Q: Dr. Eppley, I have been trying to get an abdominal panniculectomy since I lost so much weight. My insurance company denied me but I plan to appeal. I have infections and skin ulcers. It makes it hard to do my job. I heard about the Patriot Plastic Surgery Program and wondered if you can help. PLEASE!!! I wanted to get this done before my husband got home from his latest deployment and I was wanting to get this done before he got home and I’ve run into roadblock after roadblock. Can you help? I have attached some pictures of my abdominal problem.
A: While there is little doubt that you would benefit from an abdominal panniculectomy, I am not surprised that you have been denied by your insurance company. By insurance requirements you do not meet the very basic criteria of the size of the pannus, it must reach down and overlap onto the thighs. Plus there must be a 6 month history of medically documented skin infections that have failed to respond to topical therapies and there must also be current photographic evidence of active skin infections. Failure to meet all of these criteria will result in denial of coverage for an abdominal panniculectomy. This is a very common occurrence and can be difficult to appeal without providing documentation of their established criteria.
The Patriot Plastic Surgery program is where some reduction in fees is offered for a variety of cosmetic surgery procedures, including tummy tuck and abdominal panniculectomy.
Dr. Barry Eppley
Q: Dr. Eppley, I was wanting some more information about the Smart Lipo and discounts under the Patriot Program.
A: Thank you for your inquiry. I would need to know what body areas you desire for liposuction and what they look like before a cost quote could be provided. You may feel free to do that by description or sending pictures, whichever conveys what you need. I would also point out that although I use Smartlipo technology for liopsuction it is done under general anesthesia and not local anesthesia to achieve the best results possible.
The Patriot Program is a discount program for plastic surgery for active military and their families. The amount of discounts from regular surgery fees are determined on a per patient basis. As a general rule, we make a 25% reduction from the normal surgeon’s fee for the procedure.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about getting liposuction. I am in the Military and am curious about the Patriot Plastic Surgery Program. Quick bit about me, I was injured a little bit ago, and was pretty much unable to work out for a little over a year; where I gained weight and loss quite a bit of muscle mass as well. I would like to get my abdomen and love handles sized down as much as possible (or that is possible).
A: The Patriot Plastic Surgery program offers some reduction in fees for any cosmetic surgery for those who are in or have been in military service. While I have no idea as to what your body looks like, you are obviously a young man who is probably in reasonable physical condition. (not obese) Because you are a male your abdominal and flank skin is likely in good condition (no stretch marks) and can shrink down nicely after the fat is extracted. Reducing your abdomen and flanks should, therefore, provide an effective and visible improvement with liposuction.
Dr. Barry Eppley
Q: Dr. Eppley, I was reviewing your Patriotic Program for plastic surgery. Honestly, I never in my wildest dreams thought I could receive a military discount for cosmetic surgery. I’m interested in having a consultation for an Tummy Tuck and liposuction around my knees. I have been waiting for close to 10 years to do this surgery. I think now is the time. My husband of almost 20 years is now serving in Afghanistan.
He should be home in the next two months. That being mentioned, I would like to be healed buy the time he comes home and look fantastic or at least as good as it gets. My husband has been telling me to go ahead and do it but I never do. I always find other ways to spend the money. I know I will feel so much better when my clothes fit nice and I don’t have to wear spanks…especially in a formal gown. Yep, I know I have at least 4 more formals to attend before retirement because of my four children. Thank you so much for taking your professional time to support our troops and their families using your gift.
A: Tummy tuck surgery can make a dramatic difference in your body shape and how you fit in clothes. Since you are done having children the results of a tummy tuck can last a lifetime and is one investment that cap pay dividends for decades.
We have offered military discounts for years for a wide variety of cosmetic surgery procedures. We are happy to do so and try to make a small contribution to those that serve or have served to protect the freedoms for what we have the opportunity
to choose to do every day.
Dr. Barry Eppley
Q: Hello, I have been researching for a while now on getting a procedure done before my husband whose is in the service returns home from Afghanistan. I came across your page and was wondering if I could have a little more information on your Patriot Program? I am interested in getting a tummy tuck done. After having 3 children and losing a lot of weight, i am left with a loose stretch marked covered skin. I only weigh 120 lbs and am happy at the weight I’m at. But I just do not the appearance of my stomach. Any information would be greatly appreciated. Thanks so much!
A: It sounds like what you may need is some form of a tummy tuck. Whether this is a full tummy tuck or a more limited variety will depend on how much loose skin you have. In most cases if one can tolerate a longer scar, a much better abdominal result is obtained with a full tummy tuck. The Patriot Plastic Surgery Program was established to provide some reward for those and their families that are in the active military. It is not a free surgery program but substantial cost reductions are offered. To get an exact cost, please send me some pictures of your stomach for my review and my assistant will forward you that information.
