Explore Plastic Surgery

In the most recent July 2008 issue of Plastic Surgery News, the top five most expensive cosmetic surgical procedures for 2007 were reported. These figures are based on the national average per plastic surgeon and represent the physician’s fee only, excluding the cost of the operating room, anesthesia, and any other related expenses.

Circumferential Body Lift $ 8,073
Tummy Tuck $ 5,264
Facelift $ 5,031
Buttock Implants $ 4,722
Buttock Lift $ 4,711

These plastic surgeon’s fees vary per region across the United States and represent an averaging of different geographic regions into a single typical fee. These numbers do not necessarily reflect a typical fee here in Indianapolis and will vary somewhat between different plastic surgeons. Operating room and anesthesia charges, which are additional, can vary dramatically based on what facility the plastic surgeon uses. As an average, you can add 30 - 35% of the plastic surgeon’s fee as the additional costs of surgery to get an estimate of the total cost of the procedure.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Cosmetic plastic surgery is both elective and very individualized. The decision to have plastic surgery is obviously very personal and every patient has their unique reasons for wanting a specific plastic surgery procedure, although most of the reasons are quite similar for most patients. Much thought should go into the before surgery aspect, including what plastic surgeon(s) to consult with, what procedures do you need and want, and what are the risks and complications. As a plastic surgeon, it is my privilege to take each new patient that I see and educate them about their surgical options. I do not personally care wheher any patient chooses surgery or not…I only care about whether I have given them a good education so they can make the right decision for themselves.

After surgery care is just as important to me as the before surgery discussions. Once I have taken a patient into my ‘family’, I am obligated to care of you as if you were my family. (and in the short term you might be just as wanting and demanding!) The best way I accomplish this is through what I call a ‘concierge’ approach. Other than my office staff, I leave no interface between you the patient and myself. I am available by cell phone to all of my patients 24 hours a day…every day. If a patient has a problem or concern, I want to know about it. It does me no good, and it is not good service, if you have to weed through two or three people in hopes your message gets through or you eventually get an answer. Since I will have to know about it eventfully, I might as well know about it right up front. And besides, I am the most knowledgeable to deal with whatever problem or concern you may be having. After 20 years in plastic surgery, I basically have seen and heard it all. So whatever problem you may be having, rest assured I have seen it before.

This is what I call concierge plastic surgery. I am available to my patients anytime and no question or problem is insignificant or irrelevant. This is simply good service and I am happy to do it….and besides….this is the way I would want it if I were a patient. Why would I treat you any different than what I would do for myself?

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

While the economy partly has been in a recent downturn, partly driven by higher gas prices (amongst many issues), there is no certainty as to how far south it may go. Where it stays as it is today or gets worse in the next 6 months is impossible to predict. What is possible to predict is that plastic surgery business is down and will continue to be so for awhile. Since cosmetic plastic surgery is completely elective, it is a luxury item that can wait for another day.
But my observation has been that the demand will not change, just the timing and amount of service. People still want change in their face and bodies and most people still want to look their best and fight father time and mother nature. So bigger more expensive surgeries will be put off, but not forever cancelled. I have a few patients every week that talk about ‘doing it later in the year’, probably after the national election, but they are definitely going to do it at some point. For those patients who have saved for the procedure or have a good amount of disposable income, they will go ahead and schedule now. Others choose financing their procedure and the concept of low monthly payments may make them more recession-proof.
One aspect of plastic surgery that is likely not to be affected are the office-based procedures. Botox, injectable fillers, and medical skin treatments have not changed in numbers in my practice nor do I expect them to be. In fact, we may see a temporary increase in demand as the economy is down as patients will do smaller, less costly procedures in lieu of surgery.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

