A quartet of women in their 50s huddled around a table in a Superdome suite. While their husbands cheered and jeered the action on the football field, the foursome kept busy discussing “it” – who’s already had it, who needs it, who wants to have it but is afraid.

The “it” under discussion was cosmetic surgery, and the consensus of the group was that just about everybody over the age of 30 could benefit from a nip here, a tuck there and an injection of Botox right in the forehead.

Cosmetic surgery, once reserved for movie stars and aging heiresses, has gone mainstream. About 7 million surgical and nonsurgical cosmetic procedures were performed in the United States last year, and local physicians say the flagging economy doesn’t seem to have stopped their patients’ quest for better looks. Women and men, eager to look their best for personal and professional reasons, are increasingly willing to shell out for brow lifts, tummy tucks and other assorted surgeries. Nonsurgical procedures, such as microdermabrasion and Botox injections (sometimes called “lunch-hour procedures”) are also popular.

People are naturally reluctant to divulge the details of their “repair work,” but it’s fair to say that a lot of the bright eyes, taut foreheads, flat stomachs and voluptuous bosoms you see around town benefited from cosmetic surgery.

The lure spans generations, doctors say. Younger people are taking advantage of less-involved quick fixes, while those in their 50s are ready for more major procedures. And some people in their 80s are still eager to shave off a few years in appearance, especially if they have a younger spouse. Dr. Jerrold Gendler, who has practiced plastic surgery for 35 years, recently operated on a woman of 87. He says seniors tell him that after a lifetime of spending money on their children and grandchildren, they are ready to spend a little on themselves. “They just want to look good at their bridge games,” he says.

What’s hot with the locals

In Miami or Hollywood, people might be going for an extreme makeover, but New Orleans cosmetic-surgery patients want to look more natural, says Dr. Ruth Owens, who specializes in facial plastic surgery. “We’re very conservative,” she says. People here want to look like a more rested and refreshed version of themselves. What they don’t want is for strangers to say, “Who did her face lift?”

Owens says eye-lift surgery is her most common procedure. Once people hit their 30s and 40s, they notice their eyes start to look tired. Removing the excess skin and puffiness around the eyes makes people look more youthful and approachable. Surgery on the skin below the eyes can be done from inside the eye, without incisions, which reduces swelling and healing time. Patients having their eyes “done” should allow about four to five days for recovery, Owens says. Prior to the surgery they must refrain from alcohol and drugs that can cause bleeding, such as aspirin.

Although most cosmetic surgery is not covered by insurance, some plans will pay for repairs to the eyelids if the excess puffiness and skin are causing vision problems.

Face lifts are still popular, Owens says, but today’s face lift is much improved from the pulled-tight versions of the past. “We’ve discovered planes in the face, certain areas where, if you cut in a certain place, then you don’t get as much swelling afterwards,” she says. “In about three days, you feel great.” Total recovery takes about 10 days, she says.

Dr. David Metzner, a board-certified plastic surgeon who has practiced since 1977, says the face lift of today is more of a “restoration.” Doctors are able to lift deeper layers, and remove or add fat, and the “skin today goes along for the ride.” The result is a more natural look.

Forehead lifts are also radically improved, Metzner says. Instead of a long incision across the top of the head, Metzner uses an endoscopic technique that results in smaller incisions and no hair loss.

One of the most exciting new procedures, Owens says, is the Radiance injection. Radiance is a synthetic filler material that, like collagen, can help to smooth out lines and depressions and enlarge and enhance lips. Collagen lasts only two to three months, while Radiance injections last five to seven years. “I think it’s going to be a revolution in filler materials,” Owens says. She sees Radiance as a “beautiful adjunct to face-lift surgery, which takes care of the sagging around the neck, jowls and cheeks.”

Good skin is in

Most doctors agree that a face lift is only one part of a whole procedure; patients still need to care for the skin. “You have to get the skin in good condition,” says Gendler. “The skin is obviously what you see.” Doctors have a wide array of skin treatments today, including Botox injections, chemical peels and lasers. These “lunchtime procedures” can be done in a short period of time, after which patients can head back to work. Botox injections work well to lessen the appearance of crow’s feet, frown lines, laugh lines and forehead wrinkles. Metzner recommends that the injections be given in a doctor’s office. “It is a medical treatment,” he says.

