Cut-Rate Work

It’s not common knowledge (but keep reading and maybe it will be) that at several teaching hospitals around town – Mount Sinai, NYU, New York–Presbyterian, Manhattan Eye, Ear & Throat – cosmetic surgery is available for a fraction of the prices quoted by marquee names on Park and Fifth avenues. That’s because senior residents (doctors with three to five years of training in general surgery and two to three years of training in plastic surgery) and plastic-surgery fellows (doctors seeking advanced training in a particular corner of the corpus) are doing the cutting, nipping, tucking, and rearranging. But they’re doing it – nose jobs, eye jobs, face-lifts, liposuction, and breast augmentation and reduction – under the supervision of senior practitioners. And many of these so-called attending physicians are, indeed, those very marquee names.

“It’s an ideal situation because we need to train doctors, the doctors need patients, and the patients are getting a service they couldn’t normally afford,” says Richard Skolnik, who heads the residents’ aesthetic-surgery-training program at Mount Sinai.

As with folks paying for the high-priced spread, at least some bargain-hunting clinic patients even come back for more: One, a real-estate broker in her middle fifties, went to NYU’s clinic two years ago to have her lower eyelids done. “I didn’t have any problems, so I feel I can trust them more, and I’m going in again in a few weeks to have a mini-face-lift.”

“It’s important to train residents well, and this is how to do it,” observes Joseph McCarthy, director of the institute of reconstructive surgery at NYU. “Otherwise you’re going to have a bunch of quacks out there.”

It’s perhaps a point worth contemplating that the most sought-after plastic surgeons in the city – Alan Matarasso, Sherrell Aston, Dan Baker – all mastered their craft in clinics when they were senior or chief residents (okay, two or three decades ago). Patients who line up for such superstars are buying experience, privacy, and bragging rights, along with nicer amenities than those typically offered in a hospital-clinic setting. Naturally, it’ll cost you: $11,400 for liposuction of the abdomen, hips, and outer thighs, says plastic-surgery consultant Wendy Lewis; $10,800 for a nose job; $15,850 for a face-lift. At NYU’s clinic, on the other hand, fees for the same services are $4,000, $4,300, and $5,800, respectively; at New York–Presbyterian, $3,400, $3,500, and $5,000; and at Mount Sinai, $1,650, $1,650, and $2,450.

Modest fees do not necessarily make for meek patients. “They want a nose like Raquel Welch’s when they have a nose like Karl Malden’s,” says Skolnik. “But that can happen in a Park Avenue office, too.”

If all this sounds perilously reminiscent of cut-rate coiffure by cosmetologists-in-training, fear not. “We’re not hair colorists,” protests Skolnik. “We take a medical history. We treat the patient like a patient.”

In fact, with residents eager to expand their roster of services – ophthalmology residents who’d like to do blepharoplasty (eyelid surgery), and ear, nose, and throat doctors, dermatologists, and dentists interested in performing rhinoplasty and face-lifts – even at the clinics it’s a buyer’s market. “The competition for cases is enormous,” says Skolnik. “We’re all vying for patients.” That’s an understatement: Hospitals are desperate not only for patients but for patients paying out of pocket (insurance rarely picks up the tab for these procedures).

Location, and the reputations of the attending physicians at a given facility, attract a particular clientele. Thanks to attending physicians like Matarasso and Baker, at Manhattan Eye, Ear & Throat, “we tend to see a lot of patients in the clinics for face-lifts,” says John Perrotti, the program director of the aesthetic-surgery fellowship. “If one of our fellows gets a case and has a question and shows the photo to Dr. Baker, our patient gets a pretty high-level second opinion.” Mount Sinai, which stretches uptown from the upper Nineties, has become a magnet for Hispanic women with a common goal, apparently: “Our residents could do nothing but breast reductions for two years,” says an attending physician.

Despite the hospitals’ system of four-to-six-month rotations, doctors like Sinai’s Matthew Lynch have started to develop a following of sorts. “I’ve done a lot of tummy tucks,” he says. “I did one woman last week, and she’s going to send a bunch of her friends.”

“Someone will come with friends, and when the first person, who’s a little braver than the others, gets through her procedure and she’s happy with you, the others will have something done, too,” says Robert Centeno, a plastic-surgery fellow at Manhattan Eye, Ear & Throat. “The first face-lift I did here – I’ve done breast augmentation and facial procedures on three of the person’s friends and family members.”

Do you get what you pay for? Clinic staff will point out the huge variation in the skill level of private physicians, and that paying premium rates is no shield from complications, no guarantee of a happy outcome.

“Let me put it this way,” says Lloyd Hoffman, chief of plastic and reconstructive surgery at New York–Presbyterian Hospital. “The attending surgeons who are supervising the residents are people I’ve trained myself. I trust them and would trust them with anybody in my family.”

“There are certain nuances that could be achieved by someone with a lot more experience,” concedes John Perrotti. “Does that make any difference to the majority of our patients? I think most of them get a good result and are happy.”

One such patient, a 30-year-old Brooklyn nurse-midwife, came to Manhattan Eye, Ear & Throat for liposuction after losing 70 pounds and being told by several doctors in private practice that she needed a tummy tuck, a more expensive protocol. “I was pleasantly surprised to be told at the hospital that I shouldn’t have it because I hadn’t yet had children,” she says. “I knew the surgery fellows weren’t in a position to gain financially by their decision, so it felt more honest. And it went excellently well.

“Before, I had never thought plastic surgery was for regular people,” says the woman, who paid under $5,000 for the treatment.

“It’s like flying JetBlue without the lunch,” says Hoffman. “You want to get from point A to point B? That’s what we pride ourselves on.”

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Cut-Rate Work