The cost of cosmetic surgery may have little to do with the quality of your operation!

Richard H. Tholen, MD, FACS

Article by
Minneapolis Plastic Surgeon

Patients often ask about how a plastic surgeon sets prices for operations. Is the most expensive surgeon “the best?” Is a properly-trained and certified surgeon (see my article about board certification) who offers the lowest price the best value? Or is it just a matter of “All surgeons have the same ability to do an operation properly, so go with the lowest cost?” These are good questions that deserve a detailed answer.

First of all, make sure you are comparing surgeons properly. That "low-price" cosmetic surgeon may actually be a family practitioner or other non-surgeon who has decided to open up a cosmetic surgery practice and operates in a non-accredited, non-credentialed, non-peer-reviewed facility. This kind of "cosmetic surgeon" may spend more on marketing and "appearances" than on your safety. It may not be clear to you that this doctor has bypassed all of the proper surgical residency training, plastic surgical fellowship training, written and oral examinations leading to American Board of Plastic Surgery certification, and office surgical facility accreditation (AAAASF or JACHO). However, the "real" plastic surgeons in your community DO KNOW, and perhaps low price is the only way this doctor can compete with the properly-trained, properly-board-certified, and properly-accredited surgeons in the community.

The perverse reality is that sometimes these "psuedo-plastic surgeons" even charge MORE than their "real" competitors, in an effort to be perceived as "better." These con artists even go out of their way to boast of themselves as "cosmetic surgery 'specialists'" rather than "general plastic surgeons" who are derisively described as "fixing burns" or "taking care of bedsores." (Of course, what they don't tell you is that their cosmetic surgery "training" consisted of a couple of two-day courses given by other non-surgeons, or spending time with another con artist doctor to learn how to fool the trusting public.) If this sounds extreme or "bogus" I can tell you of a Dermatologist in my city who tried to put in breast implants in his office exam room under local anesthesia, used up to toxic levels of Lidocaine, and only got one implant in. Two days later he tried again to get the remaining implant in, again reached toxic levels of Lidocaine, and again failed to get the second implant in. 10 days later I had to remove the existing implant (under proper anesthesia) which had bleeding and early infection present. Lawsuit pending.

So let's assume you have done your homework and consulted with only ABPS-certified plastic surgeons. There will still be discrepancies in costs. Sometimes this is because a plastic surgeon works at a hospital (this will be most plastic surgeons, who do a multitude of reconstructive and cosmetic surgeries--remember, we have COMPLETE training; that's what the circular American Society of Plastic Surgeons logo denotes). Make sure your cost quote is complete. I have seen many patients who come in with the surgeon's quote, only to find out that it does not include the hospital operating room costs, costs of the implants, or the anesthesia provider's costs--those bills are sent separately! And then there's the big surprise that the "low" cost wasn't a complete quote, or that it was only an estimate, and didn't include the "extra" 15 minutes that the surgeon took to do the procedure (extra charges not included in the "estimate").

Other ABPS plastic surgeons may work out of a stand-alone hospital-owned or privately-owned surgical center, where costs are more tightly controlled, volume of elective surgeries higher, and frankly, profits better. These plastic surgeons may be able to charge a bit less and deliver an overall superior procedure from start to finish, also avoiding exposure to "sick" patients and bad bacteria!

Some plastic surgeons (superbly-trained and skilled reconstructive experts) just don't do much cosmetic surgery, and have to price these procedures accordingly.

Other plastic surgeons have gradually steered their practices towards elective cosmetic surgery, even though they have completed the full training, certification, and accreditation of their reconstructive colleagues. This may be out of interest, talent, insurance reimbursement pressures, or a host of other factors, but these plastic surgeons have become the cosmetic surgery specialists in a competitive sea of non-surgeons, Derm surgeons, ENT surgeons, facial plastic surgeons, and REAL plastic surgeons who have chosen different paths within cosmetic and reconstructive procedures. Now there's REAL price competition.

The best and brightest ABPS-certified plastic surgery stars who specialize in cosmetic surgery may well be so busy they never have to "discount" their prices. (Or, they may just publicly state that to keep up appearances!) For some in some locations that indeed is true. God bless their good fortune in these past years of economic woe! For the rest, there has indeed been the same harsh economic reality we all have faced. Even the most successful surgeons and practices saw price competition, discounts, and patient "shopping." Some practices saw these times as an opportunity to increase their expertise and experience by offering modest discounts or incentives, while still maintaining top-notch quality, staffing, and procedural details. Most well-run businesses (including surgical practices) saw these past few years as an opportunity to become even more efficient, quality-oriented, and patient-centric when their competitors were not only cutting prices, but "cutting corners!"

So, is it "rude or disrespectful" to ask for a discount? You might be made to feel that way, if the surgeon's ego is bigger than his or her awareness of reality. I have been in private practice for 27 years, and I still offer professional discounts to doctors, nurses, medical students, armed forces personnel and other select individuals close to my heart. The "flip-side" reality is that I do the vast majority of my highly-skilled and attentive-to-detail surgery for the very best price I can deliver. I choose to do charity work overseas during my cleft lip and palate mission trips. My partner chooses to do charity work in our community with disadvantaged and at-risk youth. Most plastic surgeons do some form of charity or pro bono work--BUT we're not the dollar store or a used car lot! Our prices are based on the fact that pretty much everything medical sees costs go up yearly, our staff are the highest-skilled and capable personnel available who deserve wage increases, and there is only so much efficiency (cost savings) that can be squeezed out of a quality and service-minded elective surgical practice.

While you make good points about re-business and the like, even plastic surgeons have fixed (increasing) costs. You really don't want the surgeon who is "cheapest." You probably don't want the surgeon who is the most costly either (usually just a "cover" for average work masquerading as "the best"). You want the best ABPS-certified plastic surgeon you can find, regardless of the exact cost. Re-do surgery is not only expensive, but you have to take off your own work and activities a second time (making even a "simple" re-do VERY expensive! Ask those "low-price Charlies" what their re-do or touch-up surgery policy is. Who pays for re-operation for bleeding? All this needs to be considered.

Remember, the bitterness of poor quality remains long after the sweetness of low price is forgotten.