In Houston, we are much more fortunate than many of the other US states in relation to unemployment and impact of the double-dip recession that began in Fall 2008. However, that does not mean that local families are not affected. Economic experts tell us that sales in durable goods, automobiles, and items reserved for discretionary spending are down. Cosmetic surgery and cosmetic dermatology are of course classified by most Houstonians as discretionary spending. So, what should a patient do when faced with the need to have some aesthetic work performed in these times? First and foremost the patient should spend some time in contemplation and be earnest in what is a true “need” and what is a “want.” Those things are quite different, though we often combine the two. For example, having a suspicious mole looked at by a dermatologist is a need because such an exam can confirm or rule out skin cancer. An example of a want might be a facelift. Though the patient’s health is not at risk by foregoing a facelift, it is disheartening if the patient has concerns over his/her appearance. Although financing is available for some cosmetic surgery procedures, patients should think long and hard before taking on debt as well as the interest rate. Fortunately, all is not lost. There are alternatives patients can choose now to help improve the facial aesthetics until such time as things improve. One alternative is Botox, which is a relatively inexpensive, non-invasive procedure designed to temporarily reduce the appearance of fine lines and expression lines by paralyzing certain muscles. Many patients report that their Botox lasts up to four months, and sometimes longer the longer they receive injections over time. Other options for facial rejuvenation include laser skin resurfacing and cosmetic fillers. Both stimulate collagen production that not only makes skin appear fuller, but it also makes the skin regain some of the elasticity it loses with the natural aging process. Finally, patients of all economic levels benefit from simply taking care of their skin. Good skin care includes a healthy diet, gentle cleansing and removal of impurities, protection from UVA/UVB rays from the sun, and moisturizing.