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Economics of Facial Plastic Surgery

I just read a very interesting online article discussing the economics of facial plastic & cosmetic surgery and thought it would be a good time to post a blog entry on this somewhat controversial topic. This article highlighted the fact that there has been a significant spike in the number of non-plastic surgeons who are now offering cosmetic surgery services. For instance, there are obstetrician-gynecologists who routinely advertise liposuction of the face and body. And there are even dentists now offering facelifts and eyelid lifts here in San Diego. In fact, all you have to do is pick up one of the local weekly publications here in San Diego to find several different doctors who now advertise cosmetic surgery services without being board certified in plastic surgery. But almost all of these offices advertise that their doctors are board certified, which certainly may be the case. But board certified in what?

Board Certification in Plastic Surgery

A good number of these advertisements indicate their doctors are board certified, but they are not necessarily board certified in plastic surgery or facial plastic surgery. They are likely board certified in some other medical discipline – like OB-GYN, family medicine, internal medicine or dentistry – not plastic surgery. You might be asking why would an OB-GYN or dentist be performing plastic surgery? The answer is largely economically based. In today’s day and age, it is becoming increasingly difficult and frustrating to run a standard medical practice that requires reimbursement from health insurance companies. Many of these doctors are now looking at getting into the world of plastic surgery where payment is largely independent of any insurance company and might prove more lucrative. The problem is they have already finished their residency training in a medical field outside of plastic surgery with many of them having already practiced for several years in their core discipline, such as OB-GYN. Going back to formal residency or fellowship training in a plastic surgery specialty would require them to take a significant cut in pay (since residents are paid a fraction of what practicing doctors make). In addition, these doctors would have to take a huge step backwards in terms of quality of life to go back and complete a new surgical residency program. So how do they get around this issue? The answer is that many of them try and obtain certification in something that sounds like it is plastic surgery. In most cases, this is certification in something that has ‘cosmetic surgery’ in the title. Now, granted, the surgical specialty of plastic surgery does involve performing cosmetic procedures to enhance the appearance. But being board certified in plastic surgery or facial plastic surgery is quite different than being board certified in cosmetic surgery. Most board certified facial plastic surgeons or board certified plastic surgeons have completed years of surgical training dedicated to their chosen specialty. They then become board certified by the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS) or the American Board of Plastic Surgery (ABPS), respectively. These two boards are widely considered the standard when it comes to finding a qualified surgeon who specializes in plastic and reconstructive surgery. In your research, you should look for one of these two board certifications as an absolute criteria before deciding on a plastic surgeon. Membership in one of the many other ‘cosmetic surgery’ organizations out there is simply not the same. Membership in these other cosmetic surgery organizations does not require the same stringent requirements that membership in the ABFPRS and ABPS demands. This is largely why non plastic surgeons choose to join these ‘cosmetic’ organizations. To a degree, it gives them credibility in the public eye to say they are board certified in something cosmetic. The general public and average consumer sees ‘board certified’ and ‘cosmetic surgery’ in the same ad, automatically thinking this is the same as being board certified in facial plastic surgery or plastic surgery. Unfortunately, this is simply not the case in many surgeons’ opinion.

The Catch

So how are these non-plastic surgeons offering this type of surgery and getting a response you might ask? They are able to do this because so many people out there are after a deal, especially in the current economic environment. In a good number of these cases, the doctors are slashing prices way below what the average plastic surgeon charges for the same procedure. I am sure you have heard the old saying, “If it sounds too good to be true, it probably isn’t.” Well, this old adage certainly applies here in the world of plastic surgery. When it comes to your facial appearance, you get what you pay for in terms of services. A board certified facial plastic surgeon or board certified plastic surgeon is going to charge a reasonable amount of money for their education, surgical training and experience.  Granted, there are those surgeons out there who charge a ridiculous amount of money compared with other plastic surgeons in the same community. But, for the most part, board certified facial plastic surgeons within the same city are going to be in the same price range for similar procedures. I recently saw an advertisement here in San Diego for a rhinoplasty (nosejob) procedure offered by a non-plastic surgeon  in the neighborhood of $3500. And this included the surgeon’s fee, anesthesia and facility costs! Now if this doesn’t scream illegitimate, I don’t know what does. The average cost for a rhinoplasty surgery in San Diego by a board certified plastic surgeon is approximately $6000-7500. So this gives you a good perspective of how far outside of the normal range some of these non-plastic surgeons are charging for similar cosmetic procedures. Regretfully, there are a good number of patients out there who are deciding on their surgeon simply based on price. Many of these patients are going to opt for the $3500 rhinoplasty and actually get less than what they paid for in terms of a result. This is because buying plastic surgery is not like a purchasing a car. If you pay$3500 for a used car that normally goes for $7000, you’ll probably get a car that works but is just not as nicely conditioned as others. And if you feel like you got cheated in the transaction, you could likely turn around and get your $3500 back by selling it to someone else. Unfortunately, plastic surgery doesn’t work this way. For $3500, you are going to get a rhinoplasty result that is probably not going to compare with similar outcomes by board certified rhinoplasty surgeons. But even more unfortunate is the fact that your nose will more than likely be damaged and mis-shapen in the process. And when you go to try and repair the nose with a revision rhinoplasty procedure by a board certified specialist, it is now going to cost you nearly $10,000 the second time around! This is because corrective plastic surgery is usually much more difficult than the primary (first time) procedure. And this same scenario also applies to other plastic surgery procedures like facelifts, forehead lifts, eyelid lifts, ear reshaping, breast implants, etc.

I truly hope this discussion raises some eyebrows out there. And more importantly, I hope it provides prospective plastic surgery patients out there some helpful information that allows them to make a more educated decision regarding their choice of a board certified plastic surgeon.

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