Out of the Country Plastic Surgery: Although Less Expensive, Is It Worth the Risk?

The practice of medical tourism, where patients seek medical care abroad, has experienced a significant increase in recent decades, leading to an annual market value of over $100 billion. In the past, those from less-developed nations typically sought medical care from wealthier countries, but this trend has reversed. Patients from rich nations, including the USA, seek affordable surgeries in lower-income countries. Consequently, the facilities in these destinations have expanded to meet the rising demand.

Aesthetic surgery is one area of medical tourism that has experienced significant growth; because elective procedures often require out-of-pocket payments, they are well-suited for medical tourism. This trend has led to the development of a specific industry subset that supports cosmetic surgery tourism, impacting patients and U.S. physicians. Over 80% of American plastic surgeons have had experience with patients who traveled abroad for cosmetic procedures, and this number is expected to continue growing.

This blog from a Board-Certified Palm Beach plastic surgeon explores why many patients choose to have plastic surgery overseas and the risks to consider when consulting plastic surgeons in other countries, as evidenced by a 2022 study from the National Library of Medicine.

Why Do People Go Out of the Country for Plastic Surgery?

Surgery abroad is increasingly appealing to patients due to its perceived affordability, shorter wait times, and familiarity with the host country. In some cases, comprehensive packages arranged by the surgical center in the destination country include medical treatments, flights, and hotel accommodations. Travelers often find aesthetic surgery centers in popular tourist destinations that provide elective procedures at discounted prices.

What Are the Dangers of Plastic Surgery Abroad?

The vacation-like experience may come with costly complications upon returning home, and patients may receive limited support from the original surgeon. Countries with lenient regulations, little counseling before surgery, and truncated postoperative care may amplify risks. Research has shown that patients who seek care abroad often require follow-up treatment for complications in their home country due to short stays and lack of adequate follow-up care.

When considering traveling to another country for medical treatment, know the risks associated with the destination and the procedures involved. While the stakes may vary, some general issues include:

1. Communication Challenges: Seeking care at a facility where you are not fluent in the language can lead to misunderstandings about your treatment.

2. Medication Quality Concerns: Counterfeit or substandard medication may be more prevalent in certain countries.

3. Antibiotic Resistance: Resistant bacteria, which pose a global health issue, could be more widespread in other countries compared to the United States.

4. Increased Risk of Blood Clots: Flying after surgery increases this risk.

To make informed decisions, you must carefully consider these factors before traveling to another country for plastic surgery or any cosmetic procedure.

What Do I Need to Know About the National Library of Medicine Study, Complications of Aesthetic Surgical Tourism Treated in the USA: A Systematic Review?

To comprehensively analyze the complications of aesthetic surgical tourism, the National Library of Medicine conducted a thorough review using reputable databases such as Web of Science, Cochrane, Embase, Scopus, and PubMed. The study focused on articles written in English and included detailed reports of complications experienced by patients who received postoperative care in the USA after undergoing cosmetic surgery abroad. To ensure accuracy and reliability, two reviewers independently screened the articles for eligibility, with a third reviewer available for conflict resolution. The study carefully extracted and analyzed critical information such as patient demographics, procedure details, and outcomes.

Results

Ultimately, the study included 20 articles published between 2008 and 2021 reporting complications experienced by 214 unique patients.

Each article included an average of 12.55 patients, with nine pieces comprising single-patient case reports. Most patients (97.1%) were female, 1% were male, and 1.5% identified as transgender females. Some patients identified as Hispanic and had various ethnic backgrounds, including Dominican, Colombian, Laotian, Puerto Rican, and Mexican.

The study revealed that surgeries occurred in thirteen countries: 82.7% in the Dominican Republic, 4.2% in Mexico, and 3.7% in Colombia.

Most Common Surgical Procedures

According to the study, the most common cosmetic procedure was abdominoplasty (35.7%), followed by breast augmentation (16.3%) and foreign body (free silicone or unknown substance) injection of any region (6.2%). The authors point out that surgical procedures were not mutually exclusive.

Complications

The report identified various complications among patients, including:

• Infections
• Wound dehiscence (meaning an incision reopened)
• Granulomatous (inflammation) complications
• Cosmetic complaints
• Seromas (accumulation of clear fluid under the skin)
• Thromboembolic (blood clot formation in the vein) events

Two patients experienced retained foreign objects. Infectious complications, such as surgical site infection and abscess, were exclusively reported in thirteen papers. Furthermore, eleven studies reported non-tuberculous mycobacterial infections, which were treated with extensive operative debridement and long-term antibiotics.

Treatments

The time it took for patients to arrive at a clinical facility after undergoing surgery in an overseas location varied. However, noteworthy studies examined mycobacterial infections and reported delays in diagnosing these infections. Furthermore, when patients sought an examination and evaluation at multiple hospital emergency rooms, they experienced delays in diagnosis. In one specific case, numerous plastic surgeons rejected a patient before the patient finally received surgical treatment.

Nearly 37% of patients had to be admitted to the hospital for treatment after an overseas procedure. One study comparing the average length of stay for patients with conservatively managed infections versus surgically managed infections showed that the surgical group had a shorter length of stay (8.8 days) compared to the conservatively managed group (13.4 days), suggesting that surgery may result in a quicker recovery time for patients with infections.

Over half of patients undergoing treatment required surgical intervention for various purposes, such as removing foreign objects, reconstructing breasts, and repairing ventral hernias. Furthermore, many patients experienced unwanted cosmetic outcomes, including deformities, dissatisfaction with their appearance, and noticeable scarring.

In the studies analyzed, therapy for patients lasted longer than two months, with some individuals requiring treatment for up to a year due to repeated surgeries or extended antibiotic therapy. Six studies reported adverse reactions to antibiotics, including hearing loss, nerve damage, and kidney problems. Complications from these antibiotic treatments included severe gastrointestinal issues, hearing impairment, and the additional expense of prolonged intravenous infusions.

