In 2004, teachers in the school district had received plastic surgery worth around $1 million, which then ballooned to $5.4 million annually.  But in 2009, it seems that they were “extra” conscious with their appearance that the cost of their elective procedures were estimated to have reached a whopping $9 million—enough to pay 100 educators if they will be given an average salary.

According to reports published by The Buffalo News, 100 percent of the procedures were elective, and 9 out of 10 were skin treatments.

This seemingly extravagant perk started in the 1970s as a way to help teachers pay the cost of reconstructive plastic surgery.  But probably because of the city’s disorganized collective bargaining system, cosmetic surgeons have found ways to advertise their services to educators.

Teachers have started enjoying cosmetic plastic surgery in 2004, with its usage almost tripling just after six years of its introduction.  Meanwhile, it has been estimated that 500 employees were taking advantage of the free aesthetic procedures.

After the scandal has been publicized by several newspapers, even some of the officials from the Board of Education agreed that the whopping cost of plastic surgery proves to be extravagant almost to a fault.

However, it may probably take some time before the plastic surgery perk is scraped off.  Since 2004, Buffalo’s public school teachers have been working without a new contract, and with a state law that allows public employees to work under the last contract’s terms, it simply means that they can still enjoy the rider, including a 2.5 percent annual increase in salary.

It may be appalling to know that in August, the school district laid off 117 staff members.  And with the $5.4 million annual expenses from cosmetic surgeries performed on teachers, the money could have prevented at least 100 of educators from losing their jobs.  But perhaps one consolation is that those who are able to keep their works are still sitting pretty—literally.

In an effort to avoid layoffs, the school board requested to suspend the cosmetic surgery rider for at least a year.  However, the union declined because they wanted to deal with the issue during a full contract negotiation.

The goals of reconstructive plastic surgery are different from cosmetic procedure as it is conducted to make the patients appear as normal as possible and/or improve body functions.

Because reconstructive surgery is deemed as “medically” necessary (to help people live a more normal life), it is often covered health insurance.  By contrast, cosmetic surgery is an elective procedure so a patient has to shoulder all the expenses.

One of the most common procedures in reconstructive plastic surgery is breast reduction that is used to treat macromastia in which the busts become abnormally large (each breast weighs more than 600 grams).  Women with this condition often suffer from chronic back and shoulder pain because of the excess weight, limited physical activities, irritation along the breast crease and cleavage, and poor body posture.

Because patients with macromastia suffer from chronic physical pain and discomfort, some states even require automatic health coverage for those who are “medically” qualified to undergo breast reduction surgery.

But when breast reduction is performed on patients who are asymptomatic (e.g., they do not experience pain and discomfort) but just want to achieve a more symmetrical figure, it is considered a cosmetic and elective procedure, and as a result, it is not covered by health insurance.

Another common example of a procedure that can be used both in reconstructive and cosmetic surgery is rhinoplasty or nose surgery.

Rhinoplasty is the second most popular cosmetic surgery in the US last year, with about 252,000 patients who had the procedure.  However, this is also given to those who are suffering from breathing difficulty, deformities caused by abnormal nasal growth or birth defect, and irregularities due to accidents.

It is possible to perform cosmetic and reconstructive rhinoplasty at the same time.  For example, a person undergoes a procedure to correct his deviated septum (tissue separating the nostrils) so he can breathe more easily and another one to reduce the size of his bulbous nostrils.

In this case, only the reconstructive part of rhinoplasty is covered by health insurance while the procedure that involves reducing a patient’s nostrils is not because its only purpose is to improve the appearance of the nose.

While weight loss surgeries have associated risks, most plastic surgeons believe that these far outweigh the health benefits such as lower chance of developing diabetes, heart disease, degenerative joint disorders, and other weight-related problems.

As people shed a significant amount of weight, they will most likely develop excess skin particularly in their thigh area, abdomen or even the entire lower trunk, upper arms, chin and jaw line, neck, and “bra line.”  And for women, they may also develop sagging, deflated-looking breasts with nipples pointing downward.

It is important to note that loose, hanging skin not only results to cosmetically displeasing body, but may also lead to breakdown of skin, rashes, foul odor, poor hygiene, and difficulty in performing physical activities.

To treat this problem, plastic surgeons use skin removal surgery which is perhaps the most important part of body contouring procedures such as the tummy tuck, breast lift, neck lift, arm lift, lower body lift, and thigh lift.

