(Author’s Note: The ASPS briefing paper referenced below has been revised and augmented with audio and video since 2005. Please visit this page at plasticsurgery.org for current information. However the overall advice remains true to the original briefing paper. If I were preparing a new edition of Beauty from Afar, this section would be rewritten … but would say many of the same things.)

Chapter 2 Page 5 | American Doctors Speak Out

What are the real risks against which to weigh the considerable cost savings? In April of 2005, the American Society of Plastic Surgeons (ASPS) issued a briefing paper that overwhelmingly cautioned against traveling abroad for surgery, though not in the stark terms used regarding going to the Dominican Republic. If one read nothing else, one would conclude that traveling overseas for plastic surgery is a poor idea. In the broadest context, however,the ASPS statement is full of sound advice for anyone considering cosmetic surgery. I offer the entire briefing paper, interspersed with commentary and context.

Cosmetic surgery tourism is a price-driven phenomenon that has experienced increased growth over the past decade. Numerous companies offering all-inclusive vacation packages that include cosmetic surgery are popping up all over the world and can be easily located via the Internet. The offers generally include private hospital services and tout “highly trained” and “credentialed” medical staff. Since elective cosmetic surgery procedures are not covered by insurance, price is the major selling point of cosmetic surgery tourism, with entire vacation/surgical packages costing less than individual procedures in the United States.

This is entirely true. Clearly, however, the ASPS disapproves of cosmetic surgery being a “price-driven phenomenon,” even as its member surgeons continue to work on devising lower-cost, less-invasive techniques and procedures and to compete with each other. U.S. cosmetic surgeons, however, in almost all circumstances, are unable to compete on price with their counterparts in the nip-and-tuck nations of Central and South America and Asia.

Although there are many skilled and qualified physicians practicing all over (the) world, the ASPS cautions that it may be difficult to assess the training and credentials of surgeons outside of the United States. Patients may take unnecessary risks, when choosing cosmetic surgery vacations, by unknowingly selecting unqualified physicians and having procedures performed in non-accredited surgical facilities. The ASPS urges patients to consider the potential complications, unsatisfactory results, and risks to general health that may occur.

Yes, it can be difficult to assess the training and credentials of surgeons outside the United States. Surgeons and facilities overseas that are marketing to prospective patients in the United States, however, have made it considerably easier. Overseas surgeons offer their credentials online, and ways of verifying them are available via Internet and telephone. Prospective patients can consult directly with surgeons and staff from other countries online; references can be provided and evaluated; consultations can be conducted by phone, e-mail, Internet chat, and even via Internet video. Indeed, many ASPS members are building Internet practices in exactly this way to draw patients from around the country and from abroad.

Plastic-surgery professional organizations, no doubt, would agree whole-heartedly that the ASPS certainly can not be faulted for urging patients to consider all possible risks and to be aware of selecting unqualified physicians who operate in substandard facilities. To that I would even add a further cautionary note: People who are considering the option of going overseas for cosmetic surgery, or any other kind of health care, should keep solidly in their minds that they must be ready and willing to walk away from the decision at any point: If they come to believe they have been misled about the surgeon’s expertise, the quality of the medical facility, the procedures involved, the price, or other terms, the right decision in the end may be to walk away. A patient who has done sufficient research is very unlikely to end up in such a position, but one must be mentally prepared to not go through with surgery if one develops serious doubts — even if it means cutting your losses on the expense of traveling there.

Vacation-related activities may compromise patients’ health. Cosmetic surgery trips are marketed as vacations. Although enticing, vacation activities should be avoided after surgery. To properly heal and to reduce the possibility of complications, patients should not sunbathe, drink alcohol, swim/snorkel, water ski/jet ski, parasail, take extensive tours (walking or bus), or exercise after surgery. Yes, some firms are marketing cosmetic surgery as vacation trips, and it is also true that some patients who go abroad allow for some vacation time by arriving early or extending their stays past the period of enforced recovery. Patients can certainly arrange to recover in comfortable, even luxurious, surroundings. But your surgeon abroad is going to tell you the same thing as well. Further, patients should budget extra time at the end of their trips, bearing in mind that complications and infections are possible and that you can not absolutely count on being physically ready to go home on a pre-arranged schedule.

Cosmetic surgery is real surgery. At the highest level of care, every surgery, including cosmetic surgery, has some risks. These risks may increase when procedures are performed during cosmetic surgery vacations. Infections are the most common complication seen in patients that go abroad for cosmetic surgery. Other complications include unsightly scars, hematomas, and unsatisfactory results. Travel combined with surgery significantly increases risk of complications. Individually, long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots.

Traveling combined with surgery further increases the risk of developing these potentially fatal complications, in addition to swelling and infection. Before flying, the ASPS suggests waiting five to seven days after body procedures such as liposuction and breast augmentation and seven to 10 days after cosmetic procedures of the face including facelifts, eyelid surgery, nose jobs, and laser treatments.

