Tag Archives: surgery techniques

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

Facelift Surgery: A Modern Approach

Modern facelift surgery

Facelift Surgery (rhytidectomy) is a cosmetic plastic surgery that is increasingly being performed to rejuvenate the facial structures that sag with age.

If you want to see some photos of facelift surgery patients, look here: https://www.tavmd.com/Facelift_photos.html

For more information about the surgery, look here: https://www.tavmd.com/facelift.html

What happens to the face as we age?

The aging process has specific effects on the skin of the face:

  • The skin color changes and blemishes occur
  • Skin elasticity decreases because the elastin and collagen proteins disintegrate
  • Skin thins out as structures such as dermis and hair follicles undergo involution
  • Fat deposits of the face move down as the ligaments and facial structures holding them up stretch and break
  • Muscles loosen and stretch down with gravity
  • The bone structures of the face resorb and cause regression of the maxilla and mandible

What a plastic surgeon does in a facelift

Facelift surgery is designed to address each of these different situations using different surgical techniques:

  • The muscles and fat are lifted up in a rotational manner and sutured into place.
  • Skin is elevated  and excess removed from behind and in front of the ears.

The surgery typically takes about 3-4 hours and  is often accompanied by eyelid lift (blepharoplasty) and/or forehead lift surgery.

Facelift techniques

Although multiple techniques have come and gone over the years, these basic principles have stayed the same:

  • Remove skin only,
  • Lift the skin and muscle/fat, or
  • Lift all of the facial structures clear off the facial skeleton.

In my opinion, a skin-only facelift is a waste of time, a deep plane facelift is horrendous and a skin and muscle/fat elevation facelift is… just right.

A modern facelift

What has not stayed the same is the difference in philosophy with respect to the surgery. Twenty years ago, plastic surgeons would wait until the patient needed a full facelift and often a brow lift, too—a full overhaul. Indeed, cosmetic patients would only come in when everything had drooped!

A more modern approach is to view each cosmetic facelift patient individually and address only the areas of the face that have sagged and need to be lifted. For example, a patient may need to have their neck and jowl lifted but not their cheeks, or they may need a brow lift but not an eyelid lift (blepharoplasty).

Facelift under local anesthesia

Another modern innovation has been performing facelift surgery on cosmetic patients under local anesthesia. The patients are given a mild sedative by mouth such as Valium and some pain medication. The areas for surgery are then injected with local anesthetic to numb the skin.

The advantages of facelift with local anesthesia are:

  • No general anesthesia and its side effects
  • No changes in blood pressure as with general anesthesia
  • Less complicated recovery
  • Less “frightening” surgery
  • Reduced cost

The modern facelift has developed into a safe, reliable and uniquely tailored cosmetic surgery procedure in the hands of board-certified plastic surgeons—of course! A small procedure under local anesthesia and a fortnight of healing can make a huge difference in your face.

Here is another post about facelift surgery: https://tavmd.com/?s=face+lift

Driving through Cosmetic Plastic Surgery

Plastic surgery driving techniques

 

Cosmetic plastic surgery gives me the opportunity to think about different aspects of my non-surgery life through the eyes of a surgeon due to my professional surgical training. Sometimes this has advantages…
My daughter turned 16 a few months ago, and we are in the middle of that all-American period of our lives when she is learning to drive. I have a silly aversion to the many talented and caring driving instructors who nourish young adults in teaching them to tame 250-300 horses under the hood, but I decided to teach her driving myself.

That may seem strange to those of you who know that I have never passed a driving test!

I learned to drive while in England. Every week, there I was, driving around the business parks and dull streets of Slough, which later became a world-famous town as the set for the English version of “The Office.” I failed my test. In fact, at one point, the official giving the test had to reach over and yank the steering wheel away from me to prevent an accident…
The following month, I arrived in the US and applied for a driver’s license. I showed my English learner’s permit as ID. I did pass the “written” test, and they must have assumed I could drive because they gave me a full license without a test. I had my share of fender benders while growing up, but only totaled one car.

I finally learned how to drive properly once I trained as a surgeon. That is what I wanted to talk about: the similarities between driving and cosmetic plastic surgery. Some basic rules apply to both tasks. Here are my ten:

  • Have a surgical plan—always know where you are going

In cosmetic surgery, a plastic surgeon should have a plan before starting. A driver should have looked at a map and gotten an idea of where to go. Situations may change as one moves through, but at least there’s a plan.

  • Plan your next move while performing the current one

In surgery and driving, you need to look ahead. Your brain is performing one task ahead of your hands. You also need to look at traffic two blocks ahead and not just at the car in front of you.

  • Go twice as fast in the easy areas and twice as slow in the difficult ones

That surgical wisdom was given to me by one of my old professors in New York. In cosmetic surgery, there are times when more care is needed than in other more routine movements. Likewise, you can go faster on a straight road and slower on a curve.

  •  When in doubt, stop and think

If you are not sure of who is going to take the priority at a stop sign, stop! Likewise, in plastic surgery, if you lose your way, stop and re-think your approach.

  •  Make sure you have fuel

Performing plastic surgery on an empty stomach is as silly as driving on an empty tank. You will stop too soon.

  •  Make sure you have good instruments to work with

Obviously you need a car that works, and having A/C and heating can only help. In plastic surgery, specialized equipment like liposuction may be necessary, without which you cannot perform cosmetic surgery.

  •  Don’t speed

A good plastic surgeon, as well as a good driver, will keep a constant and steady rhythm. Some may go slower and some faster, but at no time should a plastic surgeon or driver speed just to get to the end.

  • No jerky movements

Rash, unexpected or jittery movements may harm the patient or your assistant and must be avoided. Likewise, the driver should not turn the wheel in a jerky manner or change lanes in such a way.

  •  Do not operate for too long

Becoming a tired plastic surgeon is as bad as becoming a tired driver. Only bad things can happen thereafter.

  •  Always give priority to humans

No matter how involved you get with the task of surgery or driving, you still have to remember to give way to humans/pedestrians. The plastic surgeon should never forget that it is a patient he or she is operating on and not just a belly or a breast.

That should do it—I now feel a little like Abraham with these commandments.  Next time you drive, think of yourself as a little bit of a surgeon when you follow these rules.
By the way, my daughter is coming along just fine and is an excellent driver.