The Hidden Dangers of Medical Tourism

Hello and welcome to the Plastic Surgery Practice Podcast on the MEDQOR Podcast Network. I am Keri Stevens and I’m the co-chief Editor of Plastic Surgery Practice.

Today I’m excited to have Dr. Alex Zuriarrain back with us to discuss the growing and potentially dangerous trend of medical tourism. It’s a topic he recently covered in an article for PSP. Dr. Zuriarrain is the founder of Zuri Plastic Surgery in Miami, where he specializes in aesthetic procedures of the face and body, including facelift, eyelid surgery, rhinoplasty, breast augmentation, and reduction, abdominalplasty, liposuction, and the Brazilian butt lift. Dr. Zuriarrian, thank you for joining us today.

Thank you so much for having me on. It’s always a pleasure.

It’s always ours, too. We love having you on. And I think this topic right now, honestly couldn’t be more timely because the news lately of people that were killed and abducted in Mexico with a friend getting plastic surgery.

Can you just kind of discuss your reaction to that story from a plastic surgeon perspective, and potentially how do you address the concerns about the potential exploitation of patients who are seeking cheaper cosmetic surgery options in foreign countries like Mexico?

Yeah, I think that practicing here in Miami, I see a lot of this happening in terms of patients seeking to go outside of the United States to have plastic surgery. I’m pretty much like the last stop before they decide to exit the country, because here in Miami the pricing is so competitive and the demand is very high. So if you’re in the United States and you want to have reasonably priced surgery, most of the time you’re going to be heading down to Miami in general.

But for those seeking even lower prices and that type of environment, they end up going a lot to the Caribbean. So the Dominican Republic is a very hot location, and then Venezuela used to be before the government changed. Columbia’s still pretty high up there, Mexico, et cetera.

Yeah. So this recent event, it just is very timely. It illustrates how dangerous it could be to travel to some of these destinations, including Mexico, which is right now very violent in some locations. There are warnings from our government, from the State Department that literally tell you, do not go to certain places in Mexico, okay? You are not supposed to be there. You’re not supposed to travel there for any reason whatsoever.

And one of the locations where this individual went with some family members, I believe they were traveling from South Carolina via vehicle, and they crossed the border and they were intercepted by the drug cartel. And the rest of the story can be found online, but it’s a pretty sad story about what happened.

So when people are going abroad for cosmetic surgeries, what are the most common complications associated with them? And also what are some of the most common surgeries that people tend to look abroad for?

Yeah, I think nowadays they’re going abroad for almost anything. I mean, from rhinoplasty in Turkey, to mommy makeovers in Dominican Republic, liposuction in Mexico, breast augmentations. I mean, the sky’s the limit. And let me be clear, this is not just a plastic surgery phenomenon. This is a phenomenon that’s occurring with gastric bypass patients who want to lose weight and they’re getting it done in other countries. These are people that have major dental work, veneers, teeth implants that are going to Columbia to get it done for half the price with a Colombian dentist. This spans way, way broader than plastic surgery.

The issue with plastic surgery is that, in my opinion, is way more dangerous than getting a root canal or a tooth implant. These are major surgeries. They can have major implications, complications that I see a lot are infections, a lot of infections. I see a lot of necrosis, like wounds that open up. They separate. Blood clots, we see a lot of blood clots from the traveling. They’re traveling too soon after surgery, long flights. So we see it all, and they end up in the emergency room, typically here in Miami because Miami’s the hub to get to the rest of the US. So a lot of them land in Miami International Airport, and then they go straight into one of our local hospitals. And it’s a burden to our system, quite honestly.

And also, your article I think mentioned this really well, but you talk about how the financial costs where people think, going abroad, getting cheaper surgery, but then they end up with all these hidden fees. Can you talk about that, the financial risk associated with undergoing cosmetic surgery abroad?

