Cost of Plastic Surgery: Nickel and Diming Cosmetic Patients

Cost of tummy tuck surgery increases with technology

 

We live in an age of exponential growth in information and technology and in the cost of surgery. Even in the past few years, advances in cosmetic plastic surgery techniques have been enormous—and so has the cost of surgery! Some cosmetic plastic surgeons still cling to old methods. That is sad.

Here are a few other posts on these topics:

https://tavmd.com/2012/02/24/plastic-surgery-without-pain/

https://tavmd.com/2011/07/02/new-technique-for-tummy-tuck/

dollar sign

New surgery techniques  come with  a higher cost. How to deal with an increase in the cost of surgery in an era when we are all trying to keep surgery costs down is problematic.

As a cosmetic plastic surgeon, I have a certain cost for my surgeries. Regularly, costs of implants and garments are added to  costs for surgery in addition to hospital/anesthesia fees. Think of it as the cost of performing surgery + materials.

 

Exparel

I have previously written about Exparel.  This slow-release formulation of a common local anesthetic (Bupivacaine) that many plastic surgeons use is set to explode on the market and change the way we practice medicine. The drug  provides for a three-day area of numbness when injected into the surgical field. That means three days of reduced need for narcotics (with all of its problems), not suffering pain and getting back to normal faster!

It adds $285 to the cost of surgery (breast augmentation or tummy tuck).

The hospital doesn’t provide it to plastic surgeons; they do provide regular bupivacaine as part of a global surgery cost. What do they care if you have less pain once you are out the door?  They don’t save any money.

This leaves cosmetic plastic surgeons with the sad choice of telling cosmetic patients that a drug exists that will reduce their pain but add to the cost of surgery. Patients can then choose whether to buy it or not. First-class ticket or economy? I find it hard to practice medicine knowing that a better alternative exists for my patient but that it will not be offered due to cost. That just seems wrong. Reduce my fee and eat the cost? OK; but by the same token why not increase my fee and include Exparel?

Prineo

This is a new wound closure system from  the Ethibond suture company. The combination of Dermabond (tissue glue) and tape makes for a far superior dressing after surgery that stays on patients for about one month. Scars are rare because it decreases incision and tension on the skin for most patients.

My surgery center used to provide it as part of the hospital fee. Not anymore.  I have to either abandon what I know to be a far better closure system and go back to the old, lesser techniques… or have patients pay an extra $250.

Liposuction

For my abdominoplasty/tummy tuck patients, I regularly include abdominal and hip liposuction. It turns out that many plastic surgeons do not include  liposuction, and if they do, they charge patients extra for it… like I used to!

I used to offer patients the option of liposuction at the same time as abdominoplasty because I knew that the cosmetic results were better.  Most would say “no thanks”—the cost was another 20% on top of  tummy tuck fees and that turned out to be too much for most patients. Those who had the liposuction at the same time were happy, and the ones who did not returned later to have it or left unsatisfied despite my best efforts to forewarn them.

I have decided to include the liposuction in all my abdominoplasty operations as standard. I had to cut my fee down for the lipo, but I now get better results. I was able to do this because it was my work and time, not a fixed cost of materials from another company.

Medical economics

The above gives you an example of how the cost of plastic surgery continually rises advances in technology.  New medical advances cost money, which is usually transferred to the patient’s insurance company, which may or may not pay for particular therapies.

In cosmetic surgery patients who pay out of pocket, a new/better treatment modality will cost more. As a cosmetic plastic surgeon, I want the best possible results for my patients, but now I have to offer them a choice between the “best” techniques and simply “good” ones.  If I keep on eating the cost, eventually I will be performing the surgery for free, as my costs will be greater than my income. After all, this is how I make my living.

I can’t decide what to do! I fear that increasing the cost of plastic surgery without telling patients the reasons will frighten away patients who may not understand the nuances of surgery and differences in results.

Or should I be offering a two-tier surgical result—a basic economy tummy tuck and a first-class tummy tuck with all the extras ? Advice is welcome—only first-class advice at no extra cost please!

Morad Tavallali, M.D., FACS