Perhaps deflation is also more in the news because almost everybody is haggling and bargaining to stretch the few hard-earned Dollars, Yen, Pounds and Drachma on hand.

The cost of cosmetic plastic surgery is no exception; many people now want to look younger, more refreshed or just more capable for the workplace.

So there are some discounts you can ask about, including:

1. Cash payment

When financing cosmetic surgery, the lending company grabs three to five percent of the surgeon’s fee. Requesting a two to five percent discount is reasonable for forking over the full fee in advance.

1. Slow seasons

Cosmetic plastic surgery procedures tend to revolve around school schedules, with more patients having procedures when school is in session. To keep some cash flowing, many surgeons will offer reduced fees during their slowest times.

1. Ask about layaway

Some plastic surgery firms (including CSI!) allow you to pony up a little at a time until you’ve paid for the procedure in full. Then your procedure is scheduled.

1. Stand-by surgery

If you’re retired or self-employed and your schedule is your own, ask your surgeon if stand-by surgery is available in case a scheduled patient suddenly must cancel. It can be worth a lot because the plastic surgeon is already obligated for an operating room and the staff to run it. If you can have standby surgery on a two to six day notice, you may be able to bargain for a 10 to 20 percent discount.

1. Combine surgeries

If you have in mind a procedure of the head or neck – like a face lift or a rhinoplasty – and also would like to have a procedure of the body, say, a breast augmentation or a tummy tuck, think about combining them.

It’s more efficient for the surgeon, or surgeons, to perform several procedures during one surgical session.

So while your nose job costs X dollars, adding a breast enhancement  may be X dollars minus 5 percent. Adding a third procedure like a tummy tuck might even be X dollars, minus 10 percent.

Comfortable in Swimwear

A popular Chicago board-certified plastic surgeon, Allan Parungao, M.D. has found he can get health insurance companies to cover the costs of labiaplasty, a cosmetic surgery procedure that reshapes the inner vaginal lips.

What’s more, the big-hearted cosmetic plastic surgeon is sharing his knowledge with readers of the CSI blog.

An opportunity for help presents itself when a patient has large or uneven labia minora that cause continuing infections, problems while voiding or feminine hygiene.

For instance, a 30-year-old New Jersey patient identified only as Jennifer went to see Dr. Parungao because she was a newlywed experiencing painful relations because the labia minora were drawn inside during her intimate moments.

Additionally, Jennifer has suffered in silence other symptoms of uneven labia, including:

• Persistent moisture
• Chafing and irritation
• Embarrassment in swimwear or jeans

“I was also have a recurring yeast infections and was irritated by most clothing,” said Jennifer who admitted “freaking out” if her husband walked in while she was in the shower.

Jennifer sent Dr. Parungao pictures of the problem area and wrote to him, asking for an appointment.

Dr. Parungao told the CSI BLOG:” I send the before plastic surgery pictures and a statement of the patient’s complaints to her insurance company. I have found most insurance firms are playing fairly so far.

“Only on occasion do I need to send in another opinion from an obstetrician. For the most part, once I send a letter and a picture to the insurance company, I get approval.”

(Read more about the insurance approval scheme for cosmetic surgery of the labia.)

The other common plastic surgery procedures that are often covered by insurance include:

• Breast reduction
• Rhinoplasty
• Ear pinning, or Otoplasty
• Upper eyelid lift, or blepharoplasty
• Breast reconstruction after Cancer

Basically, reconstructive surgery by a plastic surgeon corrects abnormal bodily parts due to congenital defects, trauma, infection, tumors, or disease. That can also include surgery to create a normal appearance.

Those surgeries are approved, or denied, on a case-by-case basis by insurance firms.

Adds Gary Alter, M.D. a Los Angeles board-certified plastic surgeon and urologist: “It’s true; many women will get insurance coverage if they have discomfort with clothes, sports, sex or if they have recurrent infections. Insurance policies and coverage varies.”

When economic uncertainly hit really hard  in 2008, statistics show that consumers sprang for less costly luxuries to substitute for more expensive items.

In cosmetic surgery, for instance, the Lipstick Effect shows up when patients choose, say, dermal fillers over more pricey surgical face lifts. Results? Botox sales in 2008 grew about eight percent when compared to 2007’s sales. But the more expensive invasive plastic surgeries dropped.

