Dr. Warren Lent

Plastic surgeons are calling for better price transparency saying that most patients are “price unaware” when they are seeking non-emergency health care.

Leading surgeons are complaining that hospitals don’t provide good pricing information to patients. At present it is thought that hospitals tend to take one of two approaches, neither of which is particularly helpful to patients. Hospitals are either declining to discuss pricing over the phone and instead tell patients to make an appointment or refer them to a website or they are spending too much time discussing pricing and never hear from the patient again.

One option that has been put forward to help is the development of apps to help patients gather information on plastic surgery and the associated costs the app can also be expanded into a website widget so that it is not limited to smartphones and tablets.

There is already a version of this available known as “Build My Bod” which is used by a number of doctors in Louisiana to help patients make health care spending decisions.

The app gives patients the chance to shop from a number of procedures with the bundled pricing components very clearly listed. For example, a joint replacement price would include the surgeon fee, anesthesia fee, hospital charge and rehabilitation costs.

It has also been found that those who use the app or website are 41% more likely to follow-up by booking a procedure.

According to the Affordable Care Act hospitals need to provide patients with pricing information. However, this regulatory element of the ACA has been slow going. Centers for Medicare & Medicaid Services released proposed rules in 2014 and both the American Medical Society and the American Hospital Association support the concept of price transparency on their websites. However, in reality many hospitals are listing charges rather than the actual prices that a patient might pay which is unhelpful when patients are trying to make informed decisions.

A woman from Southern Texas was convicted and sentenced for murder after fatally injecting a woman in 2012 with fake Botox.

Elva Mendoza Navarro, from Hidalgo, was sentenced to five years in prison after she pleaded guilty to the murder of Zenyasent Cisneros. Cisenros died as a result of complications from the injections she received in October 2013 at Bella’s Face and Body Spa which was owned by Navarro.

Court documents show that Cisenros had paid for a buttock enhancement procedure using Botox. However, the product used was mislabeled hardware store grade silicone.

Navarro’s attorney, Terry Canales, argued that Nevarro was unware that the Botox was fake when she injected six women with it and claimed that she also used the product on herself. Canales said that there was a possibility that Navarro had “been fooled herself and had no idea the product was not what it was labelled”.

In June 2014 Canales also represented Navarro in a federal case where she pleaded guilty to receiving and importing the liquid silicone she used to inject Cisneros with the intent to “defraud and mislead” her customers. In that instance she was sentenced to three years in prison which will run at the same time as the five years she was sentenced to in the more recent case.

Canales asked that the judge reduce the murder charge to manslaughter and recommended that Navarro be given probation as there was no proof of intent to kill Cisneros. Originally Navarro was facing 99 years in prison but in exchange for her guilty plea prosecutors dropped two counts of practicing medicine without a license and one count of kidnapping from a separate case.

After serving half of her sentence Navarro will be eligible for parole and she has already served about nine months in jail.

The case highlights the need for patients who choose to undergo Botox treatment to be sure that they are being treated by a fully qualified and American Board of Plastic Surgery recognized surgeon.

The modern trend for plastic surgery reality television isn’t the first time that people have had the chance to compete for the chance of a plastic surgery makeover. In the 1920s a competition was run in the New York Daily Mirror asking for the “homeliest girl” in the city to come forward and the winner would be made into “a beauty” by a plastic surgeon.

Plastic surgery has a much longer and convoluted history than most people realize. It has mixed origins which lie in part in the correction of syphilitic deformities and racialized ideas about acceptable facial features as well as the aim of aesthetic improvement.

Some of the first known plastic surgeries took place in 16th century Britain. There were Tudor “barber surgeons” which treated facial injuries, an essential role in a society where an ugly or damaged face was considered to reflect a disfigured inner self. However, due to the pain and risks of surgery at the time cosmetic surgeries were generally restricted to severe and stigmatized disfigurements, such as the loss of a nose.

Purely cosmetic surgery didn’t really become commonplace until it wasn’t as painful and the risk to life had been greatly reduced. Thanks to the various advancements in the fields of anesthesia and hygiene this had been achieved by the 1880s.

Soon it wasn’t unusual to see adverts for various surgeries such as Derma-Featural Co’s adverts for treatment for “humped, depressed, or… ill-shaped noses”. However, the surgeries were still very primitive and full of risks. For instance the use of “paraffin wax” for nose jobs where hot wax was injected into the nose and them molded into the desired shape could result in the wax migrating to other parts of the face and cause disfigurements or even wax cancers.

Much of the work to advance plastic surgery techniques came about as the result of a desire to correct features such as ears, noses and breasts which were seen as “ugly” as they weren’t typical of “white people”.

In the US, where the immigrant population was steadily growing, pug noses, large noses and flat noses were seen as signs of racial difference and were therefore considered ugly. Similarly, small rounded breasts were considered youthful and sexually controlled while larger breasts were considered primitive and a deformity. As a result in the early 20th century breast reductions were common.

The changing views about noses, breasts and so on demonstrate how standards of beauty change with time and place. Surgical trends have always been linked to the qualities valued by the surrounding culture as well as ideas about race, health, femininity and so on.

While today plastic surgery is on the whole viewed as an entirely positive thing it is worth remembering that modern cosmetic surgery owes a huge amount to racism and not, as is often thought, to the helping of those injured in war or other horrific circumstances.