Why am I Expected to Pay so Much for Revision Rhinoplasty? Shouldn't it be Free or Discounted?(photo)

Question

I had rhinoplasty done in July 2011. I had my dr. file down the small bump on the bridge % define the bridge more. Yes, I can tell it has been "modified"..but I still have a bump. It's about 1.5-2 mm high, so yes, it's very small. When I press down on it, it feels hard like bone. My dr. & I had discussed a revision surgery. Now, I just thought I only had to pay for the anesthesia fee? Total cost? 2200. 1000 for anesthesia & 1200 for the surgery. Should I pay this? or go to someone else?

Thomas A. Lamperti, MD · Answer

It sounds like you'll only have to pay for the anesthesia and operating room fees for your refinement surgery. It is common for the surgeon to waive their fee in situations like yours. Depending on where the surgery is done the surgeon doesn't necessarily control this pricing.

Robert Kotler, MD, FACS · Answer

Dear AmW920x0;

	This is a tough issue for another doctor to discuss when perhaps more information is needed. 

	From the photos and from your description, indeed a very minor revision rhinoplasty may be necessary. 

	Most surgeons do not charge for their services, but do ask the patient to pay for the operating room and the anesthesia specialist at the time of the revision surgery.

	My question: what was your understanding before the primary rhinoplasty?  Did the office issue a written fee confirmation that included all the information including additional charges  if a secondary &ldquo;touch-up&rdquo; or revision rhinoplasty becomes necessary?

	If you go to another surgeon, he or she will be expected to pay.  I would not know what surgeons charge for these services in your area, but I certainly would inquire.

	However, I think you need to sit down and have a heart-to-heart discussion with your surgeon.  It may not be that it was his fault or that Nature somewhat was exuberant in the healing, but nonetheless, typically if you explain to him that it is hard for you to come up with additional money after having paid for the first surgery, perhaps he can accommodate you.

	All surgeons want their patients to be happy, not only with results, but with the financial issues. 

	Robert Kotler, MD, FACS
	Facial Plastic Surgeon
	Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON
	Author, THE ESSENTIAL COSMETIC SURGERY COMPANION

Michael L. Schwartz, MD · Answer

You should definitely wait longer to be certain that you are not under corrected. Regarding fees, each surgeon has their own policy but it sounds as if your surgeon is not charging you anything and you are only paying for OR and anesthesia which are not under his control. I follow the same policy and all my patients sign an informed disclosure of this prior to surgery.

Gregory Pippin, MD · Answer

Talk to your surgeon.  It sounds as if your surgeon has waived their fees.  Whenever you have surgery there are anesthesia fees, facilty fees, and surgeon fees.  It is very likely that your surgeon fees have been waived.  If you go to someone else the fees will be  higher.  I hope this helps.  You might wait a little longer.  I ideally recommend you wait at least one year for revision surgery.  Your nose will continue to change during the year healing phase.  Warmest regards.

	Dr. Pippin

Chase Lay, MD · Answer

Most likely, if you went to someone else they would charge you quite a bit more.  When I am revising someone else's work my surgeon's fee is increased from my regular fee.  You should discuss this fee with your surgeon.  I would guess that the surgeon's fee from someone besides your current surgeon would be between $4,500 and $7,000.  I encourage you to meet with other surgeons.

	 

	Best of luck

	Chase Lay, MD

Kenneth L. Stein, MD (in memoriam) · Answer

The potential for need for a revision procedure should have been discussed prior to surgery. I typically would charge $300 for anesthesia and $200 for operating room and my services would be at no charge. If I were doing a case that was originally done by another doctor, anesthesia would be $700, operating room would be $800 and the procedure fee would be $2500. I would recommend that you share your dilemma with your surgeon and see if he would work out a more reasonable deal.

Richard W. Fleming, MD (retired) · Answer

You are just 4 months post-op; I suggest you wait another 6 months before doing any revision surgery. The cost of your revision will depend on the agreement you had with your surgeon before the first operation. I assume you have discussed this with him before you submitted this question to us. It will be more expensive if you go to another surgeon.

Randolph Capone, MD, FACS (in memoriam) · Answer

Since it's only been 4 months or so since surgery, I suggest you put several more months behind you to allow for more healing.  You might find that the residual fullness is because of residual swelling.  It may get smaller!  

Don't stress- you commented that you've already seen improvement, so you have that going for you.  I always recommend to prior rhinoplasty patients that they air the laundry with their surgeon and really keep the lines of communication open- tell your doc that you were really hoping/expecting a straight dorsum (or slight scoop if that's the look you're going for) and 
come to a collective decision at the 1-year mark.  If there are other problems with your result (new twist, tip irregularity, new breathing difficulty, etc.) AND you don't feel that your surgeon 
is in your corner, only then would I consider cutting bait for a different surgeon.  But, you'll pay a hefty price to do this.  Most surgeons charge a minute nominal fee for their own revisions, but with anesthesia, and O.R. Time- even a straightforward revision, it can still be a 
couple thousand dollars.

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