Beauty from Afar

Chapter 4 Page 2 | Cosmetic Surgeries and Procedures

There are new cosmetic techniques and new variations of old ones being tested and tried all the time by creative and innovative surgeons around the world. Below are some of the most common ones, with their general definitions, some tips and advice gleaned from patients and surgeons, and some general price comparison information. Price ranges are rough measures; the figures I use here represent approximations based on a number of sources. You can almost certainly find surgeons in both the United States and abroad who charge less than the lowest figures I cite, and you can absolutely find surgeons who charge and get higher prices for their work.

There is far more information available online, of course. How to go about researching surgical information on the Internet is covered in Chapter 5.

Liposuction/Lipoplasty

Liposuction is a procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks, and neck. Good plastic surgeons are generally fastidious about reminding patients that cosmetic surgery is “real surgery,” and this is particularly true of liposuction. “Getting a little lipo” should not be trivialized. Experienced cosmetic surgeons wince at the suggestion that liposuction is easy and cringe at the thought of a cannula (the fat-suctioning tool) in unpracticed hands. Liposuction is both physically demanding work and an art, according to its leading practitioners.

Improvements in technique over the past decade have brought into use the term liposculpture, emphasizing both that the procedure is an art and that surgeons can be remarkably precise, even restoring fat to some areas to achieve the desired result. Patients often ask about “aggressive” liposuction; in general, liposuction is for removal of relatively small volumes of fat that resist dieting and exercise. Some surgeons — including experienced ones both in the United States and abroad — will go beyond that, but one should not assume that more is better. More can be riskier; more will also involve a lengthier convalescence and recovery.

Liposuction is generally priced by the number of areas from which a patient wants fat removed in a session, with discounts offered for additional areas beyond the first. Prices in the United States can range from around $2,500 to $5,000 for a single area on up to more than $10,000 for five areas. The range is much lower overseas but again depends on the need of the individual patient. My guesstimate, looking at prices in Central and South America and Asia, is that median prices are 40 to 75 percent less than in the United States, or about $1,000 to $3,000 and more for up to five areas.

Facelift (Rhytidectomy)

A facelift is a highly individualized procedure and is often done in conjunction with other facial procedures. Surgeons these days strive for a natural appearance. Gone is the pulled-back, stretched look more common a generation ago. A basic facelift does not eliminate wrinkles. It does not directly address the forehead area or upper eyes. It does generally address the neck area. A neck lift is usually part of a facelift but some surgeons will do it separately.

Surgeons can recommend newer, less-invasive or noninvasive (and less expensive) alternatives to a full facelift. My feeling about new facial surgical techniques is that there is an increased amount of uncertainty as to results and that patients should be extra-cautious until the techniques are proven.

The average cost of a facelift in the United States is in the range of $7,000 to $10,000, but adding in other facial procedures can easily double the bill. Again, the price overseas is generally 40 to 75 percent less. A facelift in Brazil or Costa Rica can run in the $2,500 to $3,500 range.

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Chapter 2 Page 9 | Prices in the United States and Abroad

Consumers who consider going abroad to save money for cosmetic surgery, dental work, or any other kind of medical care, will hear these bromides, either from voices in their heads or from well-meaning friends and relatives:

• You get what you pay for.
• If it sounds too good to be true, it probably is.
• Quality doesn’t come cheap.

One does not have to have an intimate knowledge of international economics to understand why prices for high-quality cosmetic surgery can be far lower in less-developed countries than in the United States or Western Europe. A good surgeon is an artist, a psychologist, and modern-day wizard of sorts who transforms and restores; but he or she is also a businessperson. Cosmetic surgeons treat patients and are paid fees; cosmetic surgeons whose services are in demand can and do charge higher fees.

Simple, right? You get what you pay for, and quality doesn’t come cheap. However, among other things, geography matters a great deal. In your own town or city, you may find a range of prices from different cosmetic surgeons, as you might expect. Well-known surgeons with years of experience and hundreds or even thousands of satisfied customers will charge the most. A surgeon fresh from his or her residency, just starting out, trained but relatively inexperienced, will charge less. It is not unheard of for surgeons just starting out to offer reduced fees to clients who will agree to provide testimonials or referrals or otherwise participate in marketing the new business.

In your town, there will also be doctors and surgeons who may not be board certified in plastic surgery who nonetheless legally practice it, to an extent. The ASPS warns that such practitioners may be less-safe choices and, generally speaking, one would guess that they are right. Still, it goes on.

The average price of a typical facelift in the United States performed by a board-certified plastic surgeon in an accredited surgical facility, including surgeon’s fee, anesthesia fee, and operating facility fee, is in the $7,000 to $9,000 range, according to InfoPlasticSurgery.com (2005)

That might be the range in your town. But if you live in New York City, the range might be 50 percent higher. If you live in parts of the less-urban South or Midwest, the range might be a little lower. Geography matters, even within the United States. There is more demand for cosmetic and aesthetic surgery and procedures in urban areas and on the coasts; and the costs of living and of doing business are correspondingly higher. So how can board-certified, experienced surgeons working in modern facilities in Mexico, Brazil, Costa Rica, the Dominican Republic, Thailand, India, and other countries charge so much less? While a facelift abroad is more likely to cost between $3,500 and $6,000, including travel, meals, and accommodations, the costs of living and of doing business is correspondingly less in these countries. The top surgeons in the world, those with international reputations, can charge and get U.S. prices wherever they may be, but the many trained and qualified surgeons who aspire to be known as among the elite in the world must charge far less to draw patients from abroad, including the United States. And they can make a good living doing so.

Many think U.S. surgeons are greedy, but I do not think that is the case. They face significantly higher costs than do their counterparts and peers in other countries. In many ways, the reasons prices for cosmetic and other surgeries are lower in other countries than in the United States and western Europe are the same reasons why it is less expensive to produce DVD players or textiles abroad: They have less-expensive land, less-expensive construction costs, lower labor costs, lower taxes, and lower administrative costs. It is a mistake to single out any one thing as being responsible for the difference.

Malpractice insurance costs are also partly to blame. Though malpractice rates vary, depending on amounts of coverage, U.S. surgeons I interviewed said they each pay between $40,000 and $70,000 annually, compared to the less than $6,000 a year a Brazilian surgeon I know pays. This is a substantial difference, yet a small part of the overall equation. About the only business expense that is the same for surgeons regardless of where they live is medical equipment and medical supplies.

Price is relative from country to country, and a patient looking at the possibility of traveling abroad for care can responsibly factor that in. Some prices are so low that one can not help but be suspicious. Substantial inquiries are merited and references should be required. Cosmetic and elective surgery prices in the Far East are, for the most part, somewhat lower than those in South America, which are somewhat lower than those in Central America. I know that there are good surgeons in all those places.

Surgeons in the Far East, in fact, may be more likely to have trained in the United States and be fluent in English, though they have no monopoly on either of those things.

The cosmetic surgeon who charges the highest prices in your town may well be among the best and will almost certainly be among the most experienced. But paying the highest price does not guarantee the best outcome. Is a $10,000 face-lift in New York City better than a $7,000 one in Cincinnati? Is either better than a $3,000 one in Brazil? It depends.

I have talked to people who are unhappy with their expensive cosmetic work and people who are thrilled with the quality of their inexpensive results. For every anecdote, there is another one to give lie to the first. Beyond the borders of the United States, options abound for those willing to take the time to investigate, analyze, and choose.

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