What constitutes cosmetic versus reconstructive surgery is definitely a gray line. Trying to put things simply, cosmetic surgery is surgery to improve your appearance; it is not something that is medically necessary. Reconstructive surgery is surgery to repair or restore form or function; it is considered medically necessary. However, that does not mean that reconstructive surgery should not emphasize the cosmetic outcome. A good plastic surgeon is able to use the techniques that he/she has learned from performing cosmetic surgery to perform an aesthetically-pleasing reconstructive surgery and utilize concepts from reconstructive surgery to enhance the outcome from a cosmetic surgery.
To complicate matters, insurance companies have different policies regarding what they consider cosmetic and what they consider reconstructive. Examples of cosmetic surgery include tummy tucks, breast augmentations, and facelifts. Examples of reconstructive surgery include cancer reconstruction and reconstruction after trauma. Some procedures that can be cosmetic or reconstructive include breast reductions, upper eyelid surgery, and surgery after massive weight loss; whether or not these procedures are covered by your insurance depends on your individual circumstances and your insurance policy. Moreover, when deciding to undergo cosmetic surgery, you should realize that your insurance may not cover surgery for complications related to the surgery, whether that is immediately after the surgery or ten years later.
Insurance does not cover cosmetic surgery. Cosmetic surgery is an elective procedure to improve your appearance and is not medically necessary. However, reconstructive surgery can and should also be performed with cosmetics in mind. Some procedures do fall under the umbrella of being cosmetic in some cases and reconstructive in others. For example, a breast reduction can be performed to address back pain and rashes under the breasts, upper eyelid surgery can be performed if it is affecting one’s vision, and nose surgery (rhinoplasty) can be performed if one’s breathing is impaired. For these types of procedures to be considered reconstructive, certain criteria need to be met, typically including documentation of symptoms from other healthcare providers and efforts to treat these symptoms with conservative measures (like medications and physical therapy). If these criteria are met, typically Dr. Elswick will send a letter to your insurance company to request approval (pre-determination) for the surgery from your insurance company prior to proceeding. Reconstructive surgery due to an accident or cancer is typically also covered by insurance.
Most of our patients have a choice on where their outpatient surgery will be performed. The quality and safety of the facility should be your top priority in choosing not only your surgeon, but where he or she will operate. Our private surgery suite, Columbia Surgical Center, is fully accredited through AAAHC and held to highest standards of quality. Both our surgeons also have operating privileges William Beaumont Troy and Dr. Elswick also operates at William Beaumont Hospital Royal Oak and McLaren Macomb Hospital. If you have any major medical problems, elect to have multiple procedures that may require an overnight stay, are having a surgery that is covered by insurance your surgery will be done at the hospital only.
Most of our surgeries are performed as outpatient surgery, meaning you go home the same day.. We find patients recover best in the comfort of their own home. We keep in contact throughout the recovery process and someone is always available should an emergency arise. An overnight stay may be required if you are combining multiple procedures or if you have any underlying health concerns that the doctors wish to monitor prior to sending you home.
Most of our cosmetic surgeries are outpatient. You will need to have someone stay with you for the first 24-48 hours to assist you at home. Every surgery and person’s recovery is different, however, it is important to remember this is a surgical procedure and will require downtime. On average you will need anywhere from 2-6 weeks to resume normal activity, including exercising. Many individuals can return to work after a week for administrative and non-physical jobs. Additional details will be provided at your consultation with the surgeon and will depend on the surgery you choose and your lifestyle.
Generally we recommend you be at least 18 years old and have explored all alternative treatments before considering surgery. There are definitely exceptions to this, especially for reconstructive, medically-necessary surgery. Certain types of surgery can be attractive to different age groups. Individuals in their 20’s and 30’s may be more interested in breast augmentation, rhinoplasty and body contouring procedures while older adults may inquire more about facial surgery and skin tightening treatments. However, cosmetic surgery is based on individual desires and most surgeries are done in a wide age range of patients. If you plan on becoming pregnant and/or breastfeeding it is important to discuss the timing of surgery with these plans in mind as these things can impact the results of your surgery.
With elective surgery you want to ensure you are healthy and at your ideal weight. Our qualified staff will give you specific instructions on how to prepare for surgery, including guidelines on diet, medications, activity level, and smoking. If you smoke or use other nicotine-containing products, plan to quit at least 4 weeks before the scheduled surgery; nicotine puts you at increased risk of complications from surgery such as infection and poor wound healing. Avoid sun exposure before and after surgery as this may interfere with scar formation.
This is a common question but it cannot be provided without a consultation. Fees are based on the specific surgical procedure, which is only able to be determined after discussing your goals and examining you. Typically you will be charged for three different items: a surgeon’s fee to perform the surgery, an operating room fee (to cover the expense of the facility and its employees who will assist the surgeon) and an anesthesia fee. These are all dependent on the procedure and the time needed to perform it. All surgeries require an initial consultation with the surgeon to develop a plan that works for you and ensure your questions are answered. Once a plan is developed a fee is communicated prior to making any decisions. Financing options are available for those that qualify.
Board certification is an extremely important qualification to discuss with your surgeon. It is a testament of a surgeon’s dedication to knowledge, experience, continuing education and patient safety. Unfortunately the US allows any licensed physician to perform a cosmetic procedure even though they do not have specific training in plastic surgery. To make things even more confusing, there are multiple different types of board certification so it is important to clarify exactly what type of certification your surgeon has. Plastic surgeons are certified through the American Board of Plastic Surgery. They have received specific training in plastic surgery (including a minimum of 5-8 years of training specifically within plastic surgery and potentially other surgical fields related to plastic surgery). Plastic surgery training is extremely highly sought-after and only the most competitive candidates are chosen for this field. This is completely different from the American Board of Cosmetic Surgery, who will board certify physicians who have never completed plastic surgery training after only a one year fellowship in cosmetic surgery (in fellowships that are taught mostly by non-plastic surgeons). Dr. Schenden is a plastic surgeon who has been board certified by the American Board of Plastic Surgery and Dr. Elswick is board eligible (she is eligible to take her board certification exam, a process that takes at least 1.5 years to complete after finishing her already rigorous plastic surgery training). To check if your surgeon is certified by the American Board of Plastic Surgeons, visit their website at https://www.abplasticsurgery.org/VerifyCert?section=SurgeonSearch.
There are many alternatives to surgery and prior to exploring surgery you should research non- or minimally-invasive treatments. For example, when it comes to fine lines, wrinkles and skin discoloration, there are several options such as aesthetic injections, laser resurfacing, microneedling and even chemical peels. Non- or minimally invasive procedures frequently have the advantage of less recovery time and can be less expensive; some patients are great candidates for these things. Often times, better results can be obtained, or the results of surgery can be maintained, by using these procedures in conjunction with surgery. Luckily our practice has a medical day spa and aesthetic injectors; our providers are well-versed in all these options and can customize your treatment plan even if you decide surgery is not the best option for you right now.