Bad economy is making patients more cost-conscious, and plastic surgeons, the elite corps of lavishly compensated surgeons are going to unheard-of lengths to drum up business.

Some are sending out discount coupons and offering payment plans. Others are turning to less expensive and less invasive procedures. And all of them have to actually market their aesthetic practices.

After many years of steadily growing demand, spurred by increasingly higher standards of beauty, a  30% to 50% drop in the number of cosmetic procedures performed comes as a big surprise to many plastic and cosmetic surgeons. Many of them have boasted annual incomes in the seven-figure range. Dr. Mark Sultan, plastics chief at Beth Israel Medical Center, earned $4.1 million in 2006. That made him the second-highest-paid doctor on the payroll of any New York City hospital, according to a 2008 Crain’s Health Pulse survey of hospital salaries.

After seeing his cosmetic business shrivel by 20%, Dr. Steven Pearlman, who operates at Lenox Hill Hospital in New York says, “For the first time ever, I sent out “To my loyal patients’ discount cards”.

In a city that has long been driven by Wall Street money, Park Avenue facial specialist Dr. Yael Halaas has come up with a spiel that fits with that ethos. “We’re telling people it’s a great time to invest money in yourself [with cosmetic surgery],”she says.