A new survey highlights surgeons’ concerns of cosmetic surgery abroad

A new survey of members of the American Society of Plastic Surgeons highlights the concerns that American plastic surgeons have about cosmetic surgery abroad.

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.

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Keith Pollard
As Editor in Chief of International Medical Travel Journal (IMTJ) and a Healthcare Consultant for LaingBuisson, Keith Pollard is one of Europe’s leading experts on private healthcare, medical tourism and cross border healthcare, providing consultancy and research services, and attending and contributing to major conferences across the world on the subject. He has been involved in private healthcare, medical travel and cross border healthcare since the 1990s. His career has embraced the management of private hospitals in the UK, research and feasibility studies for healthcare ventures, the marketing and business development aspects of healthcare and medical travel and publishing, research and consultancy on cross border healthcare.