SAN DIEGO -- From botox and breast implants to chemical peels, a proposed federal tax on cosmetic procedures has local surgeons and their clients frowning. But the people hurt the most by the tax may not be who you think.

When Colleen Barone looks in the mirror she likes what she sees and she wants to keep it that way.

"As you get older, you have to have 'the maintenance,' as I call it," Barone said. By 'maintenance' she means botox. Barone works as a spray tanner and said it's important to stay looking good for her job.

"It's good for the self-esteem," she said. "It just makes me feel better about my skin and myself."

But 'looking nice,' whether it's tummy tucks, lipo, facelifts or breast implants could soon be more pricey.

In the Senate health care bill, the so-called 'botax,' a proposed 5 percent tax on cosmetic surgeries and procedures, is expected to raise over $5 billion over the next decade.

Dr. Sassan Alavi of the Center for Cosmetic Surgery said not only will it hurt the industry -- the San Diego area is home to some of the top surgeons in the field -- it will hurt women, and not the rich.

"What we're doing here is taxing middle-class women," Alavi said. "Most of my patients are middle class."

According to the most recent numbers, 90 percent of cosmetic surgery patients have household incomes of less than $90,000, including Barone.

Many wonder: if it's elective, why shouldn't it be taxed?

Barone said that in this recession every dollar counts, and she may have to give up botox if the tax is passed.

Right now, the tax would apply to procedures that are more vanity than necessity. But some surgeons have said that since there's no specific list, the ambiguity could lead some who really need a procedure -- like skin removal after dramatic weight loss --- to be taxed. Many also fear this tax will lead to more taxes on other medical procedures.