The monetary effect of last year’s continued economic downturn on America’s plastic surgery industry has yet to be determined, since sales figures aren’t final. But many plastic surgeons are certain that customers often ignored major operations and looked to less expensive treatment options to change their look.

“We thought we’d be insulated better,” Dr. Toby Mayer, a Beverly Hills cosmetic surgeon, told the Los Angeles Times. “But even though we have a large percentage base of Hollywood clients who are not affected by these economic conditions, for the large majority of our patients, the big procedures are out of the question for now.”

Official statistics from the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) differ, but both indicate a significant dip in revenue. The number of cosmetic surgeries in 2008 was lower than 2007 by 9 percent, according to the ASPS, while ASAPS says they dropped by 15 percent. The statistics for 2009 aren’t expected until around March. But according to the Los Angeles Times, some plastic surgeons cite a 20 percent decrease from 2008.

Still, the cosmetic surgery industry will likely endure, even in tough times. Dr. Mayer noted that people still want to improve how they look – and some feel a little nip and tuck may be necessary to compete in a tight job market. Mindful of peoples’ financial constraints, surgeons have found a way to compromise by offering patients less expensive ways to alter their looks. Botox injections replace the more expensive face lift, and topical skin treatment replace the more expensive Botox. Surgeons are also offering payment plans or reduced fees to accommodate their customer base.

“We all want immediate gratification — more so now, when times are distressing,” Dr. Debra Luftman, a dermatologist, told the Times reporter. “I like to make a plan with my patients, look at treatments over a period of time and budget everything. We’re doing incentives and packages to make it easier for them. They don’t even have to ask me.”

The circus that followed Michael Jackson’s death in late June continues. The Los Angeles County coroner has ruled the death a homicide, a law enforcement official told The Associated Press. A search warrant affidavit reveals that the King of Pop had lethal levels of propofol in his body when he died, according to the Los Angeles Times. Dr. Conrad Murray, the personal physician to Jackson at the time of his death and the one who administered what would come to be the lethal injection, will likely face criminal charges.

Dr. Murray has already acknowledged that he administered propofol to the 50-year-old pop star the night he died. Murray reported he had been treating Jackson for insomnia for about six weeks, administering 50 milligrams of the potent drug via IV. The powerful anesthetic (also known as Diprivan) is normally used only in hospitals, and its use is commonly monitored by an anesthesiologist.

Murray believed Jackson was forming an addiction to the powerful sedative, according to records obtained by the Los Angeles Times, and so he chose to give Jackson a milder drug at 1:30 a.m. on June 25th. When Jackson remained awake, Dr. Murray allegedly gave him a shot of lorazepam — a drug similar to Valium — a half hour later, followed by midazolam, another anesthestic used to render someone unconscious before surgery. These medications didn’t induce sleep, so the doctor finally administered 25 milligrams of propofol, and the celebrated star apparently fell asleep right away.

At this point, Dr. Murray admits that he left his patient’s side ostensibly to use the restroom, although other reports indicate that he made several personal phone calls during this time. When he returned, Michael Jackson was no longer breathing. Of course, efforts to resuscitate him proved futile.

The King of Pop presumably received strong sedatives and anesthetics prior to his June bout of insomnia. Some are speculating that he became addicted to the drugs several years ago when undergoing plastic surgery. Although Michael Jackson only admitted to having two cosmetic surgeries on his nose, the transformation of his face over the years indicated that the singer in fact had multiple nose jobs, cheek implants and other work, likely required general anesthesia during each procedure.

The LA County Coroner’s Office has not publicly released the cause of death, and autopsy results have been delayed indefinitely.

It is worth noting, however, that investigators have not accused Murray of procuring the propofol illegally. Jackson had apparently been prescribed the medication from other doctors, including two based in Germany.