Yeah. I think people fail to recognize how important it is to be able to follow up with your surgeon in person, actually see them and have them evaluate you physically. I can tell you that as a practicing plastic surgeon, it’s very hard to diagnose certain conditions or complications from a video call or over the phone or through pictures and email. I mean, it’s very challenging.

So the price that you end up paying, even if you have a very minor complication, let’s say the wound just kind of separates a little bit, you’re going to be so nervous. You’re going to be so concerned. You’ve never had this happen to you before. You’re going to end up having to fly back, typically to see this surgeon wherever you had surgery. And these flights and these hotels and all of these things, they add up very quickly as opposed to traveling within the United States. Domestic flights are much cheaper than international flights for the most part.

And then that’s just for a minor complication. If you get anything more significant than that, then you’re going to be paying out of pocket here in the United States to have a plastic surgeon who doesn’t know anything about your surgery, has no clue what they did to you, doesn’t have the operative notes from the other surgeon that are probably in another language. And then you got to decipher all of that and figure out how to help somebody.

So let’s get into the postoperative care that you’ve talked about, with people come back to you after they’ve had these botched surgeries. But can you discuss the importance of post-operative care and follow-up appointments, especially for patients who’ve undergone cosmetic surgery abroad?

Yeah, so the post-operative care is a big deal. When you’re in the US you have access to your surgeon that can intervene physically if need be, even if it’s just a short flight away. The post-op care is going to be involving wound care, drain care, all types of exams to make sure you’re not developing a seroma, hematoma, a wound infection. When is the right time to pull the drain? How many drains do you have? How extensive was the surgery? I mean, these require a lot of handholding by the surgeon. But a lot of these surgeons that are abroad, they’re busy doing such high volume surgery because their prices are so low that it all ends up based on their staff, the staff at these facilities trying to help patients that are coming to them from the United States.

And again, there’s a huge language barrier when it comes to these situations. And sometimes it’s hard to get even people to pick up the phone in another country, in another time zone. Forget about trying to deal with a real serious problem. So again, what ends up happening is that the US system, healthcare system gets burdened. People end up in the emergency room all the time trying to figure out what to do. And it could be very frustrating for the ER doctors and the US plastic surgeons.

Do you feel like the medical tourism, especially for plastic surgery, is becoming a worse problem? And I hate to say worse, but because it can have so many complications, I think that might be the proper term.

Yeah, yeah, and I think now that we’re having this change in the economy, that we’re seeing a lot with inflation, rising interest rates, this is the time that most people end up even considering leaving and seeking surgery elsewhere, abroad. And I would caution them, be very careful. There are good surgeons out there, but you know, have to be very, very careful.

And we offer insurance programs here in the United States. There are two major companies that offer you cosmetic surgery insurance, and those are Aesthetisure and CosmetAssure. I particularly use Aesthetisure in my practice, and I offer it to all of my patients. It’s a very small fee. We’re talking about a one-time fee of about $300, and it covers you the first 45 days of any type of complication related to your surgery, going back to the operating room, going to the ER, getting in an ambulance for whatever reason. It’s a huge safety net that you don’t have to pay out of pocket for.

Do you think that Covid changed the medical tourism industry in plastic surgery? I mean, especially with the restrictions?

Yeah, I think there are parts of this country that got very, very, they got hit very hard. Places like New York, Manhattan, places in California like San Francisco that were total shutdowns, total closing of all elective surgeries. I know I have a lot of colleagues that suffered tremendously financially, almost at the brink of bankruptcy and collapse as cosmetic surgeons.

And so yeah, that really changed the landscape. Places like Florida, Texas that were opened much faster and allowed surgeons to get back to work on elective surgery quickly allowed surgeons like myself to stay afloat and stay in practice. And so I think a lot of patients came to places like Florida and Texas to have surgery. But yeah, a huge percentage went abroad. They left the US because of that.

I want to get to the regulations now. So how do the regulations and standards of care for cosmetic surgery vary between different countries, and how can patients ensure they’re receiving high quality care when traveling abroad?