According to American Society of Aesthetic Plastic Surgeons (ASAPS) the top five non-surgical procedures during 2008 (the most recent year for which statistics exist) included:

• Botox
• Laser hair removal
• Hyaluronic acid dermal fillers
• Chemical peels
• Laser skin resurfacing

Chemical peels, a 40-year-old procedure became popular again, because, basically, it does an excellent – if low-tech – job of restoring facial skin. Light peels are sometimes known as “lunch hour peels.”

What’s more, with various level peel strengths, some can be applied by physician assistants, making the cost even more reasonable.

A wrinkled face is a tough nut to crack. A face lift won’t remove them while Botox does the job for a few months. Younger patients in their 30s to 40s with early signs of aging skin can often get a smoother, younger looking face with a mild chemical peel. Except for deep peels, recovery is quick while results can last many years.

An older person well into the 60s or beyond, may need a deep phenol peel which would be somewhat more costly because that patient must be under a general anesthesia. So a deep chemical peel requires an M.D. plastic surgeon and perhaps a week of recovery.

Who benefits from peels? Those whose faces have:

• Deep wrinkles
• Sun and age spots
• Leathery skin
• Acne and mild scarring

But a highly trained – and doctor supervised – aesthetic practitioners may be good with lighter chemical peels. Always ask about training and experience!

The same facial results are also available with procedures like:

• Laser skin resurfacing
• Dermabrasion
• Microdermabrasion

(“Botax”, a combination of “tax” and “Botox” has become the unofficial name for the surcharge.)

The logic behind the luxury tax appears to be: if you are so flush you can afford plastic surgery, you can also pony up a ten percent surcharge.

Hey, why not? Works for yachts, fur coats and six figure German and Italian autos!

So somebody, somewhere must be thinking only the idle, privileged rich undergo rejuvenation surgery.

But actually, according to yearly statistics compiled by the American Society of Plastic Surgeons (ASPS), patients’ incomes rank at:

• Thirty percent in household incomes of $30,000 or less
• Forty-one  percent between $31,000 to $60,000
• Sixteen percent between $61,000 and  $90,000
• Thirteen percent over $90,000

Moreover, a good percentage of plastic surgery procedures are financed or put on credit cards.

There is also the dicey matter of some plastic surgery procedures not being for appearance alone but to restore a bodily function or normal appearance.

Those procedures include:

• Upper eyelid lifts create a more open, attractive face but also stop sagging eyelids from obscuring vision.
• Deviated septum surgery often creates a more attractive nose but also unblocks nasal airway obstruction, stops loud snoring, sinus headaches and infections.
• Breast reduction creates a more balanced, attractive and sleek figure but also cures back, neck and shoulder pains while preventing spinal and health problems later on in life.
• Weight loss surgery – like via a Lap Band — makes a person look better and younger by causing massive weight loss but also tends to halt high blood pressure, type II diabetes and sleep apnea.
• Ear pinning, or otoplasty, makes a child look much better but also stops the teasing and ridiculing that goes hand-in-hand with having large, stand-out “Dumbo” ears. The procedure is so important to having a normal childhood, pediatricians and plastic surgeons often recommend the operation be performed before the youngster starts elementary school.

Could there be more handwriting on the wall? Will a government “plastic surgery decision committee” be required to pin the luxury tax on one procedure but not on another?

Imagine the uproar when tax officials decide who pays the extra tax!

• Huge billboards, featuring low, low prices for plastic surgery
• Coupons for huge discounts
• Awarding surgical services as a prize from a raffle or contest
• Limited time offers
• Any breathless message that shouts: “Hurry! Hurry! Do it Today!”

The largest plastic surgery professional organizations like:

• ASPS (American Society of Plastic Surgeons)
• ASAPS (The American Society for Aesthetic Plastic Surgery)
• AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery)

level the playing field by requiring their surgeon members to put their advertising messages to the public in an ethical way.

Thus, surgeons who do not want to have complaints in their societies files, would not:

• Claim their services are better than any other surgeon’s
• Advertise their prices are the lowest
• Offer free plastic surgery in return for a patient speaking freely to the media about the surgeon

The basic concept behind the rules is that finding plastic surgery by price alone is a fool’s errand.

Instead of bargain basement shopping, the professional societies ask their surgeon members to offer to the public information via:

• The patient experience – Testimonials are O.K.
• Results of surgery – Before and after pictures rule!
• The surgeon’s credentials – Those four to seven years extra training after medical school really, really count!

