By Alexander Zuriarrain, MD
“There’s no place like home. There’s no place like home.” Those were Dorothy’s words when she clicked the heels of her ruby slippers in the “Wizard of Oz,” but anyone considering undergoing cosmetic procedures outside the United States may take heed.
Authors of a recent study—published in a 2020 issue of the Aesthetic Surgery Journal—contend patients seeking cosmetic improvements abroad can be “lured by lower-cost procedures, shorter waiting lists, and affordable airfare and hotel accommodations” in sometimes spa-like, resort facilities.
“[But] operations are often performed by non–board-certified plastic surgeons, sometimes not even by plastic surgeons. Preoperative counseling, frequently limited to a video chat with an office secretary, provides inadequate discussion regarding potential complications. Postoperative care is careless and rarely involves the operating surgeon. Complications are frequent, with management falling into the hands of plastic surgeons unfamiliar with the patient’s care” after the patient returns to the United States.
Another article, this one appearing in the Journal of Travel Medicine in 2021, indicates the choices medical tourists make “could have significant consequences” for them, as well as for hospitals and health providers in the United States. These consequences can include “post-procedural infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications,” following the return home.
Risks of Surgery Abroad
Unfortunately, little data exists on outcomes and needed, corrective follow-ups of cosmetic procedures performed out-of-country. Authors of a 2021 study in Aesthetic Plastic Surgery reviewed the experiences of 171 patients who underwent aesthetic breast surgery and found record of 222 complications among them, including infection, breast abscess, and ruptured implants. Two patients required a stay in an intensive care unit and even one died.
Even in experienced surgeons’ hands, aesthetic procedures, such as facelifts and contouring to remove wrinkles and the injection of dermal fillers or Botox, pose risks. Potential complications include scarring, infection, allergic reactions, blood clotting, skin death, and damage to nerves that control facial muscles.
Of course, risks are magnified when surgeons who are not board-certified in plastic or cosmetic surgery or who simply lack experience to perform aesthetic procedures do the work. In such instances, patients may be left with permanently scarred skin or skin too tightly stretched from a facelift; a necrotic nose tip following rhinoplasty; oversized lips; and an asymmetrical face. Cosmetic procedures gone wrong also may lead to chronic pain, disfigurement, and death.
Of course, health-related dangers are not the only problems medical tourists face. Surgery abroad has legal implications as well. In a late 2018 article in its medical journal, Plastic and Reconstructive Surgery, the American Society of Plastic Surgeons (ASPS) called medical tourism an “unregulated industry” and stated, in a separate news release, that patients often have limited legal recourse. “Patients may…have signed forms waiving their right to file a lawsuit, including against the medical tourism agency with which they booked their trip.”
Also, establishing jurisdiction against foreign defendants in U.S. courts is difficult, the ASPS indicated in its medical tourism article. “And, even if [patients] manage to file and win their suit, they may find it difficult or impossible to enforce the judgment and collect financial damages.”
“Medical tourism also raises ethical implications, given the inherent risks of surgery,” ASPS authors state in their journal article. “A major question is who will provide [and assume the cost of] necessary follow-up care after the patient returns home?”
Demand for Aesthetic Surgeries on Rise
A 2017 study in Plastic and Reconstructive Surgery estimates 15 million Americans annually seek medical procedures abroad, but the number is likely higher today—in 2023. That is because demand for undergoing non-essential procedures like aesthetic surgery outside the U.S. is increasing at a rate of 15% to 25% a year, according to experts. Mexico, Brazil, Italy, and Japan seem the favored countries for cosmetic surgery, with liposuction, Brazilian butt lifts, breast augmentation, breast lift, eyelid surgery, rhinoplasty, and abdominoplasty topping the list of procedures.
Lower costs for cosmetic procedures not normally covered by health insurance—often 40% to 80% less than what plastic and aesthetic surgeons and surgical facilities might charge in the United States—as well as shorter appointment wait times are key factors driving patients to international locales.
However, the promise of cheaper surgery abroad often proves elusive. The research published in 2017 in Plastic and Reconstructive Surgery followed 42 patients who had traveled internationally for cosmetic surgery and determined that treating postoperative complications among this group averaged more than $18,000. Even worse, eight of the patients studied were dissatisfied with the results of their procedures, and 11 patients indicated they would not go abroad again for any additional cosmetic procedures.
As plastic and aesthetic surgeons, we must do a better job correcting patient misperceptions of the costs of cosmetic procedures and availability of services in this country and explaining to them the advantages of undergoing aesthetic surgery at the hands of highly experienced, board-certified practitioners in the U.S.
Consider the following facts:
- Procedures performed by U.S. specialists with a high volume of surgical experience substantially reduce postoperative complications and achieve results that better meet patient expectations.
- Cosmetic surgery costs vary widely according to U.S. region. For instance, procedures are typically more affordable in Miami than in Manhattan.
- Finding an affordable option in America is simply a matter of doing due diligence. Besides, traveling from one’s home to another region in the U.S. is cheaper than traveling internationally.
- U.S. surgeons oftentimes offer patients “cosmetic health insurance.” That means payment of an affordable fee upfront can substantially reduce a patient’s out-of-pocket costs should a complication occur requiring postoperative treatment.
In summation, plastic and cosmetic surgeons must work with their professional societies, including the ASPS, to further patient education and understanding of cosmetic surgery, its availability, costs, and risks. After all, complications developed because of procedures performed in foreign facilities create a financial burden on the U.S. healthcare system, including hospitals and surgeons.
Most importantly, we must make patients aware that cost should not outweigh quality and safety when it comes to personal health and achievement of a younger, improved appearance.
Alexander Zuriarrain, MD, FACS, is a board-certified plastic surgeon and owner of Zuri Plastic Surgery in Miami. Listen to a podcast PSP did with him here.