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Everyone loves a deal. But there are certain products and services in life where it could be, let’s say, less than optimal to shop for the deepest discount. Engagement rings come to mind. Criminal defense attorneys. Shellfish. And most people would probably add plastic surgery to the list. The old adage, “you get what you pay for,” carries a particular sting when it comes to your face or your body. And yet you may have noticed some social feeds recently touting a specific kind of aesthetic bargain, for example this TiKTok about influencers getting discounted plastic surgery from surgical fellows at Lenox Hill Hospital in New York City.
After talking to plastic surgeons at every level—from residents and fellows to board-certified surgeons—I can confirm that this is a legitimate and longstanding medical practice occurring not just at Lenox Hill, but at teaching hospitals and academic institutions all over the country. Plastic surgery fellows routinely operate at discounted rates in the process of advancing their training and honing their aesthetic skills. Patients of all stripes can take advantage—the opportunity isn’t exclusive to social-media somebodies—and there’s nothing unsavory about it.
Historically, though, “fellows’ clinics” were something of an insider’s secret, my sources say. “It was known within the hospital community that there was this program where you can have surgery done at a lesser cost, but a fellow does the procedure,” explains J. Madison Clark, MD, chief of the division of facial plastic and reconstructive surgery at UNC Chapel Hill, director of the department’s fellowship program, and chair of the fellowship committee for the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). “The nurses would talk amongst themselves to find out which fellows had good hands, and then a nurse who might be ready for a facelift would schedule with that fellow.” But recently, thanks largely to social media, word has spread beyond hospital walls. On the heels of the aforementioned TikTok, Dr. Clark’s office fielded multiple calls from people asking how much his fellows charge for a facelift. In the 10-year history of the fellowship, this is the first time he’s ever received such inquiries.
While many fellowships do offer substantial price cuts—on the order of 50% or less of the particular surgery’s going rate—“I don’t want to give the impression that it’s dirt cheap,” says Mark G. Albert, MD, program director for the Aesthetic Surgery Fellowship at Manhattan Eye, Ear, and Throat Hospital (MEETH), a division of Lenox Hill Hospital. In light of the attention his program has received of late, he says, “I think it's important to set the record straight” about both the costs involved and the quality of care at these clinics. But first…
What exactly is a “fellows’ clinic”?
For starters, “these are not medical students experimenting on you,” says Dr. Clark. Fellows are full-fledged, licensed plastic surgeons who’ve graduated from accredited residency programs and thus have completed their formal training. But instead of going straight into practice, they’ve chosen to devote an extra year to learning the nuances of aesthetic surgery, specifically. “They'd otherwise be out in the community operating, but they're seeking the highest level of training possible,” says Dr. Albert.
While each fellowship has its own flavor (MEETH emphasizes facial surgery, for example, where other programs may focus on breast and body), they’re all designed to offer an intensive deep dive into aesthetic surgery under the mentorship of some of the biggest names in the field. A surgeon who scores a top fellowship “can get, like, a 15-year head start on anyone who goes straight into practice out of residency,” says Faryan Jalalabadi, MD, a fellowship-trained, board-certified plastic surgeon in Beverly Hills.
Surgeons generally play a dual role in fellowship. In the early months, they’re observing in the operating room and helping to care for their program directors’ patients. When they scrub in on a senior surgeon’s case, they’re assisting—holding the retractor, cutting sutures—but they’re not typically doing any portion of the procedure unless the patient has consented to it, which is pretty rare. “If a plastic surgeon is charging $100,000 for a facelift, the person having it done is going to expect that surgeon to be their [only] surgeon,” notes Dr. Clark. “They don’t want to have the quote-unquote medical student doing any part of that.”
“These are not medical students experimenting on you.”
Once fellows have proven themselves to be safe and competent, they’ll usually be given “the green light to start seeing their own patients in the fellows’ clinic,” says board-certified plastic surgeon Bob Basu, MD, who is a fellowship director and the president of the American Society of Plastic Surgeons (ASPS). “By the time someone is six months into my fellowship, they’ve probably seen at least 200 breast augmentations, just to give an example, and that’s in addition to everything they saw and did in their six to nine years of residency.” In other words: “This is not a newbie dabbling in surgery,” he says.
Fellowships may introduce surgeons to specific techniques they haven’t seen before, though. “I saw zero deep plane facelifts in my residency, and I operated in the biggest medical center in the world,” says Dr. Jalalabadi. The deep plane (an advanced technique that releases and repositions the tissues in a lasting and natural-looking way) was a focus of his fellowship, however, and is now, four years later, a mainstay of his practice. “My fellowship program had a strong clinic built in, where I could book my own cases and I had supervision,” he says. “It’s crazy, the amount of learning that happens when you actually do a technique for the first time.”
