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.”

Demi Moore is still hot at 47, but she says she just doesn’t get offered the kind of movie roles she wants, and she blames it on her age.

“The frustrating part is that the type of roles I’d be interested in are not really coming to me,” Moore told W Magazine. “I hate to say it’s a function of my age — but yes, I think in some ways it is. The majority of [female] roles are geared between 25 and 35.”

Many entertainment bloggers contend that Moore has to have gone under the surgeon’s knife to stay looking the way she does, but in the August issue of French Marie Claire, Moore said she is 100 percent natural.

Plastic surgeons say it’s a combination of Hollywood magic and great bone structure. Dr. Toby Mayer of the Beverly Hills Institute of Aesthetic and Reconstructive Surgery says often older stars purposely pose under heavy lighting or flashes to help conceal wrinkles.

“If you saw her in person, she would look like she had twice as many wrinkles,” Mayer told E!Online. “The makeup and the lighting is concealing the depth of the wrinkles.” The rest, he says is geneticsand maybe 31-year-old husband Ashton Kutcher. But, don’t call Moore a cougar.

“I’m certainly not the first person to be in a relationship with a younger man,” says Moore in W. “But somehow I was plucked out as a bit of a poster girl. I’d prefer to be called a puma.”

RELATED STORIES:

• More information on facial rejuvenation!
• Considering a facelift?

Demi Moore has rarely shied away from controversy. From her infamous nude Vanity Fair cover to her shaved head in G.I. Jane and that whole May/December romance thing with hubby Ashton Kutcher, Moore is generally fearless. But now, the Hollywood star is running scared from accusations she has gone under the knife.

The debacle began when Moore was quoted in the latest issue of French Marie Claire magazine denying she has previously had plastic surgery.

When the mag asked about all the rumors that Demi had cosmetic surgery to achieve her preternaturally youthful appearance, she said, “It’s completely false, I’ve never had it done. But I would never judge those who have. If it’s the best thing for them, then I don’t see a problem.”

Instantly, posts from doubtful bloggers and entertainment industry gossips created a flurry on the Web. Britain’s Daily Mail even wrote that the evidence against her claim is “overwhelming.”

A denizen of the Web 2.0 world, Moore responded to the Internet attacks via Twitter, tweeting, “All this garbage that came out today about me is nothing more than an effort to diminish not just me but all women.”

According to the experts at MakeMeHeal.com, Demi may have undergone several cosmetic procedures, including liposuction to her hips, inner and outer thighs and stomach, breast augmentation, breast reduction, breast lift, brow lift, chemical facial skin peel, collagen injections, dental veneers, and even knee liposuction surgery.

Plastic Surgeon Dr. Jennifer Walden hypothesized, “Demi Moore looks fantastic for her age. It seems that she has undergone breast augmentation, liposuction of the thighs possibly, Botox, a great skin care program with perhaps some resurfacing like peels or laser, and at this point maybe even a mini-facelift. She’s a machine, more power to her.”

But, Beverly Hills plastic surgeon Dr. Toby Mayer thinks Demi’s story holds up. He told E! Online, “Her lower eyelids have a little excess skin and wrinkles on them compared with a decade ago. If you saw her in person, she would look like she had twice as many wrinkles. The makeup and the lighting are concealing the depth of the wrinkles.”

For now this brat-packer is causing a bigger conundrum than she ever did with the St. Elmo’s gang. Like every celeb cosmetic mystery–no one really knows the truth. But, lipo or no–in that hot beach scene from Charlie’s Angels: Full Throttle, she was 40 years old. Wow.