Some preventive measures can keep skin looking younger longer, says Dr. David Jansen, chief of plastic surgery at Tulane University Health Sciences Center. Jogging, for example, causes the face and breasts to fall, while heavy smoking causes vertical lines in the face. The nicotine in cigarettes is also a skin disaster, he says, because it collapses and clogs the capillaries. It’s already well-known what the sun does to skin; slathering on sunscreen is an inexpensive but effective way to stave off wrinkles.

When it comes to over-the-counter skin treatment for skin renewal, Owens recommends a Retin A product or products with glycolic acid. Cheaper products are mainly water, she says, and might not last as long. It’s especially important to use something emollient around the eye, where the skin is always dry.

Jansen, who specializes in procedures on the body, expects to see a real surge in body lifts to remove excess skin. More and more obese people are undergoing gastric-bypass surgery to lose large amounts of weight. These patients are left with large “aprons” of fallen skin that must be removed. People should wait about 18 months after their obesity surgery so they can reach their recommended weight before they have this excess skin removed, Jansen suggests.

Stretch marks after childbirth are a common skin complaint for many women. Jansen says the use of pulsed laser treatments to remove the marks is still under debate.

Great Expectations

A problem many plastic surgeons face is that of patients’ unrealistic expectations. Jansen quotes the axiom, “Smart surgeons turn down about half their patients.” Some patients believe that cosmetic surgery won’t just improve their looks, it will radically change their lives. “These patients will never be satisfied,” he says.

Some of these people have a psychiatric condition known as body dysmorphic disorder, says Dr. Samuel Parry, who practiced plastic surgery at Tulane for 20 years and now has offices on the West Bank and Uptown. Parry says these patients have a distorted image of their body and believe they are fat. Some have repeated cosmetic surgeries, constantly trying to reach an unobtainable goal. Others tell the doctors they are having the surgery to save their marriages or to lure a new mate.

Patients also sometimes underestimate the amount of time it will take to heal from a procedure. “I go to lengths to give them information,” Gendler says. But many believe that deep down, they will be the exception. He stresses that the body takes time to repair itself from surgery. “Many final results do take time,” he says. Younger patients heal more quickly, he adds. Patients are generally willing to put up with some discomfort from the procedures, and a lot of procedures aren’t really very painful at all.

The vast amount of medical information available on the Internet has also changed the way doctors do business. Mixed in with helpful Web sites is a fair amount of misinformation, Metzner says, so doctors still need to do a lot of patient education. Most plastic surgeons can provide patients with before-and-after photographs, and many have testimonials and photos posted on their Web sites.

Some patients also want cosmetic procedures performed too young, Jansen says. He prefers not to operate on teenagers unless they have a congenital defect. Teen faces are still growing, he says, and they already are obsessive about their appearance.

Although many of the “quickie” procedures do improve a patient’s appearance, the old saw about getting out of something what you put into it does hold true, Metzner adds. More extensive procedures may take longer, cost more and have a longer recovery time, but they also can improve appearance for a longer period of time. Botox, for example, wears off in a matter of months.

Bigger, smaller breasts

Both breast augmentation and breast reduction are popular cosmetic surgeries, locally and nationally. Last year breast augmentation was the second most popular procedure for cosmetic surgery patients in the United States, according to the American Society of Aesthetic Plastic Surgery; breast reduction was No. 5.

Today, patients in this country who want their breasts enlarged receive saline implants. About 15 years ago, silicone breast implants hit the news as women suffering with autoimmune diseases claimed that the leaking silicone in their breast implants had caused their illnesses. Some implants were leaking, Gendler says. In an effort to keep the implants from hardening, manufacturers were making them thinner, which allowed some of the silicone to escape.

By 1991, silicone gel implants were removed from the market, and doctors were left with saline implants. In 1995, Gendler says, scientists changed their opinions and said that silicone gel implants had not caused the autoimmune disorders. Studies are being done on a new gel product, which may leak less.

Jansen says he also performs a fair number of breast reductions. Today, the surgery to reduce the size of the breast is less invasive and leaves fewer scars. The procedure is extremely successful, he says. Breast reduction surgery can be covered by insurance if it is done to reduce neck and back pain.

Plastic surgeons are excited about new procedures. Gendler says there are at least 30 or 40 filler materials on the market in Europe, awaiting approval by the U.S. Federal Drug Administration. Cosmetic surgeons are by their nature creative, Metzner says, and are always looking at better ways to improve a person’s appearance. And as technology improves, pain and recovery time from many procedures will lessen.