Distinctions between Cosmetic surgical procedures and Reconstructive surgical procedures may appear clear, but occasionally these distinctions may be less obvious.
Cosmetic surgery is performed on normal tissue to improve the patient’s beauty. This optional enhancement is not considered medically necessary from a health perspective, but rather a way to alter a person’s appearance to boost their self-esteem.
Examples include body contouring with liposuction, breast augmentation, face lift, and minimally invasive injections of Botox® (one of the many muscle relaxants). Cosmetic procedures are usually not covered by insurance.
Reconstructive surgery is performed to repair wounds, remove a cancer or return function to an injured body part. Some examples include treatment of accidents victims, burn treatment, hand surgery and cleft lip/cleft pallet reconstruction. These procedures are usually covered by insurance policies.
Some procedures fall into a gray area. Breast reduction, for example - if the large size of a patient’s breasts prevents her from performing her activities of daily living, then reduction surgery would be considered reconstructive rather than cosmetic.
An upper eyelid blepharoplasty (excess eyelid skin removal) would typically be a cosmetic procedure. If the patient’s visual fields were compromised, then surgery is required to improve vision. The procedure, therefore, is medically necessary for functional purposes.
When the distinctions between Cosmetic and Reconstructive surgical procedures are less clear, the need to correct a functional impairment implies that the procedure is reconstructive. If the procedure elected by the patient is for the improvement of “looks”, this is indicative of a cosmetic procedure.
Matthew Greenwald.
The Ohio State University.
Bryan J. Michelow, MD., FACS
