Is cosmetic surgery covered by insurance? The answer depends less on the specific procedure performed than on its medical indication. And this difference can mean the difference between partial or full coverage and having to pay several thousand euros entirely out of pocket. A charming system, of course.
Congenital abnormalities, functional impairments, or sequelae resulting from an accident, illness, or cancer: in certain situations, you may be eligible for reimbursement, sometimes following a request for prior authorization. Breast reduction, functional rhinoplasty, abdominoplasty, and breast reconstruction are subject to specific criteria.
Here are the criteria you need to know to determine whether your procedure is eligible for reimbursement and to estimate the remaining costs you will be responsible for.
Let's start by distinguishing between cosmetic surgery and reconstructive surgery.
Everything depends on the medical indication approved by the health insurance provider, not on the technique used by the surgeon.
A procedure is considered purely cosmetic when its sole purpose is to improve physical appearance, without any associated medical condition or functional impairment. This includes elective breast augmentation, a facelift, or rhinoplasty performed to alter the shape of the nose without any respiratory problems. In such cases, Social Security does not provide any coverage, regardless of the personal impact felt by the patient. The patient is therefore responsible for the full cost of the plastic surgery, including the surgeon’s and anesthesiologist’s fees, as well as clinic expenses.
Reconstructive surgery corrects a accident-related anomaly, a disease, a congenital malformation or a aftereffects of intensive treatment. When an objective functional criterion is demonstrated—such as respiratory distress, chronic pain, or a loss of visual field—the Health Insurance program may approve coverage partial or total for the procedure. This coverage is always based on a reimbursement rate set by Social Security, to which the health insurance plan’s contribution may be added. Each case is reviewed individually by the CPAM’s medical advisor.
Psychological distress related to physical appearance is real and should never be downplayed. However, it does not, on its own, constitute grounds for reimbursement by the health insurance system. Health insurance providers base their decisions exclusively on medical criteria and objective functional criteria through a clinical examination or additional tests.
An exception applies when the distress stems from a recognized anatomical malformation, such as severely protruding ears that cause documented social distress.
Outside of this context, only a consultation with a plastic surgeon in Paris can provide an objective assessment of your situation and the options that are truly right for you.
The following are the procedures most commonly covered by insurance, each of which meets specific criteria.
Breast reduction surgery may be covered by insurance when the’breast hypertrophy causes back pain, neck pain, or chronic skin irritation under the breasts. The criterion most often used by health insurance providers is a removal of approximately 300 grams of tissue per breast, with this threshold subject to adjustment based on the patient's body type and the medical advisor's opinion.
Prior approval is required before any treatment can be performed. For details on the criteria, the applicable CCAM code, and the estimated out-of-pocket cost, please visit our page dedicated to Coverage for breast reduction surgery.
Only the component functional Rhinoplasty is eligible for reimbursement when a deviated nasal septum causes respiratory obstruction documented by an ENT evaluation. This is referred to as septoplasty. The cosmetic aspect of the procedure, which alters the profile or the nose tip, is the patient's responsibility even if it is performed during the same surgical procedure.
In this case, the surgeon prepares a quote that clearly distinguishes between the two components of the procedure—functional and aesthetic.
Upper Eyelid Blepharoplasty is reimbursed only when a Excess skin restricts the field of vision, which must be confirmed by an ophthalmologist.
Purely cosmetic blepharoplasty of the upper or lower eyelids, performed to rejuvenate the eyes, never falls under this category. Our page blepharoplasty cost explains the fees charged and the differences between functional and cosmetic procedures.
Social Security sometimes covers the cost of a tummy tuck when the abdominal wall completely covers the pubis, usually after significant weight loss or several pregnancies in quick succession. The presence of stretch marks or a abdominal diastasis That alone is not enough to justify coverage. Prior approval is required, along with an evaluation by your health insurance plan’s medical advisor. Find detailed pricing information on our page price of abdominoplasty.
Ear Surgery corrects protruding ears and can be considered starting at age 7 at Dr. Djian’s office. It may be covered by health insurance when the deformity causes a significant social discomfort (repeated teasing, low self-esteem; common among children and adolescents). A medical certificate from a primary care physician specifying the psychological distress will be required. In addition, the protrusion must be measured and objectively significant. However, otoplasty performed solely for cosmetic reasons will not be reimbursed.
