In a new wrinkle for Michigan's battered economy, plastic surgeons are experiencing the worst downturn ever for cosmetic procedures - while the treatments soar elsewhere in the country.The pinch began two years ago and by mid-June of last year, "everything suddenly came to a standstill," said Dr. Michael Busuito, a Troy plastic surgeon. "Husbands told their wives, 'I don't care if you want a face-lift. I could lose my job.' "With job cuts, home sales stalled and profit-sharing checks gone, demand in Michigan has dwindled for cosmetic procedures, particularly big-ticket surgeries such as breast augmentation and tummy tucks.Cosmetic plastic surgery is "like diamonds, jewelry and fancy cars," said Dr. Michael Gellis, chief of plastic surgery at Beaumont Hospital in Royal Oak. "If you don't have the money, you don't spend the money on it."He said his business has declined 40%, similar to estimates offered by the most candid of more than a dozen plastic surgeons interviewed.

The decline has chilled Michigan's reception to the commercial comeback of silicone breast implants this year. And some consumers are lengthening the time between Botox injections, the way cash-strapped consumers postpone haircuts. Savvy plastic surgery veterans volunteer for new procedures for free."If he benefits, I benefit," said Doreen Kanakis, 50, of West Bloomfield. She underwent a face-lift five years ago by Troy plastic surgeon Kenneth Shaheen and was happy recently to undergo treatments with a new dermal filler to plump up parts of her face. Because Shaheen is just beginning one of the newer procedures, he has done three for free."A face-lift turns back the clock but it doesn't stop it," said Kanakis, who also had a breast augmentation and a permanent eyelid-liner procedure.