Oct 07

I still don’t know the source of the infections that caused the Center for Disease Control and the U.S. State Department to warn against cosmetic surgery in the Dominican Republic in 2004. I don’t know the names of the patients; I think it would be very hard to find those out. Their privacy would be protected by both the CDC and their doctors.

But there has been no such outbreak since that time, or I almost certainly would have heard about it. In:

Chapter 2 Page 4 | Sticks and Stones

… I kind of closed the circle on that story, as much as I could. Good doctors and surgeons everywhere agree on fundamental practices that impact patient safety. Surgery, almost by definition, is not 100 percent safe. Even good surgeons can have poor or even disastrous results on occasion, despite every effort to reduce the likelihood to zero.

Patients take risks. They sign a lot of papers before undergoing surgery in which they acknowledge risk. They do their own part to minimize risk by informing themselves about what to expect; by preparing their minds and bodies for surgery; and by choosing a good doctor and surgeon. That is a lot of what Beauty from Afar was (and is) about: patient choices, and how to make good ones. I included the lengthy segments about the Dominican Republic because the story illustrates so many aspects of medical travel. In the end, I draw a different conclusion than did New York City officials, or the U.S. news media. I would not tell anyone not to go to a particular country for surgery. Tens, even hundreds of thousands of patients have gone to the Dominican Republic … or to Mexico, Costa Rica, Brazil, Columbia, Thailand, Malaysia, etc.  for cosmetic surgery in the last five years and have been happy with the results and the price.

And a few have gone and have been unhappy, or worse.

Tagged with:
Oct 07

Chapter 2 Page 4 | Sticks and Stones

On one side, we have U.S. doctors and public officials issuing a very real warning: don’t go out of the country for plastic surgery, especially to the Dominican Republic. On the other side, we have the trained medical establishment of the Dominican Republic arguing that they have been unfairly vilified for competitive reasons and with ignorance of the true state of affairs in the country. It would probably pass for journalistic fairness these days if I simply let representatives of the two views slug it out. I have certainly talked to earnest, well-spoken, successful, well-known surgeons who can do just that.

Lost in the shouting, likely, would be the common ground. I could choose a top, board-certified cosmetic surgeon in the United States and a top, board-certified surgeon in the Dominican Republic or another country and wager that they would agree on the following:

  • Schooling, training, and board certification processes are substantially similar. In fact, they are so similar among the United States and other countries with modern medical schools, teaching hospitals, and national peer oversight that a discussion of the differences would only be of academic interest.
  • There are similar personal standards for operating facilities, regardless of what national board is responsible for certifying the facilities.
  • No patient should undergo a cosmetic procedure without fully understanding the risks and having a realistic estimation of the outcome.
  • Cosmetic and aesthetic surgery should only be performed by fully trained, experienced professionals such as themselves.

It is easy to browse the World Wide Web and find successful, board-certified plastic and cosmetic surgeons with lengthy and impressive resumes and glowing recommendations from grateful patients. The only significant difference you will find among the surgeons are geographical location — and price. Both are important factors to a patient.

The attention the don’t-go-to-the-Dominican-Republic-for-cosmetic-surgery scare drew in 2004 and 2005 shows that there is controversy and confusion about medical tourism, in general, and cosmetic surgery, in particular.  The story also added credence to the notion that traveling out of the country for cosmetic surgery is a phenomenon, not an aberration. A dozen or a few dozen serious infections, while disastrous for the individual patients and alarming and confounding to their doctors, is completely unsurprising given the number of surgeries performed. In fact, one can be reasonably sure that there have been quite a few more infections than those reported and that there are many more patients who have been less than satisfied with their results.

Choosing even the best, most experienced, and most expensive cosmetic surgeon, whether it be in the United States or abroad, is no guarantee that a patient will heal perfectly. Certainly it must cross the minds of any person who elects to have cosmetic surgery that there is at least a small chance that he or she will be disfigured or will die. There is a somewhat greater risk that someone will simply be dissatisfied, to some degree, with the results. Top U.S. plastic surgeons complain that too much of their time is spent fixing the poor work of others from the United States and abroad. However, top surgeons in other countries make the same complaint.

The bottom line is that the Dominican Republic scare story made it manifestly clear just how price-sensitive the cosmetic surgery consumer market is. In the minds of an increasing number of consumers, the difference between a $3,000 tummy tuck overseas and a $7,000 one in the United States is, simply, $4,000; and the $4,000 represents not a cost of quality assurance but a cost some people are either unwilling or unable to bear. The fact that the story did not hurt the cosmetic surgery business in the Dominican Republic much, if at all, says that traveling abroad for inexpensive cosmetic surgery is not a fad any more than cosmetic surgery itself is. If the price is right, Americans will shoulder some inconvenience, bear some uncertainty, and weigh risk when considering their medical and health-care options. They are doing it for cosmetic surgery. In lesser but growing numbers, they are doing it for other kinds of medical care, too.

(Next)

(Previous)

Tagged with:
Oct 06

Today, we continue the short saga of the U.S. and its media vs. cosmetic surgery in the Dominican Republic in 2004.

Chapter 2 Page 3 | A warning lives on, mostly unheeded

When I was writing Beauty from Afar, I remember being somewhat concerned about the fact that I was saying that the U.S. State Department was still warning in 2006 against having cosmetic surgery in the Dominican Republic based on a 2004 CDC report … surely, I thought, that warning will be taken down at some point in time.I was careful to note the time element.

I needn’t have been concerned on that count, anyway. The warning is still up in 2009.

In this passage, I quote Dr. Roberto Guerrero. I remember the conversation well and regret that I never have gotten to meet him in person. His web site isn’t in the book. I see he can now be found at PlastiCenter: New Concepts in Plastic Surgery.