Dr. Barry Eppley
Q: I am in the military. I am 40 years old and have been selected for promotion to Commissioned Officer. I have a large build and constantly struggle with the military’s height vs. weight standards. A secondary circumferential method is used for the neck and waist. I am always just at or above the limit. I have found it even harder now that I am older. I think liposuction would get me ‘over the hump’ with some stomach and waistline shaping as I just need to drop an inch or so around the waistline. I have attached some photos for your assessment and would I qualify for the Patriot Plastic Surgery program.
A: I receive a fair number of requests from men and women in the military for plastic surgery and it is almost always about trying to pass the measurements that are used in the service’s fitness evaluations. While the physical part of these required tests are based on push-ups, situps and a 2 mile run, there are also circumferential measurements done with an important one being that of the waistline. To help men get to their desired waistline measurement, liposuction can be very effective by aggressively treating the entire abdomen and the flanks as they head around into the back. For some women this is effective also, but there are some women that really need a tummy tuck to get rid of the excess skin and overhang if they have had children. We do offer discounts for these surgeries for active military peronnel.
Dr. Barry Eppley
Q: Dr Eppley I am currently in Iraq and my wife and I have been researching breast augmentation for her upon my return. She has had two children over 4 years and, as a result, has since lost much of her perkiness. She is currently 32 yrs old and is 5′ 3″ and weighs 124lbs and is a 34C. She wanting to go to a 34DD. We are currently stationed in Texas. We do not mind traveling if the price is right. If you could let me know the prices and also how long we would have to stay. We want the procedure to be done this summer but we could also wait until fall when I am on leave.
A: Thank you for your inquiry. I will have my assistant pass along the costs for breast augmentation through our Patriot Plastic Surgery program. In general, the cost is about 20% less that that of the average cost of the procedure. Several important questions to know is whether she prefers saline vs silicone implants as that has a major influence on costs of the procedure. (up to 20% in cost differential) Also with C cup breasts, having two children and having lost her perkiness, does she have any significant ptosis? (breast sagging) If she does, implants alone will not lift a breast up or move the nipples upward. Implants add volume and will only make the way her breasts look now bigger.regards. So the potential issue of a some form of breast lift may be needed although it is impossible for me to say without at least seeing some pictures of her.
Dr. Barry Eppley
Q: I am interested in buttocks injections and basically wanted to know a little more about the procedure. I would like fat removed from my waistline or abdomen area and injected into the buttocks. I would like a fuller bottom and a smaller waistline. I am an active member of the Indiana National Guard and also wanted to know more about the Patriot Program.
A: Thank you for your inquiry. How you have described the procedure is exactly how it is done. Fat is removed from the waistline and flanks and then transferred by injection to the buttocks. The issue with buttock augmentation with fat injections is how much fat will survive afterwards and how much of a size improvement will there be. The first part of the procedure, fat reduction, is assured in that you can be guaranteed your waistline and stomach areas will be less full and have less fat.
The other issue with the Brazilian Butt Lift, also known as fat injections to the buttocks, is whether enough fat can be transferred to create the size that you want. Unlike a buttock implant, where the size increase can be bigger and its postoperative volume increase stable, fat injections may or may not be be to reach your buttock size increase goal. However, the ‘ying anf yang’ effect of a smaller waistline helps the buttocks look bigger and more shapely regardless.
The Patriot Plastic Surgery program provides free consultations and surgery fee discounts to all those that quality.
Dr. Barry Eppley
Q: Hello, I read about the Patriot Plastic Surgery Program on your website and have a few questions. I was wondering if that included the National Guard as well. I am in the Army National Guard and I am being deployed next summer. I was looking to have a tummy tuck done before my deployment so I would have time to get back in shape. I have lost around 50 lbs from the birth of my daughter and have the excess skin that needs to be removed. I would appreciate any information you may have about the Patriot Plastic Surgery Program. Thank you so much for your time.
A: The Patriot Plastic Surgery program is for all members of the Armed Services and their immediate families. It provides some financial relief for those desiring many popular cosmetic surgery procedures. The costs of surgery are both fixed and variable. The fixed costs of any surgery are the fees associated with the use of the operating room, anesthesia charges, and the costs of any implants used. The only variable fee in cosmetic surgery is what the plastic surgeon chooses to charge for his/her professional time. Dr. Eppley makes an adjustment in his surgical fees to provide some well deserved financial relief for those who qualify for the program.
Many members of the Armed Services have taken advantage of the program since its inception in 2009. Given the young age of most program participants, the most popular procedures include tummy tuck and liposuction, breast reshaping, and rhinoplasty and otoplasty.
