Dr. Dean Kane Q&A – What payment options are available for self pay cosmetic surgery clients?

Question from Allentown, PA: The approximate costs after an assessment by a surgeon I respect for a facelift and neck surgery was $11,000. The receptionist mentioned insurance options. I'm wondering what is out there and whether any one has used a particular insurance company? 

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

​​Thanks for this question! It is a source of confusion and frustration for both the Patient and the Cosmetic Surgery Practice. 

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​The medical insurance industry separates "RECONSTRUCTIVE" surgery from "COSMETIC" surgery. 

1. ​Reconstructive means it is covered but needs approval from your medical insurer. (Unfortunately, some insurers such as Blue Cross Blue Shield, Medicaid and Medicare will not pre-approve, so you are financially at risk until you submit and they approve payment or not). 

2. Cosmetic means it is for personal enhancement with no "therapeutic" improvement and is not covered by the terms of your medical insurance contract. 

​It also non-verbally expects you to recognize that ALL surgery is:

1. ​"ELECTIVE" (meaning the choice of time, date and place are variable and may need pre-authorization approval) from 

2. ​"EMERGENCY" (in which case, surgery is required to recover a life or limb threat).

​Your particular medical insurance contractual agreement will explain what is covered for:

1.  Direct payment to the physician and healthcare facility (where deductibles and co-pays are paid by you)

2.  Or whether the procedure(s) are fully "self-paid" by you. 

​The options our patients have used for lending sources outside of their own means or that of family and friends include:

1.  ​Your bank,

2.  ​Reverse or second mortgage,

3.  ​Care Credit

4.  American Health Lending

Many practices, like ours, will offer a link on the Finance Page of their website directly to some lending sources. It is best to have those lined up prior visiting your consulting cosmetic surgeon. Tips for loan approval also include:

1. If your credit score is too low for the loan you are requesting, ask for less and later come back and ask for more.

2. Review all the fine print to understand your payout as some options are overwhelming and some may even have 0% financing within a limited time.

3. Many practices have "private" banking lines for their patients who are more flexible than standard banks or lending sites. Ask the patient coordinator if you may speak with them directly. 

I hope this was helpful! All the best!

Dr. Dean Kane Q&A –I would like to get rid of the flab under my chin. Is there a procedure that addresses this without having a lower facelift at the same time?

Dear Facelift options patient: 

Various options for facelifting and skin texture improvements are available according to the skin laxity and areas of lift or tightening you wish or need. Both surgical and minimally invasive / non-surgical options are listed below.

Surgical lifts would be likened to pulling the bedspread and or top-sheet of your bed up to the head-board and removing the excess material.

Minimally invasive procedures such as fillers provide volume such as adjusting a pillow under the bedspread. Botox and Dysport act by pulling the top-sheet which drags the bedspread upwardly. If the bedspread (or skin) continues to fall to the foot of the bed despite fillers, Botox or Dysport you will need to consider a facelift.

Non-invasive options such as laser and light therapies, skin tightening products and technologies perform their tightening and smoothening of the skin similar to sending your bedspread to the dry cleaners. A more refreshed, even colored, glowing smoother and tighter spread covers the surface of the bed.

If you can pinch more than an inch of skin along your jawline toward your earlobe, there is NO non-surgical or minimally-invasive technique which will shrink the skin excess. Please consider a procedure with appropriate skin redraping and skin excess excision.

We can consider: a traditional face and neck lift, short scar face and / or neck lift.

The recent resurgence of the S-Lift (created in the early 1900’s), also called by other names as the  Quick-Lift, Lifestyle-Lift, Swift-Lift, Soft-Lift, MACS-Lift and others; are a single modification of the S-lift targeted to elevate sagging lower cheeks jowls and lateral upper neck. The shorter scar, limited undermining and second layer lift achieve the “quicker” procedure but not necessarily the quicker recovery or the improvement you desire.

Facelift alone will probably not provide adequate skin tightening of the neck skin excess. Neck lift may or may not be all you need.

As you see, it is imperative that you seek a proper consultation by a well experienced Board Certified Plastic Surgeon or Facial ENT for your concerns.

I wish you the best!

Sincerely,

Dean Kane, MD, FACS

What’s new for 2015?

Here at the Center for Cosmetic Surgery and MediSpa, there are definite trends in Plastic Surgery for 2015! With continued financial challenges among many, the Medi-Spa services including non-surgical and minimally invasive procedures continue to do well. These include Botox and Dysport to relax those lines made by facial muscle expression and the Restylane family and Juvederm family of gel fillers to plump lips, eyebrows, folds and lines which gravity, sun-damage and aging have created.

Dr. Kane and his gifted nurse injector, Heather remain top-tier in the mid-Atlantic region as Botox and Filler injectors. They have late hours and Saturday hours for those need to be seen after work.

Sculptra is the big, minimally invasive procedure for 2015. It provides mild skin fill but mostly firming of the face, temples and neck. The use of “stacking” properly coordinated options such as Sculptra for skin firming with ClearLift Laser, retinols and Retin-A for further stimulation has significantly shown promise and results in our Practice!

We continue to provide progressive skin health rejuvenation for those wishing to stall or reverse the pigmentation, wrinkling and creping textures of aging skin. Our skin services including many different types of facials for exfoliation, acne, pigmentation, rosecea and many other skin texture irregularities remain strong. ZO Skin Health is our #1 “Go-To” skin products; they are Dr. Obagi’s new and significantly improved products and services over the OMP NuDerm or our previous Emerge skin lines.

What I have noticed and others have written in similar articles are a bust on the promises of skin tightening lasers. Lasers, Ultrasound and Radio Frequency energy devices such as Pelleve’, Ulthera and Thermage among others are simply not providing the skin tightening nor cellulite reduction once promised.

Laser Hair Reduction continues to do well. We expect it will increase though out 2015 with more male patients requesting back and arm hair reduction and women cleaning up their underarms and bikini areas.

With the advent and escalation of self-portraits or “selfies”, skyping, on-line photo sharing, patients are becoming more aware of their “imperfections. Our consultation rate has sky- rocketed with interest in all manners of self-improvement. Brow sagging and extra eyelid skin, or wrinkles around the nose, eyes and mouth, gobble-necks and bulldog jowls and common reasons for an evaluation. This is generating more interest in fillers to the corners of the mouth, the marionette line, the nasolabial folds and upper cheek sagging.

Over all, the economy is improving albeit slowly but Americans who have held off surgery are re-exploring their desired: face and neck lifts, breast lifts and mommy make-overs (lipocontouring and tummy tucks).

One definite increasing trend is associated with an aging population. Jowl and neck fullness along with nasolabial folds and cheek sagging are best addressed with a face and neck lift. Dr. Kane’s signature face lift will suspend the neck as well as lift the jowls to fill the cheeks. The skin is then redraped without the telltale windblown look. Each face and neck lift is unique and individualized for the patient. Some patients have undergone a prior face and/or neck lift or need a smaller lift along the jowl and neck; they may require only a smaller tuck. Others, have waited and need the “full Monty”; a neck lift and liposuction with a platysma muscle sling and suspension and facial rejuvenation with lipocontouring of the jowls, fat grafting to the cheeks and 2 layer lift of the soft tissues and skin. The scars are placed neatly where they are least noticed.

When Botox no longer works to elevate the brows, men and women are considering a more permanent brow lift. Upper Eyelid Lifts are gaining favor as well in the new economy.

Interestingly, rhinoplasty or nose reshaping is making a stronger come back. For some, non- surgical techniques for straightening the back of the nose, refining the tip and reducing nasal flaring or the “gummy” smile are attractive. For others, improved breathing by straightening the septum or reducing the turbinates with the addition of a new nose profile is increasing.

2014 has seen a rise in different kinds of surgery too. Lipo-contouring which is a steady “staple” procedure in our Practice is using the fat to augment and shape or frame different areas of the body! For example, there has been a genuine increase in the Brazilian Butt Lift. This trend is due to the Black and Hispanic influences of a tight waist and thighs framing a fuller and rounder booty. Fat is now used routinely in many facial procedures as a filler of your own tissues. It is now acceptable to use fat to contour breast deformities following biopsies, lumpectomies re-fill the upper pole volume loss following weightloss, pregnancy and after a breast lift (if no implant is used).

Those individuals who are stable following massive weight loss are requesting more integrated body shaping including reduction of upper arm skin (brachioplasty) with upper back fold and breast lift. Another coordinated procedure is the extended tummy tuck to cut off the “muffin” fold of skin along the sides and may go as far as the body-lift (360 degrees) to raise the butt, reduce the lower back folds and elevate the outer thighs.

Dr. Kane continues to do his share of breast augmentations, lifts and reductions. The “shaped” memory implant is relatively new for 2015 as they become more popular to provide a teardrop shape to those women following mastectomy or who are younger and underdeveloped wishing a more feminized appearance. A smaller areola with a forward looking appearance is performed with a “donut” breast lift (scar only around the areola). The perkiest of the lifts with the breast mound lifted higher on the chest wall is accomplished with the “T” or “anchor” style breast lift.

A non-surgical natural look is in again for 2015. Plumper, defined natural lips are in. It takes skill and understanding of the patient’s anatomy to reduce lipstick lines, accentuate the lip edge and smoothen the natural lip roll without looking like an overdone celebrity. The same is true for a Botox or Dysport appearance.

For men, the trends include: Botox to lift the brows, fillers in the hollows of the cheeks, male breast reductions with liposuction or CoolSculpting and body contouring with liposuction or CoolSculpting.

Dr. Kane and his Team continue to self-educate to provide the very best in old procedures and new trends with an eye toward care, compassion, artistry and value. We hope to see you soon in 2015.

Thinking of having a facelift, w/limited incision, and fat transfer to help the hollow under-eye area.

Question from Austin, TX: I am over the age of 60, in good health; however, I am also considering as an alternative using fillers because I understand that if I do not like the effect I can correct it. The fat transfer may more difficult to correct. An alternative would be injections of sculptra, restylane and radiesse to achieve the same effect.

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

Much like the aging process of the rest of the face and body, under eye hollowness is a combination of skin and soft-tissue laxity, loss of volume, loss of muscle tone and changes in the boney support. A facelift per se will provide little to improve the skin laxity specifically under the eye. If there is more skin laxity than a volumizing filler (including fat) can fill, a mid-face lift and eyelid lift trimming skin excess maybe an option.

​
​It should be pointed out that no technique, product, or procedure are equivalent in result, benefits, side-effects, risks and complication or duration. Only a caring, well experienced, broadly skilled, Board Certified Plastic Surgeon will provide for you the comprehensive evaluation and treatment options for your best consideration. Obtain another consultation to assist you in your decision making process.
​
​I hope I have been helpful. All the best!

Dr. Dean Kane

Center for Cosmetic Surgery and Medi-Spa

www.DrDeanKane.com 410-602-3322 DeanKane@DrDeanKane.com

What is the price of a 15 minute Y lift and does it last 2 years?

Question: What is the price of a 15 minute Y lift and does it last 2 years?

Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:The “Y” lift is another twist on the evolution of the “Liquid Facelift”. The use of injectibles based on the following types of minimally invasive and non-invasive options is the basis for non-surgical facial enhancement. 
​
​These options include:

• ​ZO Obagi Skin Health and Rejuvenation
• ​​Temporary Volumizing Fillers: HA (Restylane, Perlane, Juvederm, Voluma, others), Calcium Hydroxyapatite (Radiesse)
• ​Permanent Volumizing Fillers: Artefill and Artecol, Silicone
• ​Biostimulants: Sculptra
• ​Laser and Lights: ClearLift, IPL, fractionated CO2 or erbium non-ablative lasers
• Muscle Relaxers: Botox, Dysport, others
• (even a surgical facelift is temporary, pushing “back the clock” many more years than the above)

Only 2 techniques are approved to be marketed by the FDA with 2 or more year duration. These are Voluma and Sculptra. Each provides different rejuvenating changes in the face.
​
​You must consider daily, weekly, monthly and yearly options to reverse aging just as the body continues the aging process.
​
​No injectible will “stop the clock” only to resume 2 years later. The body and of course, the face continue to age but you will look better if the options you choose are matched by the skills of your Board Certified, well experienced Plastic Surgeon and expert injector.
​
​I hope this has helped. All the best.