For massive weight loss patients, skin removal is usually performed in conjunction with liposuction to remove the pockets of fats, suturing techniques to correct the loose tissue, and realignment or reduction procedure for weakened, stretched muscles.

The advantages of skin removal for massive weight loss patients are not only in cosmetic terms since it can also eliminate the physical symptoms such as skin irritation and difficulty in moving.  For this reason, some insurance companies cover the expenses if the procedure is “medically necessary” and can treat the health problems associated with excess skin.

But as with any invasive procedure, skin removal surgery and its complementary treatments involve prolonged recovery, surgical scars, longer operating time, high medical costs, and risk of complications.

While this surgery is associated with permanent scars, these are usually placed along the natural creases of the skin and hidden areas (which will be covered by a person’s underwear), although this is sometimes not possible especially when treating patients with a significant amount of excess skin.

From an aesthetic standpoint, patients who were once slightly overweight or mildly obese can achieve more excellent results compared to those who were morbidly obese, although the latter will still experience dramatic “functional” improvements that will allow them to perform exercises and other physical activities.

To address a specific body area, plastic surgeons have developed “isolated” body lift techniques that can treat the buttocks, thighs, abdomen, breasts, and neck.  But since most massive loss patients have more than one “problem area,” these “isolated” techniques are usually combined to achieve the best result.

For patients who need the most correction, the lower body lift (also called as belt lipectomy) and the upper body lift are the two most commonly performed body contouring procedures.  When these two techniques are performed on a person, the procedure is already referred as a total body lift.

While body lift is usually performed after massive weight loss, this plastic surgery procedure may also be used to counteract the physical effects of pregnancy and aging.

As with any plastic surgery, body lift involves risk of complications and recovery.  For these reasons, people who have had weight loss surgery (such as lap band or gastric bypass) should wait for one or two years before considering the procedure to make sure that they are no longer nutritionally deficient due to the sudden decrease of their caloric intake.

Aside from being physically fit, plastic surgeons also require their patients to engage in a healthier lifestyle to ensure that the result of the surgery will most likely last a lifetime.

It is important to note that weight fluctuations can reverse the result of the procedure, which means that individuals have to commit themselves to a healthier lifestyle that includes exercising regularly and eating in moderation.

Because of the extensiveness of the procedure, most plastic surgeons perform body lift in a hospital, although this can be also conducted in an accredited outpatient surgical center.  In most cases, a patient’s body mass index will determine if the surgery is to be performed in an outpatient facility or hospital.

To be on the safe side, patients should review their surgeon’s certifications, credentials, education, training, and experience.  They should also evaluate their doctor’s before-and-after photos of previous patients who had body lift procedure.

This plastic surgery procedure is commonly used to target areas which are prone to sagginess such as the abdomen, thighs, breasts, arms, and buttocks.  For massive weight loss patients, most of them will benefit more if several body lift techniques are performed at the same time.

Examples of these techniques include lower body lift which is used to target the abdomen, buttocks, back, and thighs; and upper body lift which is performed to treat the breasts, chest, and middle back region.  If these two procedures are combined, the surgery is referred as a total body lift.

Most people who seek body lift are patients who have had weight loss surgery such as gastric bypass, bariatric operation, and lap band.  However, some women who have developed bulging fats and excess tissues in the abdominal area due to the physical effects of pregnancy may also benefit from this plastic surgery procedure.

Because of the invasiveness of body lift, plastic surgeons recommend patients who have had weight loss surgery to wait at least one year before even considering having this procedure.  In this way, their body can recover from the abrupt changes in their food intake and their weight will have enough time to become stable.

While the result of this procedure will most likely last a lifetime, plastic surgeons warn that pregnancy and weight fluctuation can reverse it.  For this reason, they usually advise women who are planning to have children and individuals whose weight is fluctuating to postpone the procedure.

In most cases, the surgery is performed at a hospital (rather than in an outpatient surgical center), particularly for patients who need the most correction.  And more often than not, it requires several days of hospital stay so they can receive immediate medical attention in case of complication.

As with any cosmetic surgery, body lift is associated with recovery that largely depends on the extensiveness of the incision and the healing ability of each patient.  To be on the safe side, they are generally advised to take some time off from work to make sure that they will have enough rest and sleep.