Dr. Barry Eppley
Q: I am currently a nurse in the US Marines stationed in Afghanistan and will be visiting home for a month in September later this year. I’m interested in breast augmentation surgery and have thought having this done for some time. Do I get a discount because of the Patriot Program? I am also interested in having a Skype consultation which would be great for me given the distance. That way I could get everything arranged so when I return I can have my surgery within a day or two after my arrival.
A: The Patriot Plastic Surgery program has had a good response since we have offered it over the past year. I have gotten numerous inquiries from around the world, particularly from overseas in Europe and Afghanistan. I am happy to offer what we can to a very deserving group of men and women who are doing far more for our country that I ever could.
Because of the age group (ages 18 to 35) that make up a significant percent of the military, most requests have been for body procedures such as breast augmentation and liposuction and face procedures such as rhinoplasty, otoplasty, and chin augmentation.
Many of these military patients come in for surgery during their leave back to the United States or from where they are stationed here in the United States. The use of Skype as a free internet method of discussions and consultations makes the consideration and coordination of surgery possible from afar. By using the video feature of Skype, one can have a good conversation about potential surgery almost as if one was in the office. I often review pictures that are sent to me before these Skype discussions to help focus the conversation. Patients can then have surgery arranged and come in and see me the day before for a real hands-on evaluation and final discussion prior to surgery the next day.
Dr. Barry Eppley
As an appreciation of what our military does around the world, our Patriot Program exists to help make plastic surgery more affordable to them. Having seen and talked to many of these military patients, I have become aware that elective plastic surgery is often done at Armed Services facilities. In addition, one of my plastic surgery techs spent nearly a decade in the military and he often speaks of the cosmetic surgeries that he knows where done or participated in.
According to a recent article in Stars and Stripes (passed along to me by one of my military patients…he thought I might be interested), the military says it does not pay for unnecessary plastic surgery. But an audit of patient records released in February by the Pentagon says this is not so. The audit found that military doctors were regularly performing breast augmentations, tummy tucks, liposuction and other cosmetic surgery without charging the patients as they are supposed to do.
Plastic surgeons exist in the military to perform reconstruction of many injuries that are sustained from war, accidents and disease. The very existence of plastic surgery as we know it today is the result of the experience gained in the first two World Wars in the first half of the last century. Because military plastic surgeons need to keep their skills up for when they get out (and to encourage them to enter the military in the first place), they are allowed to perform cosmetic plastic surgery for patients as long as they pay for it…just what people have to do in the civilian world. Such requirements have been in place for the military for some time. Troops have had to do so since 2005 and dependents and retirees have been required to pay since 1992.
However, it appears that some service members and their dependents are having cosmetic surgery on the military’s (your) dime according to the audit. Arguments can be made that they deserve it or it doesn’t really matter since most of the costs are already built-in anyway. The basic costs of the facilities and doctor’s and operating room staff salaries is an ongoing expense, it is really just a supply issue to perform the surgery.
One of the real interesting sides to this story, and one that we face every day in the civilian world with medical insurance, is what is the difference between medically necessary (reconstructive) and cosmetic plastic surgery. From the military’s standpoint, what should they be paying for and what should patients be paying for? By definition, plastic surgery is reconstructive if it restores or repairs appearance or function from trauma, disease, or birth defects. Cosmetic plastic surgery is changing what is not deformed, injured, or diseased. That seems like a simple differentiation…but it often is not.
In the Stars and Stripes article, for example, they discussed male breast reduction or gynecomastia surgery. This is a source of embarrassment for many young men but is often viewed as a cosmetic problem in the civilian world and is not often covered by medical insurance. But in the military, male breast enlargement can make wearing body armor difficult and that can make it medically necessary. Similar situations may exist for rhinoplasty (breathing problems), otoplasty (helmet wearing), and even tummy tucks. (hernia repair)
One of the side, but important, issues is being able to recruit or retain plastic surgeons in the military. Outside of being close to a war zone, plastic surgeons in the military may encounter few combat casualties and may not do enough reconstructive surgery to keep their skills and board-certification current. (in some ways, this is thankful) Cosmetic surgery techniques are an extension of those used in reconstruction. A midface lift, for example, is a cosmetic procedure developed from repairing cheek bone fractures and lower eyelid deformities. There are many connections between cosmetic and reconstructive plastic surgery and their differences in technique are often more gray than trying to determine the medically necessary basis of the procedure.
Of significance, the military report suggests that plastic surgeons are increasingly leaving the military because of their inability to keep up their cosmetic surgery skills due to the 2005 patient payment policy. That is unfortunate as plastic surgeons have a lot to offer our military service members. Perhaps continuing to provide cosmetic surgery is a retention factor for both plastic surgeons and our military alike.
Dr. Barry Eppley