Hello, is this the plastic surgery clinic?
Yes.
Do you perform rhinoplasty?
Yes, we do.
What is the cost of rhinoplasty?
We need to see you before we comment on the treatment plan or the cost.
Is it possible to give a rough estimate?
…….

We tend to have the above conversation multiple times. Sometimes rhinoplasty gets replaced by another procedure such as liposuction, fat grafting or something else. I thought of elaborating more about our resistance to comment on treatment costs before seeing the patient.

Imagine a person with a desire to build a home. Not an apartment in a high-rise, but someplace on a piece of land with a small garden. Such a person would have certain ideas about size, location, immediate vicinity, style, etc. And if there is a lack of clarity related to these aspects she would assume that she would be guided by an expert. Now let's imagine another conversation.

Hello, is this the builder's office?
Yes.
Do you build homes?
Yes, we do.
What is the cost of building a home?
……..

We find both these conversations very similar. Because we are dealing with situations in which making plans would not make sense without a good grasp of what the customer needs. In other words, both cosmetic surgery and building a home are highly customized endeavors. There are a lot of variables which need to be sorted out or understood before we finalize a plan. In both cases, the expert brings to the table his or her expertise. Once a plan is finalized it is reasonable to arrive at the cost.

 It is nearly impossible to follow a cookie cutter approach in cosmetic surgery. Let me give an example. Let us assume an individual seeking rhinoplasty. Following a clinical examination and discussion, we usually arrive at a treatment plan. A plan found suitable for one person may be quite different from a plan for another individual. One may require a short procedure lasting one hour whereas the other may require something much more complex lasting six hours. The cost, in turn, depends on the complexity and duration of a treatment procedure.

Like an architect who seeks input from her client, we give a lot of importance to input from our patients. This more so in cosmetic surgery when compared to other surgical specialties. Because of this, a similar looking deformity may get treated using different techniques. One individual may be satisfied with a simple correction whereas another may be keen on a more exacting remedy. This again reflects on the cost of the procedure. This sort of variability in treatment options applies to almost procedures in cosmetic surgery.

 Because of these reasons we hesitate to comment on any treatment plan when certain pictures or images are sent to us. We do get an approximate idea of the deformity with the images, but in the absence of a discussion with the patient, it does not make much sense to decide on a treatment plan. Also, a clinical examination gives a lot of important and useful information relating to the management of the condition. These are not otherwise apparent by inspecting images of the body part. To give an example, in rhinoplasty we get to assess aspects like the thickness of the skin and soft tissue, structural support, status of the nasal cavity as well as nasal obstruction with a clinical examination. These can't be inferred from the pictures.

It may sometimes be possible to give an estimate of the cost when a procedure is simple or straightforward. This applies to procedures like excision of a mole with a straight-line closure or repair of an earlobe cleft. This can also apply to procedures like hair transplant when the cost can be correlated in terms of a smaller unit say, cost per follicular unit.

All of the above reasons lead to a reluctance to comment on the cost of a procedure without a clinical examination and discussion. I suppose similar reasons would also apply to those who seek to get a home built somewhere.