Carol Johnson, 63, of Milford decided against full-fledged surgery and underwent a speedy face-lift procedure called a Lifestyle Lift that had her in and out of surgery in an hour.

Today's image-conscious can get a little nip and tuck in less time than -- and with about as much effort as -- it takes to watch the plastic surgery reality show "Extreme Makeover."

All are possible with new cosmetic procedures that promise more affordable results that spare patients pain, risk and recovery time. But is ultra-quick and easy cosmetic surgery safe? And does it work?

Some doctors warn that such procedures often don't deliver lasting results and can put patients in danger. With so many new offerings on the market, many patients are trusting medical procedures that haven't been tested by time.

"Everybody wants to do something without going through surgery," said Dr. Bruce Chau, a Southfield plastic surgeon who performs a controversial new procedure that uses a barbed thread to lift the face. "People always want the best result but they want to go through the least effort."

As new technology has emerged and techniques improved, cosmetic procedures are less invasive and recovery times shorter. Popular shows like ABC's "Extreme Makeover," where people undergo a long list of procedures to improve their looks, have taken away much of the stigma associated with cosmetic surgery.

Doctors in the area are cleaning up as patients go under the knife -- or the laser, thread and needle -- in record numbers. Cosmetic surgery, once popular with a small segment of the population -- usually aging and wealthy white women -- is becoming more popular with men, minorities and younger people.

"Years ago we could only do so much with people," Chau said. "Now we have something in between. It's like ice cream. It used to be only vanilla. Now we have Ben and Jerry's and all these flavors."

The thread lifts were featured on "Today," "Good Morning America" and "The Oprah Winfrey Show." Thousands of doctors are signing up to be trained in the procedure, in which serrated plastic sutures are inserted into the face through small incisions. The sutures catch the fatty layer beneath the face to raise drooping tissue.

Nationwide, more than 3 million people had work done in 2004, nearly two-thirds of which was considered minimally invasive, according to the American Society of Plastic Surgeons.

Spending on cosmetic procedures nationwide totaled $7.2 billion in 2002, the most recent figures available, according to the surgeons group. Most of those costs are out-of-pocket since insurance plans rarely cover such procedures.

A career secretary, she said hours spent bending over her desk caused her jowls, cheeks and neck to sag. So Johnson, 63, went to California last year to visit a plastic surgeon who worked on her friend.

The surgeon said he could do the work but it would cost $16,000 to $28,000. He suggested multiple procedures, including a face-lift and liposuction, which would have laid up Johnson for weeks.

She took the idea back to her husband, Clark, who immediately protested. The couple travels and has a busy social schedule. Neither wanted Johnson recovering in bed for weeks.

Then Johnson heard of a center in Troy that performs a minimally invasive face-lift dubbed the Lifestyle Lift. For about $4,000, she could tighten up the lower part of her face and neck and be well enough to drive home afterward. She went in for a consultation and decided immediately to do it.

Johnson showed up at the small Big Beaver Road office on Wednesday. The waiting room was packed, with all the seats taken and people standing against the walls. Doctors and nurses bustled in the back rooms, rushing from one procedure to the next. A backup of patients delayed Johnson's appointment more than an hour.

Once the procedure began, however, she was done in less than an hour. Johnson lay awake calmly, sometimes talking, as Dr. Jeffrey Colton made incisions around both of her ears. After pulling her skin away from her face, Colton began to pull Johnson's muscles and stitch them in a new, higher place. When he was done, Colton cut more than an inch of skin off each side of Johnson face.

He stitched her up, and the results were remarkable. She had a newly narrow chin and smoother neck. The bandages around her ears were the only signs of the surgery.

Dr. David Kent, the plastic surgeon who developed the Lifestyle Lift, said he sees more patients who don't want to take the time off for major surgery.

"Women between the ages of 40 and 60 can't be out of commission for months," Kent said, sitting in his Troy office. "With this, you have the traditional results of a face-lift, but you leave within an hour with a Band-Aid and go to work."

New chemicals are taking injection treatments further than Botox and collagen. A chemical called Sculptra, used on only 390 patients in 2004, allows doctors to fill in cheeks sunken by age or illness. While Botox numbs the face to prevent it from wrinkling and collagen fills in wrinkles, Sculptra is injected throughout the face to help the body re-create its own tissue.

Those wanting to trim down can now get a gentler and more precise form of liposuction aided by an ultrasound machine. Waves from the ultrasound help break down the fat, making it easier for doctors to remove the tissue with less tugging and pulling and more precision.

Women who want their breasts enhanced can opt for a surgery in which a deflated implant is funneled to the breast through an incision in the navel. The implant is filled with saline once in place. Doctors say the recovery time for the procedure is usually about a week.

Doctors are feeling the pressure to provide the latest. Grosse Pointe surgeon Dr. George Goffas regularly buys new equipment to keep up with the latest trends. He recently spent about $10,000 on a device that allows him to perform a minimally invasive forehead lift to smooth out the skin on the forehead and lift the eyebrows. The procedure costs patients about $4,500.

"It's good for business," Goffas said of the growing demand for new procedures. "But they think you can do everything for them and do it all at once."

Goffas, like many colleagues, also worries that the push for new and fast is creating unrealistic expectations and making an already image-obsessed society even more sensitive about its appearance.

The thread lifts, in particular, have come under fire lately as some patients report disastrous results and doctors question how they'll hold up. The threads can detach from the skin after a short period of time or, if not inserted correctly, they can be seen through the skin, leaving railroad track-like marks.

"There's no good study that talks about the longevity of all these things," said Michael Olding, chief of plastic surgery at George Washington University in Washington, D.C. "All the somewhat-uneducated public hears is 'face-lift.' Not a pull and tug on a portion of the face that only works on selected individuals."

Rhea Heil, for one, is happy with the work she had done. A fit size 10, the 67-year-old from Birmingham was still unhappy with some fat on her legs, thighs and belly. She decided to get ultrasound-assisted liposuction. She's now a size 6 and has no marks from the procedure except for 13 pea-sized scars that are fading fast. Heil was back doing volunteer work five days after the surgery.

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