Cost of Treatment and Insurance Coverage

Complication management costs varied significantly, with an average price of $15,083 and a maximum charge of $154,700 for a single patient. Of the 117 patients with available insurance information, 59% had Medicaid, 21% had commercial insurance, 9% had Medicare, and 11% had no insurance. Sadly, one patient reported losing their home due to the financial burden caused by their medical situation.

Study Summary and Projected Outcome from Overseas Aesthetic Plastic Surgery

The study found that the Internet has facilitated the medical tourism trend by providing patients with information about foreign hospitals and advertising discounted aesthetic surgical procedures. The COVID-19 pandemic and the shutdown of elective procedures in the U.S. have also sparked interest in cosmetic tourism, as evidenced by increased inquiries for elective surgery abroad in Ireland. However, as the number of patients seeking care abroad grows, so does the number of complications they experience upon their return to the U.S.

While seeking aesthetic surgery abroad promises confidentiality and cost savings, no one should ignore its accompanying challenges and potentially dire consequences:

• Medical records may be unavailable
• Health standards may be less stringent
• The overall quality of care may not be optimal

U.S. physicians then grapple with the management and costs associated with treating complications that arise after the patient returns home.

As the demand for medical tourism grows, patients and physicians must be aware of the potential risks and challenges to guide decision-making and ensure the best possible outcomes.

Infections: A Significant Portion of Patient Complications

The study found that infections caused a significant portion (50.9%) of the complications—a risk of undergoing surgery abroad. Specifically, mycobacterial infections, which rarely appear in the United States, were a notable complication of medical tourism due to the lack of proper sterilization of surgical instruments and contaminated tap water in destination countries.

U.S. physicians face a formidable challenge in diagnosing these infections because they are unfamiliar with the signs and symptoms, and routine cultures may not show much growth, resulting in delayed care. Treating mycobacterial infections can be particularly difficult for patients with weakened immune systems or pregnant women who cannot take certain antibiotics. Even if a patient has a compassionate doctor in the United States practicing according to the Hippocratic Oath, the treatment often involves long and intensive antibiotic regimens, which can have adverse effects. It's particularly concerning because the affected population is of childbearing age.

Study Conclusion

Research reveals significant risks associated with medical tourism. Complications can lead to severe consequences like extended treatment periods, disfigurement, and financial hardship. One patient even described it as the "worst experience of my life." A survey revealed that most patients would not choose to undergo surgery abroad again.

While cosmetic surgery abroad may seem appealing, patients should carefully consider the inherent risks and seek reputable facilities.

What Should You Do to Prepare for Plastic Surgery Abroad?

Before undergoing any procedure abroad, thoroughly research and verify the qualifications of the healthcare providers performing the procedure and the credentials of the facility where the procedure will occur. Because healthcare standards can vary across countries, check if the facility is accredited by reputable organizations such as Joint Commission International, DNV International Accreditation for Hospitals, or the International Society for Quality in Healthcare.

Make an appointment with a travel medicine provider at least four to six weeks in advance. They will provide general information for healthy travel and discuss any risks related to your procedure and travel plans.

A written agreement with the healthcare facility or the group facilitating your trip is crucial. This agreement should clearly define what the cost of the trip covers, including treatments, supplies, and care, to ensure transparency and prevent misunderstandings.

Take detailed precautions for your health and safety, especially if you do not speak the language. Planning how you will communicate with your doctor and others involved in your medical care is crucial.

Before departing, obtain copies of your medical records, including any relevant lab and study results related to your condition and a list of allergies you may have. Bring copies of your prescriptions, including brand names, generic names, manufacturers, and dosage information.

Ensure that your current medical conditions are well controlled and inform your regular healthcare provider about your intentions to travel for medical care overseas. They can provide appropriate guidance or support when you tell them about your plans.

Arrange for follow-up care with your local healthcare provider before leaving to secure proper support and guidance upon your return.

Before engaging in any vacation activities, such as sunbathing, drinking alcohol, swimming, or taking extended tours, consult your healthcare provider to determine if these activities are permissible post-surgery.

Finally, obtain copies of all your medical records before returning home to ensure continuity of care.

Choose Palm Beach Plastic & Cosmetic Surgery in West Palm Beach, FL, for Your Plastic and Reconstructive Surgery

While the demand for plastic surgery abroad—including facial plastic surgery, body contouring, tummy tuck, breast lift, breast surgery, facial rejuvenation, and other services offered by a cosmetic surgeon—continues to increase, seek the best plastic surgeon in Palm Beach, rather than travel out of the country. As the study we cited indicates, there are too many downsides to your overall health and finances.

Are you seeking an amazing surgeon who can give you natural results using the latest techniques for the best possible outcome? Led by Board-Certified Plastic Surgeon Dr. Fredric M. Barr, M.D., F.A.C.S., one of the top plastic surgeons in Palm Beach County, Palm Beach Plastic & Cosmetic Surgery has provided consistently beautiful results while prioritizing patient safety. In his over 33 years in medicine, Dr. Barr has practiced the philosophy of "less is more" while delivering exceptional results. His commitment to artistry and ability to listen with empathy to his patients has attracted patients throughout Florida, the United States, and the world. We welcome out-of-town and out-of-the-country patients; our patient testimonials speak for themselves.

The entire staff at Palm Beach Plastic & Cosmetic Surgery shares the mission of providing remarkable patient care to ensure safety and enhance natural beauty. Our patient counselor will listen to your concerns and goals during a consultation to help you choose the right procedure. Contact us at (561) 833-4122 or complete our online form to schedule an appointment.