All good points, but it is also the same advice you would get from a qualified surgeon in any other country. Patients shouldn’t ignore this advice. I don’t mean to place blame, but far too many cosmetic surgery horror stories can be traced, in part, to patients not following a doctor’s orders for the recovery period.

Travel can be stressful and exhausting, and attempting it too soon after surgery can impede recovery. Despite the ominous tone of this caution, individual surgeons I talked to agree with this sentiment: Follow your doctor’s orders if you want your best chance at a trouble-free recovery. Don’t travel until your doctor says it is safe to do so.

In addition, airlines make special provisions for patients who are traveling with disabilities, and that includes travelers who have had recent surgery. If you have a long trip with flight changes, for example, it may be prudent to call the airline in advance and arrange for wheelchair service.

Follow-up care and monitoring may be limited. Follow-up care and monitoring is an important part of any surgery. Cosmetic surgery vacation packages provide limited follow-up care, if any, once the patient returns to the United States. Patients who have traveled outside of the United States for cosmetic surgery and experienced a complication may find it hard to locate a qualified plastic surgeon to treat the problem or to provide revision surgeries. Local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible. Revision surgeries can be more complicated than the initial operation and patients rarely get the desired results.

In general, this is true and should be considered carefully, especially regarding follow-up care. Some patients are afraid to tell their family doctors what they are going to do, or have already done. It’s best to be as prepared as possible for complications. Many experienced patients recommend consulting with your family doctor before going overseas. Also, reputable overseas surgeons are available for consultation with you or with your doctor at home via e-mail and telephone. This is not a deal-breaker, but it is something to think about.

Bargain surgery can be costly. Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the United States.

Well, yes. That can happen. Bluntly, it can happen in the United States as well, and you’ll be out far more money in the end. Choosing a qualified and experienced surgeon is your best chance at minimizing the risk of bad surgery that can lead to additional rounds of expensive surgery. Good cosmetic surgeons overseas often charge far less than good cosmetic surgeons in the United States. The ASPS cannot really quite get around that fact.

You should ask your surgeon in advance what his or her policies are on revisions, should you be dissatisfied. Some will do revisions for free, in certain circumstances, or for a reduced charge. A cosmetic surgeon’s best advertisement is satisfied customers.

Surgeon and facility qualifications may not be verifiable. In order for cosmetic surgery to be performed safely, it requires the proper administration of anesthesia, sterile technique, modern instrumentation and equipment, as well as properly trained surgeons. Vacation destinations may not have formal medical accreditation boards to certify physicians or medical facilities. Many facilities are privately owned and operated, making it difficult to check the credentials of surgeons, anesthesiologists, and other medical personnel. There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside of the United States. There may be no legal recourse if surgical negligence by the physician or institution occurs.

If the surgeon’s credentials and the quality and standards of the surgical facility can’t be reasonably verified and vouched for, you shouldn’t go. Simple.

As to legal remedies, should a patient be dissatisfied with surgery — or maimed or killed by it — it is true that it is easier and far more convenient to sue a U.S. doctor in the United States than it is to attempt to litigate outside our borders. However, suing a plastic surgeon in the United States is far from a slam-dunk, and reputable surgeons here and abroad are generally willing to extend themselves to produce a happy patient rather than a disgruntled one who will call a lawyer.

Devices and products used may not meet U.S. standards. Cosmetic surgery products or devices used in other countries may not have been tested, proven safe and effective, or been approved by the U.S. Food and Drug Administration (FDA). For example, an implant used in the United States must meet standards of safety and effectiveness, a process regulated by the FDA. Other countries may not have similar regulations.

Patients should, of course, check on what substances are injected and what devices are being inserted into their bodies. However, one of the reasons many American women have gone abroad for breast augmentation is the availability of silicone implants, banned by the FDA in 1992 but popular in other parts of the world. It is possible that silicone implants may again be widely available in the United States because the ASPS says silicone is safe and that the FDA should drop the ban, arguing that patients should have the option of choosing silicone. The ASPS says silicone implants are safe and the FDA, at this writing, seems inclined to allow wider testing. The ban could well be lifted at almost anytime.

(Author’s Note: The ban was lifted in November 2006, five months after Beauty from Afar was published.)

The ASPS briefing paper goes on to name Argentina, Brazil, Costa Rica, the Dominican Republic, Malaysia, Mexico, the Philippines, Poland, South Africa, and Thailand as cosmetic-surgery trip destinations, noting that these countries offer everything from “safari and surgery” to “tropical, scenic tour” vacation packages. It concludes with a useful checklist of questions to ask when choosing a cosmetic surgeon, clearly advocating the selection of an ASPS member. Point by point, however, the briefing paper offers advice no different than one would get from a qualified surgeon overseas — and, the ASPS, however briefly, acknowledges there are many of them.

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