Which is precisely the point of a fellows’ clinic: Instead of merely watching or assisting, fellows can devise surgical plans and operate autonomously, but with the safety net of having a mentor nearby. In the clinic, “the co-surgeon model is flipped,” says Tyler Safran, MD, a dual fellowship-trained plastic and reconstructive surgeon in Montreal. “The fellow becomes the primary surgeon of record, and the senior surgeon is assisting or at least available to help.” When Jason Bloom, MD, a double board-certified facial plastic surgeon and co-director of the Facial Plastic & Reconstructive Surgery Fellowship program at the University of Pennsylvania, allows fellows to do aesthetic cases in his private surgery center, he’s “always around in case they have questions,” he says. “I could be in the other room operating, or I could be across the parking lot at my office, but I’m nearby to assist if needed.”
Some residency programs offer similar experiences—what’s known as resident aesthetic clinics or chief cosmetic clinics—enabling plastic surgery residents in their final years of training to perform injectable treatments or surgical procedures on patients for a nominal fee. (Residents’ clinics have been around since the late ’80s; today, upwards of 75% of plastic surgery programs have them.) A critical difference between residents’ clinics and fellows’ clinics is the degree of oversight. Residents require direct supervision, as in a senior surgeon (a.k.a., an attending) in the room with them. When a fellow is operating, however, “there’s not necessarily going to be an experienced surgeon looking over their shoulder,” says Dr. Clark. “Some fellowship directors may do that, but that's largely going to be the exception rather than the rule.”
How much experience do these surgeons actually have?
Every plastic surgery resident must log a certain number of surgeries across the breadth of the specialty, including a minimum of 150 aesthetic cases. “By your final years of residency, you’re functioning as a surgeon,” says Matthew Farajzadeh, MD, a plastic and reconstructive surgery chief resident at UC Davis. “You still have supervision, and you still have to answer to the attendings, but you’re fully working as a surgeon in the hospital.” Otolaryngology (ENT) residents, who may be training to become facial plastic surgeons, have their own case requirements. In both fields, each five- to eight-year residency affords its own mix of cases and its own unique ratio of reconstructive to cosmetic procedures.
With certain exceptions, dedicated “aesthetic training is probably the weak point of the majority of plastic surgery residency training programs,” says Jacob M. Marks, MD, a fellowship-trained plastic surgeon in Gilbert, Arizona. Training tends to focus more heavily on the reconstructive side of surgery. Dr. Clark says the same for otolaryngology: “Most residencies don’t have a lot of cosmetic exposure.” Studies have even shown that graduating plastic surgery residents feel “deficient in performing aesthetic procedures, particularly those of the face.” This is partly due to the fact that patients paying out-of-pocket for elective cosmetic surgery generally prefer to see surgeons in private practice rather than in the hospital setting where residents work.
Addressing the gap in hands-on aesthetic training are resident cosmetic clinics. Here, senior residents take the lead on cases, consulting with patients, planning and executing operations, and handling follow-up care. “I know in the outside world, people are like, ‘Why would anyone go and get something done by a resident?’” says Milind Kachare, MD, a fellowship-trained plastic surgeon in St. Louis. “But you’re not only being taken care of by that resident. They’re fully monitored by an attending surgeon.” As a rule, residents can’t fly solo in the OR because they’re not yet licensed plastic surgeons. “Any procedure they perform is under the supervision of an attending surgeon—a professor, program director, or faculty member,” says double board-certified facial plastic surgeon Babak Azizzadeh, MD, who is a fellowship director and the president-elect of the AAFPRS. “But that supervision can be light or severe”—meaning the attending may observe from the sidelines or be actively involved from start to finish.
“You’re not only being taken care of by that resident. They’re fully monitored by an attending surgeon.”
For residents aiming to specialize in aesthetics after graduation, these clinics can supercharge their training. As a chief resident in plastic and reconstructive surgery at UCLA Health, Kyle Luvisa, MD, says he’s participated in “well over 1,000 cases—everything from cosmetics to reconstructive to cleft lips and palettes.” These were mostly his attendings’ cases. But Dr. Luvisa also sees patients in UCLA’s residents’ clinic, where he performs facelifts, tummy tucks, nose jobs, liposuction, and the like. These procedures are overseen by volunteer clinical faculty (plastic surgeons with practices of their own in Beverly Hills), who review his plan ahead of time and are in the operating room during surgery.
