The nation's cosmetic surgeons are being hurt by the sagging economy, but hope is rising. The first competitor to Botox was approved last week and there are potentially revolutionary new treatments on the horizon, including stem cell injections and a cream that can remove unwanted facial lines. The number of cosmetic procedures in the United States last year fell 12.3% from 2007, to just over 10.2 million, according to the American Society for Aesthetic Plastic Surgery.