Revision Tummy Tuck - Who should pay?!
Unfortunately, if your PS does not own the facility then the patient is responsible for the facility and anesthesia fee. The big point is that revision surgery and how the fees are allocated should have been discussed prior to the original surgery. Continue to have on going dialogue with your PS so that you both may have a satisfactory solution to this issue.
Revisionary Tummy tuck surgery
No surgery is ever guaranteed 100% and I agree with the other surgeon's that it's difficult to say exactly what went on since your surgery was 1 year ago. It is customary for the surgeon to reduce or eliminate his/her fees but when there are other fees involved that are not controlled by the surgeon (surgery center and/or anesthesia), these fees need to be paid by the patient.
Revision fees for a tummy tuck.
There are multiple factors that can impact your final result. You state that the excess skin is your surgeon's "mistake." The truth is that the skin often time loosens after a tummy tuck, particularly if you have lost weight in the meantime. This is normal. When you sit down, you will always have some small folds of skin. If you didn't have this extra skin, you would not be able to stand up straight! The alternative of removing too much skin during a tummy tuck can lead to disastrous consequences.
Unless the surgeon has his own operating suite, the facility fees are out of his control. Waiving his surgical fee is a fair and common practice.
I am sorry you are unhappy with the results of your tummy tuck surgery. However I cannot say your surgeon made a mistake and I think the course he has proposed are very reasonable. I agree the additional charges are beyond his control but he is waiving his fees.
Conservative excision is always wise. If the surgeon was too aggressive and you had skin loss, that would not be good. Your surgeon has agreed to a no charge minor revision. This is standard for cosmetic surgery. Paying the facility fee should be minor. I think this is reasonable.
based on your abdominal scar and lack of umbilical scar, it appears you had aprocedure somewhat less thn afull tummy tuck. the problem is not the fees but the improper setting of high expectations for a somewhat limited procedure. before the next surgey, make sure your expectations match the power of the procedure.
Revision Policy for Plastic Surgery
Without seeing photos of what you looked like before your surgery and without knowing exactly what your surgeon did during the surgery, it is impossible to say whethe or not your plastic surgeon should have taken off more skin as you suggest. But regarding your question about fees for your revision surgery, I think your surgeon is being very reasonable. It is clear that he wants you to be happy and has agreed to waive all the fees that he has control over - his surgeon fee. However, the surgeon has no control over the other associated fees such as the anesthesiologist, operating room, and other facility fees. Regardless, it is important to clarify your surgeon's "revision policy" before surgery. In my office, this policy is a written policy contained in my surgical consent packets.
Questions about revision costs folowing an abdominoplasty
Your photos are helpful but they don't fully answer the issue of excess, the amount and what your situation was last year. For example, have you lost some weight since last year? Was a more conservative skin removal performed due to an issue such as smoking? Etc.
Your sugeon was entirely reasonable in waiving any surgical fee for the revision. Since this will be performed in an outpatient center, these costs are out of his/her control and therefore, you being responsible for them is also entirely reasonable unless something else had been agreed upon prior to your surgery. His/her approach, therefore, is quite reasonable, acceptable and professional.
Tummy tuck revision--who pays?
The information NOT included is how much you paid and for what? You called your procedure a "tummy tuck" and perhaps your surgeon did also. If he did, how much did you pay, and how long was this portion of your procedure scheduled for? Was your muscle sheath tightened as part of your procedure? Was your belly button transposed into a new opening in your tightened abdominal skin (scar around the umbilicus)? Did you have liposuction of the abdomen as "part" of your tummy tuck?
I assume you were happy with your breast surgery. I hope your surgeon is an ABPS-certified plastic surgeon, not a "cosmetic surgeon" of some other specialty training.
What I see when I look at your photographs is a short scar consistent with a "mini" tummy tuck. I cannot see a scar around your belly button, but this could be hidden within the belly button if it IS present. This does not look like a full and "standard" tummy tuck, which would have a scar extending further towards your hips, a scar around your belly button, muscle tightening (called rectus sheath plication), and a tighter overall result.
So if your surgeon is not a fully-trained and ABPS-certified plastic surgeon, that may explain the incomplete job, particularly if you were told you were having a full and "standard" tummy tuck and all of its proper components (and if you paid for a "full" tummy tuck).
But, regardless of training and certification, if you paid for a mini tummy tuck, that is what you got, and that is why we routinely tell patients on this site that mini-surgeries tend to give mini-results. You get what you pay for. BTW, the "smooth tuck" fits this appearance--liposuction of the abdomen and "some" skin tightening (at a high full tummy tuck cost). This degree of skin laxity requires a full "standard" tummy tuck, not what it appears you had.
If you paid for a full tummy tuck and 2-3 hours of operating time, I must say that this does not look like what you got. I would be particularly upset if I heard this was performed by an ABPS-certified colleague, for we can and should do better than what you show (IF this was supposed to be a full tummy tuck and you paid for that).
In general, whenever I perform plastic surgical procedures for my patients, they know in advance (verbally and in writing) that any touch-up or revisional surgery is done without surgeon's fee, but with the full knowledge that the patient is responsible for operating room, anesthesia, and any implants, garments, etc. used for them. Fortunately, since I operate in my own accredited in-office surgical facility, my costs are ALWAYS lower than the hospital. "Free" re-dos are not "built-in" to the fees I quote for surgery since they occur infrequently. But if I have to do a no-surgeon's-fee operation, and the patient has to pay (again), there is an implicit MUTUAL understanding that surgery requires not only my best efforts, skill, and attention to detail, but also the patient's compliance with restrictions, instructions, and follow-up visits to monitor progress and make ongoing recommendations. Healing, risks, and complications are not always controllable by the surgeon OR the patient, and a shared responsibility for re-do costs is not only reasonable and fair, but a proper inducement for both the surgeon AND his patient to do their best.
I would be very interested in the training and certification of your surgeon, the exact procedure quoted and paid for, and what was actually done and dictated in the operative report. There's more to this story! Best wishes!
Revision fees after a tummy tuck
A surgeon has to make a judgement during surgery as to how much skin is safe to remove. Trust me, it is worse to take too much than too little. As long as the doctor uses a surgery center and not one in his own office he doesn't control anything other than his own fees which he has waived. His plan is fair and reasonable.