Your first chore: finding a board-certified plastic or head and neck surgeon who performs the surgery you want at least twice a week. Phone the practice and ask about the most frequently performed surgeries and the range of costs for them. Also ask how many years the surgeon has been doing it.

Don’t get the wrong idea – you can still bargain for services and ask if you qualify for discounts after you have met the surgeon to find if you are a good candidate for surgery. (See our post on finding discounts at plastic surgeons.)

General rule of thumb: while the lowest price is not a good idea, neither is the highest price. A surgeon who frequently does the surgery you want can offer a middle price because he or she works extremely efficiently.

Another five minute procedure?  Nope, good plastic surgery requires time.  Or, another high-tech gizmo for:

• Liposuction
• Breast Augmentation
• Growing hair
• Reducing wrinkles

No, medical devices in the offices of plastic surgeons are already more numerous than spam in email accounts.

The latest trend is something old that is new again: Layaway plastic surgery. Think of it as banking your plastic surgery procedure as you go.

California Surgical Institute joins a handful of other plastic surgery offices — ones in Scottsdale, Arizona; Oklahoma City; Ft. Meyers, Florida and Shelby Township, Michigan, among others.

Layaway plastic surgery allows patients to nail down a specific fee for a cosmetic plastic surgery like breast augmentation, make a down payment and then pay on it until the total fee is covered.

Advantages include no additional fees paid to the credit card companies by either patient or doctor. This may be news, but when you use your credit card to pay for a procedure, the credit card company also nicks the physician – usually about four or five percent of what the patient spends.

That’s why wise consumers wait on elective procedures like face lifts,  pony up the cash as they go and then ask the surgeon for a two or three percent discount — because they are actually saving the physician money.

Patients who have tried the layaway plan says it’s easier than you think because as time goes by, you more carefully consider other spending choices and usually wind up diverting that money into your plastic surgery layaway account.

Once your surgery and healing period are completed, you not only look better, you will have doubled your self-confidence. Once for looking better and twice because you don’t have one of those “forever” credit card bills hanging over your now good-looking head or body.

And with all the other job and financial uncertainties, who wants to be stuck with a huge bill – that can always go up with various penalties and other fees?

At the California Surgical Institute, you can extend the date of your layaway if you need more time. Or, if things really go South and you find you can’t complete the planned layaway procedure, you can apply whatever you’ve banked on other services.

CSI: Nice to talk to you again, Cindy. We are all ears!

Cindy: Most of my tips are essentially common sense, based on years and years of experience having cosmetic plastic surgery.

CSI: And the first would be?

Cindy: Don’t have a “mini” or quickie face lift. Results are minimal and often do not last even a year.

CSI: So instead of going for the lowest cost of cosmetic surgery……?

Cindy: Do homework, do homework, do homework!  Research plastic surgery and plastic surgeons. Getting it wrong the first time is not a good option. If that happens, you must then spend much, much more for revision surgery.

CSI: Know a good how-to source for doing plastic surgery research?

Cindy: Sure, my book Cosmetic Surgery Secrets, tells how to save a fortune by choosing the right surgeons, procedures and treatments. Stick with standard procedures. Don’t waste money on expensive or fad treatments others have found to be useless or ineffective.

CSI: As you know, many more people today are forgoing the more expensive invasive cosmetic surgeries for injectable fillers. Any tips on those?

Cindy: Avoid both short term and permanent fillers. A good, thick hyaluronic acid injectable like Perlane is best. That avoids having the expense of a permanent filler removed if you are not happy with the results.

CSI: You say you have done microdermabrasion three times weekly for years. That must cost a fortune!

Cindy: Not the way I do it! I do microdermabrasion at home, using my own unique formulation. I get 25 treatments from one tube. If I did that in a clinic, I would be looking at $1,250 bill! But, using my stuff at home amounts to only four percent of the cost of clinic microdermabrasion.

CSI: Do London clinics welcome you gratis, with no charges?

Cindy: I wish! I advise people not to be shy about haggling. Most retailers would rather end the day with something in the till, even if it is a bit less than what they planned.

CSI: Thanks  again, Cindy.

Las Vegas plastic surgeon Goesel Anson, M.D., says that many Americans are getting plastic surgery to stay on top their game during a tough economy.

O.K., doctor, but what procedures?

While you may need to update your resume, you also must consider your appearance. A tired, haggard or unrested look does not put your name at the top of the hiring list!

