Denver Cosmetic Surgeon Hails Bo-Tax Elimination In Final Health Care Reform

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Jeffrey Raval, MD, FACS, a Denver plastic surgeon, says the removal of the 5% tax on cosmetic procedures and elective surgery from the final Senate health care reform bill is a boon to the middle class. Contrary to Senate thinking that such a tax would target only the wealthy, Raval says most cosmetic patients are middle class wage earners trying to stay competitive in a job market obsessed with youth.

Medical professionals in the cosmetic surgery industry objected to this tax provision because it didn’t really reach the wealthy as intended, but rather it fell largely on women making less than $90,000 a year, which is just the type of person we a suppos

A proposed tax on cosmetic medical procedures and elective surgeries as part of sweeping health care reform legislation was eliminated at the 11th hour by Senate Democrats, a moved hailed by Denver cosmetic surgeon Dr. Jeffrey Raval as a boon to the middle class.

The so-called Bo-tax – a take-off on the popular Botox injections for temporary wrinkle relief – was originally designed as a tax on the wealthy, but many in the medical community argued that the largest group of patients receiving such treatments is, in fact, middle-class wage earners trying to stay competitive in a culture obsessed by youth.

“The vast majority of patients seen in our office come from an average household income of under $90k a year; middle class income levels,” said Dr. Raval, who performs a wide range of surgical and cosmetic procedures through Raval Facial Aesthetics, P.C. and Rocky Mountain Laser Aesthetics, Professional LLC., both based in Denver’s Cherry Creek North neighborhood.

Botox isn’t just for the rich and famous; it’s really gone mainstream,” he added.

Versions of the Senate health care reform legislation proposed last summer would have imposed a tax of 10% on cosmetic procedures, but the tax amount was changed to 5% and remained in the bill as late as December 18th. In removing the provision, Senate Democrats instead included a 10% tax on indoor sun tanning services in the final bill, which passed Christmas Eve 60-39 on a strictly party-line vote. The U.S. House passed its own version of health care reform in early November, and experts say reconciliation of the two bills could result in final legislation ready for President Barack Obama’s signature by late January.

Such non-surgical and largely cosmetic therapies like BOTOX injections and other injectables aimed at temporarily easing wrinkles and fighting aging would have been subject to the tax, as well as such elective surgical procedures as face lifts, breast augmentation, tummy tucks and nose jobs. Also, procedures like teeth whitening and hair replacement would have been taxable had the provision remained in the bill. Reconstructive surgery due to illness or injury, as well as laser eye surgery, would have been exempt from the tax.

A report from the American Society of Plastic Surgeons (ASPS) cited many problems with the Bo-tax provision, chief among them a 2005 survey conducted by the group indicating that only 10% of people considering cosmetic surgery over the next two years had a household income greater than $90,000 per year, a clear indication that such procedures go well beyond the privileged few. Moreover, the association said that 86% of cosmetic surgery patients are women, with the bulk of them working women between the ages of 19 and 64.

“Medical professionals in the cosmetic surgery industry objected to this tax provision because it didn’t really reach the wealthy as intended, but rather it fell largely on women making less than $90,000 a year, which is just the type of person we a supposed to be helping with healthcare reform and other economic stimuli the democrats are proposing,” said Dr. Raval. “Today many working people are turning to cosmetic procedures to heighten their employment prospects in today’s competitive working environment. Contrary to what the Senate Democrats were saying, this unfair cosmetic tax would have indeed been a tax on the middle class.”

To date, the only tax on cosmetic medical procedures imposed in the US has been in the state of New Jersey, a 6% tax, and early indications are that the state has realized a 59% shortfall based on projected revenue estimates when the legislature passed the measure in 2004. At least six other states – Texas, Illinois, Washington, Arkansas, Tennessee and New York – have such Bo-tax bills introduced or budget provisions proposed, although none of them have actually passed such legislation.

According to statistics from the ASPS, in 2008 there were 12 million cosmetic plastic surgery procedures that would be subject to such a tax performed in the United States, a 3% increase from 2007. Of those, 1.7 million were surgical procedures, with breast augmentations (307,000 procedures; down 12% from 2007), nose reshaping (279,000 procedures, down 2%), liposuction (245,000 procedures, down 19%), eyelid surgery (221,000 procedures, down 8%), and tummy tucks (122,000 procedures, down 18%), the leading categories.

The ASPS said that there were 10.4 million minimally-invasive cosmetic procedures last year, an increase of 5% over 2007. Leading the way were: Botox injections (5 million procedures, up 8%); hyaluronic acid fillers (1.1 million procedures, up 6%); chemical peels (1 million procedures, up 2%); laser hair removal (892,000 procedures, down 2%); and microdermabrasion (842,000 procedures, down 6%).

There were also 4.9 million reconstructive procedures, including such things as tumor removal, laceration repair, scar revision, hand surgery and breast reduction, the ASPS said. This category rose 3% from 2007 tallies.    

Botox Cosmetic is the trade name of the prescription medicine developed and marketed by the pharmaceutical company Allergan, Inc. Derived from the same toxin as botulism, the therapeutic material is called Botulinum Toxin Type A and has become widely popular in recent years for its reputed ability to ease facial wrinkles and also for its cost – far below cosmetic surgery.

Dr. Raval said the cost of Botox injections in his clinics is approximately $300 per area of the face. A newer product, Dysport, is approximately 20% less expensive than Botox and offers the same benefits as Botox, he noted. Approximately 30% of Rocky Mountain Laser Aesthetics and Raval Facial Aesthetics’ services are Botox and other filler injections.

For more information on Raval Facial Aesthetics and Rocky Mountain Laser Aesthetics visit the websites or call 303-381-FACE (3223).

Media contact: Nancy Clark, Unleaded Group, Denver, 720-221-7126.


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Nancy Clark
Unleaded Group
720-221-7126 ext. 205
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