Consult with Dr. Agha

I flew down to Newport Beach from San Jose for a few hours yesterday to have a consult with Dr. Agha.  His office, knowing that I "know" Jillian, but hadn't met her IRL, arranged for our appointments to overlap.  It was GREAT to meet her, and her wonderful friend Carol as well -- she is such a sweetheart and is taking wonderful care of Jillian.  She is a lucky and beautiful lady!  And her recovery process is very encouraging to me -- she is doing SO well for being only 10 days out from such major surgery.

My consult was very informative.  Overall, Dr. Agha spent around 2 hours with me, on and off, as I hung around his office until time to leave for my flight home.  We intensely discussed the various options I had.

As I suspected, and what fueled my reasons for wanting an in-person consult, the photos I sent (and they were taken by another PS) did not fully convey the extent of the issues I have -- after "laying on of hands," we identified issues resulting from my many years of being obese, the way my fat was and still is distributed, and my age.  Unfortunately, that means that he is going to need to do additional and more complicated procedures to do the best job on me -- and the costs went up considerably -- another $17+K.  I am not happy about that, of course, although it is not his fault.  I am just disappointed.  It changes the math considerably. 

I had a consult last summer in person in Costa Rica with the Rosenstock-Lieberman clinic, and the total was $30K.  Agha's original proposed price was $50K, which -- given his advanced procedures and the fact that I wouldn't have to travel as far and would not have to leave the US, seemed to be a reasonable premium.  Now, however, we are looking at nearly $70K, before the cost of staying in Newport Beach for a few weeks (I want my face done as soon as possible after the LBL, so I can have one recovery period for both).

Sigh.

I am 56 years old.  How good of a result do I really need?  How much slack skin can I tolerate in places that are not stuff that anyone other than my husband and I will ever see?   I don't have back rolls, but I do have some goozsh back there that can be used to help autoaugment my breast reconstruction and tighten up my back, which adds several $1000s to the price.  How badly do I want to incude the autoaugmentation of my butt from my not-awful lower back fat to prevent the flat-ass look, which adds several $1000s to the price?  What about the very expensive tweaking of the facelift to include canthopexy to prevent my lower eyelids from drooping?

I am having trouble distinguishing needs vs. wants, being penny-wise vs. pound foolish.  My money needs to be going towards retirement, or I could end up looking lovely and eating catfood.  I need to think on this for a while.

Sigh is right, that's a big chunck of change. Just a suggestion. Make a list of the things that absolutely, positively bother you the most. Maybe if you have a list of say 4 or 5 things you could pick the top 2 or 3.

It's gonna take more than 2 or 3.

The LBL is absolutely necessary.  The thighs -- in some form -- are absolutely necessary.  The arms are absolutely necessary.  The breasts are absolutely necessary.  Those 4 things are all or nothing -- not doing one would look horrible if the others were fixed.

The face is absolutely necessary.  I may be job hunting soon, and my neck and midface are drooping from being formerly fat and make me look even older than I am.  And the eyes are also not going to match if I do the neck, as well as making me look tired and constantly annoyed -- and the upper lids are actually starting to impinge on my field of vision.  No forehead work though.  No vertical thigh incision (even though the spiral thigh lift probably won't be enough).

Fixing my upper back and making the boobs bigger and making the upper flank shaped better are probably optional.  Having a nice rounded butt may be optional -- but not if it helps pad my sore sitting bones. 

So there you have it -- almost all of  it is "necessary."  I've made some concessions.  And it can't be done part-way.  It's a cascade.  But if I am going to only get a minimal job (without the frills that are additional charges), I may as well think about spending much less and going to Costa Rica.

So I'm still thinking.

Hi Diana,

Having plastics is a very big decision and it's easy to get carried away with our needs/desires as well as costs etc. For me, being a similar age (I'll be 58 in a couple of weeks) I had realistic goals when I decided on what I needed/wanted. I went in for two separate procedures 4 months apart. I LOVE my results and feel that I look 20 years younger and am able to wear sleeveless tops and look and feel great, yet still age appropriate. I don't need to be wearing bikinis and short shorts. I spent $28K on all of my plastics but had estimates going up to $75K. For me I look at this like buying a car....I could purchase a Honda or Toyota for my price range or I could get a more expenshive loaded car for $75K. I decided I'm the Honda sort of gal and even though I could get more procedures, I'm calling it quits right now and am happy to wear shorts to my knees. You need to weigh out what you can live with and what will make you happy as well as the amount of $$ you are willing to spend. Both my husband and I are totally happy with my results...I have photos on my website you can look at and I'm happy to answer any questions you may have.

