Plastic surgeries and or other cosmetic procedures are still hot in 2009

A pullback is one thing, but what plastic surgeons are seeing can hardly be called a downturn, as the cosmetic surgery business still raked in nearly $12 billion last year. But the popular procedures of today are very different from those of 10 years ago. While all procedures are up about 69 percent on average since 1998, nonsurgical procedures are up 239 percent—mainly driven by the popularity of Botox. Botox injections, which decrease muscle activity that causes wrinkles, jumped from 65,157 treatments in 1997 to more than 2.4 million in 2008, bringing in $1 billion. That's more than any other procedures, both surgical and nonsurgical.

Ellenbogen's patients are not just tightening their purse strings, they're also concerned about taking too much time off of work in an economy that isn't synonymous with job security.

At the same time, Dr. Ellenbogen says some of his patients who were close to retirement but forced to stay on feel as though they need face treatments to compete with a younger workforce.

Therein lies the popularity of Botox. The injections smooth lines and wrinkles in a 30-minute treatment for a few hundred dollars, whereas a face lift averages more than $6,000 and requires up to two weeks of recovery.

Face lifts are up a mere 33 percent from 1997, while Botox treatments are up more than 3,600 percent since then.

And then there are the procedures that require surgery no matter what, which remain popular despite the downturn: nose jobs and breast implants. Rhinoplasty was one of the few areas that saw an increase from 2007, up 0.4 percent.

Breast augmentation was down 11 percent from 2007, but its popularity is still strong, up 482 percent since 1997.

Overall, though, the cosmetic procedures were down—surgical procedures were off 15 percent, and noninvasive procedures, which make up 82 percent of all procedures, were down 12 percent.

But surgeons say in the three months of 2009, business is starting to pick up again, especially for Botox and derma fillers like Juvederm and Rystalane, which use hyaluronic acid, a naturally found substance in the skin that diminishes over time, versus collagen, to plump up the skin.