Q: Dr. Eppley, I have been insecure about my body ever since I was in first grade and was made fun of for my build, weight, and lack of breasts. I want a surgery done involving chin tuck, tummy tuck, possible liposuction and rib removal; for I have too short of a torso to have curves and it bothers me. Another struggle is I am covered by Medicaid because my family can’t afford regular insurance or hospital visits. Is there anything that can be done, or anyone I can be referred to?
A: While I can empathize with your body concerns, the reality is that cosmetic surgery is not covered by any form of insurance, Medicaid or otherwise. There are no justifiable medical reasons for your body change requests, regardless of the psychological or physical symptoms that they may create. Also there are no referral places for free or substantially reduced costs for cosmetic surgery procedures even at a local University or large medical center. Plastic surgeons have costs no matter where they are located, some of which they have no control over (operating room, anesthesia) and significant liability exposures. Thus the hard reality is that the barrier for you having cosmetic surgery is an economic one.
On a more instructive note, the one suggestion that I do have is that you pick one procedure (since you can’t afford them all) and the one that is the most important to you. In other words, if you could only have one plastic surgery procedure ever in your lifetime, what would it be? Then with that one procedure in mind, reach out to plastic surgeons and see if you can find someone who will do the procedure for you at a negotiated rate that you can afford. Most plastic surgeons are extremely compassionate and have done a lot of ‘community work’ in their practices over the years. If you approach your desire for cosmetic surgery this way, you are likely to be far more successful.
Dr. Barry Eppley
Q: I read your blog on plastic surgery after a large amount of weight loss. I’m pretty sure that you broke my heart, but I’m glad you wrote the reality. I am so completely disappointed. I joined a sight that said men donate to women like me for breast lift and breast augmentation surgeries. I now know that it’s hopeless. I am on disability and have no way to pay for these procedures. It would take me many years to save for the procedures I need desperately. I only wish that if medicaid or medicare could understand that these procedures are needed and not just for cosmetic reasons. Having low self esteem, a feeling of complete hopelessness, depression, and anxiety are all factors they should consider too. I really hoped that when I lost most of my weight that I would once again be nice looking. I used to weigh almost 280 pounds and I am now 145 pounds. It did not make one bit of difference because now I have sags and hanging skin. I would do anything to look good and feel confident again. Thank you for sharing your wisdom. Please remind people who can and do succeed with their procedures that they are lucky and truely blessed.
A: The unfortunate reality is that cosmetic surgery is not free nor are any health insurances going to pay for elective body contouring surgeries. This is of great disappointment to many massive weight loss patients that understandably feel that their loose hanging skin poses many physical as well as psychological problems. Even in the few body contouring procedures that some insurances may cover, such as a panniculectomy, plastic surgeons are very hesitant to do them because the reimbursements are so low, they take a lot of work with potential complications and there are always medico-legal risks and exposure.
Dr. Barry Eppley
This is one of those headlines that attract a lot of attention as the concepts of Free and Plastic Surgery go as much together as Peyton Manning and quarterback sacks. One of the not infrequent requests that I get as a plastic surgeon, however, is about this very concept. On my practice website and numerous blog sites, requests come in every week for some form of plastic surgery ‘donation’. Many of the requests go into great detail about why they want a certain procedure and they are often quite moving. While the idea of performing surgery for free seems fairly simple, it actually is not.
This can best be explained by my response to a recent request for a free breast augmentation with a heart-felt plea for an improved perception of herself.
‘I have great empathy for the concerns you have about your breasts, and wish that providing you with a free procedure were an easy choice. Given the number of women who come into my office with similar concerns about their bodies, I can understand how connected self-esteem and a positive self-image are. Providing surgery for free may seem like a simple and straightforward thing to do, but there are many factors involved that make the concept of ‘donated’ surgery not exactly free. While any plastic surgeon can give away his time to perform the operation, a surgeon’s fee represents just a fraction of the total costs of surgery. The cost of the breast implants, use of the operating room, and the fee for the anesthesiologist expertise are other cost factors that must be accounted for and paid. The surgery center or hospital, implant company and anesthesiologist are under no obligation, and usually are unwilling, to provide services and materials at their expense for an elective procedure. Often times, these costs make up more than that of the plastic surgeon’s normal fee.’
One of the hidden costs of any donated surgery in this country is the potential medical-legal responsibility. Unfortunately, donating surgery does not waive any responsibility on the plastic surgeon for the outcome. Should any untoward events happen, such as a rare but possible complication, the surgeon is still liable and responsible. The possibility also exists for the need for revisional surgery after the initial procedure should the result not be ‘perfect’ and the question then arises is the surgeon again expected to waive his or her fees? While many patients say they will sign anything to get the procedure for free, the legal reality is that there are no forms or waivers that a patient can sign that will legally hold harmless the physician for the services that he or she has provided.
One may wonder then how do they do these free makeover surgery contests, either done locally or even on TV? The answer is whoever is doing it most likely is not a board-certified plastic surgeon. The American Society of Plastic Surgery strictly forbids providing any free surgery as a result of a contest, promotion, or any other method of inducement which encourages a patient to undergo surgery based on an economic incentive. Doing so is an ethical violation of its membership and could be grounds for dismissal from the Society. Those non-plastic surgeons who do offer such free surgery are not bound by these ethical guidelines and merely see the risk as a marketing expense.
While a plastic surgeon may choose to donate his or her skill and experience for free, the rest of the costs of surgery remain, and are usually out of the surgeon’s control. The legal and ethical issues, that are completing unaware to most patients, makes donating an invasive operative procedure not quite the same as giving away a more traditional retail product.
Dr. Barry Eppley