I have 2 daughters that are recent college graduates and currently exploring the difficult job market.   I  have had many discussions with both regarding the interview process and the image that is best received by an employer.  Most potential employers would expect an applicant to have a stylish haircut,  neat and well-tended nails,  pressed and freshly laudered clothing, etc.  Should we begin taxing all of these services since they could be construed as unnecessary and a reflection of vanity?  Nope.  The reality of plastic surgery and noninvasive cosmetic procedures is that most people that utilize the different options are like you and I.  They are middle class, responsible with their spending and view these procedures as maintenance.  Of course,  there will always be a few sensational bizarros like Michael Jackson and the Octomom  to tweak  negativity amongst  those that would never do any of these procedures anyway.  Then again, there are many of our politicos that I have noticed move almost nothing on their faces during interviews.

This sort of plastic surgery taxation has been tried in several states unsuccessfully already.  Currently only New Jersey still has a tax on cosmetic surgery and even the legislator that wrote the original bill has recommended canceling it.  Why you ask?  The  amount collected  by the state of New Jersey was 75% off the targeted amount.  Patients were crossing into nearby states to take advantage of nontaxable procedures.  The question of defining what was or was not a cosmetic surgery procedure became blurry.  Several examples of that are:  the woman that had a breast reconstruction requiring breast implants and required revisions,  the massive weight loss patient that required a tummy tuck to remove a large abdominal panice so that she could go on with a normal life and seek employment or the elderly patient with an upper eyelid fold that partially obscured vision.  I would guess that most of us have dealt with an insurance company that has ruled a medical procedure unnecessary.  Imagine the same group of uninformed individuals deciding on taxation.

Let me give you an example,  the patient below needed a facelift and eyelid lift.  Her neck had lost definition, her jowl lines were softened and her midface was sagging.  To have merely injected dermal fillers and Botox into her face would have created relaxed muscles in the areas that were already relaxed and a puffiness to her face that did not match her distinctive look.  She was better served by performing a facelift and an eyelid lift, followed by strategically utilizing  injectable dermal fillers, Radiesse and Restylane, to correct the nasolabial lines.  Her facial muscles were tightened, her midface was lifted with her eyelid lift, her neckline redefined and the extra skin from her face and eyelids were removed.  No Botox was used on this patient.

The next patient was an excellent candidate for Botox and injectable dermal fillers, but again, they were used as an adjunct to cosmetic surgery.  Before surgery, this patient had lower lid puffiness and upper lid drooping that was correctable only by an eye lift.  She had midface laxity and her nasolabial lines were prominent,  as were the lines between her brows.  Botox was  utilized to weaken her brow lines and the the lines in her crow’s feet areas, and to slightly lift her brows.   Restylane was used to correct her nasolabial lines.  However, the greatest correction was seen following her upper and lower eyelid lift.  At that time, extra skin and muscle were removed, the malar fat pads (over the cheekbones) were repositioned and the midface was lifted.

There are certainly times when the physical anatomy of the face or financial choices make the usage of Botox and injectable dermal fillers, without cosmetic surgery, a wonderful choice.  My concern is that patients need to be informed of all methods, tried and true, that may be of benefit  for the cosmetic concerns that they are trying to solve.  Dermal fillers and Botox are great temporary solutions, but when used in great quantities to avoid a surgical solution, their costs can be equally as daunting.

My recommendation:  By all means utilize these valuable nonsurgical solutions, however, an informed plastic surgeon can assist you in providing a reality based plan for your short-term and long-term goals.  At my Marin County plastic surgery practice, I evaluate every patient’s individual needs so that you understand all of your options prior to treatment.