I read a recent article in People magazine this week entitled the same name as this blog. The fundamental premise of the article was that plastic surgery today is done on the ‘average person’, not necessarily the rich and famous. They go on to cite five people who had differing plastic surgery procedures and their stories.
This article was refreshing because they all had positive experiences, which is usually the norm, as opposed to many articles which talk about patient’s problems and complications which is not the norm. But the underlying theme of the article is what is most poignant for me. The large numbers of plastic surgery procedures done today could occur for only one reason….that the typical plastic surgery patient is just reflective of the average person in society. There is only a very small fraction of society that is famous or wealthy. The plastic surgery numbers of today, which total in the millions of procedures (surgical and non-surgical), could not come from that segment of society. In the past twenty years we have seen plastic surgery work its way into the mainstream of society and is much a part of American culture as Starbucks, cell phones, and My Space. The typical plastic surgery patient in my practice is just a normal person from the middle fabric of society, the range goes from the unemployed to a company CEO. Nearly 40% of my patients now use financing for major procedures, reinforcing the concept of the ‘average’ patient having plastic surgery. That number is starting to approach finance numbers for major appliances or other big ticket home items.
You may ask yourself why…..why do so many people undergo plastic surgery today? Is it the marketing hype from surgeons, is it the media convincing us that me must look better and younger through their projected images, or is our society just so vain? Probably all three of these have some responsibility, but there is one bigger reason. The main reason, in my practice experience, is that most plastic surgery procedures simply work and deliver what they purport to do. Breast implants make breast bigger and more shapely, tummy tucks really do flatten stomachs, facelifts do turn back the clock and tighten that jaw and neck line, and noses do get better shapes that look better on one’s face. Yes, plastic surgeons and plastic surgery procedures are not perfect. Every result is not ideal and some patients do experience complications. And yes sometimes plastic surgery procedures are overhyped. But, on average, most plastic surgery patients are very satisfied and would repeat the experience. A phenomenon that I call accompishment feedback. This explains why 30% of my plastic surgery operations in any given year is ‘repeat business’. Such positive experiences very directly promotes plastic surgery as a satisfied patient is very likely to consider another procedure or tell a friend, who may then go on to have plastic surgery themselves. Every business and profession recognizes the tremendous influence of such word of mouth referrals.
Plastic surgery today is and will continue to be for real people. Its benefits are wide reaching and the ability for all of society to benefit, from the child born with a cleft defect to the middle-aged sales representative who wants to look more refreshed, will continue to be more pervasive. The propagation of plastic surgery has as much to do with its overall effectiveness and high patient satisfaction as it does with marketing and media promotions.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

One of the most important things we do as plastic surgeons or any surgeon for that matter…is to match the solution to the problem. Large operations for small problems run the risk of creating complications that exceed the scope of the original problem. Small operations for big problems simply will not work and are destined for failure and more surgery. Learning this judgment skill can only be done through experience…otherwise known as mistakes.
I have learned to carefully match the magnitude of the operation to the size of the problem. Small problems need small operations. Big problems require big operations. You cannot make a big problem better by a small operation…no matter how much the patient would prefer it. The allure and excitement of a big operation (to the plastic surgeon) is doomed to likely create a problem for the patient which is just as significant, if not more so, than the original problem.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

On Tuesday March 25, 2008, Dr Barry Eppley, board-certified plastic surgeon, presented a lecture open to the general public on the topic, ‘Trick, Trend, or Truth: The Insider’s Guide to Plastic Surgery’ at Frederic’s AVEDA Institute in Indianapolis. In this presentation, Dr Eppley reviewed ten of the most popular cosmetic plastic surgery procedures today and discussed the facts versus the myths/misconceptions surrounding them.

A recent study released by the prestigous American Society of Aesthetic Plastic Surgery has revealed some interesting findings on the public perceptions of plastic surgery. And remember, we are talking here about cosmetic plastic surgery, not necessarily reconstructive plastic surgery where the decision to have surgery is not completely controlled by the patient.
In a report based on a survery of 1,000 people over the age of 18 polled, the main findings were: 1) Young adults between 18 - 24 years of age have the highest approval rating of cosmetic surgery while those over age 65 had the lowest approval rating (not surpising for all the generational gap reasons), 2) Women are much more likely to have cosmetic surgery than men (which is why about 85% of my practice is women), 3) Nearly 80% of respondents said they were not embarrassed to say or tell others that they had cosmetic surgery (again, an issue of more common acceptance today), 4) 16% said their attitude over the past five years about cosmetic surgery had become more favorable, and 5) Men and women with children are more likely to consider cosmetic surgery than those without. (makes sense as childbearing does take a toll on many women’s bodies)
While there were not great revelations in this study that could not have been predicted, it does lend credence to the increasing numbers of plastic surgery procedures being performed with more than 11 million cosmetic procedures done in the U.S. in 2007. With the state of the economy here in 2008 and a presidential election year, it will be interesting to see what that number is for 2008.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

The Unhappy Patient
Despite the best efforts of both patients and plastic surgeons, a small percentage of surgeries will not have the best outcomes. As the healing processes of the body are not always predictable, a plastic surgery result may be potentially affected by many factors including complications (e.g., infection) or undesired results in the size or shape of the surgically treated area. As a result, revisional surgery may be needed to obtain the desired result.

The need for revisional surgery for elective plastic surgery is estimated to be about 15%, which may be higher or lower depending upon the particular procedure being performed. So you can see that its occurrence is not rare. It is important for all patients considering plastic surgery to understand that undesired postoperative results can and do occur, and the potential need for revision exists with every surgical procedure.
Let me reiterate these points again:
· surgical outcomes can not be guaranteed,
· the need for revisional surgery in elective cosmetic surgery is not rare
· and, when needed, incurs expense to perform.

