"And I'd like to keep it that way," she said this week.

With that in mind, the special projects coordinator at UNLV's School of Dental Medicine went to see Pancholi for a consultation.

She's excited about what Pancholi tells her about skin rejuvenation treatments. But she's not so excited about what he shares with her regarding the possibility of a new tax being added to cosmetic treatments.

"I really have a hard time affording it now," she said. "If it were to cost more, I probably couldn't."

To help offset the projected $849 billion cost of health care reform, U.S. Sen. Harry Reid, D-Nev., recently included a 5 percent levy on elective cosmetic procedures in his 2,074 page health care bill.

It may be a small part of the legislation, but what has been dubbed the "Botax" is garnering a lot of attention, particularly from drug makers, plastic surgeons and their patients.

Caroline Van Hove, a spokeswoman for Allergan Inc,. the maker of Botox, said in a statement this week that taxing cosmetic procedures is "unnecessarily punitive on people who have merely decided to enhance their appearance."

While Reid and other legislators argue that the tax could raise an estimated $5 billion over 10 years, plastic surgeons say it would only cut into the number of procedures being done, making the tax an unreliable and risky revenue source while further increasing unemployment.

"We'll lose a significant amount of business," said Las Vegas plastic surgeon Dr. Julio Garcia. "I don't think this is well thought out at all. If I have to let a nurse go, how does that help the economy?"

Pancholi, a spokesman for the American Academy of Cosmetic Surgery, says it is a mistake to characterize cosmetic surgery, which generally isn't covered by insurance, as an indulgence of the rich. He said 86 percent of cosmetic surgery patients are working women between the ages of 35 and 50, who have an average income of $55,000 a year.

"Many of them say they have procedures done to remain competitive in the job market," he said, adding that appearance means even more in Las Vegas than in other cities because of the customer service aspects of the casino business.

"We have people come in all the time to get facial lifts because they say that their employers keep hiring younger and younger people," said Dr. Lane Smith, president of the Las Vegas Plastic Surgery Society.

Often, he said, women must find ways to finance face lifts, breast augmentations and tummy tucks.

"People spend some of their retirement dollars," said plastic surgeon Dr. Edward Zimmerman. "Many don't have the money. They may have to save up for years and then finance the rest."

The procedures can be expensive -- $8,500 for a tummy tuck, $10,000 for breast augmentation and $15,000 for a face lift isn't chump change.

But those prices, say plastic surgeons, have come down considerably during the recession. Many physicians saying they've trimmed the fat out of their prices by almost half.

Physicians also assert that the language of Reid's bill creates confusion over when a procedure is cosmetic or reconstructive.

As the legislation now stands, Pancholi said it is unclear, for instance, whether it would be considered cosmetic to remove the massive folds of flesh from an individual who lost weight after bariatric surgery, a procedure than makes the stomach smaller so patients don't eat as much.

Reid spokesman Jon Summers said, however, that there is plenty of time for the bill to be "fine tuned" so that only "clearly elective cosmetic procedures" are taxed.

He said the bill's current language applies to surgery "not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease." In other words, elective cosmetic surgery.

A source close to Reid said the senator believes that individuals who undergo clearly elective procedures such as breast augmentation will pay the tax without complaining because "it's something they want."

Smith and Zimmerman said Reid and other legislators could raise far more money by including tort reform in the health reform legislation. Tens of billions of dollars could be saved by preventing nuisance lawsuits, they said.

Garcia said a tax on cosmetic procedures in New Jersey did not work out as planned -- the American Academy of Cosmetic Surgery said it generates 59 percent less money than projected -- because patients simply went to neighboring states. He said if a nationwide tax on cosmetic surgeries becomes law, you can expect more and more people to take inexpensive plastic surgery vacations south of the border.

"Medical tourism has already been growing by leaps and bounds," he said. "This will just make it expand even further."

Contact reporter Paul Harasim at pharasim@review journal.com or 702-387-2908.