Good luck to you on making the right decision for you!
Kathie

Thank you so much for writing and for sharing your pictures.  I think you made some good choices -- you look great.

I agree that sometimes more is less.  I didn't come this far in my quest for health to end up looking ridiculously overdone -- or worse, die in attempt to satisfy my vanity.  But some of the extra work that was proposed were things that were -- well, more like tweaks than additional procedures, IMHO -- not significant changes to what was being done.

I will send you more specifics in a private message.

The bottom line is, what were added were not new procedures, per se, but refinements.  I was already accepting certain compromises -- for example, Agha thinks he can reduce the circumferance of my still-massive thighs with lipo and the spiral thigh lift, but the compromise in NOT getting the horrible inner thigh vertical scars from knee to crotch will be accepting some "laxity" (I think that's the word for serious saggage, like "discomfort" really means "searing pain") of the skin on my thighs.  That sounds reasonable to me -- like you, I don't wear short-shorts anymore anyway, and I'd rather have somewhat saggy but reasonable sized thighs than have nice taut ones with a big gory scar anyway. 

The canthopexy tweak to the facelift sounds necessary to prevent functional problems, and I'm somewhat surprised it wasn't automatically included.  The extra work on my upper body lift would give me better shape, tighten the lax back skin and add  boobage to the breast reconstruction -- perhaps it is dispensible, like adding booty to my bootay -- although if that would make my ass not hurt so much when I sit for more than 10 min, I could call that necessary.

I was ALMOST ready to go $50K.  Now, I am thinking about Costa Rica again.  If I can't afford (without spending more than I feel comfortable) the refinements that were the reason for going to Agha in the first place, what's the point of spending the extra money over the $30K in Costa Rica?

By the way, not only have I had a consult with them, a friend of mine who is a surgeon has used the Costa Rica practice, and is going back for more -- she trusts them, and so do I, at least for a workman-like result.  Agha's work looks more esthetically refined, but -- I am 56, and I am not going out in a bikini.

Diane, Dr. Agha's work is simply beautiful.  I want the careful and even cuts - I don't want to look like a surgeon just cut my excess skin off.  At 56, why not drive a mercedes!!!  Your young yet!

I'm feeling guilty too - up to about $42ish and I haven't even had my virtual consult yet.  I thought I only wanted the spiral  but I deserve to look like I have recovered from obesity.  I don't want to feel bad when I look in the mirror.  And as a single woman I don't want to hide from intimacy when the right guy comes along (being heavy allowed me not to share my body).  It makes me cry when I think about how bad I feel about myself "in the nude".

I was looking at videos last week of me from age 19 to around 27 (my nephews birthday parties from age 1 to 9?)  and I was so crushed inside for that girl I saw.  I thought to myself "she never had a chance"cause nobody likes a fat girl (people are mean - I see the difference with the way I am treated now).  A was an actor/singer for God sakes.  I would have had such a better chance had I not been obese.  I want to give that girl all the chances that she missed . . . even if my dreams are different now.

Yeah, I could go back to school instead of having PS but it is more profitable for me to feel good about myself.   And who knows, things seem to somehow, someway fall into place.  I may be able to do that too.

I have Healthnet too.  I've never inquired about them paying for PS.  Why do you think they will?  And how would I possibly get them to do that for me.  Any reimbursement would be an amazing blessing.

 

Best,

Leila

Renee and Kathie...

U two look FABULOUS!

Thank you!

Diana-
I am glad to know that your consult went well.  But my goodness that is a good sum of money.    I know this is something that you have wanted to do for a long time and I do not envy how hard it is going to be to make the decisions about which procedures to have and where to have them done.   

Red

BTW the revision I will be having to my lower lids is either the canthopexy or canthoplasty.  I know that the plastic surgeon said that he would have to graft something.  So he may have been talking about a  tarsal strip resuspension .  I will know more after I see him again in October.

First of all, I want to note that Dr. Agha continues to spend time and no small effort on discussions with me -- again, without my having ever paid him one red cent.  I truly believe he is being very engaged in these discussions, even if we are disagreeing on certain things.

Dr. Agha gave me permission -- and in fact asked me -- to share some of his comments to me (I had previously treated such specific information as confidential between us yesterday, when I did not have his express permission).  He wanted a fair explanation of where both the initial and the additional costs come from.  I am happy to do so. 