Tagged with:
Oct 06

Chapter 2 Page 3 | A warning lives on, mostly unheeded

The costs for common cosmetic surgery procedures in the Dominican Republic are roughly 40 to 70 percent less than they are in the United States. Dominican surgeons, particularly members of the Society of Plastic Surgery, felt that they were under assault by the U.S. media, by U.S. doctors, and by U.S. politicians because of their success in attracting U.S. patients. They thought that their skill and medical facilities had been unfairly maligned.

Their suspicions were raised by the fact that their statement went unreported in The New York Times or anywhere in the United States and that the initial story lived on in news releases and through references in other stories. As of January 2006, the U.S. State Department was still posting a warning on its travel advisory for the Dominican Republic:

The U.S. Embassy in Santo Domingo and the U.S. Centers for Disease Control and Prevention are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s Web site contains further information for all patients seeking elective surgery overseas at http://www.cdc.gov/travel/other/elective_surgery_2004.htm.

Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgery (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

A similar report posted on the CDC’s Web site had been taken down months before, but the scare lived on. I assumed that business for plastic surgeons in the Dominican Republic had to have gone down the tubes. Negative publicity is bad enough when it involves a single doctor but the Times’ story was directed at the cosmetic surgeons and doctors of an entire country! What damage did it do to the country’s cosmetic tourism business? Surely, I thought, it had slowed to a trickle.

Not so.

If anything, business is better, Roberto Guerrero, M.D., of Santo Domingo told me a year after the story was published. Dr. Guerrero is a plastic surgeon who trained under Brazil’s Ivo Pitanguy, M.D.; it is a credential most U.S. plastic surgeons would love to have. “People heard more about us, about what we do. If anything, the story helped us.”

Dr. Guerrero, in a lengthy phone interview, defended the quality of surgery and the facilities available in the Dominican Republic. There are roughly 60 board-certified surgeons, and the requirements for certification are every bit as stringent as in the United States.

“The infections — they can happen anywhere. They happen in the U.S.,” he said. “We have doctors here who are not board-certified, who do cosmetic procedures … and you have that in the U.S. as well.”

But by then, Dr. Guerrero was telling me what I already knew — that there are supremely talented cosmetic and aesthetic surgeons working in the Dominican Republic in modern facilities, just as there are in Brazil, Costa Rica, Argentina, Mexico, and, of course, in the United States, and around the rest of the world. Like one woman told the Times: “There are good and bad doctors everywhere.”

(Author’s note: The CDC Internet page cited  above no longer exists in 2009. However, the State Department warning about cosmetic surgery is still up, here; and the dated CDC report lives on, herefive years later.  My guess is that it is a bureaucratic nightmare to get the State Department to remove such information.)

(Next)

(Previous)

Tagged with:
Oct 05

News coverage can make — or break — the medical travel business of a doctor, a hospital or even a country. Reports of poor health care abroad — or reports of bad results in otherwise good health care — can have a significant impact on medical travel decisions.

One can imagine that the news media coverage in 2004 of illnesses allegedly connected to cosmetic surgery done in the Dominican Republic might have led to a significant decline in the number of people going to that country for procedures.

Chapter 2 Page 2 | News Gets Around

As I  have noted, however, the story was short-lived and in this particular case, may have done more to publicize the availability of inexpensive cosmetic surgery in the Dominican Republic than it did to convince prospective patients of danger! More on that in the next post …

Tagged with:
Oct 05

Chapter 2 Page 2 | News Gets Around

The story certainly got my attention; At the time, I was in the early stages of research for this book. And I was appalled. The Dominican Republic was not on my short list of countries to write about. In fact, I knew next to nothing about it.  “I guess I won’t be suggesting people go there for surgery,” I said to a friend. “People really will think I’m crazy.”

I waited for a follow-up story …  that never came. No lipo-tourism sales network was closed down or even investigated; no beauty parlor operators were arrested. The story vanished from the news. It only resurfaced as a reference point anytime a reporter did a story about traveling abroad for plastic surgery.

It wasn’t until a year later that I had the opportunity to personally talk to some Dominican doctors about the story, and find out that the Dominican Society of Plastic Surgery had issued a statement refuting the allegations. It never made it into the New York Times. The only reference I could find was reported in the Dominican Republic news. I was able to find it on a Dominican Web site:

The president of the Dominican Society of Plastic Surgery, Julio Pena Encarnacion, says that there has not been a single case of skin infection in the Dominican Republic similar to the 11 patients from New York who have lodged complaints after having operations here. The cases, which are being investigated by a team of plastic surgeons and Public Health Ministry officials, resulted in abscesses and cutaneous [skin] rashes near the area on which the surgery was performed. Pena Encarnacion said that the cause of the infection could be related to the water used, the sterilization of the instruments, or the piercings or lesions resulting from treatments carried out in beauty parlors. Yesterday, anesthesiologist Ariel Perez said the reports are due to fear of competition in the plastic surgery field in the Dominican Republic. Pena was cautious when referring to the competitive zeal as being the motive for the grievances. As reported in [the newspaper] Diario Libree, he said:

“It could be a result of the competition because of the professional quality services being rendered here, but in the end, each patient opts for the physician they consider to be the most trustworthy.”

Pena mentioned that it is not only Dominicans living abroad who travel to their home country to have surgery, but also foreigners from the United States, Puerto Rico, Venezuela,  St. Thomas,  Argentina,  Switzerland and the Netherlands.

(Next)

(Previous)

Tagged with:
preload preload preload

© 2009-2014 Beauty from Afar All Rights Reserved