Liposuction performed on its own for purely cosmetic purposes is never covered by Social Security.
However, a refund is still possible in two specific situations:
After a bariatric surgery or a significant weight loss through dieting, certain procedures such as the brachioplasty or the cruroplasty can be restorative. The key factor remains the presence of a excess skin that causes functional discomfort, as documented by the surgeon during the consultation, rather than mere cosmetic concerns related to sagging skin.
A request for prior approval is always required for this type of transaction.
A genital surgery procedure, such as a reduction nymphoplasty, may be covered by insurance. Unlike most of the corrective procedures mentioned above, this procedure does not require No request for prior approval. If the enlargement causes actual functional impairment (pain during sexual intercourse, discomfort while walking, playing sports, or wearing tight clothing) or proven psychological distress.
Every situation is different, and only a clinical examination can determine whether your case qualifies for treatment.
Dr. Jérémy Djian's office, plastic surgeon in Paris, offers consultations to accurately assess your eligibility before any surgical procedure.
List of Surgeries Covered by Social Security >
Breast cancer is on the list of long-term conditions recognized by the Health Insurance program, which allows for partial coverage of medical care related to this condition. The breast reconstruction Reconstruction following a total or partial mastectomy falls under this category, whether it is performed using an implant, an autologous flap, or lipofilling.
There is no deadline between mastectomy and reconstruction, which may be immediate or delayed depending on the patient's plans.
The symmetrization of the contralateral breast, which is intended to restore symmetry between the two breasts, is also covered. However, the patient may still be responsible for any excess fees, depending on the practitioner and facility chosen.
Certain procedures are considered cosmetic surgery in the strict sense and, barring rare medical exceptions, are paid for entirely by the patient.
These services can still be included in a detailed estimate, which we’ll discuss later in this article.
It's the’medical indication It is what determines whether a procedure falls under one system or the other—never the surgical technique used.
Conversely, in the absence of an objectively confirmed functional disorder, these same procedures are still classified as cosmetic surgery and are therefore the patient’s responsibility. Only a thorough clinical examination can determine the appropriate classification.
The prior authorization is the key document that determines whether Social Security will approve the procedure.
An application for a prior agreement must be complete to minimize the risk of rejection.
It generally includes the medical report detailed report written by the surgeon, the certificates from the attending physician or the relevant specialists, the results of additional tests required by the deed, as well as medical photographs.
The more detailed and well-reasoned the medical record is, the easier it is for the medical advisor to make a decision.
A thorough consultation with the surgeon remains the essential first step in this process.
The Preliminary Agreement Form is sent to your health insurance provider’s medical advisor before the procedure is scheduled. According to ameli.fr, your health insurance provider has a within 15 days of the date the request is received to make a decision. The lack of a response in this 15-day period constitutes tacit acceptance. In the event of a denial, you will receive a written response by mail specifying the avenues of appeal available to you to challenge the decision.
A denial of prior approval is never final. The denial letter specifies the remedies available to you, including the option to request a new medical evaluation through your health insurance provider. This appeal process sometimes allows for a reassessment of borderline cases, particularly when new medical information is added to the original file.
An experienced surgeon can help you put together a more comprehensive application before you resubmit it.
If you have already been denied, a consultation with Dr. Djian will allow you to review your case point by point and assess any missing medical evidence.
Even when a procedure is covered, the patient is generally still responsible for a portion of the costs.
When a procedure is covered, Social Security does not reimburse the actual amount billed but a percentage of a tax base set by agreement.
The remaining portion, called copayment, may be covered by supplemental health insurance depending on the policy you have. In addition to this, there may be a excess fees when the surgeon practices in Sector 2; this additional fee is never reimbursed by the national health insurance program and is covered by the supplemental health insurance only if the policy provides for it.
Let’s use a fictional example to illustrate this mechanism, with arbitrary figures chosen solely for educational purposes and unrelated to any actual rates. Claire is approved for coverage of a procedure recognized as restorative, with a total estimated cost of 4,300 euros. The reimbursement base set by Social Security for this procedure is 900 euros, of which 630 euros are paid directly to her. The remaining 270 euros—the copayment—are covered by her supplemental health insurance. The surgeon also charges an additional fee of 1,800 euros, of which 1,000 euros are covered by her supplemental insurance’s surgery coverage. Ultimately, out of a total estimate of 4,300 euros, Claire pays 2,400 euros out of pocket.