Yeah, so the most rigorous board examination in the world, I would argue is the American Board of Plastic Surgery. And the most rigorous medical training in terms of even just based on years of training is the United States. I mean, we are for the most part, held as the gold standard for medical education across the world. I mean, many countries that don’t even speak our language use our textbooks to teach their students and teach their residents.

So when you’re dealing with a board certified plastic surgeon in the United States, I really can’t, I really don’t have a handle on how we’re able to compare that type of surgeon to a surgeon in another country. I don’t know their rules and regulations honestly, regarding their medical education. I know that many countries in Latin America have a system whereby, you know, you go straight to medical school out of high school. You don’t go through four years of college or university, and then an additional four years of medical school and then an additional five or six years of residency. They shorten and they condense all of that time significantly. And so in that regard, again, I don’t think that the level of expertise is the same or even the level of experience. You can’t say you have the same level of experience.

And then the other aspect of it is the regulations regarding facility management, cleanliness of the operating rooms. I mean, we have some very, very strict accreditation agencies in the United States regarding OSHA, regarding all types of workplace environment stipulations. So I mean, I personally, and I’ve been in operating rooms in many different parts of the world, and I’ve never felt that they were at the level or above of those that I’ve operated on in the United States.

And that kind of gets into my next question. Can you just discuss the importance of having a qualified plastic surgeon, a board certified plastic surgeon, why that’s so necessary for patients? Because I don’t think they always know that.

No, I think it’s a struggle. I think that even though we try to educate every day about it, I think that just the word board certification, it’s like they just check that box and they move on. But I don’t think people really understand how rigorous it is, the examination process. I mean, we’re put through a very, very difficult three day grueling oral examination process, where all of the cases that we did during the last year are scrutinized by a group of some of the most qualified academic plastic surgeons in the country, and they put you through the ringer. I mean, they put you through the grind, and they will fail you either for lack of ethics, for improper billing, the way you bill your patients, how you document your surgical technique, your complications, how you managed your complications.

That’s actually one of the biggest parts of the exam is everybody has complications, but what did you do? How did you fix the problem? How did you follow up with the patient? How responsive were you? How did you document everything? That really sets us apart from, for I think even a lot of other specialties, I’ll argue, in terms of how rigorous the training is and how rigorous the examination is.

Yeah, definitely. I mean, that’s a very important message for this industry, I think. So for our last question, how can plastic surgeons work to raise awareness about the risks of unregulated cosmetic surgery practices in foreign countries? What can you all do to change the narrative?

Yeah, it’s funny because on social media it’s kind of a double-edged sword. And I’ve had this experience personally where I’ll say, “Hey, be careful going to X, Y, or Z country. We’ve been seeing infections of this type of bacteria coming back into US.” And then some people kind of comment on the threads and say, “Oh, but why do you have to knock going to other places?”

I’m not knocking anything. I’m not trying to say that those places may not have good surgeons or that, you know, you may not have a good outcome. It’s just that there’s a serious concern that if you do go abroad, that what happens if something serious were to happen over there, number one, and if you get back and you have a serious problem, then what are you going to do and how much are you going to have to come out of pocket for?

So I still think that as surgeons, we have to do a better job, I think of educating our patients and our citizens in the US about the dangers of going abroad. But we also don’t want to come across as being elitist or that we’re the best in the world and everybody else’s subpar and all that, because then we get into this tit-for-tat with a lot of patients that may have had a good experience abroad. So it’s a dicey, it’s a touchy subject to be honest with you.

No, thank you. Well, this was very informative. And just to our listeners, be sure to check out Dr. Zuriarrain’s article on the Plastic Surgery Practice website. Until next time, be sure to subscribe to the MEDQOR podcast network. To be alerted to future episodes and to keep up with the latest plastic surgery news, visit plasticsurgerypractice.com. Until next time, take care.