For people who will receive weight loss surgery such as lap band, gastric bypass, and bariatric operation, most of them should expect to develop a severe case of panniculus which may even extend to their hips and genital area.  For this reason, they will most likely benefit from circumferential tummy tuck which is more extensive than the standard technique.

As its name suggests, this plastic surgery procedure uses an incision that extends around the circumference of waistline that will allow doctors to eliminate the excess fats and skin, and tighten the surrounding muscles.  In this approach, they also lift the buttocks and thighs and may reposition the navel to achieve a more natural outcome.

With the extensiveness of the incision, plastic surgeons do not recommend this technique on patients who have small amounts of excess skin around their midsections or individuals with a slightly protruding abdomen.  This type of patients will most likely benefit from the traditional or mini tummy tuck technique.

In almost all cases, the circumferential tummy tuck is used to treat massive weight loss patients who have a significant amount of panniculus which may lead to other health problems such as breakdown of skin, non-healing irritation, ulcers, foul odor, and poor hygiene.

In certain situation, patients with panniculus may also have some trouble in walking and sitting and may even experience back problems due to the weight of the excess skin, tissue, and fats, according to experts in plastic surgery.

Because of the invasiveness of circumferential tummy tuck, plastic surgeons usually perform this under general anesthesia.  And once the drug takes effect, they will then create an incision that covers the entire circumference of a person’s torso.

Through the incision, doctors can reshape a patient’s figure (from the ribs to the knees), in front and back of the body with the use of liposuction and other contouring techniques such as abdominal muscle tightening.

In most cases, plastic surgery specialists also reposition the belly button for a more natural appearance before removing the hanging, excess skin and tissue.  After all the necessary alterations have been made, doctors will then close the incisions using sutures.

Compared to other body contouring surgeries, the circumferential tummy tuck is more invasive and involves more risks.  For these reasons, patients are required to stay for several days in a hospital following their operation.

These are the aesthetic problems which can be treated with otoplasty plastic surgery: macrotia or overly enlarged ears; microtia which is a congenital defect where the outer ear is severely disfigured; and protruding ear which may occur on one or both sides in varying degree.

In some cases, this procedure is performed not just for cosmetic reasons but also to improve a patient’s hearing.  With this, some insurance providers might cover the cost of this treatment particularly if it is considered as “medically” necessary.

Plastic surgeons can perform otoplasty on children as young as five years old or as long as their cartilage is stable enough to retain the result of the procedure.  Most experts believe that it is easier to reshape, pin back, and change the appearance of children’s ears compared to adults whose fully developed ears have a firmer cartilage which is difficult to mold.

Performing this procedure at an early age may also provide children with psychological benefits particularly if they are suffering from teasing and name-calling from their peers.

However, most plastic surgery specialists believe that the desire for this procedure, especially if performed for aesthetic rather than reconstructive reasons, should come from children rather than their parents.  This is because some kids are really not bothered with the way they look or care on the teasing.

Meanwhile, plastic surgeons perform the procedure under local anesthesia, intravenous sedation, or general anesthesia that will provide comfort to their patients.  And once the drug takes effect, they will create incisions which are usually placed on the back surface of the ears or along the natural creases of the skin to hide the scars.  And with the ears positioned closer to the head, the surgical lines are unnoticeable.

Through the incisions, plastic surgeons can put internal sutures in order to create and/or support the newly shaped cartilage in place.

Once the necessary changes have been made, they will close the incisions using external stitches.  This is carefully done to preserve the other structures and avoid the unnatural “pinned back” look.

Usually, otoplasty provides an immediate result especially for patients with protruding ears.  However, they have to keep the dressings for several weeks to support the new shape during the initial phase of recovery.

This plastic surgery procedure can treat different areas of the body that tend to sag after weight loss such as the buttocks, breasts, abdomen, and thighs.  But for patients who have lost a significant amount of weight, they will most likely benefit from combining “isolated” body lift techniques; for example, individuals who have an excess flap of skin around the hips, buttocks, and thighs are recommended to have lower body lift, while those who have sagging skin in the lower rib cage and back are best suited to have upper body lift surgery.

To perform the lower body lift, plastic surgeons create a belt-shaped incision around the waist and down the inner thighs.  In this way, they can remove the excess fats and skin, lift the buttocks, and improve the overall figure.

But since the procedure does not treat the excess skin and tissue around the abdominal area, plastic surgeons usually complement this with abdominoplasty or what is more commonly referred as tummy tuck surgery.