But not every residency offers the same opportunities. Dr. Marks did his residency at the University of Wisconsin in Madison, which, unlike LA, “isn’t a heavily saturated cosmetic surgery market,” he says. And his program didn’t have an operative clinic for residents (though it did have a nonsurgical residents’ clinic). “Had I just left residency and never done a fellowship [at MEETH], my comfort level with facelifts would have been very low,” he says. Immersing himself in the Manhattan plastic surgery scene was an essential next step on his path to private practice.
What do we know about the safety of these clinics?
While research on fellows’ clinics is scant, many studies have been published on residents’ cosmetic clinics—and they’re mostly reassuring. In 2019, researchers at Baylor College of Medicine in Houston reviewed the existing literature and found that, overall, residents’ clinics in the US “provide safe and successful surgical results” and produce “surgical outcomes that closely resemble results seen in the community setting.”
A separate 2022 study looked at a year’s worth of data from the Resident Aesthetic Surgery Clinic at NYU Langone Health. The majority of procedures involved the head and neck, with blepharoplasty being number one. Lipo and tummy tucks were the most common body procedures; breast lifts made up half of all breast surgeries. The authors reported a “low complication rate of 5.5%, with no major complications among the 420 procedures.” Complications were mostly minor and solved nonsurgically. The 1% rate of “moderate” complications—those requiring “small interventions” but not reoperation—was comparable to national benchmarks.
Other studies reveal similar findings. A 10-year review of surgical outcomes from the residents’ aesthetic clinic at Johns Hopkins and the University of Maryland found their rates of major complications to be comparable to those reported by board-certified plastic surgeons. A 2025 study from the University of Pittsburgh Medical Center compared tummy tuck cases led by attending physicians to those led by supervised residents and saw no statistically significant difference in the overall complication rates between the two groups. The surgeries performed by the residents did take longer, however. Other studies have also linked residents' involvement in certain cosmetic surgeries with longer operative times.
Not every paper casts residents’ clinics in a positive light, though. A 2024 study published in Plastic and Reconstructive Surgery Global Open found that revision rates were “much higher” when third-year otolaryngology residents participated in the operations. According to the study authors, “10% of revisions were for functional concerns…while the rest were driven by cosmetic or patient satisfaction demands.” In response to the findings, clinic privileges for this particular program were deferred to the fifth year of residency rather than the third.
What sort of discounts are we talking about?
The first thing to know about plastic surgery pricing: Whether you’re seeing a resident in a hospital-based clinic or a veteran surgeon in a Park Avenue practice, the bottom-line cost always includes certain itemized fees. There’s the anesthesia fee (an hourly rate paid to the anesthesiologist), the facility fee (the cost of the operating room, staff, and supplies), and then there’s the surgeon’s fee, which is the number that tends to make headlines. Depending on the procedure, charges for materials may also apply: If you’re having a breast augmentation, for example, you’ll have to pay for the implants. But the biggest variable in all of this is usually the surgeon’s fee, which typically climbs as doctors gain experience and esteem.
This holds true even in the minor leagues: Residents typically charge less than fellows. While every hospital has its own pricing policies, the surgeons I spoke to used words like “massive” and “steep” to describe the discounts offered in residents’ clinics. In the aforementioned study of NYU’s residents’ clinic, the authors state that the surgeon’s fees for all procedures were discounted 60% or more compared with the 2020 ASPS and 2021 Aesthetic Society national averages. Which is pretty remarkable since these averages, published by the plastic surgery societies, are already on the shockingly low side (think: $11,000 for a facelift and $8,000 for a tummy tuck).
Surgeons used words like “massive” and “steep” to describe the discounts.
At UCLA’s residents’ clinic, injectable treatments, like neuromodulators and fillers, are “completely free,” Dr. Luvisa says. For surgery, patients pay anesthesia ($574/hour) and facility costs (high end: $6,000), plus a $500 flat fee, which keeps the clinic running and covers post-op visits, but the typical surgeon’s fee is waived, he says. There are sometimes out-of-pocket expenses related to safety, however. For example, patients having bigger procedures, like facelifts and tummy tucks, have to pay to stay overnight in the hospital’s surgery center, where they can be monitored by nurses (in accordance with UCLA’s standard of care). Dr. Luvisa estimates this cost to be about $1,500, for a likely grand total of somewhere around $11,500 for a longer, more involved surgery like a facelift.
In fellows’ clinics, pricing is more variable. “Some fellows are just charging for the operating room and anesthesia fees,” says Dr. Azizzadeh. “Others are charging a percentage of what their fellowship director is charging.” Even so, he adds, “the costs can still be significant,” especially in cities like Beverly Hills, where “operating room and anesthesia costs on their own can run between $10,000 and $15,000.”
