by Michael Yaremchuk, M.D.
Medical tourism is an established element of the international medical landscape. The major incentives for patients travelling abroad for plastic surgery are access to otherwise unavailable or perceived superior care, cost and, sometimes, a pleasant, vacation-like environment for early recovery. If all goes as planned, the treatment and recovery occur over a relatively short period — perhaps a one or two-week vacation.
But buyer beware: Plastic surgery tourism is a reflection of both the best and worst of our global society.
With easily accessible information and communication provided by the Internet, the savvy patient can find procedures that might be otherwise unavailable to them or a surgeon who has recognized expertise in the procedure they desire. If the cost is less and the environment is desirable, so much the better for the patient. If all goes well, as it usually does when patients do their homework and the objective is quality, everyone wins: Patients are rewarded for doing their homework and surgeon’s are rewarded for their expertise.
Yet, too often, and probably more often than we can document, the incentive for plastic surgery tourism is cost alone.
You get what you pay for.
Buying plastic surgery is not like buying a new car. A new Cadillac sold in New Haven is structurally no different than one sold in Providence. If you can get a better price in New Haven, all things being equal, why not go with the better price?
But when you are purchasing plastic surgery you are purchasing the unique training, expertise, experience and the commitment of the plastic surgeon.
We have only anecdotal data regarding the quality of plastic surgery performed on patients who leave the United States for plastic surgery. We are unable to calculate the rate of complications from these surgeries because we lack the necessary data. There is no registry for patients who suffered complications from surgery performed offshore.
However, personal experience would suggest that the incidence of complications is not insignificant. We have seen six patients in the last 3 months who have had complications from previous surgeries. Almost without exception, these patients did not know of the qualifications of their surgeon or the surgical facility: There was no informed consent, no records, no mechanism to contact the surgeon post-op. These patients who have had complications after elective cosmetic surgery often have no insurance and their complications are treated without payment to the hospital or physician.
Researchers reported a series of 8 U.S. residents who, in a 2 year period, were infected with Mycobacterium abscessus after having undergone body contouring (liposuction) procedures in a clinic in the Dominican Republic. By comparison, there were no reported incidences of Mycobacterium abscessus infection among 230,000 operative procedures over a 5 year period at the Columbia Presbyterian Hospital in New York. This suggests that the known cases of complications in offshore procedures is just the tip of the iceberg.**
When seeking treatment in the US, remember that a plastic surgeon’s membership in the American Society of Plastic Surgeons (ASPS) or American Society for Aesthetic Plastic Surgery (ASAPS) assures an appropriate level of training, competence and ethical behavior.
Many of our offshore colleagues have obtained memberships in these societies based on their accomplishments in their own countries. The International Society of Aesthetic Plastic Surgery (ISAPS) is developing a program to set certification standards and recognize surgeons’ competency. This should have a significant impact on patients seeking cosmetic surgery throughout the world.