In a viral video shared on Twitter in 2021, we see a line of women waiting to board a flight from Santo Domingo to Atlanta. Airline staff in safety vests stand around the women, all of whom are sitting—in wheelchairs. These women had recently undergone the popular Brazilian butt lift or “BBL” surgery, where fat is transferred from one part of the body to the buttocks, despite being the cosmetic procedure with the highest mortality rates. These women are legally considered disabled under the Americans with Disabilities Act, which defines an individual with a disability as someone “who has a physical or mental impairment that substantially limits one or more major life activities … has a history or record of such an impairment, or … is perceived by others as having such an impairment.” Since this broad definition does not comment on the acquisition or duration of disability, we can conclude that ‘disability’ includes voluntary and temporary conditions such as the recovery periods from BBLs and other cosmetic surgeries. The BBL recovery process typically takes six weeks. During that time, your activities are highly restricted to avoid excess pressure on the buttocks: you sleep on your side or face-down, and you use a special booty pillow for sitting. After four to five weeks, you may be able to resume light exercising and driving. For about two more months, you must wear a corset-like compression garment that helps retain your body shape but causes difficulties urinating. This recovery period would keep someone from working, imposing financial burdens on the individuals and families. Most cosmetic surgeries cost thousands, and breast augmentations and tummy tucks can range from about $3,000 to over $7,000. Online, we see numerous guides on plastic surgery financing, and many people take out loans for the procedures. So, it makes sense to see patients searching for other financial prospects to cover their surgery and recovery. Short-term disability (STD) insurance is a popular one: On RealSelf, a cosmetic surgery Q&A platform, we see patients asking about the possibility of STD insurance coverage for tummy tucks, BBLs, facelifts, and mommy makeovers. Most surgeons say it’s not possible—for elective surgeries, STD insurance only covers reconstructive ones; purely cosmetic surgeries are not deemed “medically necessary.” But other surgeons respond differently: Under “Will doctors fill out short-term disability forms for a tummy tuck for employers?” one replies, “I am always happy to complete these forms. Medical indications for time off work following surgery include mandatory bed rest, wound care, antibiotics … usually these requirements are sufficient to allow time off work.” While we lack data to confirm whether these patients succeeded in obtaining insurance coverage or whether the surgeons have stretched the truth in practice, given the frequency of cosmetic procedures (15.6 million performed in the U.S. in 2020), this exploitation of disability insurance has likely occurred more than once. Why is this exploitation a problem? While each state has different policies on STD insurance funding (e.g., employers fund it in New York, employees fund it in California, both employers and employees fund it in New Jersey), in the end, if one secures STD insurance for a medically unnecessary procedure, it is a misuse of resources contributed by other citizens. But what if someone undergoes cosmetic surgery and develops a complication like a serious infection? While complications are rare, this patient would now be eligible for STD insurance because the infection could impact the skin and hemic systems, resulting in physical impairment. Recall that a physical impairment — “any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: Neurological; musculoskeletal; special sense organs; digestive; genitourinary; hemic and lymphatic; skin; and endocrine” — is one condition that defines disability in the first place. Hayley Layne’s reconstructive surgery is another instance of secondary treatment becoming eligible for STD insurance. Layne, a U.S. model and social media influencer, underwent thirteen breast operations in two years, resulting in four emergency room trips and medically necessary reconstructive surgery; her body couldn’t support her j-cup breasts. Our discussion doesn’t end there: While many individuals share successful recoveries and leave their short-term disability behind, others incur long-term disabilities. Impairments after BBL surgeries are reportedly “common,” ranging from abdominal numbness, circulation issues when sitting, back pain, and sleeping troubles. In our society built mainly for the non-disabled, having a disability, whether short-term or long-term, brings about socioeconomic costs. From treatment to rehabilitation and follow-up appointments, many of these costs are covered through health care and other means of public financing. So, is it fair that we are impacted by some individuals’ pursuit of medically unnecessary cosmetic procedures? Is it wrong for those individuals to use the resources allocated for people who actually need them? Sure, cosmetic procedures can boost an individual’s self-confidence, but where should we draw the line between individual benefits and societal costs? Source
