As the economy has sputtered and sunk these past couple of years, the billion-dollar cosmetic-surgery industry has experienced a dip in sales after a decade of double-digit-percent growth, sparking a new trend in our youth-obsessed society: an increase in discount plastic surgery.

Billboards advertising $2,999 bargain boob jobs from a "surgeon to the stars" have sprouted on the California 405 Freeway, a sign in the Midwest proclaims you can "Buy One Implant, Get One Free," while an advertisement near Clearwater, Florida brags "$8 Botox" injections.

While most of these catchy campaigns can be chalked up to clever marketing by enterprising plastic surgeons, horror stories like that of former Miss Argentina, who died at age 38 following a butt augmentation, prove that some bargain-basement procedures have their price.

"To get the cost down, they could be cutting back on things like general anesthesia. They make you feel like the procedure must be easier and not so serious if you're just getting local sedation. Nothing could be further from the truth," says Long Beach, Calif., plastic surgeon Dr. Marcel Daniels.

In fact, The New York Times recently published an investigative piece on the increase in doctors offering breast augmentation without anesthesia. Dr. Robert L. True of Colleyville, Tx., who is featured in the story, claims to prop up locally sedated patients halfway through surgery so they can confirm that they like the size of their implant before he stitches their breasts closed.

Even more shocking: Dr. True is actually a gynecologist.

This type of foray into plastic surgery by a doctor who studied an entirely different branch of medicine is part of what is fueling the cheap-surgery trend. Since patients pay in full up-front, these physicians don't have to deal with health insurance and hiring staff to process billing and claims.

"Many physicians not trained as plastic surgeons can legally perform a surgical procedure in their office. These people often claim that they can do the same procedure as a plastic surgeon under local anesthesia and may even claim they are more scientifically advanced," says Beverly Hills plastic surgeon Dr. John Anastasatos. "The truth is that they don't have surgical privileges at hospitals and surgery centers because they simply are not surgeons and never trained as surgeons."



Everyday folks looking to save a buck aren't the only ones falling prey to unskilled physicians; Olympic gold medalist and "Keeping Up With The Kardashians" star Bruce Jenner suffered for years with a poor face-lift that cut corners by just lifting the topmost layer of skin. Jenner eventually sought the help of Beverly Hills plastic surgeon and CellCeuticals skin-care creator Dr. Garth Fisher, who performed a reconstructive face-lift.

"I basically relaxed one part of his face and tightened and contoured the remainder to achieve features that were more in harmony with each other," says Dr. Fisher. "In an aging face, it is not only the skin that sags but also the deeper layers. It is critical to elevate and mold these layers to provide a much more pleasing and natural result. Just 'shortcut' pulling of sagging skin tight is not good surgery and will seldom give a good result."

The craving for lifts in a downturned market has helped birth discount chains like Lifestyle Lift, which claims to perform a simple procedure that removes the "anesthesia risk and physical trauma" of a face-lift. But experts have doubts. "Face-lifts have been around for 100 years. There are no new cuts to be made, but doctors just market it differently. The Lifestyle Lift is basically a well-marketed mini face-lift with mini results," says Dr. Daniels. And Lifestyle Lift hasn't been without controversy. The State of New York sued Lifestyle Lift last summer for allegedly creating false patient testimonials on the cosmetic-surgery review site RealSelf.com (which also settled its own separate lawsuits with the company for the same issue). Patients have discussed their experience with the lift on the site's message board, writing negative comments accompanied by gruesome photos showing infected open wounds.

One such patient is 63-year-old Christine Knudsend of Illinois, who says her experience with the discount chain was not worth any savings. "I chose Lifestyle Lift because they promised me no downtime and a one-hour procedure with just two small scars in front of each ear. Instead, I was cut completely around the ear and down the neck," Knudsend tells StyleList.

The retiree ended up with four weeks of recovery downtime from a serious infection that was accompanied by severe pain and swelling. Because the infection hit on a holiday weekend, Knudsend was unable to reach her Lifestyle Lift doctor and instead had to admit herself to the hospital, which significantly added to her total surgery costs.

"My stupidity could have cost me a lot more than it did. I should have done my homework. I hope my story at least makes someone think twice," adds Knudsend.

Seniors aren't the only ones looking for discounts; the most popular surgical procedure among younger women is breast augmentation, which also has discount options cropping up all over -- particularly in bikini-culture areas like Southern California, Florida, and Las Vegas.



"It sounded so easy and the price was right," a 33-year-old San Diego makeup artist tells StyleList. Her surgeon chose saline water-filled implants -- a poor choice for the patient's frame, as she was starting out with no breast issue. Saline can appear obvious and feel hard when placed behind the chest wall of an A-cup. But it also costs significantly less, which is why many discount breast augmentations utilize saline, regardless of the patient's needs.

