Soothing classical music plays in the background as the surgeon snips thin threads hanging from the corners of the patient's eyes.
Finished with the scissors, Dr. Daniel Teet tells her that everything went well in the hour-long procedure, adding that she should expect little discomfort during the six days until he removes her stitches. The Chicago woman, who asked that her name be withheld, appears relaxed and insists to observers in the operating room that she feels fine after the surgery that lifted and tightened her upper eyelids.
This is not her first trip to his Renaissance Cosmetic Surgery Center and Day Spa in Greensburg, she said. And if she wants to have something else done, she'll be back.
Cosmetic surgeons say patients will continue to seek surgery despite a proposed 5 percent tax on elective cosmetic procedures that Senate Democrats buried within their 2,074-page health care bill as a way to trim its $849 billion price tag. Still, surgeons oppose the tax, arguing that it targets medical professionals, discriminates against women and most likely will fall short of the $5.8 billion lawmakers say it will generate over the next 10 years.
"I'm against it. Taxation has basically been on products produced and not on services rendered. Cosmetic surgery is primarily a surgical service rendered and should not be taxed," said Teet, who holds four board certifications and has performed some 30,000 cosmetic surgery procedures.
"My patients won't like it or agree with it, but they'll pay it."
Every year, millions of Americans undergo cosmetic surgery to enhance their appearance, increase their self-esteem, correct physical deformities or improve conditions that adversely affect their health. The tax, which would take effect Jan. 1, targets only elective procedures and would not apply to surgeries that correct birth defects or conditions arising from accidents, trauma or disfiguring illness.
Because elective cosmetic procedures outnumber those for medical reasons, millions of patients would be required to pay the tax each year, according to statistics compiled by the American Society of Plastic Surgeons.
Despite the worst recession since the Great Depression, there were 12.1 million cosmetic procedures performed last year in the United States, where women accounted for 91 percent of all patients, the organization reported. More than 10 million were cosmetic, minimally invasive procedures, while 4.9 million were reconstructive surgeries and 1.7 million were cosmetic surgical procedures.
Numbers for this year are not yet available.
Overall, surgeons agree most patients would not cancel surgery because of the proposed tax. Teet, for example, said his patients are "searching for surgical credentials and competency" and would be willing to pay a little extra.
Many surgeons say the tax on beauty will have the most impact upon the aging baby boomer population and the working class, particularly working women ages 35 to 50 with an average yearly income of $55,000. That group accounts for 86 percent of cosmetic surgery procedures, the American Academy of Cosmetic Surgeons reported.
"This is not a luxury tax on the rich," said Dr. Raymond A. Capone Jr., a board certified plastic surgeon who maintains what he describes as "a body contouring practice" in the Shadyside Surgi-Center. "In Pittsburgh, particularly, most of our patients are hardworking women with kids."
The average patient will take a hit on procedures such as face-lifts, breast augmentation and rhinoplasty, which cost thousands of dollars, surgeons say. The tax bite will be a little less severe for minimally invasive procedures such as Botox injections, laser resurfacing and laser hair removal.
Across the board, organizations representing cosmetic surgical professionals plan to fight the tax that they claim will open the door to future taxes on additional medical, legal and other professional services.
Any tax on surgical procedures is a bad tax, according to the 2500-member American Academy of Cosmetic Surgery, which maintains that the tax "is not the solution to funding a health care overhaul." In a statement, Dr. Steven Hopping, the group's immediate past president, said implementing the bill "would be a bad idea for patients and physicians."
The 7,000-member American Society of Plastic Surgeons, whose members represent 94 percent of board-certified plastic surgeons in the United States, opposes all taxes on physicians, according to its president, Dr. Michael McGuire. He said in a statement: "Medical care should not be used as a tool to fix broken finances."
Capone said he fears the tax could disrupt the physician-patient relationship. He said some patients inevitably will not be honest when discussing the reasons they seek surgery, in an effort to try to get insurance to pay for it and avoid the tax.
Because the lines between cosmetic and reconstructive surgeries often are blurred, the tax would leave determination of medical necessity up to auditors or a government agency, surgeons say. They argue that those reviews would create problems with privacy issues and enforcement that would negate benefits of revenue generated by the tax.
Similar taxes proposed in other states in recent years were rejected everywhere but New Jersey, where lawmakers in 2004 approved a 6 percent tax on elective cosmetic procedure. Since then, the amount of money collected from that state's tax has been 59 percent short of projected estimates, according to the New Jersey Department of Taxation.
Surgeons say the federal government should learn from New Jersey's mistake.
"I question whether it will be worth it," said Dr. Lori Cherup, a board-certified plastic surgeon who operates the Radiance Plastic Surgery Society in Bridgeville. "I think it's going to be a wash."