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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

Indianapolis, Indiana

Q: Dear Dr. Eppley,  I’m 20 yrs old and currently in my junior year at college. I just found out earlier this year I have a breast deformity called ‘Constricted Breasts”. I knew something was wrong growing up when I wasn’t developing as I should. So I asked my doctors, at 18, about that, and he told me that when I get 20, my breasts should be fully developed. Well I’m 20 now, and they still look the same as they did in 7th grade. I have already tried to see if my insurance would cover a breast augmentation procedure, but they won’t, and my heart just sunk. It hurts so bad. It causes me mental, physical, and emotional pain. Just talking about it I burst into tears. My self-esteem is low, and I am not happy with the way they look and I also find myself cringing when I look down at them. I’m contacting you because I’ve seen your work here and I’m very impressed. I don’t want to seem as if I’m begging, but please, would you grant me with a free procedure? Being in a low-middle class family and in college, at times it’s really hard to make ends meet. I really don’t have anybody around me that understands the way I feel, or where I’m coming from, but you would make me smile from the inside out if you did this. I will be so blessed, and you can possibly change my life forever. From my heart, please consider this procedure for me. I can’t explain how happy I will be if you did this for me.

Thanks for your time, and I hope that for your kindness of your heart, you will make me happy.

A: 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 our 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 at no cost, 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, implant company and anesthesiologist are under no obligation to provide services and materials at their expense for a cosmetic procedure. Often times, these costs make up more than that of the surgeon’s normal fee.

One obscure but significant cost of any surgery is the potential medical-legal responsibility that exists in every state. Unfortunately, donating surgery does not equal any waiver of responsibility  on the surgeon’s part.  Should any untoward events happen, such as a rare but possible complication,  the surgeon is still liable and responsible.  The possibility exists too, for the need for revisional surgery after the initial procedure and the question then becomes is the surgeon again expected to waive his or her fees?   There are no forms or waivers that a patient can sign that can legally hold harmless the physician for the services that he or she has provided.   

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.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have always wanted plastic surgery but can’t afford it. I have not aged well and I think it would make me feel better about myself. Do you know where I can get it for free? I would be willing to be a guinea pig to let someone learn on me. I would be willing to let them use an extra skin removed from me for help in reconstruction of burn victims.

A: Interest in cosmetic surgery continues to increase. While there are some people who say they wouldn’t subject themselves to something as vain or as drastic as plastic surgery, most people do not feel that way. In a recent online surgery of over 2,000 people done on behalf of theWeb community RealSelf.com, they  reported that more than two-thirds (69 percent to be exact) said they would choose to undergo cosmetic surgery if they had the money. Perhaps to no surprise, a lot more people would have cosmetic surgery if money wasn’t the limiting step. I suspect in this group that some of those state opposition to plastic surgery would change their mind.

The bottom line is that there is no place where cosmetic surgery is done for free. There are costs involved, beyond the plastic surgeon’s time, that are incurred in surgery. In addition, there are medicolegal risks and exposure that one would not risk for no reimbursement. There was a time, years ago, when plastic surgery training programs did do cosmetic surgery for free for the educational experience of the residents and fellows. But that time has long passed and will not likely be seen again.

By the way, a patient can not use someone else’s skin for reconstruction. It would be rejected and cause infection. Skin can only be used from yourself.

Dr. Barry Eppley

Q : I would love to sign up for some free plastic surgery. I have never been happy with the way I look. My ex-boyfriends always told me I’m not good enough for them and they could do better. I always wanted plastic surgery but with no money and no time to work extra hours. I’m a single parent of three and try to give them the best. My time and money is for them, they are my life. I’m unable to save for surgery. Please contact me and let me know what I need to do.

A: The possibility of free plastic surgery is certainly appealing. Like a winning lottery ticket, the opportunity to be able to ‘afford’ something you could not previously is intriguing to say the least. But unfortunately, real life is not like a television show. Extreme makeovers for free really only do exist on the television screen. It simply is not provided by any plastic surgeon in any community.

There are a variety of reasons plastic surgeon do not provide cosmetic surgery for free. First and foremost, cosmetic surgery does not usually improve any medical function. Yes it is true it will make one feel a whole lot better about themselves but that is different than reconstructive surgery where the origin of the problem is from a birth defect, cancer, or a traumatic injury. Patients in need of reconstructive surgery are more in need than that of any cosmetic concern. Plastic surgeons have a long history of being very benevolent with their services for reconstructive surgery. Secondly, there are more costs involved than just the plastic surgeon’s time or expertise. The use of the operating room and an anesthesiologist (if needed) must be accounted for.  Those providing these costs do not feel or have any obligation to give away their materials and labor. Lastly, free cosmetic surgery does not waive the plastic surgeon from medicolegal liability and exposure. Why should a plastic surgeon assume those financial and professional risks without compensation?

Board-certified plastic surgeons also cannot provide cosmetic surgery as a prize from a contest or giveaway. This is an ethical violation as a member of the American Society of Plastic Surgeons. While many cosmetic surgeons from different specialities freely do promote such contest prizes, board-certified plastic surgeons can not do so.

Dr. Barry Eppley