botox injections

Cosmetic procedures, including Botox, have become much more popular for the general population.

Jennifer Siegel has had more than her share of unsolicited medical advice. Her OB/GYN offered to do a tummy tuck after she delivered Siegel’s third child. Her eye doctor suggested injectables for the wrinkles between her brows when she went in for an eye exam. And when she asked her dentist about some simple cosmetic dentistry, he offered to nearly overhaul her entire mouth.


Cosmetic procedures — from dental veneers to Botox — have proved to be financial boons to many dentists and doctors. But what’s good for the physicians may not always be in the best interest, at least financially, of the patients. Porcelain veneers can cost as much as $2,000 a tooth; each area of wrinkles treated with Botox can run $400. Few cosmetic procedures are covered by insurance, and high-pressure sales pitches are far harder to spurn when you’re in an examination room. After all, turning down the person you’ve turned your health over to is a lot harder than dissing the perfume lady at your local department store.

“People mistakenly think that doctors and people in positions of authority are the voice of truth,” says psychotherapist and “money coach” Olivia Mellan. “Consumers have to learn to be their own advocates.”

Siegel, of Westfield, N.J., has gotten good at saying no but wishes she didn’t have to be so on guard with health care providers. It was during a visit to her eye doctor to update her contact lens prescription that the doctor suggested she get the filler Restylane for the furrow between her eyebrows. She was nearing her 40th birthday at the time. He even tried to convince her that it would be a good birthday present to herself.

“I was horrified,” says Siegel. “Now, if I were going to have the furrow filled, I certainly wouldn’t have it done by my eye doctor.”

With cosmetic procedures soaring in popularity, it’s going to get increasingly harder to avoid pitches. Consumers opted for 69% more cosmetic procedures — everything from a shot of collagen to a face-lift — in 2009 compared with 2000, according to an April report from the American Society of Plastic Surgeons. Botox injections increased 509% during that period, the report says.

Revenue from cosmetic dentistry climbed to $2.75 billion nationwide in 2007, up 15% from 2005, according to the most recent numbers available from the American Academy of Cosmetic Dentistry.

With so many elective procedures, Cleveland-based dentist Matthew Messina says he tries to explain to patients what’s available but also what’s truly necessary.

“Part of the practice of dentistry today is making sure your patients understand what opportunities exist for them,” says Messina, an American Dental Association consumer advisor and spokesperson. “But at the same time, that doesn’t mean that everything needs to be done for everybody.”

Messina says he and his patients evaluate whether to address only medical needs, such as decay or infection, or to consider cosmetic procedures, such as teeth whitening or veneers. He recommends patients ask if a procedure being recommended is elective and, if so, why they should consider going through with it. He adds that patients should ask their dentist if the procedure will be covered by insurance.

Many procedures performed by dermatologists — such as removing benign skin lesions — aren’t covered by most insurance providers, including Medicare, says Vernon, Conn.-based dermatologist Robert Greenberg. But insurance providers will usually cover the removal of lesions if there’s a chance they’re harmful.

Greenberg says he writes down the pertinent information about any diagnosis or procedure he recommends so patients can check with their insurance providers to see if it’s covered.

Many procedures fall into a “gray zone” between medical and cosmetic, says Daniel Rousso, president of the American Academy of Facial Plastic and Reconstructive Surgery. These include the removal of scars, surgery on the outside of the nose to complement surgery to fix a problem inside the nose and surgery on the upper eyelids.

“If it’s not enough of a visual problem, then it’s not going to be covered,” he says.

Grant Tarbox, Aetna’s medical director for the Dallas-Fort Worth region, says some procedures may seem cosmetic but are still covered by insurance because they’re done out of medical necessity. Examples include breast-reduction surgery to treat back problems or breast augmentation following a prophylactic mastectomy.

Consumers have mixed feelings about the move toward multipurpose medicine.

Ellen Bernstein of Manahawkin, N.J., says she’s never had a doctor or dentist try to sell her a product or service that wasn’t medically necessary. If they did, “I would be very angry and probably find a new doctor,” she says.

Jill Jarvis of New Castle, N.H., says she’d be offended if she went to, say, a dermatologist for a medical issue and had a cosmetic procedure suggested. But if “they approached the subject delicately and with courtesy and respect,” it wouldn’t bother her as much.

Mellan, co-author of the book Overcoming Overspending, says no matter how soft the sell, consumers still need to be on guard when cosmetic procedures are involved.

“Looking perfect … can be another addictive purchase,” Mellan says.

 Via USA Today