Whilst we can blame social media and the online world we all now occupy for a lot of things, there have always been (for as long as there have been cosmetic surgeons) the "celebrity" surgeons, the men and women who charge exponentially more for a given procedure than everyone else.

Whilst it may sound absurd, we are now in the era of the $300 000 facelift. A certain New York plastic surgeon seems to be leading the charge to these ridiculous amounts, but there are plenty of others nipping at his (no doubt expensively shod) heels. Breast surgery, and in particular breast augmentation, is a far quicker and technically far simpler procedure than a full face/neck/brow/eyelid lift, but we are certainly seeing a rapid move away from the idea of "discount" breast augmentation that was popularised by the now disgraced "Cosmetic Institute" in Sydney (which recently settled a class action for about $25 000 000). The days of $4999 breast augs may be behind us (thankfully), and there is a substantial variation to be found, but some of the (self-proclaimed) "breast masters" are out there charging $25 000 for what is essentially a 1 hour operation, and they'll repeat that 6 or 7 times in a day quite happily.

Now, in all honesty, I say good luck to em. Its a market after all, and if these players can charge that much and people are willing to pay it, then off you go.

The question that I want to consider though is this:

"in 2024, what does "good value" in plastic surgery look like?"

So, let's say you go off to Dr $25K for your breast augmentation. On top of that you'll have your anaesthetic and hospital fees, maybe implant costs, maybe surgical garments, maybe some post-op care "package", maybe accommodation (if you travelled for surgery)....it can certainly add up. There are absolutely ladies out there who will have paid $40K for their breast augmentation. How does that stack up in terms of value?

Well, it really depends on what we include in that judgement, right.

Value (to a patient) might be judged primarily on any number of criteria. For one patient, value might be entirely dependent on the outcome - so if that surgeon who is charging a motza, is the same surgeon who gets the very best results (however one judges that), then the big price tag may well represent good value.

To another patient, value might depend on something like how often they see a surgeon, whether they can easily get in touch with a surgeon, whether they have pain after surgery, what their scars look like, how durable their results are, whether they have to pay for follow up, or how the surgeon deals with a complication. Value remains very much in the eye of the beholder.

The funny thing about that is I reckon most people would still judge the relative "value" of plastic surgery against their cosmetic outcome.

So, if we take that assumption and go one step further, we have to then ask: "is the most expensive surgeon the best surgeon?"

And if they're not, then how/why are they charging more than everyone else?

Hmm.

The psychology of this is quite interesting.

For one, there is a pretty well recognised phenomenon whereby a surgeon puts their prices up, and suddenly they get busier than ever. Why? Well, the assumption is that if his / her prices are higher, on the assumption of that being a direct reflection of quality, then more people (within a certain demographic) will want surgery with that surgeon. Let's call that the "Double Bay Effect". It is a bit of a fake-it-til-you-make-it sort of thing. Build the gold-plated rooms, with prices to match, and irrespective of when that practice started, some consumers will assume that is a reflection of skill, quality etc. That has been a well-trodden process for both plastic surgeons and cosmetic practitioners - the untrained cosmetic doctor with the posh rooms with a slick aesthetic, in a chic part of town, tends to do very well for themselves up to a point; and then the house of cards comes tumbling down if the outcomes don't match the expectations.

On the other hand, the more a consumer pays for a service, the harder they will work to convince themselves that the quality of their outcome justified the high price that they paid. This ties in to something I have discussed previously, regarding issues like chronic pain after breast augmentation. No one wants to suffer from "buyer's remorse", and so ladies with chronic pain will often under-report their symptoms because they don't want to regret their decision to have surgery.

Both of these phenomena have limits though. We can only fool ourselves for so long in the face of overwhelming evidence. So they patient who either has a mediocre outcome, or perhaps more commonly, whose outcome deteriorates over time, will eventually come around to the conclusion that they need to address the problem, at which point it is interesting to see whether a person's value judgement changes.

What I tend to see, as someone who almost exclusively sees this sort of thing at the point that a patient has decided to fix things, is that many women will tell me that something has only recently changed (for the worse), when all the evidence suggests that the outcome was poor all along. Curious.

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We've been off on a little tangent there, so let's come back to the idea of value.

Whilst we can fool ourselves as much as we want, and our notions of value may vary, value in plastic surgery eventually comes back to some sort of composite judgement: is the outcome any good, has it lasted, was the process pleasant, did the office smell nice, were the staff good to deal with....oh, and did it cost more than an apartment to get that outcome?

I guess I should throw in here what exactly I mean by value in plastic surgery.

For me, in my practice (and you can call me old fashioned), time = money. And that works both ways. So we can also put it this way: for a given price, my patient buys my time. The value in that equation then comes from both the amount of time I spend with them, and what they get from any amount of time I spend with them.

In pure numbers, for someone having say an explant with a mastopexy, I spend 2-3 hours pre-op, 4-5 hours in hospital (yes, about 4 hours operating, but you have to account for all the other faffing around), and then around 3-4 hours post-op with them. So that is perhaps 10-12 hours total of my time, plus the time my staff spend. And for that time, I charge around $13,000. I could definitely argue that I should be charging more. I could also compare that to other surgeons and conclude that I could easily charge more. But that is what I consider a fair price.

Of course, time alone is insufficient. It is what we achieve in that time that matters just as much.

So, I think it is calculation of time spent, filtered through the prism of outcomes and satisfaction that leads us to the ultimate value equation in what I can offer to my patients.

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I think it is necessary for any patient to consider their own notions of value in making the decision to have surgery. Perhaps most importantly, don't take someone else's value assessment as your own, and don't just look at price in isolation.

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