Probably the information most often requested of my staff and me by a patient or potential patient relative to the cosmetic surgery services we offer is the cost of those services. We receive ten to twenty calls on a daily basis from people interested in cosmetic surgery. A surprising number of these calls begin with a question about my fee for a particular surgical procedure and end after a member of my staff relates that fee to the caller, before that staff member is able to discuss the procedure, its pros, cons, etc. These calls suggest to me that such callers are "shopping for price". I suspect that these callers fail to realize that a plastic surgeon's fee for any cosmetic surgical procedure is only one component of the total cost of that procedure. This article is designed to provide to those individuals interested in cosmetic surgery an opportunity to compare apples with apples and oranges with oranges when they consult, either by telephone or in person, plastic surgeons about cosmetic surgery. Keep in mind that, while the cost of medical care, whether or not that care relates to cosmetic surgery, is of concern to all of us these days, it never should be the sole consideration relative to the choice of "healthcare providers". Nonetheless, what follows should be of help to those of you considering cosmetic surgery.

There are essentially three components to the cost of any cosmetic surgical procedure: first, the surgeon's fee, which may or may not include the cost of any implants (such as breast implants) employed at the time of surgery; second, the cost of the operative facility (in other words, the "operating room") where the surgery is undertaken, as well as costs related to the preparation for, recovery from and documentation of surgery, all of which will be discussed a little later; and third, the cost of any anesthesia services, other than those related to the use of "local" anesthesia (similar to that which a dentist employs to fill a decayed tooth).

Surgeons' fees can vary tremendously depending upon what those fees include. I routinely package the cost of any implants I employ in the course of a cosmetic surgical procedure into my surgical fee. By buying implants in quantity, I am able to purchase them at a discount which I am able to pass onto my patients and also am assured that any implant I may require is available to me. Surgeons' fees usually include the cost of routine postoperative care but the length of that "free" care may vary from surgeon to surgeon. I routinely provide such "free" care to my patients for a period of not less than one year following a cosmetic surgical procedure. Keep in mind that, by "routine" postoperative care, I am referring to that care which ordinarily would follow a given cosmetic surgical procedure, not necessarily care which is necessitated because of a postoperative complication (for example, a wound infection leading to unsatisfactory scar formation leading, in turn, to surgical "touch-up" of that scar).

The cost of the operative facility may or may not include several related expenses such as the cost of preoperative testing, as well as the cost of interpretation of that testing (for example, by a radiologist in the case of a preoperative x-ray or a cardiologist in the case of a preoperative electrocardiogram), and it may or may not include the cost of any recovery services, which may involve no more than an hour or two in a "recovery room" to an overnight stay in a hospital, hotel or whatever. Furthermore, the cost of the operative facility may or may not include the services of a pathologist who might be called upon to examine any "specimen" removed at the time of surgery.

Finally, a patient undergoing cosmetic surgery may face the cost of anesthesia services, related to not only the cost of anesthetics (intravenous drugs, gasses, etc.) employed at the time of surgery but also the cost of an anesthetist (a nurse schooled in the use of anesthesia) and/or an anesthesiologist (a physician who specializes in anesthesia). Therefore, as I indicated, the surgeon's fee corresponding to a cosmetic surgical procedure is only one component of the total cost of that procedure and, as you can anticipate from the foregoing, may prove to be a fraction of that total cost.

Another consideration which should be important to anyone contemplating cosmetic surgery is the "setting" of that surgery. That setting may vary from a hospital-based operating room to a free-standing ambulatory surgery center to a private, office-based operating room. My personal preference is a hospital-based operating room, which allows me to undertake cosmetic surgery in a safe, secure environment with a gamut of sophisticated medical equipment and services available to me at what, in my experience, has proven to be a very competitive price. I can undertake such surgery with the assurance that, if a problem necessitating immediate and sophisticated medical care arises, the setting in which I undertake such surgery allows me to avail myself, within minutes if not seconds, of the latest medical technology and an array of well trained physicians and nurses for help.

For more information about this and other cosmetic and non-cosmetic procedures, please call The Pittsburgh Institute of Plastic Surgery at 1-800-321-7477 or The Plastic Surgery Information Service at 1-800-635-0635.



Dr. Richard T. Vagley, a Board Certified Plastic Surgeon, is Medical Director of The Pittsburgh Institute of Plastic Surgery and a Contributing Editor of Outpatient Surgery Magazine.

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