-of-towners can have surgery and do the initial recovery away from the curious eyes of family and friends.

And they can do a little shopping, see a show or just hang out at the Monte Carlo, Luxor or Las Vegas Hilton -- the hotels where Estetika books rooms for their patients. The center has a travel coordinator on staff who does everything from arranging for airline tickets to booking hotel rooms to having someone meet the patient at the airport when they arrive.

"We take a medical procedure and turn it into a rejuvenation vacation," Barsilay said. "People like the idea. They like to come here."

They come alone or with a spouse. Mothers and daughters are a popular combination as are sisters, she said.

Estetika is looking to open a second center in Washington, D.C. -- which leads the nation in the plastic surgeon-to-resident ratio with one per 31,500 -- and on the Spanish Riviera.

"This is our flagship. Every other center will be working in the model we set here," Barsilay said.

It's glamorous, but Barsilay said the staff takes the procedures very seriously. Anything that requires tranquilizers or anesthesia is done at the hospital or licensed surgical center. Nurses stay with the patient for 24 hours afterward, or they go to a licensed post-operative care facility for initial recovery.

The nutritionist gets the vitamins started before the procedure and counsels patients afterward on diet.

"If you're doing a liposuction and you don't change your eating habits, you'll be a patient again in a year," Barsilay said. "If you want to keep your figure, it's a matter of eating right and exercise."

Morello said the concept is becoming more popular nationwide, as a few other similar centers have popped up in some cities. But surgery is "clearly not a vacation," he added, and patients must be wary.

They need to make sure their "board-certified" surgeons are certified by the American Board of Plastic Surgery at the very least, he said. Membership in the elite American Society for Aesthetic and Plastic Surgery is a plus, but there are only about 1,400 of those in the country.

" 'Let the buyer beware' has never been more pertinent than it is today," Morello said. "You'll never be able to legislate good judgment. Know what your doctor's qualifications are and that your doctor can do in a hospital what he proposes to do in an office."

A surgeon that doesn't have hospital privileges isn't much of a surgeon, he said.

Career investment

For many Las Vegans surgery isn't a matter of vanity. It's a career investment. Having the right look can mean getting the right part in the right show.

Las Vegas singer Paul Finocchiaro says the minute his nose became smaller his options grew larger.

"When it got fixed my employer said, 'You can understudy the lead.' It's the difference between what you're capable of before and what you're capable of afterward employment-wise," Finocchiaro said.

He recalled a woman who worked as a dancer at a hotel-casino. She was a great singer, but the show manager said her ears were too big to leave the dancer's line and sing solo.

"He said, 'It's your ears, honey.' It's like you're good -- you can be a topless dancer. But you can't be a singer even though you have a voice to sing," Finocchiaro said. "At auditions they point-blank tell you you're not getting this job because your nose is too big or your boobs are too small."

Getting those sizes right can be costly, but not as much as in New York or Los Angeles, said Stephen Miller, who started his Las Vegas plastic surgery practice a month ago.

He says Las Vegas Valley prices hover around the national average on most procedures.

Figures from the aesthetic plastic surgery group show the average costs of procedures in the Mountain-Pacific region that includes Nevada are slightly higher than the national average. But that could be thrown off by big cities with higher prices such as Los Angeles.

In the Mountain-Pacific region the average price of a breast augmentation in 1999 was $3,248, the figures show. The national average was $3,142. The average liposuction in the Western region cost $2,518, while nationally the average cost was $2,322.

And a rhinoplasty -- nose job -- averaged $3,416 in the West compared to $3,398 nationally.

Finocchiaro paid about $8,000 for his nose job. He had a breathing problem that needed correction so health insurance picked up most of the tab. Most plastic surgery patients, however, don't have a medical condition. The price of the surgery is the price they pay for beauty.

"It does have its advantages -- especially in this business," Finocchiaro said. "Since I got my surgery, I get lead singer's jobs."

Vinnik remembers the days when people used to pay him by peeling bills off a roll of $100s. Those days definitely are gone. Even people who have the money pay for their procedures through a finance company or on credit cards. About 60 percent of Vinnik's patients pay on credit.

"One company offers an 11 percent interest rate, which is pretty good," he said. "People are buying cosmetic surgery like they're buying cars."

And just like buying cars, they price shop. About half of the calls Vinnik gets are people wanting to know what he charges for a certain procedure. If they never make an appointment, he knows they probably found it cheaper somewhere else.

Morello says patients need to forget the money long enough to make an educated decision. They need to check out the boards through which their surgeons are certified.

"They need to ask the hard questions," he said. "(Plastic surgery) has been made into a product rather than a service. People think buying a breast augmentation is the same as buying a Sony TV in the carton. That's the same product wherever you buy it, but (surgery) is not the same."

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