At the same time, budget is a big concern. Just where do you allocate any dollars you can allocate to rejuvenation surgery? Which procedures produce the most noticeable change?

Here are the results of a quick, impromptu and totally unofficial phone survey of board-certified Beverly Hills plastic surgeons who recommend what to do first:

• Fix the neck and jaw line

Aging is most noticeable when the neck becomes loose and jowls sag from your jaw.

• Next, consider eyelid surgery

If the upper eyelids sag, your eyes look hidden. If lower eyelids are baggy, you look unrested.

• Consider your  skin quality

If your facial skin is wrinkled and covered with age spots, you might try dermabrasion or an acid or laser peel as the ticket to a new job. Women usually need skin care first because men tend to have thicker skin.

• Think about facial injectables

More injectables are added to the marketplace as time goes on. For six months to a year, you can correct and plump up sagging facial features with substances like Restylane, Prevelle and Radiesse.

• Perhaps a breast augmentation?

Women with breast enhancements certainly get more attention, but first, consider the field in which you work.

A breast enlargement will probably go over well in the entertainment industry, among marketing and sales professionals and others. But what would happen in a more conservative industry, like banking, accounting or academics?

Think rejuvenation surgery would help your job hunt?

To help protect the traveler’s general health, U.S. plastic surgeons and the International Society of Aesthetic Plastic Surgery (ISAPS), an 1,800 member organization of plastic surgeons in 84 nations, have come up with a few guidelines.

The idea is to help patients have a good surgical outcome, protect their general health and give plastic surgeons in the home nation a helping hand if any unexpected complications crop up.

(Look at this post just on breast augmentation complications!)

1. Include your personal physician in on your plans for foreign surgery.
2. Check the level of the foreign surgeon’s training.
3. Make sure the certification is in plastic surgery.
4. Ask if your health insurance covers you in foreign lands. Most do not, but you can find short-term International Medical Coverage.
5. Have you arranged for aftercare? Depending on the procedure, you may need a little or a lot. Usually, a week should cover the medical needs resulting from cosmetic plastic surgery.
6. Before you leave, make sure you know who will handle complications after you return home. If something goes wrong, at least one U.S. and one Australian provider of plastic surgery vacations will fly you back to the nation where you had surgery, pay for your revision and fly you back to your home.
7. Before leaving, make sure you have spoken on the phone with the foreign doctor and his staff. Usually, the foreign doctor holds a telephone consult, using pictures of the feature you want enhanced.
8. Ask for references. Follow through and contact patients who have been seen by the foreign surgeon you intend to use. Speak with them about how their procedure turned out. Also inquire about the foreign aftercare and the surgeon’s post-operative follow-up care.
9. Don’t plan on fun in the sun. Most of your trip should be devoted to healing, not frolicking on the beach.

What nation would you like to visit for plastic surgery?

But not plastic surgery.

A board-certified plastic surgeon, Robert Wald, M.D. blogs that patients don’t have to go to highly affluent areas like New York City, Miami, or Beverly Hills to find an extremely well qualified surgeon.

Cost of plastic surgery is a big factor. It’s just that many board certified plastic surgeons practice in larger cities because they want to be close to major teaching facilities.

But the overhead in a large city is higher so the surgeon must pay more for his office and more in salaries to his office staff. Thus, overhead in locations like the Inland Empire would be less than in Beverly Hills.

Dr. Wald blogs from Fullerton, California, and has a valid point. For instance, an upper eyelid lift in Beverly Hills is typically about $4200. But an equally qualified surgeon in Temecula, California, 40 miles south, charges only $2300.

The difference in price reflects the higher costs of running a business in a larger city.

The best advice from surgeons themselves is: sure, compare prices but do it among the most qualified surgeons available.

A good starting place is the American Board of Medical Specialties. Register as a consumer and then type your surgeon’s name into the website’s search box; if he/she is board certified it should show his education, location and medical qualifications.

For instance, Dr. Wald is board certified by the American Board of Plastic Surgery and by the American Board of Otolaryngology (head and neck surgery.)

Those are the only two  American Board of Medical Specialties boards that certify surgeons to perform plastic surgery. (Read more on about the difference between cosmetic and plastic surgeons.)

After checking on certification, look for the before and after pictures on the doctor’s website. (There should be many!) The next benchmark would be the surgeon’s hospital privileges. The more, the better.

That’s because hospitals know which physicians do, and do not, cause problems

What is your plastic surgeon’s level of training?