"Two months later, my breast implant burst and deflated," says the makeup artist. "Then I found out the surgeon had overfilled the implant, which is part of the reason it burst."

Surgeons sometimes fill implant shells a smidge beyond their stated capacity for reasons varying from fullness to firmness; a few cubic centimeters (cc) is generally considered safe, but overfilling by more than 50cc can put the patient at a serious risk for a rupture and further complications. The doctor who overfilled the makeup artist's implant did so by almost 100cc.

"The office told me I would need to pay for another augmentation," she says. "They stopped returning my calls when I told them that wasn't good enough. I was so self-conscious walking around with one breast deflated. I had to pad one side of my bra, and I wouldn't let my husband see me without it.

"I finally had another breast augmentation with a real plastic surgeon. This time, the doctor said I needed silicone, and I was so much happier with the outcome."

Another area where danger lurks is the world of facial injections, which makes up the biggest percentage of nonsurgical cosmetic procedures today, according to the American Society for Aesthetic Plastic Surgery.

Botox and fillers can freeze wrinkles or plump sagging areas but what seems like a dream come true can rapidly turn into a nightmare when the surgeon isn't qualified. Priscilla Presley and a group of her celebrity friends hired a Brazilian doctor for injection parties, and only after they suffered complications including pain, swelling, and hard bumpy nodules, it was revealed that the man wasn't a doctor and that he had used a cheap car-grade silicone, which was virtually impossible to remove.

But because facial injections are less involved than full surgeries, they have become the most popular procedure that physicians like dentists and gynecologists are adding to their repertoire.

Experts cite concerns that untrained doctors can improperly inject the substances, which can be toxic and carry harmful side effects, like a droopy lid or lip. There is also the danger that an unethical doctor may use a blend of cheaper ingredients rather than the FDA-approved name brand, as in Presley's case.

Florida physician Bach McComb got into serious legal trouble after he and three others were temporarily paralyzed and almost killed when he administered injections using a raw botulism toxin instead of Botox. One of the victims was completely paralyzed and kept alive on ventilators for months, finally recovering with lingering facial paralysis and three permanently collapsed vertebra. It was later revealed that McComb had a suspended medical license and should not have been practicing.




Sometimes surgeons offering steep discounts are fully qualified but they work on more patients in a day than is considered safe by the industry. "They make their money from volume," says Dr. Anastasatos. "They do many surgeries fast, which means no attention to detail. Every patient is different, and good plastic surgery means individual attention,"

Some surgeons even take the concept of volume to extremes. Says Dr. Daniels, "I know of a radiologist who started doing plastic surgery. He was a big advertiser with a catchy name -- a ruthless self-promoter. He would set patients up for liposuction and then have his assistants perform the lipo. These patients had some assistant who was getting paid $25 bucks an hour doing their liposuction surgery!"

And most disturbingly, the world of discount cosmetic surgery can have a potentially lethal underbelly. "There was a doctor I knew of who used to reuse liposuction tubes on patients. People were getting serious microbacterial infections in their abdomens," says Dr. Daniels.

Yet Dr. Fisher wants to make it clear that paying top dollar doesn't guarantee the best results. "Bad plastic surgery is not always price sensitive. It's just that cheap and discounted surgery is often the first sign of a desperate surgeon whose skills alone don't sustain his or her business. If you want to save money, do it when buying a car, an airline-travel package, or clothes. Never do it when purchasing a plastic surgery operation."

So how does one find out if an estimate is too cheap or a professional opinion not up to par?

"Get at least a couple of opinions, if not more. No one should get just one opinion," says Dr. Daniels. Consumers can check any doctor's board qualification for free at the American Board of Plastic Surgery Web site. If the doctor isn't listed, call the organization to double check a status.

Or try the American Board of Medical Specialties to see if the doctor is board-certified in another field. Many surgeons claim to be a board-certified plastic surgeon, when in fact they're board-certified in something else entirely and practice plastic surgery on the side.

Also ask to see before-and-after photos of the doctor's work for the particular procedure you want. Don't settle for fancy pamphlets; you want to make sure there's evidence of good work from the doctor you're seeing. If no before-and-afters are available, that's your red flag that it's time to walk.

And Dr. Daniels has some time-tested advice for all patients considering cosmetic surgery. "It all comes back to what P.T. Barnum said: 'There's a sucker born every minute.' Don't be the sucker. If a doctor has significantly different methods and prices from other opinions you've received, get another professional's opinion or just get out of there."

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