This example is intended solely to illustrate how the calculation works. The actual amounts depend on the procedure, your health insurance provider, and your health insurance plan. To find out exactly how much you’ll be responsible for, always ask for a detailed estimate before the procedure.
This example is intended solely to illustrate how the calculation works. The actual amounts depend on the procedure, your health insurance provider, and your health insurance plan. To find out exactly how much you’ll be responsible for, always ask for a detailed estimate before the procedure.
For a procedure recognized as therapeutic, the health insurance plan generally covers the portion not covered by Social Security and may cover all or part of the excess fees, depending on the level of coverage purchased. For a purely cosmetic procedure, the situation is different. Most standard policies explicitly exclude cosmetic surgery from their coverage. However, some mutual insurance companies do offer specific coverage or a dedicated package, which is often limited in amount and subject to a waiting period.
We recommend that you submit your quote to your health insurance provider before making any decisions, so you can determine exactly what your coverage entails.
When faced with a procedure that is not covered by insurance, some patients consider having the procedure done in Tunisia or Turkey to reduce the cost.
Prices listed abroad may seem significantly lower than those in France. However, they often do not cover either the postoperative follow-up appointments, nor the management of any potential complication, nor a surgical revision if the result is not satisfactory.
In France, patients are entitled to a secure medical environment, rigorous monitoring, and a Detailed quote in accordance with the law. These factors, which are not reflected in the initial price quoted, represent a real potential cost in the event of complications arising after the patient’s return to France, where follow-up care must then be restarted from scratch by another practitioner.
Before undergoing any procedure, it is essential to verify that the practitioner is properly registered with the’Medical Association and qualified in Reconstructive and Cosmetic Plastic Surgery. This certification, which is distinct from simply practicing cosmetic medicine, ensures comprehensive surgical training.
A thorough preoperative consultation, including a clinical examination and a detailed cost estimate, must always precede the decision to proceed with surgery.
It's better to invest in a well-supervised surgery having to correct, sometimes at one's own expense, a procedure performed under uncertain conditions.
Dr. Djian sees patients in Paris’s 16th arrondissement who are seeking clear guidance before proceeding with a surgical procedure.
A procedure performed solely for cosmetic or comfort reasons is generally not covered at no cost. However, certain plastic surgery procedures performed for reconstructive or therapeutic purposes may be fully reimbursed, subject to approval by the national health insurance program.
Be wary of offers for free procedures or injections posted on social media, particularly Instagram or TikTok, by unqualified individuals. Illegal injections of hyaluronic acid or Botox can lead to serious complications, such as infections, irreversible skin necrosis, or even life-threatening conditions.
For your safety, cosmetic medical procedures must be performed by a qualified professional, specifically a physician licensed by the National Council of the Medical Association.
Only a clinical examination can provide a definitive answer, as Social Security evaluates each cosmetic surgery case individually. During your consultation, your surgeon will look for objective criteria—such as functional impairment, a deformity, or a medical complication—as opposed to a purely cosmetic request. Two people seeking the same procedure may receive different responses depending on their specific medical circumstances. Dr. Djian offers consultations in Paris’s 16th arrondissement to accurately assess your eligibility before any procedure.
Yes, it’s actually an essential step in the cosmetic surgery reimbursement process. The surgeon writes the medical report, gathers the necessary certificates, and submits the file to your health insurance provider’s medical advisor. A well-supported file, with precise clinical details, minimizes the risk of denial. Make an appointment at the office so that your file can be prepared properly from the very first consultation.
No, a surgical error, dissatisfaction, or minor complication following cosmetic surgery that is not covered by insurance does not automatically make the procedure eligible for reimbursement. In the vast majority of cases, the cost of revising an unsatisfactory procedure remains the patient’s responsibility. This is why choosing the right surgeon and ensuring a thorough initial consultation are crucial before making any decision. A comprehensive consultation with a qualified surgeon in Paris helps minimize this risk from the outset.