Dr. Basu tells me his fellow’s fee is “a little bit lower” than his own, but he makes it very clear: “We don’t deeply discount.” After all, he reminds me, “this is someone who is already a fully trained plastic surgeon.” And at UNC Chapel Hill, facial plastic surgery fellows charge roughly half of what the fellowship faculty would charge for surgery. They administer Botox and filler for a flat fee of $500.
In the fellows’ clinic at MEETH, the subject of the TikTok that sparked our investigation, “patients who have surgery are not charged procedure fees, but they are responsible for an anesthesia fee and for the standard facility fees that all other patients pay,” Dr. Albert says. Those having a facelift or tummy tuck also incur the cost of a mandatory overnight hotel stay with a private-duty nurse. Additionally, “we have every patient go to a professional photographer for before and after pictures, and there are fees associated with that,” he says.
Dr. Marks tells me that when he did his fellowship at MEETH in 2023, “facelift prices were a steal compared to anywhere else in New York.” Patients were paying around $5,000 or $6,000 for a facelift with blepharoplasty, and that included anesthesia and facility fees.
At Dr. Safran’s fellows’ clinic (with the Aesthetic Surgery Fellowship of Los Angeles), “the prices were much more than you’d pay in a residents’ clinic, but much less than what senior surgeons were charging for pretty much the same treatment—probably 25% of that or less,” he says. When Dr. Jalalabadi was a fellow in the same program in 2021, he says patients paid for the OR and anesthesia, “but it was up to the surgeon if they wanted to charge a surgeon’s fee.” He’d typically waive that fee, but in return, ask patients for photo consent—permission to share their before-and-after pictures online or in the office.
This is a common ask among younger surgeons aiming to build their portfolios and advertise their work. “I’m going into private practice after I graduate [from fellowship], and one of the biggest things on my mind is collecting good before-and-afters,” says Victor Hsue, MD, a facial plastic and reconstructive surgery fellow in Beverly Hills. Dr. Hsue’s fee for a deep plane facelift (including the OR and anesthesia) is $30,000. His mentors charge at least five times that. In exchange for the discount, patients must be willing to share their photos.
Another need-to-know about trainee clinics: Generally speaking, if you’re unhappy with your results, there are no free revisions. “It may sound harsh,” says Dr. Marks. “But, at the same time, when you look at the fellow’s price versus that of the surgeon down the street, you could do the whole operation multiple times and still be saving money.” Dr. Clark makes the point that plastic surgery results aren’t considered final until one year post-op, and since most fellowships only last one year, the surgeon who performed the initial operation likely won’t be around to do the revision. In such cases, the responsibility falls to another fellow or the program director.
How can I find a clinic offering discounted surgery?
Most plastic surgery training clinics are sustained by word-of-mouth referrals. Some programs, like the Aesthetic Surgery Fellowship of Los Angeles and UT Southwestern Aesthetic Fellowship, promote fellows on their websites and social media, while others rely more heavily on buzz in the community. As one of the oldest programs in the country, the MEETH Aesthetic Surgery Fellowship “is well-known in Manhattan as an option for affordable surgery,” says Dr. Marks. Still, it plugs its fellows on Instagram. Many fellows will advertise on their own social media pages, too (residents generally aren’t allowed to do so while in training).
Another way patients learn about clinics is through the program directors. If a senior surgeon meets with someone who can’t afford their fees or wants to skip the waitlist, they’ll commonly refer them to a resident or fellow. Which isn’t a bad deal, since “you may be getting a resident under the guidance of that same surgeon you wanted to have surgery with in the first place,” says Keon Parsa, MD, a fellowship-trained facial plastic surgeon in Beverly Hills.
If you’re not lucky enough to stumble across one of these clinics, there are ways to seek them out. First, “most major cities have an academic medical center,” says Dr. Farajzadeh. If you live near one, call the plastic surgery department directly to ask about their residents’ and fellows’ clinics. Alternatively, you can browse fellowship programs on the Aesthetic Society and the AAFPRS websites. The societies list all the aesthetic fellowships they endorse, along with their respective directors and contact info. If you see that a surgeon in your area has a fellow on staff, set a time to meet with both doctors as part of your vetting process. The supervising surgeon is going to be the “best judge” of that fellow, says Dr. Azizzadeh.
The bottom line: Ordinarily, we’d never recommend price-shopping for plastic surgery. But as escalating costs continue to push procedures out of reach, driving some patients to explore dicey workarounds like medical tourism, residents’ and fellows' clinics are making cosmetic surgery more affordable without compromising quality or safety. We still highly recommend you avoid steep discounts on criminal defense attorneys and shellfish, though.
