Kim Gandy

(WOMENSENEWS)–There were two reasons that 50-year-old Lori Rosenzweig of Long Branch, N.J., hesitated about her first consultation for cosmetic surgery.

She was contemplating having both Botox and Restylane procedures and said she felt bad about succumbing to societal pressures to erase her age-appropriate wrinkles. (Restylane fills in wrinkles; Botox paralyzes wrinkle-producing muscles.) At the same time, she said she felt even worse when she found out that on top of the cost of the procedure she would be taxed by the state.

“It’s tough for a woman to age in our society and, when we have to save up to get some wrinkles erased and then get taxed for it, it’s just so unfair,” Rosenzweig said.

New Jersey is the first state in the country to levy a “vanity tax,” a 6.5 percent surcharge above the cost for cosmetic surgical procedures that include Botox wrinkle treatments, breast implants, nose jobs and tummy tucks.

Six more states–Arkansas, Illinois, Tennessee, Texas, Washington and New York–are currently debating their own versions of this tax. While New York has stopped short of introducing legislation, sponsors in the other states introduced bills in March. Voting in all the states has been stalled.

While some discussion revolves around practical issues–such as how much the tax will bring in and how it can be administered–the tax also generates political heat because it disproportionately affects women.

Many of the state legislatures are poised to bring the issue to a vote after reconvening in the fall and the battle lines have been drawn. Women who don’t want to pay the tax and plastic surgeons are on one side; legislators on the other.

Plastic Surgeon Fights Back

Dr. Phillip Haeck, a Seattle plastic surgeon and editor of Plastic Surgery News, has been leading the campaign against the tax in his home state and around the country.

“We cannot have a tax that is carried on the backs of women,” said Haeck, who cites a 2003 survey by the American Society of Plastic Surgeons that found that 86 percent of the people who get the taxable procedures are women. “This tax is unfair to women, it violates their privacy, and it’s just wrong.”

Haeck said that the state legislator who introduced the bill in Washington–Sen. Karen Keiser (D-Des Moines)–told him she was watching extreme makeovers on TV and began to think that if people can afford cosmetic surgery, they can pay more.

Figures by the American Society of Plastic Surgeons, however, show that many women who undergo plastic surgery stretch their budgets to do so.

Forty percent of those planning to undergo cosmetic surgery in the next two years reported an annual income of between $30,000 and $60,000 and 60 percent reported an income of between $30,000 and $90,000, according to 2004 research by the Arlington, Va., plastic surgery group.

“These are women who are saving money over long periods of time to be able to get these procedures,” Haeck said.

Helping State Budgets

Keiser proposed the cosmetic surgery tax in Washington State to raise approximately $20 million, some of which would be used to restore cuts in children’s health services. The same initiative in Illinois aims at funding stem cell research.

Some legislators who introduced the cosmetic surgery tax bill–such as State Senator Joe Cryan, a New Jersey Democrat–say the tax does not discriminate because more men are undergoing cosmetic surgery. Many doctors who perform the surgeries, however, refute that.

“Some of the politicians are saying that there’s an increase in the number of men getting cosmetic surgery and that is true but all the numbers are going up and the tax negatively impacts women,” said Dr. Phil Hetzler, a New Jersey plastic surgeon who notes his business has been hurt since the state tax took effect in September 2004.

“The number may be 86 percent across the country but in my practice the number is 98 percent,” Hetzler said, referring to the percentage of women undergoing surgeries. “Many women I’ve met with are finding that they can’t afford the additional taxes for not only the procedure but for the added taxes assessed on the anesthesiologist and surgical room fee. The legislatures misjudged the people getting the surgeries as well. They thought they were the wealthy and that’s certainly not the case.”

In New Jersey, the average cost for a breast augmentation runs between $3,500 and $9,500, said Hetzler. Liposuction costs between $1,500 and $12,000 and rhinoplasty–or nose work–runs at a wide range of between $2,500 and $15,000. With a 6.5 percent tax, plus extra costs, those numbers become even more substantial.

Income Projections Fall Short

In New Jersey, projections about how much the so-called vanity tax will raise in its first year–between last September and next month–have been lowered to $7 million, far less than the $25 million lawmakers had predicted when the bill was enacted.

Kim Gandy, executive director for the National Organization of Women, expresses mixed feelings about the tax.

“I’m not for any tax that disproportionately affects women,” Gandy said. “But it’s a sad commentary on our society that such a large percentage of women feel the pressure to look a certain way and that 86 percent of people getting cosmetic surgery are women. It’s not the taxes that bother me as much as the procedures themselves.”

Gandy says women should be railing against the need and desire for the procedures themselves and said she wished more cosmetic surgeons would fight against the use of silicone breast implants, which she argues studies indicate are still very dangerous.

“If this tax stops one woman from getting silicone breast implants, that’s a good thing,” she said.

At the same time, there are also numerous reasons why women have cosmetic surgery, as Renee Lay testified in front of the Illinois legislature in March.

“For years I struggled with lower back pain and headaches directly resulting from the size of my breasts,” she told legislators. “My clothes didn’t fit properly. I felt self-conscious playing sports. Even exercising was difficult for me.

“My physical self-perception was taking a real toll on my self-esteem. When I finally decided to get a breast reduction, the insurance company told me the procedure was classified under cosmetic surgery and so the costs wouldn’t be covered. While I wasn’t sure I could afford to do it, I went ahead with it anyway. That surgery changed my life–not just physically–but psychologically. Unfortunately, this procedure would be taxed under this legislation.”

As for Lori Rosenzweig, despite her initial hesitation, she recently went through with her cosmetic procedures, and says she’s very happy with the way she looks now.

But she said that if she ever contemplated cosmetic procedures again, she would have the discussions and-or surgery in a state with no vanity tax.

Sandy Kobrin is a writer based in Los Angeles who frequently writes about the plastic surgery industry.

For more information:

New Jersey taxation–
Summary of New Legislation: