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> Cosmetic Plastic Surgery Research
Costs
Good Candidate
Risks/Complications
Depression
Glossary
2001-2004 Statistics
costs
See specific procedures for total average costs
2001 STATISTICS (National Average)
PROCEDURE
SURGEON/PHYSICIAN FEE
Botox®injection
$388
Breast implant removal
$2,086
Breast augmentation
$3,043
Breast lift
$3,503
Breast reduction in men
$2,747
Buttock lift
$3,717
Cellulite massage treatment
$235
Cheek implant
$1,945
Chemical peel
$516
Chin augmentation
$1,488
Collagen injection
$333
Dermabrasion
$1,254
Ear surgery
$2,168
Eyelid surgery
$2,544
Facelift
$5,007
Fat injection
$1,053
Fibril injection
$440
Forehead lift
$2,552
Laser hair removal
$360
Laser skin resurfacing
$2,243
Laser treatment of leg veins
$314
Lip implants
$1,570
Liposuction
$2,049
Lower body lift
$5,183
Microdermabrasion
$136
Rhinoplasty
$2,947
Sclerotherapy
$227
Thigh lift
$3,885
Tummy tuck
$4,205
Upper arm lift
$2,667
**These fees are averages only. Fees do not include anesthesia, operating room facilities, or other related expenses.
Source:
A USA Today article dated Oct. 23, 2000 listed the average costs of the top cosmetic procedures across the United States:
Region 1: CT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT
Region 2: IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI
Region 3: FL, GA, NC, SC, VA, WV
Region 4: AL, AR, KY, LA, MS, OK, TN, TX
Region 5: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, UT, WA, WY
| Procedure | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 |
| Tummy tuck | $4,995 | $3,926 | $4,175 | $3,681 | $4,247 |
| Eyelid Surgery | $3,063 | $2,254 | $2,199 | $2,143 | $2,378 |
| Boto x injection | $510 | $377 | $502 | $382 | $369 |
| Breast aug. | $3,949 | $2,820 | $2,936 | $2,739 | $3,248 |
| Chemical peel | $741 | $837 | $728 | $653 | $753 |
| Liposuction* | $2,746 | $2,277 | $2,289 | $2,246 | $2,699< /td> |
Note: Figures represent physician or surgeon fees only. They do not include costs for surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous fees related to surgery.
Source: The American Society for Aesthetic Plastic Surgery
Factors That Determine Cost of Cosmetic Surgery:
- Geographic Location
- Expertise of surgeon (although more expensive doesn't always mean more experienced, it can indicate that they are in higher demand which may be an indication of their experience and results)
- The number of areas treated
- Amount of time and effort required of the surgeon
- Cost of anesthesiologist's services
- Operating room fees
- Lab fees
Smokers who do choose to have surgery must quit for at least 2 weeks prior to surgery and remain smoke-free until at least 2 weeks after surgery, for proper healing and recovery. Smokers have a higher rate of infection, skin separation, skin death, and anesthesia complications. One major study found that the risk of losing a significant area of skin (also called necrosis, or skin death) due to poor oxygen supply with a facelift is increased by 1500% in active smokers.
Good candidates are close to their ideal weight (within 30%), non-smokers, emotionally stable, with low stress, exercise and maintain a healthy lifestyle. It is also wise to drink less than 5 ounces of alcohol a week and limit caffeine. It is important to have realistic expectations and not expect plastic surgery to change your life. A good candidate also accepts the disadvantages of surgery (cost, inconvenience, discomfort, and medical risk). Recovery is much easier with a good support network. If you do not meet each criteria, it does not mean you won't be a good candidate. If you meet none of them, it's more likely your doctor may want you to make some lifestyle changes before surgery.
It is important to let your doctor know your complete medical history including:
- medications as well as aspirin and vitamins
- hormones (oral contraceptives and estrogen replacement)
- herbal medications
Ask yourself:
- Are your expectations realistic?
- How will you handle unexpected results?
- Do you feel fully informed about the risks (see General Risks & Complications as well as specific considerations for your procedure)?
- Do you have the time in your schedule for proper recovery time?
- Can you afford the cost?
- Will the cost of the procedure add too much financial stress to your life?
- Are you hiding your plans from friends and family? This creates added stress.
- Are you having the surgery to please yourself or someone else?
- Do you have a support network to help you during recovery?
- Are you willing to ask for help?
Anesthesia/Sedation Complications
Some patients have serious reactions to the anesthesia or sedation used during surgery. Most anesthetic complications occur with general anesthesia.
Possible complications:
- abnormal heart rhythm
- airway obstruction
- blood clots
- brain damage
- death
- heart attack
- malignant hyperthermia
- nerve damage
- stroke
- temporary paralysis
Brain Damage: Brain damage can occur if blood circulation is depressed at dangerous levels.
Malignant Hyperthermia: This is a rare complication where body temperature, blood pressure and heart rate all rise to hyperactive levels. If not recognized and treated quickly, can lead to death. This may be inherited.
Temporary paralysis: This occurs if muscle relaxants have not fully worn off after surgery. It is easy to detect and easily treatable.
Patients who have heart trouble, lung disease or are obese are at greater risk of complications due to anesthesia. To reduce your risk, tell your doctor about any medications you are on and let her know your complete medical history.
Aspiration
Aspiration occurs if you vomit (aspirate) during surgery and the vomit is forced into the lungs. Aspiration can cause mild discomfort, and can also lead to infections, chronic cough, an obstruction in the lungs or pneumonia.
Blood Loss
Bleeding is normal with any procedure. However, if there is excessive bleeding, it can create major complications. If this occurs during surgery, your surgeon and anesthesiologist will be aware of by pooling blood or by a blood pressure drop. If bleeding occur after surgery, it can accumulate under the skin and require an additional surgery. Discuss with your physician what you can expect as far as bleeding and bruising.
Blood Clots (DVT)
A blood clot in the veins can be fatal. Longer operating time and general anesthesia increase the risk of a DVT. They can occur as a result of a medical condition or from immobilization (which allows the blood to pool) such as pregnancy, international airplane flights, and recovery from surgery. They are difficult to predict. To help prevent them, during recovery do not stay in one position for too long and flex your feet often. Patients who have liposuction in their legs are at higher risk. Compression garments worn reduce the risk of DVT.
Drop in Blood Pressure
Some decrease in blood pressure is normal during surgery. However, a sudden drop due to blood loss could lead to irregular heart beat and possibly a heart attack.
Infection
The risk of infection is less than 1% and antibiotics reduce this risk dramatically. However, if infection does occur, it is very serious. People who smoke, take steroids or have certain vascular conditions are at greater risk. The longer your surgery lasts and the more blood you lose, the more likely you are to have an infection.
Loose Sutures
If the sutures come loose this can lead to internal bleeding or a hernia. Such problems would require additional surgery.
Source: The Surgery Handbook.
See specific procedures for more information
Skin Death or Necrosis: usually follows an infection or hematoma and is much more likely among smokers. The skin is excised (surgically removed) and this may affect the cosmetic outcome.
Asymmetry: moderate or severe asymmetries may require a second surgery. Mild asymmetry is normal.
Slow Healing: due to age, skin type, failure to follow doctor's advice or factors beyond anyone's control.
Numbness/Tingling: often temporary, sometimes permanent loss of sensation. This results from injury to sensory or motor nerves.
Irregularities, dimples, puckers, and divots: can be due to surgeon error, healing irregularities or body make-up.
Seroma: fluid can collect under the skin and can occur after breast augmentation, liposuction or a tummy tuck.
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What You Should Know About the Safety of Outpatient Plastic Surgery Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A 1997 survey1 based on more than 400,000 operations performed in accredited facilities found that:
You will also be evaluated for other factors that may increase the risk of blood clots. These include:
If you are considered low risk, your doctor may simply ensure that you are positioned on the operating table in a way that allows for adequate blood circulation to the legs. If you are of moderate or high risk for developing blood clots, you may also be advised to wear elastic stockings before, during and after your procedure, or to take special anti-clotting medications. Compression devices on the legs may be used during surgery to support your normal circulation. 1. Morello, D.C., Colon, G.A., Fredericks, S., Iverson, R., Singer, R. Patient safety in accredited office surgical facilities. Plast. Reconstr. Surg. 99: 1496, 1997. Source: |
Depression is common following cosmetic surgery. There are several factors that contribute to post-operative depression, including:
- The anticipation and stress of preparing for surgery can have a rebound effect
- The medications, anesthesia and trauma of the surgery have physical effects that will affect your emotional well-being
- Stress and fear regarding complications and disfigurement
- Refraining from exercise can make you feel tired, blue, and out of sorts
- Adjusting to your new look
- Dealing with family and friends reactions to your surgery
- Financial stress
- Feeling guilty about having the procedure
Expecting to have a downtime and accepting it as normal will help you get back to normal sooner. Take time to relax, meditate and care for yourself. It is also important to have support from others. Be sure to ask for help from others. You can also find support online with other people who have had the same procedure and may have similar experiences.
Research shows that overall depression rates decrease overall following cosmetic surgery. Mean scores for depression* improved from 11.2 preoperatively to 6.5 at 1 month, and to 6.3 at 6 months after surgery.
*using the Center for Epidemiologic Studies Depression Scale (CESD). Source: Rankin M, Borah G, Perry AW, Wey PD, Quality-of-life-outcomes after cosmetic surgery. Plast Reconstr Surg. 1999 Sep;104(4):1209-10.
Abdominoplasty ("Tummy Tuck")
Sometimes after multiple pregnancies or large weight loss, abdominal muscles weaken, and skin in the area becomes flacid. Abdominoplasty can tighten the abdominal muscles and, in some instances, improve stretch marks. In both men and women, the procedure will remove excess skin and fat. Generally, an incision is made across the pubic area and around the umbilicus (navel). When skin laxity and muscle weakness is confined to the lower part of the abdomen, a modified abdominoplasty that limits tissue removal and muscle repair to the area below the umbilicus may be performed. This usually leaves a shorter scar and no scarring around the navel.
Alpha Hydroxy Acids
Alpha hydroxy acids are derived from foods, such as fruits and milk, and can improve the texture of skin by removing layers of dead cells and encouraging cell regeneration.
Augmentation Mammoplasty (see Breast Augmentation)
Blepharoplasty (see Eyelid Surgery)
Breast Augmentation (Augmentation Mammoplasty)
Breast augmentation is typically performed to enlarge small breasts, underdeveloped breasts or breasts that have decreased in size after a woman has had children. It is accomplished by surgically inserting an implant behind each breast. An incision is made either under the breast, around the areola (the pink skin surrounding the nipple) or in the armpit. A pocket is created for the implant either behind the breast tissue or behind the muscle between the breast and the chest wall.
Breast Lift (Mastopexy)
Frequently, a woman elects this surgery after losing a considerable amount of weight, or losing volume and tone in her breasts after having children. The plastic surgeon relocates the nipple and areola (the pink skin surrounding the nipple) to a higher position, repositions the breast tissue to a higher level, removes excess skin from the lower portion of the breast and then reshapes the remaining breast skin. Scars are around the areola, extending vertically down the breast and horizontally along the crease underneath the breast. Variations on this technique, in some cases, may result in less noticeable scarring.
Breast Implants (Textured-Surface)
The shell of textured-surface breast implants are made with the same silicone elastomer that is used for the shell of other types of breast implants, but a special manufacturing process creates a textured surface.
Breast Reduction (Reduction Mammoplasty)
Breast reduction is normally classified as a reconstructive procedure, since oversize breasts interfere with normal function and physical activity. However, there is an important aesthetic component to the operation, since the plastic surgeon can improve the shape of the breasts and nipple areas. Breast reduction involves removing excess breast tissue and skin, repositioning the nipple and areola (the pink skin surrounding the nipple) and reshaping the remaining breast tissue.
Buccal Fat Pad
Buccal fat pads are located above the jawline near the corner of the mouth. They can be removed in individuals with excessively round faces to give a more contoured look, sometimes referred to as the "waif look." However, plastic surgeons warn that, in some individuals, removal of the buccal fat pads can lead to a drawn, hollow-cheeked look as aging progresses.
Buttock Lift
Excess fat and loose skin in the buttock area can be reduced by performing a buttock lift in combination with lipoplasty (liposuction). Incisions required for skin removal can often be hidden in the fold beneath the buttocks.
Calf Augmentation
Increased fullness of the calf can be achieved using implants made of hard silicone which are inserted from behind the knee and moved into position underneath the calf muscle.
Cannula
A hollow tube attached to a high-vacuum device used to remove fat through liposuction. The plastic surgeon manipulates the cannula within the fat layers under the skin, dislodging the fat and "vacuuming" it out.
Capsular Contracture
Capsular contracture is the most common problem associated with breast implants. It occurs when naturally forming scar tissue around the implant shrinks and tightens, making the breast feel firmer than normal and sometimes causing pain and an unnatural appearance of the breast.
Cellulite
Cellulite is the dimpled-looking fat that often appears on the buttocks, thighs and hips. While there is no treatment that will eradicate this problem, aesthetic plastic surgeons are exploring new techniques which may improve the condition. One method is to cut the fibrous tissue that binds the fat down in these areas and creates the lumpy appearance, and then to inject fact withdrawn from elsewhere in the body to smooth out the unevenness. Another technique, called the cellulite lift, surgically removes excess skin and fat, leaving a thin scar that may extend around the full circumference of the abdomen but is placed discreetly within bikini lines.
Chemical Peel
Fine lines and wrinkles around the mouth and on the forehead and cheek areas may be improved with a wide range of skin treatments. A chemical peel solution is applied to the entire face or to specific areas to peel away the skin's top layers. Several light to medium-depth peels can often achieve similar results to one deeper peel treatment, with less risk and shorter recovery time. Peel solutions may contain alpha hydroxy acids, tricholoracetic acid (TCA) or phenol as the peeling agent, depending on the depth of peel desired and on other patient selection factors.
Chin Augmentation (Mentoplasty)
Chin augmentation can strengthen the appearance of a receding chin by increasing its projection. The procedure does not affect the patient's bite or jaw. There are two techniques: one is performed through an incision inside the mouth and involves moving the chinbone, then wiring it into position; the other approach requires insertion of an implant through an incision inside the mouth, between the lower lip and the gum, or through an external incision underneath the chin.
Collagen Injections
Collagen is an injectable protein that can be used to treat facial wrinkles. Patients to be treated with collagen should first be tested for any allergic reaction. The results of collagen injections are not permanent, and treatments must be repeated periodically to maintain results.
Dermabrasion
Dermabrasion is a procedure in which a high-speed rotary wheel, similar to fine-grained sandpaper, is used to abrade the skin. It may be recommended when there is extensive sun damage and heavy skin wrinkling. In addition, dermabrasion can be used to improve the texture of pockmarked skin resulting from severe acne or chicken pox. Following treatment, the skin should appear firmer and smoother, but permanent pigment changes may occur.
Earlobe Reduction
A simple, 30-minute procedure, earlobe reduction can be performed in a plastic surgeon's office or at the same time as a facelift operation. The earlobe should not comprise more than 25 percent of the total length of the ear. In cases where it exceeds this dimension, an L-shaped wedge is cut away, the earlobe edges are brought together and sutured.
Eyelid Surgery (Blepharoplasty)
Aesthetic eyelid surgery can brighten the face and restore a more youthful appearance by reducing the fat that causes bags beneath the eyes and removing wrinkled, drooping layers of skin on the eyelids. Blepharoplasty is often performed along with a facelift or with other facial rejuvenation procedures. Incisions follow the natural contour lines in both upper and lower lids, or can be done through the lining of the lower eyelid, providing access to skin and fatty tissue. The thin surgical scars are usually barely visible and blend into the eyes' natural lines and folds.
Facelift (Rhytidectomy)
A facelift can reduce sagging skin on the face and neck. Incisions are placed in the hairline and then pass in front of and behind the ears; the exact design of incisions may vary from patient to patient and according to the surgeon's personal technique. For younger patients, more limited incisions may be appropriate. When necessary, removal of fatty deposits beneath the skin and tightening of sagging muscles is performed. The slack in the skin itself is then taken up and the excess removed. Scars can usually be concealed by hair and makeup.
Fat Injections
Fat withdrawn from one body site can be injected into another -- for example, to smooth lines in the face or build up other features such as the lips. In most cases, a percentage of injected fat is resorbed by the body, and the procedure must be repeated. Injection of fat to enlarge the breasts is a dangerous procedure and is not recommended because of the possibility of dense scarring that may seriously hinder accurate interpretation of both breast self-exams and mammograms.
Fibrel
Fibrel is a synthetic substance which is an alternative to collagen and fat injections for the treatment of facial wrinkles. As with collagen and fat, fibrel treatments must repeated at intervals to maintain correction.
Forehead Lift (Brow Lift)
The forehead lift is designed to correct or improve skin wrinkling, as well as loss of tone and sagging of the eyebrows that often occurs as part of the aging process. The procedure may also help to smooth horizontal expression lines in the forehead and vertical frown lines between the eyebrows. Incisions are placed behind the hairline above the ear and pass over the top of the head. In some cases, incisions may be placed in front of the hairline. Some patients may have the procedure performed with the use of an endoscope, requiring much shorter incisions. Improvements are made beneath the skin and on the deep muscles; skin and muscle are then tightened to give a fresher, more youthful appearance.
Hydroxyapatite Granules
Hydroxyapatite granules are a bone substitute made from coral that can be used to enhance facial contours, such as forming more prominent cheekbones. The substance also has reconstructive uses in craniofacial surgery.
Lasers
Lasers can be effectively used to eliminate surface blood vessels on the face that become reddened and enlarged due to sun exposure. The problem is most often seen in fair-skinned individuals who cannot tan or have difficulty tanning. The use of lasers for skin resurfacing is effective in reducing the effects of sun damage. Laser resurfacing is an alternative to chemical peel for some patients.
Lip Augmentation
A permanent method of augmenting the lips is accomplished by surgically advancing the lip forward, with incisions placed inside the mouth. A dermal-fat graft, taken from the deeper layers of the skin, may then be positioned under the mucosa (the lining of the lip) to add additional "plumpness." Injecting fat collagen or other substances for lip augmentation is another alternative. The correction is not permanent, and injections must be repeated periodically to maintain results.
Lip Lift
A technique that surgically lifts the corners of the aging mouth can eliminate the pronounced droop and unhappy facial expression that often develops with advanced age. By cutting away small diamonds of skin just above the corners of the mouth, the vermilion (border of the lips) is raised into a slight smile.
Lip Reduction
To reduce the lips, a small strip of the mucosa (the lining of the lip) is surgically removed to narrow the lips to the desired proportion. The small scars on the outside of the lips are barely noticeable.
Lipoplasty (Liposuction)
Lipoplasty allows the plastic surgeon to remove localized collections of fatty tissue from the legs, buttocks, abdomen, back, arms, face and neck using a high vacuum device. The procedure leaves only minute scars, often as short as one-half inch in length or less. The use of refined equipment allows removal from delicate areas such as calves and ankles. Lipoplasty removes fat, but it cannot eliminate dimpling or correct skin laxity. If a patient's skin has lost much of its elasticity, the plastic surgeon may recommend a skin tightening procedure such as a thigh lift, buttock lift or arm lift, all of which leave more extensive scars.
Malar (Cheekbone) Augmentation
The cheekbones may be built up by placing an implant over them. This is usually performed through an incision within the mouth, but it may be done through a lower eyelid or brow lift incision.
Mastopexy (see Breast Lift)
Otoplasty (Ear Surgery)
The ears are positioned closer to the head by reshaping the cartilage (supporting tissue). This is usually accomplished through incisions placed behind the ears so that subsequent scars will be concealed in a natural skin crease. Otoplasty can be performed on children as early as age five or six.
Peel: Buffered Phenol
Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another slightly milder formula uses glycerin. Buffered phenol peels may be more comfortable for patients, and the skin heals faster than with a standard phenol peel.
Phenol
The chemical phenol is sometimes used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup.
Platysma
The muscle which, when tight and firm, gives the neck underneath the chin and jawline its youthful contour. The platysma muscle can be tightened during a facelift or as a separate procedure.
Reduction Mammoplasty (see Breast Reduction)
Retin-A
Retin-A cream or lotion may be applied to enhance the overall texture of the skin and is often prescribed as a pre-treatment prior to a facelift or chemical peel.
Rhinoplasty: Open
The open rhinoplasty technique can sometimes benefit patients who need more complex correction or are undergoing a secondary rhinoplasty procedure. A small incision is made outside the nose across the columella (the tissue that divides the two nostrils). This enables the plastic surgeon to turn the outer tissue of the nose back, providing visualization of the structures inside. Additional incisions, like those used in the traditional closed approach, are made inside the nose as well. The scar resulting from the incision on the outside of the nose eventually becomes barely visible.
Rhinoplasty (Nose Reshaping)
Rhinoplasty is usually performed to alter the size and shape of the bridge and tip of the nose. Reshaping is generally done through incisions inside the nose, but there may also be an incision passing across the central portion of the nose between the nostrils. It is sometimes necessary to narrow the base of the nose or reduce the size of the nostrils, which involves removing small wedges of skin at the base of the nostrils. The nose is reduced, or sometimes built up, by adjusting its supporting structures, which is done either by removing or adding bone and cartilage. The skin and soft tissues then redrape themselves over this new "scaffolding."
Rhytidectomy (see Facelift)
SMAS
The superficial musculoaponeurotic system (SMAS) is a layer of tissue that covers the deeper structures in the cheek area and is in continuity with the superficial muscle covering the lower face and neck, called the platysma. Some facelift techniques lift and reposition the SMAS as well as the skin.
Superficial Syringe Liposculpture
Use of a syringe to withdraw fat, instead of vacuum suctioning pumps, allows for less blood loss and speedier postoperative recovery. Superficial syringe liposculpture is performed on the layer of fat just beneath the skin.
Tattooing (Cosmetic)
Cosmetic tattooing, or micropigmentation, can be used for permanent eyeliner, eyebrows or lip color. It can also be used for permanent blush and eyeshadow, though this is infrequent. Other uses by plastic surgeons include recreating the coloration of the areola around the nipple following breast reconstruction; restoring the color of dark or light skin where natural pigmentation has been lost through such factors as vitiligo, cancer, burns or other scarring; and eliminating some types of birthmarks or previous tattoos. Micropigmentation should be performed only under medical supervision by appropriately trained personnel.
TCA
Trichloroacetic acid is used for peeling of the face, neck, hands and other exposed areas of the body. It has less bleaching effect than phenol, and is excellent for "spot" peeling of specific areas. It can be used for deep, medium or light peeling, depending on the concentration and method of application.
Thigh Lift
A thigh lift can be performed to tighten sagging muscles and remove excess skin in the thigh area. Because a thigh lift leaves noticeable scars in the inner or outer thigh area that some patients find undesirable, it is not a frequently performed procedure.
Tissue Expansion
Tissue expansion is a technique in which skin or other tissue is stretched using inflatable balloons. It can be of particular value in performing breast reconstruction, breast enlargement or treatment of male pattern baldness.
Transconjunctival Blepharoplasty
Transconjunctival blepharoplasty (eyelid surgery) is performed by making an incision from inside the lower eyelid. It avoids any scarring on the lower lid. It is a useful technique when only fat, and not skin or muscle, needs to be removed from the eyelid area.
Source: The American Society for Aesthetic Plastic Surgery (ASAPS) is the leading organization of plastic surgeons certified by the American Board of Plastic Surgery (ABPS) who specialize in cosmetic surgery of the face and the entire body.
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