Many plastic surgeons ply their highly skilled trade at hospitals or outpatient surgery centers, performing emergency reconstruction surgeries for patients who have accidents, cancer or for other medically necessary reasons, including limb transplants or reattachments.

But the business of plastic surgery has exploded the past few years with women and a growing number of men seeking a variety of popular elective facial and body cosmetic procedures. A variety of physician specialties and nonphysicians also are competing for this growing pie of patients.

Vikram Reddy, M.D., an employed plastic surgeon and chief of clinical integration at Henry Ford Macomb Hospital in Clinton Township, works the majority of his time on reconstructive surgical cases and wouldn’t have it any other way. His father, Sudarshan, also employed at Henry Ford, focuses on body contouring and breast surgery and loves hospital-based work.

“Plastic surgery is unlike any other field” with the combination of a cash business for cosmetic services and insurance-covered surgeries for reconstruction and trauma, said Reddy, who is one of 11 employed plastic surgeons within six-hospital Henry Ford Health System and also the system’s associate medical director of population health.

Because of the demand and cash payments, Reddy said a growing number of plastic surgeons, physicians and some nonphysicians are specializing in office-based cosmetic procedures.

“You don’t have to go through insurance as much with cosmetic. It’s mostly private pay” and physicians like cash payments because it usually is less hassle than dealing with insurance companies, Reddy said.

A Changing Business

Plastic surgery also has evolved over the years with doctors further specializing in face, hands and body reconstruction and because of technology and insurance reimbursement changes, said William Stefani, M.D., a private practice plastic surgeon and president of three-physician Spa Renaissance & Renaissance Plastic Surgery in Troy.

“We do a variety of procedures in our practice. I used to do a lot more reconstruction, ER on-call, but now I do more cosmetic,” Stefani said. “Reality TV has shifted the thinking of patients and some doctors.”

Mark Komorowski, M.D., a solo plastic surgeon in Bay City, practice s in and out of the hospital with half of his surgeries in a hospital and the other half in an ambulatory surgical center. A former trauma surgeon from Oklahoma, he has practiced in Bay City since 1993 and has his busy office practice with one nurse.

Board certified in plastic and general surgery, Komorowski practices at a variety of area hospitals that include MidMichigan in Midland, McLaren Bay Region in Bay City and Covenant Healthcare in Saginaw.

“I do general plastic surgery, the lumps and bumps, skin cancer and breast or hand reconstruction,” said Komorowski, who also is chair of the health policy committee with the Michigan State Medical Society. He also is president of the physician organization in Bay County, Midland County and Isabella County.

Nowadays, plastic surgeons in Michigan like Reddy, Stefani and Komorowski can take very different career paths, depending if they want to go into a more lucrative office practice with cosmetic surgery and private pay or become employed by hospitals with benefit perks and do more reconstructive surgery coupled with on-call emergency trauma cases.

“I enjoy doing reconstruction surgery,” Reddy said. “Employed doctors do a lot” and are often on-call at hospitals to cover for such emergencies as auto accidents and injuries where limbs and faces need repairing.

“The higher margins are in cosmetic surgery, and a lot of people have gone into private practice and don’t have hospital privileges anymore,” he said. “Hospitals are having a hard time getting plastic surgeons to perform trauma, reconstructive procedures and ER call. … Health systems are both employing physicians and offering stipends to private docs for support.”