Contrary to a popular belief, tummy tuck and other body lift techniques are not just performed for aesthetic reasons.  In fact, this procedure is used to treat the physical symptoms associated with panniculus—hanging skin and fats around the abdomen—such as foul odor, breakdown of skin, ulcers, non-healing irritation, and back problems due to the weight of the excess tissue.

Meanwhile, massive weight loss patients may also need upper body lift in which plastic surgeons create an excision along the bra-line skin that will allow them to remove the back fat rolls and narrow the waist.  With this approach, they can also eliminate the excess skin under the breasts, and then lift the abdominal skin by suturing it to the lower rib cage.

For patients who have developed excess skin in their upper extremities, they are recommended to have upper arm lift surgery which involves an incision that is placed on the inside of the arm extending to the elbow, or across the underarm if there is only a minimal amount of hanging tissue.

As with any plastic surgery, body lift involves risk of scarring, although the incision lines are usually hidden to make them less noticeable.

One of the most common procedures in reconstructive plastic surgery involves the use of breast implants to make the bust appear normal again after tumor removal or mastectomy (removal of breast tissue to prevent the cancer cells from spreading).  In 2009 alone, about 86,500 patients had undergone breast reconstruction surgery, which is an increase of 9 percent from the previous year, according to the American Society of Plastic Surgeons.

While this plastic surgery procedure aims to make the breasts appear normal again, patients should remember that this will not perfectly recreate the appearance of their bust before they had mastectomy, and the reconstructed breasts will not have a natural sensation.

According to plastic surgeons, breast reconstruction surgery may be performed using implant which is a biocompatible synthetic material, or tissues derived from a patient’s own abdomen, back, or buttocks.  The right approach will largely depend on the amount of skin and tissue left after mastectomy or tumor removal, but as a general rule, women with enough tissues are recommended to have breast implant surgery.

On the other hand, tissue-based reconstructive surgery is more extensive and usually requires more than one operation, involves more risks, and results to longer recovery compared to breast implant surgery.  However, this is usually the most recommended procedure for patients who had extensive mastectomy.

For post-cancer patients who will have breast implant, their plastic surgeons will most likely use tissue expander to create enough room for the implants.  This balloon-like device stays under the chest muscle for several weeks and is periodically filled with a saline solution to stretch the skin and tissue.

After the device creates enough room for the implants, doctors will then remove and replace it with silicone or saline implants.  When it comes to giving a natural result, the silicone provides a slightly better result than the saline implant because of its cohesive gel filling that is noted for simulating the movement and feel of a real tissue.

But for women who only had minimal tumor removal, they may no longer need to have tissue expander.  In fact, some of them can even have breast implant right after their mastectomy which means lower cost of surgery and shorter recovery.

To target a specific body area, plastic surgeons have developed “isolated” body lift procedures such as arm lift, butt lift, thigh lift, neck lift, breast lift, abdominoplasty (more commonly referred as tummy tuck), and panniculectomy.

In most cases, massive weight loss patients—or those who shed more than 100 lbs. of weight—will benefit with a full body lift which targets the pockets of fats and hanging skin and tissue in the midsection, extremities, and lower body.  In this way, their body’s contour will appear “smoother” and slimmer.

Because of the invasiveness of the full body lift, some plastic surgeons prefer to use “isolated” procedures or at least perform these one at a time.  In this way, they can minimize bleeding, surgical trauma, and other risk of complications.

One of the most popular “isolated” techniques is the lower body lift since most of the excess skin and tissue and pockets of fats accumulate in areas such as the hips, thighs, and buttocks.  In this approach, plastic surgery specialists create a belt-like incision from the waist, across the lower abdomen, and down to the inner thighs.

Through these incisions, plastic surgeons can remove the excess skin and fats, lift the buttocks, and “smoothen” the contour of the lower body.

Because it is difficult to address the excess skin in the abdominal area through this approach, many patients choose to combine this with abdominoplasty or mid body lift surgery.

Mid body lift, which is also called as torsoplasty, is a plastic surgery procedure that treats the abdominal area all the way down to the thighs.  Meanwhile, this approach uses the same incision sites utilized in the lower body lift.

Through the incisions made around the waist, doctors can access the abdominal muscles which are then reshaped and pulled together to create a slimmer waistline and a flatter stomach.

While the result of body lift surgery can last a lifetime, this can be affected with weight fluctuations.  For this reason, patients are advised to engage in regular exercise and eat in moderation.