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Home > Blog > 2011 > Cosmetic surgery “gone wrong”...Is cosmetic surgery tourism safe?

 

Cosmetic surgery "gone wrong"...Is cosmetic surgery tourism safe?

Cosmetic surgery patient and medical staff

A new survey of members of the American Society of Plastic Surgeons highlights the concerns that American plastic surgeons have about cosmetic surgery abroad. It’s a commonly recurring theme within the profession. Back in 2006, in a survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS), 25.4% of respondents considered medical tourism “a dangerous trend” 1. In 2010, the British Association of Aesthetic Plastic Surgeons launched an attack on “botched cosmetic surgery work” carried out by surgeons overseas, based on a “study” of 36 UK plastic surgeons who reported having to correct surgery carried out abroad

In this latest study, a research team from the Nassau University Medical Center in New York distributed a 15-question survey by e-mail to 2,000 active members of the American Society of Plastic Surgeons (ASPS). The results of the study are published in the August issue of the Aesthetic Surgery Journal 2 ($32 to download the full article). Surgeons were asked about their overall experience with patients who had travelled abroad for cosmetic surgery, the types of cosmetic surgery complications they had seen, and the remedial treatment that they had provided on the patient’s return to the USA.

368 members (18.4%) of ASPS responded to the survey. Here’s a summary of the research team’s findings:

  • The majority of respondents (80.4%; 296) had experience with patients who had travelled abroad for cosmetic surgery.
  • They mostly reported seeing one to three such patients in the past five years.
  • Around half (190; 51.6%) reported noticing an increasing trend in the number of patients presenting with complications from cosmetic surgery tourism.
  • The majority of the patients with complications had undergone either breast augmentation or body contouring procedures.
  • More than half of the patients required multiple corrective operations, and at least one patient required over a month of hospitalization in a surgical intensive care unit.
  • The largest percentage of reported complications (31%) was a result of infection.
  • The majority of respondents (83.9%) reported treating patients with complications who had undergone cosmetic procedures by non-core practitioners (i.e., non-plastic surgeons)

The authors concluded:

“Medical tourism is a price-driven phenomenon that often appeals to a subset of patients who may not be educated about the importance of outcomes and complication rates...there is a need for improved public awareness and education regarding medical tourism.”

Is medical tourism safe?

The “is medical tourism safe?” debate is one that the industry itself tends to avoid and some are reluctant to get involved in. I attended a conference in San Francisco a few years back where the organisers had lined up an eminent UK plastic surgeon for a keynote presentation on cosmetic surgery tourism. Unfortunately, the surgeon didn’t quite deliver what was anticipated...what he delivered was slide after slide of graphically illustrated cosmetic surgery disasters, patients whom he or colleagues had treated following cosmetic surgery “gone wrong” abroad . The audience sat back aghast but offered little response to a fairly damning assessment of the industry.

So, how concerned should we be by this latest survey? First, let’s put the survey (and similar surveys) in perspective:

  • Consider who is responding to the survey and how they are affected by cosmetic surgery abroad. If patients leave the USA for cosmetic surgery abroad, it means less income for US plastic surgeons.  So they have a vested interest in painting a negative picture...and creating significant  sample bias.
  • Also , bear in mind the inherent sample bias produced by the 18.4% who responded. Are these 368 members representative of the 2,000 strong membership? Did the 1,632 non-respondents fail to respond because they don’t see cosmetic surgery tourism as a problem and had never seen any evidence of post-operative problems on return to the USA?
  • Complications (and patient dissatisfaction with outcome) occur with all procedures. They are more common with cosmetic surgery than many other procedures. So, complications will occur with patients undergoing surgery abroad. The question is...does it happen more often?
  • Half the respondents reported seeing an increase in patients presenting with complications from cosmetic surgery tourism. But...given that cosmetic surgery wherever it is undertaken creates complications for some patients and given that more people are undergoing cosmetic surgery abroad, you would expect an increase in US surgeons seeing complications when patients return, even if the incidence of complications is the same as within the USA.

A wake up call for the industry?

Nevertheless...the industry will not move forward whilst all and sundry trumpet the “outstanding quality”, “international standards”, “surgical excellence”, “unrivalled expertise”  that seem to be the claims of every cosmetic surgery provider or medical tourism facilitator. Whatever the industry says, many people perceive medical travel whether it’s for cosmetic surgery or for other forms of surgery to carry a significant risk. Gathering and reporting of cosmetic surgery outcome data on an international, comparative and regular basis is a very long way from becoming a reality. It’s difficult enough to make meaningful comparisons of cosmetic surgeons within one country let alone across national borders.