Should revision of a plastic surgery procedure be necessary, the sticking point that most consistently generates friction is not that more surgery may be needed….but the expenses incurred in so doing. In other words, who is going to pay for it? These issues are particularly relevant to those patients who have limited financial resources and have expended those resources in having the original procedure performed. The potential need for revisional surgery and its costs should be considered during the decision-making process when contemplating any form of elective cosmetic surgery.
However, now that you may need revisional surgery, what do you do? In some cases, the plastic surgeon may be able to some minor revisions in the office under local anesthesia. In this environment, your expense exposure may be minimal to none. However, if it requires going to the operating room and being under general anesthesia, that is usually quite different. While most plastic surgeons will waive any fee for their professional time and efforts, the expense of the operating room and anesthesia is your responsibility. Hopefully, this concept has been explained to you prior to the initial procedure. Even if it is so explained, some patients are not going to be happy if this event becomes necessary or desired. Being angry or upset with your plastic surgeon, while you are entitled to your feelings, is not appropriate. Undergoing elective plastic surgery is not guarantee of a perfect outcome, it is only a guarantee of the plastic surgeon’s best efforts. This financial issue, in my experience, is one of the top reasons that a patient will have a complaint or negative feelings about a plastic surgical outcome.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Most patients will have a very good idea at 3 to 4 weeks after surgery of the result they are going to have. While face and body cosmetic surgeries heal differently, with swelling and bruising going away at different times for each type of procedure, 80% to 90% of the final result for most cosmetic procedures is seen at a month after surgery. Certainly any major complications, either medical (e.g., infection) or aesthetic (e.g., asymmetry, uneven, etc), will have surfaced by this time. So your level of happiness should be pretty evident by now. What may have not looked right to you at a week after surgery could look quite different by now in a better way.
The other advantage at being a month out from surgery is that you should be fairly free at this point to do any activity you want. Even in significant body contouring surgeries, the ability to start to get back near normal levels of activities, including light exercise, should now be possible.
Regardless of the type of cosmetic surgery performed, a month out from surgery gives you a pretty good gauge of how you look and feel.
If you are happy with the results, then it is likely you will be even happier as time goes on. Some cosmetic procedures can’t fully be judged until later, such as breast lift (e.g., is the upper pole volume retained?), but most procedures have very lasting effects and some are quite permanent. (e.g., rhinoplasty, breast augmentation) Little areas of swelling, unevenness, or asynmmetries will likely get better with time or, even if they are not perfect, may be irrelevant given the overall very positive changes that you have seen.
It is common and a near standard of care practice for your plastic surgeon to want to take photographs after surgery to go with the ones taken prior to surgery. This is always an excellent record to have and is more than a ‘feel good’ record for your plastic surgeon. I have often found it quite striking for the patient to see the comparison of before and after surgery photographs. While every patient has a good memory of what they looked like before, they do not have a good idea of how ‘bad’ the issues were until they see it next to what has been changed. This is both psychologically and financially reassuring that the decision for plastic surgery was a good one.
It is also likely that your plastic surgeon may ask if your photographs can be placed in their media communications, most commonly their company website. Do not be offended by this request. The plastic surgeon is proud of your results and wants to share it with other prospective patients. If you remember, you probably looked at their website before surgery to view some procedure results…this is how all those photographs got there! If you prefer not to have your photographs used, simply say so. We are not offended and will gladly respect your wishes.
While longer-term follow-up appointments will be done to check your progress, you are all but over the process at this point. If you are happy with your results now, there is no reason to suspect you won’t be later!

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

It is now a week or so after your surgery and you are starting to look and feel better. The pain is getting less, you can move around better, and you are starting to look more human (provided no one looks too close) Now what comes next?
The most important thing that I tell all patients, regardless of the cosmetic surgery procedure, is that its takes longer for recovery than you ever thought. I am not talking about the major part of a recovery, such as significant pain or swelling, but the fine parts of recovery which no patient really anticipates. I am referring to……the small amount of residual swelling that only the patient mainly sees (and which may take a month or so to completely resolve), the numbness of the skin over the surgery site (which can take months to feel completely normal), or the stiffness or tightness that is felt as one gets more active and stretches further. Whether it be eyelid surgery or liposuction, the finer points of recovering from the surgery are usually not over when it comes time to return to work or go back out into the public.
When you are at this point in your recovery, you are in what I call phase two. Most patients are usually ‘over’ the concept of recovering at this point and would really like to get back to complete normalcy. I urge patience at this point (besides what else can you do?) and reassurance that everything is going normally is the best news that you can hear.
As a general rule, facial cosmetic surgery has little pain but takes two to three weeks to look non-surgical. Body cosmetic surgery has more discomfort (usually much more) but is not socially distracting due to coverage by clothing. Two to three weeks to feeling good is usually too short for most body cosmetic procedures (with the exception of breast augmentation) and four to six for a complete recovery is more common. That is why strenuous exercise should not be done before then.
Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis