Usually, cosmetic surgery is performed to enhance physical appearance without any attached medical condition. Alternatively, reconstructive surgery is performed to correct an abnormality or dis-functioning body part, or as an enhancement of appearance with an attached medical condition. Aesthetic or cosmetic plastic surgery is usually performed to transform body shape or appearance when there is no other medical condition present. However, there are times when plastic surgeons perform procedures for conditions that have arisen from specific medical conditions that are no longer an issue for the patient. This might include body changes after massive weight loss or from extensive scarring that is a result of abdominal surgery. In these events, many insurance carriers will consider covering specific cosmetic procedures. To be sure, it is essential to discuss any medical procedure with an insurance carrier before having the surgery. Correcting Functional Deficiencies Reconstructive surgery can be an elective procedure, but is usually a medical necessity. Often a plastic surgeon will perform reconstructive surgery to make focused improvements in the abnormal region or damaged body parts. The reconstructive surgery may need to be performed for functional deficiencies when the person’s body part will not perform as needed. This may be a result of an accident, injury or birth defect. Strictly Cosmetic or Medical Necessity In the insurance world, reconstructive and plastic surgery can often become blurred. Many individuals get a breast reduction surgery or an enhancement. At first blush, it might appear as though it is strictly cosmetic, but it may be a result of a mastectomy, or the weight of large breasts causing significant back and shoulder pain. Most types of reconstructive surgeries are clearly defined as necessary while others are sketchy at best. They include:

  • Abdominal surgery – This procedure is usually performed to eliminate back pain, hernias, or the inability to walk.
  • Breast Surgery – It is performed to reduce large breasts, or add reconstructive tissue after mastectomies.
  • Ear Surgery – It is a procedure that can correct deformities from injury, disease, or birth.
  • Eyelid Surgery – Often performed to correct droopy eyelids that impair vision.
  • Facial Surgery – Often a procedure performed to help in the appearance of individuals that have been marked by paralysis, or to treat deformities of the muscle or bones of the face, neck, or head.
  • Hand Surgery – An effective procedure to treat carpal tunnel syndrome, along with fingers, tendon, or nerve injuries and other deformities.
  • Nasal Surgery – Can easily correct deformities that have formed from disease or birth defects that inhibit breathing.

Many times, cosmetic surgery and reconstructive surgery can enhance the appearance and self-esteem of the patient. Insurance usually does not cover any procedures performed only to enhance physical improvements without a medical necessity.

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