Beverly Hills Rhinoplasty Surgery Blog

For many people reading this blog, you may think- what’s the big deal if a 5% tax is imposed on cosmetic surgery? You may think those people are rich after all- aren’t they?

But the truth of the matter is that some 86% of cosmetic surgery patients are working women ages 35-50, with an average annual income of $55,000 per year. Hardly the case of a tax on the rich and famous.

Well, what about the case that this tax would bring in nearly $6 billion dollars in revenue needed for this “reform” bill? Fact is the only state that has passed a similar bill- New Jersey has a similar 6% tax- has found that the tax has only brought in about 25 percent of anticipated revenue since it was enacted. The state legislature in both houses voted to repeal the bill due to the bureaucratic nightmare but were vetoed by the governor- who just lost his seat.

This does not even begin the discussion which is perhaps the most important- what right does the government have to your medical records? How is the government to be allowed to know when you need breast reduction for back pain or a nose job after an accident, as opposed to for just cosmetic reasons, especially since you are paying for it yourself- not via insurance. The idea that this information is readily available without intrusion is simply false, since cosmetic surgery is not billed to insurance and is rarely coded as such.

Finally, and perhaps the saddest part of this misinformed new tax is the fact that it was not even thought through. As with much of this new health care “reform bill,” when they needed to show some new source of revenue to explain the massive new costs involved, they simply put this new provision in.  In July we all heard:

The Senate Finance Committee has discussed imposing a 10 percent excise tax on cosmetic surgery deemed unnecessary for medical purposes. The idea was broached in a meeting with OMB Director Orszag in mid-July, after which Senate Finance Chairman Max Baucus told reporters he had heard some “interesting,” “creative,” and “kind of fun” ideas.

But back in July Committee Chairman Max Baucus shot the idea down, saying it is not under active consideration.
“Oh, that is not on any list I have seen in a long time,” Baucus told reporters. “It was discussed briefly but I haven’t seen that on any list.”

Sadly if unchecked, you will have to pay a tax to Congress for the privilege of using your own money to pursue elective cosmetic procedures.

For those interested you can write to your Senator by either going to the link here or by writing to your state senator.

[date]

Dear Senator_________:

My name is [ ] and I am a constituent of yours from [City/Town] and a woman. I write in strong opposition to the new Excise Tax on Elective Cosmetic Medical Procedures included in the Senate Health Reform Bill (HR 3590), as the imposition of this tax discriminates against women.

Contrary to popular belief, cosmetic surgery is no longer an exclusive luxury afforded by the very wealthy. Eighty six percent (86%) of cosmetic surgery patients are working women and this five percent tax discriminates against us. In the first research of its kind, conducted with people planning to have cosmetic surgery within the next two years, 60% of respondents reported a household income of $30,000-$90,000 a year. Most importantly, 40% of the 60% reported income of $30,000-$60,000. Only 10% of respondents reported household income over $90,000. These data clearly refute the suggestion that elective surgery taxes are “luxury” or “sin” taxes affecting a privileged few.

It is my understanding that New Jersey – the only state to adopt a tax on elective medical procedures – which passed a 6% tax on elective medical procedures in 2004 has experienced a 59% shortfall of projected revenue estimates. In fact, New Jersey Assemblyman Joseph Cryan, the sponsor of the original tax bill, is leading efforts to repeal it.

As you may know, the line between “cosmetic” and “reconstructive” surgery is not always clear and this bill will leave the determination of medical necessity up to bureaucrats—a completely inappropriate proposition – and one which might open up privacy issues during the audit of a patient’s medical records. In addition, the implementation of this subjectively imposed tax will require an inordinate amount of time to interpret and administer with questionable return.

This provision places government between the physicians and the patient and in the worse possible scenario… that of doctor as tax collector, and holds physicians liable should an individual fails or refuses to pay the tax. The provision also will place an incredible burden on physician offices.

Medical procedure taxes should not be part of any health reform legislation being considered. Thank you for your serious consideration of the issues I have raised in this letter.

Sincerely,

Recently we’ve seen a number of people who have asked about the use of ethmoid bone in revision rhinoplasty. Each had previously undergone a nose job that had over time either resulted in loss of tip support- resulting in a droopy nasal tip- or had a twisted nose which had been partially corrected but over time had twisted again- resulting in a crooked nasal tip.

There have been a number of papers over the last few years regarding the use of ethmoid bone as stents in an attempt at correcting a caudal (anterior/front) septal deviation. We’ve also heard of their utilization in a similar manner with other grafts. While the initial results look pretty good, we have yet to go to ethmoid bone as a source for a couple reasons.

First, and foremost, even in 3rd and 4th time revision nose jobs, we have always found enough cartilage via the septum and/ or ears. These sources bring cartilage, as opposed to bone, and as such are much more in line with normal anatomy found in the areas of the nose usually requiring correction. As for correction of anterior/ caudal deflection we have also found that in almost every case this can be corrected without a stent, though we have no objection to the use of a stent graft for correction when necessary. Finally, our major concern with the use of ethmoid grafts in other areas of the nose as stand alone grafts is the high likelihood of resorption long term. One of the original innovators in the use of ethmoid bone was the now retired Dr Jack Sheen. In a conversation with him in the year prior to his retirement, he intimated that he had stopped using ethmoid bone grafts due to their high resorption rate.

Having had more experience than anyone else we know of, and taking into consideration all of the other potential sources of grafting material, ethmoid bone is lower on our personal list of graft sources.