Surgeons say the recession has cut demand in America for cosmetic procedures that are not covered by health insurance

Americans appear to be finally falling out of love with cosmetic surgery after a new report revealed that the number of operations dropped by 18% last year.

The new reluctance to have a facelift, a tummy tuck or a breast enlargement marks a dramatic turn away from procedures that a few years ago seemed almost commonplace.

Figures collated by the American Society for Aesthetic Plastic Surgery show that 1.9m operations took place last year, down from 2.1m in 2005. One big factor cited by many plastic surgeons is the recession. The biggest downturn since the Great Depression has hit many high-end consumer industries; plastic surgery certainly qualifies as a luxury commodity for many Americans. Purely cosmetic operations, such as nose-shaping or breast enlargements, often cost thousands of dollars and are not usually covered by health insurance.

"I believe one can credit the downturn of the economy for the decline in surgical procedures that obviously are more costly than non-surgical procedures," said Dr Elliot Jacobs, a leading New York plastic surgeon whose private surgery is on Park Avenue.

But some say there could be something in the zeitgeist, too. Over the past decade, plastic surgery saw a massive boom. Something previously seen as the province of Hollywood royalty and the very rich trickled down to the merely wealthy and then the middle class. It became the subject of numerous TV shows, such as Nip/Tuck, which followed the antics of a pair of Miami plastic surgeons and famously opened its first episode in 2003 with the controversial line: "Tell me what you don't like about yourself."

It was not just soap opera that fell under the surgeons' spell: reality TV shows got in on the act, too. Programmes such as Extreme Makeover and The Swan gave ordinary people a chance of free operations to improve their appearance. The shows were not without controversy, especially The Swan, whose premise was to transform a contestant into a more beautiful person physically. However, both shows have been cancelled, and this year Nip/Tuck also broadcast its last episode.

Nor are celebrities immune from criticism about the plastic surgery they have undergone. Many stars receive frequent sniping in gossip columns for having operations deemed too obvious.

Recently reality-TV star Heidi Montag was on the end of an avalanche of criticism – even from her husband – after she revealed she had had 10 plastic surgery procedures in one year.

Dr Michael Hall, a plastic surgeon in Miami Beach, said that an age of excess in the industry had come to an end, mirroring wider society. "When it comes to plastic surgery, people are now using more common sense. They don't want radical procedures," he said.

But while full-on surgical operations might be falling, the number of non-surgical cosmetic procedures is steady or rising. Many plastic surgeons say there has merely been a shift in taste and treatment. Non-surgical operations, such as Botox, lip injections or lasering, are cheaper and becoming more effective. "Women are looking for non-invasive procedures," said Hall.

There are other changes, too, reflecting both cultural and economic trends. Dr Richard Baxter, a plastic surgeon in Washington state, noticed a marked decrease in the size of breast implants as the economy started to go downhill. Before the recession, fewer than a third of Baxter's clients chose a B cup implant; now about half pick a B. "People have turned to more natural-looking things," he said.

The question concerning the industry now is what the longer-term trend will be. Some predict a permanent shift, while others say there are already signs of a renewed up-tick. One thing most doctors agree on, though, is that there is still no shortage of demand for changing one's body, just a change in preferred methods. "Has the plastic surgery bubble burst? I doubt it. As long as a woman or a man has a mirror available, there will be a continued interest in plastic surgery," said Jacobs. Hall put it another way, pointing out that some human emotions and desires are both recession-proof and fashion-proof: "There is no lack of vanity. There is just a little more hesitation."

• Plastic surgery
• US healthcare
• United States