Plastic surgery versus cosmetic surgery

Plastic surgery 

There is a distinction between plastic and cosmetic surgery. Plastic surgery is reconstructive surgery (chirurgie réparatrice) and is a recognised medical specialism focusing on restoring the skin, the bones and the soft tissues of the body. It can be performed on almost all areas of the body.

Plastic surgery is performed for reconstructive, functional and aesthetic reasons, most often in response to trauma, infection, disease or birth malformation. Plastic surgery can be reimbursed through social security if the procedure is prescribed by a medical doctor as being necessary for the patient.

In such cases, the prescribing doctor submits on behalf of the patient a special request for extended coverage. This is called a prior agreement for coverage by the Assurance Maladie (accord préalable de l’Assurance Maladie), and it is the same general request for extended coverage that is used for a variety of other treatments and services such as orthopaedic treatments, physiotherapy procedures and special rehabilitation services, special examinations and laboratory tests, specific cholesterol-lowering drugs, specialised medical devices, and long-distance transportation (more than 150km) for medical patients.

In exceptional cases, it may be possible to claim a reimbursement after the surgery, even if a prior agreement was not submitted ahead of the surgery. This is granted at the discretion of the social security body. 

Some of the types of plastic surgeries that are reimbursed by the social security include:

• breast reconstruction after cancer
• breast reduction or augmentation in specific circumstances (for example some people with large breasts that bother them may obtain reimbursed reduction surgery if they need to lose at least two bra sizes)
• abdominoplasty to remove excess skin following significant weight loss or pregnancy
• nose surgeries if there is a deviation of the septum as a result of trauma (accident) or congenital malformation and if this is causing pain or respiratory problems
• otoplasty to correct sticking out ears in children or adults if these cause significant psychological embarrassment or distress to the patient
• maxillofacial surgery for abnormally curved or receding chins
• skin resurfacing as a result of burns, bites, scars, infections, etc. 

These procedures can be performed in state hospitals or in private clinics.

Cosmetic surgery 

Cosmetic procedures are not seen as medically essential and aim to reduce the appearance of aging or to modify physical appearance for aesthetic reasons. In France, cosmetic procedures – including cosmetic surgery (chirurgie esthétique) – are not recognised as a medical specialism by the national medical board (Conseil national de l’ordre des médecins) and the existing legislation regulating the cosmetic industry in France is lagging behind that of many other countries.

Purely cosmetic procedures, whether surgical or not, are typically not reimbursed by social security nor mutuelles, although some private policies do include cover for them. In some cases it may be possible to obtain state reimbursement with the prior agreement process, as mentioned previously. But it will usually not be granted if the aim is purely to look better and there is no medically recognised ‘need’.

Non-surgical cosmetic procedures aimed at reducing the effects of aging, such as anti-wrinkle injections, laser dermabrasion, etc. are not reimbursable by the state. 

In France, different categories of medical doctors can practise aesthetic medicine and can perform cosmetic surgeries in private practice. These include dermatologists, dentists, ophthalmologists, vascular specialists (angiologists), maxillofacial surgeons, etc.

Sometimes, cosmetic medicine is practised by GPs but the majority of cosmetic professionals are not doctors. You may wish to check therefore that they are accredited with a reputable professional body. There are many professional associations covering the sector such as SFME, AFME, SOFMMAA and CIME. 

Some practitioners are trained by certified institutes accredited with the Agence française de la normalisation (Afnor) or other bodies, which may bring an added level of recognition. However, many of these accrediting bodies are private organisations with no public oversight.