After a preliminary discussion of the background of his training, his pioneering of some of these procedures (the ones with a * below) and the competitiveness of fees in CA, Dr. Agha pointed out the following: 

In your case, I am doing:

-          *High-Def LBL

o   with circumferential TT

o   Buttock Lift

o   formal outer thigh lift

-          *Buttock Augmentation with your lower back tissue and liposuctioned fat

-          *Spiral Thigh Lift

-          *J-upper body Lift

-          *Dermal-bra suspension mastopexy

-          Reverse abdominoplasty

-          * Modified Spiral flap augmentation of your left breast

-          *L-brachioplasty

-          * Bivectoral Face and neck lift

-          Upper bleph

-          Lower Bleph

-          Canthopexy

-          Liposuction as needed

 

In this list, you are getting 8 signature procedures (*) at national average prices.  There are PSs that charge 8 K just for the Brazilian butt lift and 10 K for the TT.  Also, some surgeons perform a circumferential abdominoplasty and call it a Lower Body Lift.  The terminology is vague.  The difference is that LBL has a formal outer thigh lift with undermining of the thigh all the way to the outer knee and placement of deep stitches internally.  The patient will never know the difference since the incision is exactly the same.  The results however are different. 

 

I typically charge 6 K for the butt, 2.5 K for upper bleph, 4 K for the lower bleph with septal repositioning, 10 K just for my personal bivectoral facelift, 2.5 for canthopexy.   Shireen made a mistake on your face quote (for the upper and lower bleph) and I honored that.   

 

Overall, you are having 18 procedures for a grant total of about 50 K.  This is about 19 to 22 hours of surgery on you by me personally.  Also, I do not charge a surgeon’s fee for revisions.  This is far more than what others were planning to do for you.  Considering the techniques and the results that I can offer you, I know that my colleagues are charging a lot more…  I am not here to compete with those in Mexico or Costa Rica,  but I can tell you that you are getting a lot more in terms of number of procedures, quality of work, scar placement and techniques that are specifically designed for weight loss tissue quality.  Correct me if I am wrong, but I think that you are getting 11 to 14 hours of additional surgery? 

(I'm not sure what he means about 11 - 14 hours of additional surgery, and I will check with him about that.  The additional procedures he mentioned over his previous quote was 3 additional hours.  Perhaps he means over what was proposed by the surgeon in Costa Rica, but I don't know the answer to that, as it was not broken out by hours of surgery in my estimate from them, just by procedure, whi*****luded OR and anesthesia time.)

Let me be clear -- the previous quote (~$50K) did not include the following additions:
* Buttock autoaugmentation (which I had understood from his website, perhaps mistakenly, was included in the High-Def LBL): $5K more in surgeon's fee
* J-upper body lift (which provides the material for the breast autoaugmentation as well as tightening the back): $5K more in surgeon's fee
* Canthopexy (which is a procedure that he determined would be needed due to the likely "side effect" of the lower blepharoplasty, and which I can somewhat understand he wouldn't have known I would need until he examined me in person): $2500 more in surgeon's fee

The additional time for each procedure was estimated as being 1 hour, for both the OR and of course anesthesia.  (There was one additional procedure suggested for each of the three stages of my reconstruction.)  I am not quibbling about those charges, although they add still another nearly $3000 to the price.

Is he entitled to charge these fees?  Of course, and his valuation of them, including the likelihood that one or more of them are more or less likely to require revisions/tweaks later on which he will not charge for, is part of his calculations.

My concern, and I want to emphasize this, is not that I think he is being unfair or "upselling" me after getting me hooked on his skills and personality (although I've probably fallen for him, just a little ...), but that I need to make a decision about what to do with the money I have budgeted for this surgery.  I did not want to spend nearly $70K on it.  I was barely dealing with $50K, but I thought that was a good deal for what I was getting.  Now, in MY mental calculus, compared with MY budget and MY tolerance for spending money on this kind of elective expense, I am having difficulty trying to decide what I want to do.

I wanted the Mercedes of bariatric surgeries, upon which my life depended.  I would NOT have accepted a free RNY or Lapband once I knew about the DS.  But this is a bit of a grey area for me.  I'm trying to figure out how to balance Agha's assertion that "GOOD IS NOT GOOD ENOUGH."  It's not that I don't think I deserve the best, but I know I can't afford the best in EVERYTHING and I don't know how high a priority this is for me.

I believe I would get the BEST outcome from Dr. Agha compared to all of the other surgeons I have interviewed.  But I don't know if I should spend what that would take.  I hope that is clear.