Cosmetic enhancements like Botox may become more expensive. Photo: Getty Images

Have you been considering Botox, laser hair removal or a little nip, tuck?

Bad news: a hulking 5% tax could be coming your way. In the enormous health reform currently being debated in Congress, a 5% tax provision for cosmetic surgery procedures has been added to help pay for the $849 billion cost for health care reform. The tax would apply to any procedure the government deems "not necessary to ameliorate a...congenital abnormality, a personal injury arising from an accident or trauma, or disfiguring disease."

Cosmetic surgeons are outraged.

"People think only rich people have cosmetic surgery, and why not make them pick up part of the bill for health care reform? Maybe it was true 20 years ago – but not now. Today, a very large portion of the middle class has cosmetic procedures, and they're going to take the hit. They want to look and feel their best, and a lot of my patients feel it's important to getting or keeping a job in today's competitive workplace," says Miami Plastic Surgeon Dr. Carlos Wolf.

And the potential ramifications don't end there. Women will be mainly affected by the tax, since they make up the overwhelming majority of cosmetic patients. And, most disturbing to those in the industry, the confidential relationship between a cosmetic patient and her plastic surgeon would be affected. The beautiful results one wants, combined with the lowest complication rate risk depends entirely on customized care.

"As it is, in order to have insurance accept a breast augmentation labeled as 'reconstructive', a doctor has to remove a certain amount of tissue. I've heard of surgeons doing that to qualify a breast reduction patient for insurance coverage – even when it's not in the best interest of the patient to do that. This bill would just encourage more of that kind of behavior," says Wolf.

There are also industry concerns that if the bill passes the tax for all 50 states, patients will increasingly seek out dangerous, uncertified options that put their health – and possibly life - at risk just to circumvent the significant tax on top of what are already expensive procedures.

"This bill would make me a tax collector, and would put me in the extremely uncomfortable position of having to decide which procedures are cosmetic and reconstructive," says Wolf.