Basic photoshopping of such things is included in my session fee and print prices. I do quite a lot with my *portrait* images to give an artistic feel that seperates me from a run of the mill photographer. At least that is my goal. Wrinkles are softened, zits and blotchy skin is smoothed etc;

I do charge extra for removing of items from the background or for removing the background. That is on an hourly basis with a min of one hour charge. I try and find positions where the background is nice, but, it is not always possible.