Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

I am such a Girl Scout!

Seattle Plastic Surgeon discusses the difference between reconstructive and cosmetic surgery and what that has to do with April 15th and the Girl Scouts of America.

Seattle Plastic Surgeon

I am such a Girl Scout. Please don’t ask me to fudge about the medical necessity of cosmetic procedures.

This time of year I get numerous requests from patients who want to “write off” plastic surgical procedures for tax purposes.    I am always happy to provide my clinic notes and operative reports and billing information for patients to use as they wish but I will not call a cosmetic procedure medically necessary.  Here are the definitions I use for the different categories of plastic surgery:

  • Reconstructive surgery includes those procedures that address an abnormal body structure to return to it normal or near normal appearance and/or function.
  • Cosmetic surgery include those procedures which address a normal body structure to improve appearance and/or function.

So both reconstructive and cosmetic surgery improve appearance and/or function.  The difference resides in starting point.  Was the body structure normal prior to surgery?  And, of course, the plot thickens because normal for a 65 year old is not normal for a 25 year old.  And to add more confusion, what is the function of the face?  The breast?  The nose?

Is the function of the face to provide a place for smell, breathing, taste, vision, hearing, speaking and eating?  How about the function of the face as our visual calling card?  And the breast:  Is the only function of the breast lactation or is the breast a visual calling card for femininity?

And then there is the issue of medical necessity.  What exactly does that mean?  Clearly, treatment of acute appendicitis is medically necessary.  But is it medically necessary to reconstruct a breast lost to cancer?  That reconstructed breast will never lactate.  Is it mecially necessary to treat  post-menopausal hot flashes with hormone replacement therapy or  how about replacing an arthritic hip in a 60 year old who wants to continue to play tennis?  Insurance will cover all of those above treatments but only the acute appendicitis is life threatening.

As you can see,plastic surgery is often not black and white but sometimes it is.  In those in between cases, I am happy to provide an opinion.   But I won’t stretch the truth on cases that are clearly cosmetic.

Don’t you just love it that your plastic surgeon is a Girl Scout?

Thanks for reading and have a happy tax day!  Dr. Lisa Lynn Sowder





Category: Financial Issues, My Plastic Surgery Philosophy | Tags: , , , , , ,

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