COSMETIC doctors have nicknames for the days on which they offer deals on anti-wrinkle shots.

Dr. Don Mehrabi, a dermatologist in Beverly Hills, California, advertises his weekly promotion as “Botox Fridays,” the days on which he lowers his fees by about 30 percent for smoothing out frown lines and crow’s feet.

On other days of the week, he gives a 10 percent discount to clients who choose a combination of Botox Cosmetic and injections of Juvéderm, a gel that plumps the skin.

“That percentage off might actually increase because of the economy,” said Dr. Mehrabi, who posts his deals on his Web site, bhskin.com. “We are contemplating going up to 20 percent.”

In light of drastic consumer cutbacks on spending, some dermatologists, facial surgeons and plastic surgeons are promoting the kinds of markdowns, coupons or two-fers you might expect to find in supermarket circulars — complete with restrictions like “offer not good with any other promotion.”

And it’s not just injection specials. The Web sites of some surgeons list promotions like $500 off a single operation or $1,000 off a combination of body or facial surgeries.

Consumers pay cash up front for cosmetic procedures and, because the treatments are medically unnecessary, they are typically not covered by insurance, which explains why doctors’ marketing efforts can resemble a department store white sale.

“Giving $1,000 off, you are going to see more of that,” said Dr. Lawrence S. Reed, a plastic surgeon in Manhattan who does not offer deals on surgery. Dr. Reed said that all upscale businesses — including plastic surgeons’ offices — are seeking creative marketing strategies to stay afloat.

“You have got to do things to get people into your fancy restaurants, your fancy car dealerships, your plastic surgeon’s office, your dermatologist’s office,” he said.

To be sure, most cosmetic doctors are neither flamboyantly advertising discounts on operations nor marketing fire sales on injections. But the economy has taken a toll on cosmetic practices. Competition from an increased number of doctors entering the cosmetic market has also stimulated more aggressive marketing.

In private consultations with patients, many plastic surgeons are reducing their fees.

“I can’t imagine anyone’s not doing that,” said Dr. James Wells, a plastic surgeon in Long Beach, California He recently asked 80 colleagues via e-mail messages how they are adapting to the economic downturn. “They are now willing to discount things anywhere from 10 to 15, 20, 25 percent,” he said.

But such price-cutting blurs the line between the tactics of commerce and the practice of medicine, in which physicians have traditionally encouraged treatments based on a patient’s condition or concerns, not on the doctor’s bottom line.

Some plastic surgeons said that incentives like discounts, treatment packages or two-for-one deals could induce people who had not previously considered it to have an injection or an operation, or to have more procedures, potentially increasing their risk of medical complications. Promotions in which existing clients receive discounts or special treatment for sending friends to their doctors can also be ethically fraught.

“It skews the caution of proper decision-making,” said Dr. Adam Searle, a plastic surgeon in London who is a former president of the British Association of Aesthetic Plastic Surgeons. His group has warned against discounts. “It simply reduces it to a commodity and that’s dangerous,” he said.

But economic realities are pushing practices once considered unseemly into the mainstream.

Sixty-two percent of plastic surgeons who responded to a questionnaire from the American Society of Plastic Surgeons reported that they had performed fewer cosmetic procedures in the first six months of this year compared with the same period last year, according to a study the group released last week.

In response, the plastic surgery society added a forum to its annual conference, which was last weekend in Chicago, entitled: “Survival Strategies for Tough Economic Times.” Some speakers at the event recommended that doctors expand their client bases by joining school boards, churches, synagogues, rotary clubs, symphony and museum groups, and breast cancer fund-raisers. Others encouraged doctors to introduce package deals and offer promotions to existing clients who refer their friends.

Plastic surgeons traditionally reduce their fees for operations on related areas of the anatomy — such as a face-lift and an eyelift — that can be performed in one session, said Dr. Mauro Romita, a plastic surgeon in Manhattan. It is also standard practice for doctors to offer discounts on Botox if a patient is having the treatment in more than one area of the face, he said.

But discounting is going public this year.

Under a three-month promotion that ended last Friday, people who bought Restylane, a facial filler, could receive a $50 rebate for one syringe or a $100 rebate for two syringes from Medicis, the brand’s distributor in the United States. The tag line for the promotion: “The economy may not be looking its best, but you can.” More than 20,000 people redeemed rebate coupons.

Individual doctors are devising their own deals.

Dr. Christine Hamori, a plastic surgeon in Duxbury, Massachusetts, said she recently mailed a two-fer invitation — designed and printed by her Medicis sales representative — to about 3,500 clients. In October, clients could buy two syringes for the price of one $600 syringe of Restylane or one $800 syringe of Perlane, another filler, Dr. Hamori said.

Seventy-five people came in for injections; many of them requested additional treatments. In a month in which few people had signed up for expensive operations, those coming in for the injection special filled up her schedule, she said. “The response was tremendous,” Dr. Hamori said.

And some pharmaceutical companies offer volume discounts to select doctors.

Dr. Hamori said that when she recently bought 50 vials of Botox, a sales representative from Allergan, which makes Botox, added another 50 vials free. Each vial costs about $500, she said.

Dr. Mehrabi said that he received one free syringe of a filler called Radiesse from BioForm Medical, the product manufacturer, for every syringe he had sold in September.

Adam Gridley, the senior vice president for corporate development at BioForm, wrote in an e-mail message that the company does not comment publicly “on specific programs and doctor metrics.” Jonah Shacknai, the chief executive of Medicis, said that only a few doctors across the country are participating in his company’s program to introduce patients to the effects of two syringes. Caroline Van Hove, vice president for corporate communications at Allergan, wrote in an e-mail message that the company does not provide free vials of Botox Cosmetic as a reward for buying the product.

Some doctors are also lowering their charges for larger procedures.

Dr. Hamori said she has been reducing her surgical fees in a range of 5 to 10 percent.

In Indianapolis, Dr. W. Gregory Chernoff, a facial surgeon, decided to lower his prices a few months ago after he noticed a slowdown in face-lifts and hair transplant patients. He calls the 15- to 20-percent reduction in surgical fees a “professional courtesy.”

“We do not want to be a Kmart of cosmetic surgery,” said Dr. Chernoff, who has also posted holiday special offers, good until Nov. 28, on his Web site. “That word ‘discount’ is shunned within our profession.”

Dr. Wells, a former president of the American Society of Plastic Surgeons, said that many of his colleagues are now trying to figure out how to provide “value added” services to entice clients. He predicted that more doctors will start offering a free anti-wrinkle shot or laser treatment for people having cosmetic surgery. But some doctors may go too far, he said.

“My conjecture is we are going to see people go over the line,” Dr. Wells said.

Along the hallways of the plastic surgery conference in Chicago, Dr. Wells toted one of his favorite books, “Cowboy Values,” an ode to the moral code of the Old West. As his coda to an interview about cosmetic surgery marketing, Dr. Wells opened the book and read a passage aloud to a reporter: “You never really know the measure of a man until there is adversity or money on the table.”