Cosmetic surgery refers to a surgical procedure performed to operating room, whereas aesthetic medicine encompasses non-surgical procedures such as injections. Neither is covered by Social Security when performed for the purpose of purely aesthetic. The distinction becomes important only when a medical procedure—whether surgical or not—is performed in response to a recognized medical indication. If you are unsure about the nature of your project, a consultation can help clarify this before any decisions are made.
No, hyaluronic acid and botulinum toxin injections performed for cosmetic purposes are never covered by health insurance. They are considered cosmetic procedures with no recognized functional or medical indication. An exception exists for certain very specific medical indications, such as Treatment of Neurological Disorders with Botulinum Toxin, which do not pertain to cosmetic medicine. For these injectable products, therefore, no prior approval process is required.
It depends on the policy you have; some health insurance providers impose a waiting period for surgery or hospitalization coverage before any costs are covered. This waiting period can range from a few weeks to several months, depending on the provider. It is essential to check this information directly in the general terms and conditions of your policy before scheduling your procedure. Don’t hesitate to contact your health insurance provider in advance to avoid any unpleasant surprises when the bill arrives.
In principle, no, sick leave following elective cosmetic surgery is not covered in the same way as standard sick leave. This rule stems directly from the fact that the procedure itself is not recognized as medical care by the health insurance system. The situation is different for a Reimbursed reconstructive surgery, where sick leave follows the standard health insurance rules. It’s a good idea to discuss this with your employer before scheduling your procedure.
This is a common question on the Official Health Insurance Forum, and the answer depends on the exact nature of the prescribed care. Nursing care specifically related to the aftereffects of a non-reimbursable cosmetic procedure generally follows the same rules as the procedure itself. The situation may differ if the care is prescribed for a medical complication unrelated to the initial procedure.
If you have any questions about your situation, your surgeon or your health insurance provider is the best person to consult for a decision.
Yes, a serious complication requiring hospitalization in the intensive care unit—such as a severe infection or a problem related to an implant—is covered by health insurance, even if the initial procedure was not. This coverage applies to treatment related to the complication itself, not the original cosmetic procedure. It's reassuring to know this before any procedure, although it does not replace the need to choose a qualified surgeon to minimize this risk.
A thorough preoperative consultation remains the best way to prevent this type of situation.
Both play a role, but at different stages of the process. The surgeon evaluates your situation during a consultation and compiles the medical record to justify, if necessary, a recommendation for reconstructive surgery.
The final decision on reimbursement for cosmetic surgery is always up to your health insurance plan's medical advisor., which reviews the submitted case file. It is this two-step evaluation process that explains why two patients with similar requests may receive different responses.
Social Security coverage applies in both cases, provided that the facility is approved. The main difference lies in the extra fees, which are more common in private clinics than in public hospitals. Supplementary health insurance therefore plays a more important role in covering the remaining costs in the private sector. Dr. Djian performs surgery at the Clinique des Princes, in Boulogne-Billancourt, a facility approved by the national health insurance program. Requesting a detailed estimate before the procedure allows you to accurately compare the out-of-pocket costs depending on the facility you choose.
At Dr. Djian's office, the listed prices include postoperative follow-up visits, unless otherwise specified in the estimate. However, this can vary from one surgeon to another and should always be verified before comparing multiple estimates. A clear estimate should specify exactly what is included in the surgical package and what will be billed separately. Don’t hesitate to ask for this clarification during your initial consultation.
Dr Jérémy Djian is a plastic surgeon based at 5 square Thiers, near the Victor Hugo roundabout, in the 16th arrondissement of Paris.
He trained in Paris and worked on the team of Professor Laurent Lantieri, a leading authority on face transplant surgery.
Hello,
Following a sleeve, I lost 40 kg, at the breast level 105F to 95B is that I have to a breast reconstruction since the care falls and sags and I have a breast larger than the other e
Do I have to be taken in charge, I am at 100% disability and I have a good mutual insurance?
I remain at your disposal
Sincerely
Hello, ma'am,
Unfortunately, the breasts are not taken care of after weight loss by sleeve,
Some fees may be partially covered by your health insurance,
Kind regards,
Dr Djian
Hello Doctor
After 4 pregnancies my belly is deformed
I would like to send you some photos so that you can give me your opinion on a health insurance claim.