Let’s take breast augmentation, the most common form of cosmetic surgery, as an example. There’s a risk of post operative infection that can last up to two months following surgery. UK cosmetic surgeons say that the post operative infection rate in the UK is well under 1% compared to the figure of 2.5% which was reported in a worldwide study of 10,000 patients. So, they would argue that patients going outside of the UK are running a significantly higher risk of infection...perhaps two or three times the risk. Even if overseas clinics can match the 1% infection rate, it still means that if 5,000 British women go abroad for breast augmentation, 50 will find themselves with a problem...and who is going to help solve that problem?

There are many potential medical tourists who spend  a great deal of time and effort researching the options for surgery abroad but ultimately decide not to pursue it. They stay at home and delay surgery, or pay the domestic rate or decide not to have surgery at all. Fear of what might go wrong and fear of the unknown are the biggest barriers to the growth of medical tourism.

Unless the industry acknowledges these fears, overcomes the credibility gap, and provides solutions to meet the post operative complications which will inevitably occur, it will continue to be open to criticism from domestic medical professionals and their associations.

References


1.   International Society of Aesthetic Plastic Surgery (ISAPS), News Survey. Hanover, NH: ISAPS; 2006.

2. Complications From International Surgery Tourism; Mark M. Melendez and Kaveh Alizadeh; Aesthetic Surgery Journal August 2011 31: 694-697

 


Date published: 15 August 2011


Comments

Comments provided below do not represent the views of IMTJ. Comments will be published 'as is' and will not be edited by IMTJ staff. IMTJ is hosting these comments, and is not undertaking an editorial role. However, it is editorial policy to publish comments that have been submitted anonymously. 

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About me

Keith Pollard

Keith Pollard

I am CEO of Intuition Communication Ltd, a web publishing business in the healthcare sector. Our sites include International Medical Travel Journal, Treatment Abroad, the medical tourism portal, DoctorInternet, the Arabic medical tourism portal and Private Healthcare UK, the UK's leading site for private healthcare services. I am a regular speaker and commentator on medical tourism and the independent healthcare sector.

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Interesting post and thanks for sharing. Some things in here I have not thought about before despite being a fanatic of tourism and having had had several <a href="http://kenyatalii.com">Walking Safaris in Kenya</a>.Thanks for making such a cool post which is really very well written. Will be referring a lot of friends about this.

marion jane (06/03/2012 08:29:44)

This is a good post.....

any maeric (14/12/2011 13:39:39)

Any kind of serious treatment, such as surgery should not be taken aboard. Countries like USA, UK and others have strict regulations regarding sanitary of surgery room and educational requirements. Some of the countries that offer cheaper services do not have the same standards.
Andrey from <a href="http://www.cosmedica.com/">CosMedica</a>

Andrey Smith (21/09/2011 19:09:03)

At Clinic DDr. Heinrich in Vienna/Austria we see and treat a lot of patients from US, Canada and other over seas countries. They travel here for our quality and experience in stemcell breast augmentation, stemcell facelift and other therapies from body own stemcells not for bargaining low fees. And this is how to avoid quality related discussions, all providers no matter where have got to deliver best possible standards in cosmetic surgery. You might check at http://www.ddrheinrich.com

Karl-Georg DDr. Heinrich (17/09/2011 17:51:03)

Great Story. This is why patients should purchase a medical complications insurance policy prior to traveling abroad for cosmetic surgery. http://www.compassbenefits.com/medical_tourism_insurance.html

David Monteiro (18/08/2011 15:14:01)

I am a cosmetic surgery medical tourism provider, practicing in the Philippines. The biggest problem is credentialing of the provider. Here in the Philippines, problem providers include beauty parlor "cosmetologists", high school (or below) level people trained on the job; and physicians without any formal training in surgery, not to mention plastic surgery.

Al Amores (17/08/2011 04:55:12)

I for one was in that audience in 2008 in San Francisco and heard and witnessed that dreadful slide presentation.

I had to have Margaret Ball gag me and tie me to the chair so that I wouldn't burst out expletives and call the presenter out on his sensational portrayal of plastic surgery abroad.

We provide a solution, such that it is... since medicine is not an exact science through our vetting and inspection process. Some of the hospitals which we inspect are put off by our probing questions and requirements to view credentialing files and privileging policies on a specialty-by-specialty basis. If the hospital will not (there is no such thing as "cannot" in this case), we simply don't contract with them. This has led us to perfunctorally bypass many would be and even established medical tourism providers that have been accepted on blind faith by other facilitators via email contracts on the basis that the hospital is "JCI" accredited.

I would offer that site inspections and primary source verification of credentials, training, experience and clinical outcomes at 36 months would help to mitigate these "problems". I would also like to know what kinds of "problems" were included in the 51.6% of the sampling, and how compliant the patients were with post operative instructions, etc.

Maria Todd, MHA PhD (16/08/2011 21:47:52)