Most patients who come here for reconstructive surgery do not live in California. Many fly in from other states. A number come from other countries.
What follows is the actual process. What happens before you book a flight, how long you should plan to be here, and how to find out whether an operation is worth traveling for.
Before you commit to anything
If you are not sure whether this is the right practice for your condition, you do not have to pay to find out.
Send a few photographs and a short summary of your history and Dr. Panossian will tell you whether this is the kind of case he operates on. If it is not, he will say so, and he will point you toward the kind of surgeon who does. There is no charge for this.
It is not a consultation and it is not a treatment plan. Nobody can plan an operation from photographs. It is a straight answer to a narrower question: is a consultation worth your time.
To start, submit a request through the contact form and mention that you would like a brief review first. A member of our staff will contact you and send a secure, encrypted way to send photographs. Please do not email medical images to a general address.
The consultation
A consultation with Dr. Panossian is $250, paid when the appointment is scheduled. It is the same fee whether you come to the office or meet by video, and the same fee whatever your condition.
You meet with Dr. Panossian directly. Not a coordinator, not a nurse, not a physician assistant.
There is no geographic limit on a video consultation. Consultations have been conducted with patients across the United States and internationally.
For reconstructive care, including neurofibromatosis, facial paralysis, cleft and nasal reconstruction, and pediatric plastic surgery, you receive an itemized superbill afterward that you can submit to your health plan for out-of-network reimbursement. Any reimbursement is paid directly to you.
For cosmetic surgery, the consultation fee is applied in full toward your surgical fee.
What to gather
The consultation is only as useful as the information behind it. Our staff will tell you how to send these securely.
Everyone should have ready:
- Photographs of the affected area, front and both sides
- A list of your prior surgeries with dates
- Your current medications
- Operative reports and pathology from any previous procedure on the same area
- Any imaging you have had, meaning the actual study on disc or through your imaging portal, not only the radiology report
Depending on your condition, these also help:
- Genetics results, if a genetic diagnosis has been made
- Nerve studies such as an EMG or nerve conduction study
- A short video, if your concern involves movement. For facial paralysis, a video of you trying to smile, close your eyes, and raise your eyebrows shows things a photograph cannot
- Photographs taken before any earlier surgery, if the question involves a revision
- Growth charts, developmental history, or records from a craniofacial or multidisciplinary team, for a child
If you are unsure whether something is relevant, send it. It is easier to set aside a record we did not need than to work without one we did.
Planning a single trip
Where it is clinically appropriate, the pre-operative visit, the surgery, and your first follow-up are consolidated into one trip. That is the default for patients traveling from out of the area.
It is not a same-day arrangement. An in-person visit before surgery is required, and not as a formality. A physical examination and an unhurried conversation about the plan change decisions often enough that skipping them is not acceptable. Plan to arrive one to two days before your surgery date.
That visit is not charged separately. It is part of preparing for your operation.
How long to plan to be here
These are minimums for an uncomplicated course. They are not guarantees.
In-office procedures. You can travel home the same day.
Electrodesiccation for cutaneous neurofibromas. Three to five days in total, including the pre-operative visit. Most patients are cleared to fly one to two days afterward.
Plexiform neurofibroma resection. A minimum of two weeks, and longer depending on the size of the tumor. A short hospital stay may be part of it. Most patients are cleared to fly seven to ten days after surgery, once sutures and drains, if applicable, have been removed. Do not book a return flight you cannot change.
Lengthening temporalis myoplasty. A minimum of fourteen days, arriving one to two days before surgery. Cleared to fly seven to ten days afterward, once sutures and drains, if applicable, have been removed.
Cleft and complex nasal reconstruction. A minimum of ten days including the pre-operative visit. Cleared to fly seven to ten days afterward.
For any procedure not listed here, ask. The answer depends on the operation and we would rather give you a real number than a general one.
An adult caregiver is required
Every patient traveling for surgery must have a capable adult with them through the post-operative period. This is not a preference and surgery will not proceed without it. Factor a second traveler into your flights and your budget from the beginning.
Getting here and where to stay
The office is at 39 Congress Street in Pasadena.
Hollywood Burbank Airport is closest, roughly twenty minutes away. Los Angeles International has more direct and international service and runs forty five to seventy five minutes depending on traffic. Ontario is a third option at about forty five minutes.
Old Pasadena and the streets around the Huntington are a short drive from the office. Patients have commonly stayed at The Langham Huntington, Hotel Dena, the Hilton Pasadena, the Pasadena Hotel and Pool, and the AC Hotel Pasadena.
For stays longer than a week, which covers plexiform resection, lengthening temporalis myoplasty, and cleft reconstruction, a short-term rental is usually more comfortable and less expensive than a hotel room.
These are listed because patients have used them, not through any arrangement. This practice has no affiliation with any of them and receives nothing from them.
International patients
International patients are accepted. Two things work differently.
A medical visa or a letter of agreement from your embassy may be required depending on your country. Documentation supporting a visa application can be provided once a surgical date is held.
Payment in full is due at booking and must clear by international wire before you arrive in the United States. There is no post-operative billing arrangement and no insurance filing for international patients.
Cost and insurance
This practice does not contract with any health plan.
That does not mean insurance pays nothing. For reconstructive surgery there is a real process, and what your plan does and does not pay follows a pattern worth understanding before you book a flight rather than after.
Starting
The first step costs nothing. Send photographs and a short history, and you will get a direct answer about whether an operation here is worth traveling for.
Request a consultation