Thank you for your reply.
Hello, ma'am,
If you can't come in person, we can do a teleconsultation on doctolib,
Yours sincerely,
Dr Djian
Hello,
Following a weight loss, I have an apron that makes it difficult for me to tie my shoes, prevents me from going about my daily life and makes it difficult for me to dress properly. I'd like to know if this could be covered by the Sécu and my mutual insurance company.
Sincerely
Hello, ma'am,
If you have lost a lot of weight and your BMI is < 30, treatment is possible,
Dr Djian
Hello Dr Djian
Following two pregnancies close together, I've put on 20 kg and I'm overweight. I'd like to have a breast reduction because it hurts my back and I've had scoliosis since I was a teenager. .
What steps do I need to take to benefit from social security coverage? And what fees do I have to pay?
I look forward to hearing from you. Please accept, Dr Djian, my most respectful regards.
Dear Madam,
you should be examined,
Surgery fees (see rates page) are partly covered by the mutual insurance company.
Dr Djian
I often have back pain, I think it may come from my large breasts, is surgery covered?
Dear Madam,
If the reduction of your breasts results in a loss of more than 300 grams on each breast, treatment is possible.
However, you will still have to pay for the surgery (partly covered by your health insurance).
Kind regards
My daughter (22 years old) has excessively large breasts: a 95H cup. She has suffered from back pain for many years. She would like to undergo breast reduction surgery to lose 2 or 3 cup sizes.
What is the procedure to follow? And how much will the procedure or the extra fees cost?
Thank you for your reply
Sincerely
Ms EGUIA
Dear Madam,
The first step is to carry out a diagnostic consultation.
If it's a breast reduction, which seems to be the case (95H), an estimate will be issued: you can find indicative prices on the Prices page of the site.
Breast reduction is covered. However, there are still surgical fees which are partly covered by the mutual insurance company. Reimbursement amounts vary from one mutual insurance company to another,
Kind regards
Good evening I've lost 12 kilos I'd like to reduce my breasts I'd like to know if it's covered I've already consulted a doctor and he told me normally it's covered I need to find a doctor I looked on the internet I found you I hope to have an answer from you
Dear Madam,
To be considered, 300 grams per breast must be removed. To assess whether this is possible without altering the shape of your breast, you should be examined,
Kind regards
Hello, following my 3 pregnancies I have lost a lot of breast already that I did not have much and this is a huge complex for me today ..... it prevents me from living I do not accept my body at all ..... I would like a breast augmentation and I would like to know if I could be covered by social security having very low incomes .....
Hello,
Breast augmentation is only covered if there is breast agenesis = total absence of the mammary gland.
In your case, this will not be covered. All surgery prices are listed in the relevant section.
Sincerely
I had a sleeve operation 18 months ago and now I'd like to have some fat removed from my stomach and arm. How much is it reimbursed by social security and mutual insurance if I want to have the operation and how much are the fees? Thank you
Hello,
In the case of Sleeve surgery, the tummy can only be treated after weight loss if the abdominal apron covers the ewe.
Some surcharges are covered in part by the mutual insurance company (not in full).
Sincerely
Hello, I'm currently having a 70A appraised. I'm 25 years old and I'm suffering a lot psychologically. I have almost no breasts, I wonder if the social security can cover an operation in a case like mine. thank you in advance for your answer.
Dear Madam,
if you have 0 mammary gland, this is called breast agenesis: there is a treatment available.
Nevertheless, there will be surgical fees covered in part by the mutual insurance company,
Kind regards
Hello Dr, I am currently a G cup and would like to make a reduction to a c cup.
Does ss cover this?
Thank you for your reply. Sincerely
Mrs caffiaux
Hello, ma'am,
Yes, but if you opt for a plastic surgeon in a private clinic, there is a surgery fee.
These are partly covered by mutual insurance companies.
Kind regards
Hello,
I'd like to have a nymphoplasty/labiaplasty for non-aesthetic purposes. Do you have any idea what reimbursement/expenses are generally covered? What steps do I need to take?
Thank you in advance for your answers,
Sincerely
C.Pouchou
Hello, ma'am,
If there is psychological damage, treatment may be available.
Surgery fees are available.
Consultation is required in all cases.
Yours sincerely