Dr. Dean Kane

Center for Cosmetic Surgery and Medi-Spa

Baltimore, MD 21208

www.DrDeanKane.com 410-602-3322 DeanKane@DrDeanKane.com

Dr. Dean Kane Q&A – What can I do to speed up healing and reduce swelling after surgery or injectibles?

Q. What can I do to speed up healing and reduce swelling after surgery or injectibles?

A. We are very pro-active when it comes to nutritional suggestions to help our patients have minimal bruising, inflammation and swelling from both non-surgical rejuvenation procedures using Botox/Dysport, Sculptra, and fillers like Restylane and Juvederm as well as all our face and body cosmetic procedures. We also feel strongly that without a good diet high in protein, vitamins, minerals and anti-oxidants, the recovery periods will be prolonged and healing delayed.

From a homeopathic approach we highly recommend that our patients eat fresh pineapple several days before their procedures, the day of and following. The Bromelain in fresh pineapple has been shown to have great anti-inflammatory properties that helps to reduce the bruising of the face and body. In addition we recommend arnica montana in pill form and gel form the day of the procedure and following. Again this homeopathic products have tremendous anti-inflammatory effects on the body.

On a daily nutritional basis, I recommend to our patients what I do for myself and my wife, Lauri. We are a believer in the low carb diet with moderate to large amounts of protein 3 times a day along with a strong anti-oxidant diet of fresh vegetables. For breakfast we try to not only get our protein, but our anti-oxidants by having a green protein shake. Lauri mixes up a cup of fresh spinach, half a carrot, a small tomato, a quarter of a green apple with 2 scoops of vanilla protein powder with water in a blender or nutra-bullet. In addition we add in a liquid form of Vitamin D and Calcium into our shakes. This is a super healthy way to start your day with great vitamins, minerals and anti-oxidants. Lunch and dinner always includes salads, veggies and a protein food (fish, chicken, tofu, turkey).

When we do any cosmetic procedures, we are strong believers in how diet affects the healing process. Lack of protein and poor nutrition will lead to break down of tissues in the healing phase. We go over diet very seriously with all our patients prior to any cosmetic surgical procedures and always encourage a high protein diet especially for our, breast lifts and reductions, tummy tuck and body lift procedures and even face and neck lifts that require all those building blocks from protein to heal the large surface area created by surgery. For our liposuction patients, Lauri, who has degree in nutrition, will discuss diet and lifestyle changes to help patients lose weight and maintain their surgical results. Lauri will do the same with our CoolSculpting patients, while non-surgical, also need to understand that without changing diet and exercise no procedure will get the desired results.

Visit our website: www.DrDeanKane.com  or call our office at 410-602-3322 for additional information.

I had Restylane for my under eye hollows in Aug & unhappy with the result. Should I get it corrected by adding some more?

Question from Jacksonville, FL: This is just a follow-up from my previous post..I think that the Restylane wasn’t injected in the right dermal plane and made the hollows worse. I regret getting it done as I only have minor under eye hollows to begin with..Going back to my ps is not an option at the moment, due to financial restraints and distance – he’s in CA and I’m in FL. I am hoping someone here could recommend a ps close to North FL who is familiar with cases like mine. Thank you!

 Answer from Dr. Dean Kane, Board Certified Plastic Surgeon from Baltimore:

Injectibles under the eyes for hollows and wrinkles are very challenging and require a very skilled injector! Your injector must understand the anatomy of the eyelid and cheek, the pros and cons of the different injectibles, evaluate your unique variations and have the skill level to try to achieve your desires.
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Consider:

• ​Skin tightening with ZO Obagi Skin Health and Peels
• ​Laser and Light therapies
• ​Deep fillers along the bone
• ​Sculptra
• ​Surgery
• ​There are too many options and considerations to offer you without a proper exam.

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Word of mouth followed by responsible social media like RealSelf should direct you to a well experienced Board Certified Plastic Surgeon or other expert injector to help you.
​
I wish you the best!

Dr. Dean Kane

Center for Cosmetic Surgery and Medi-Spa

www.DrDeanKane.com 410-602-3322 DeanKane@DrDeanKane.com