Heading overseas for cosmetic surgery? Here’s what you need to know.

Three main factors drive Australians and New Zealanders to seek cosmetic surgery overseas: lower surgical costs, aggressive advertising by overseas providers, and ease of access to a range of cosmetic surgeries.

Cost: The cost of cosmetic surgery overseas is often significantly lower than in Australia and New Zealand. This is largely due to minimal or absent regulations around minimum wage, workers’ rights, and working hours in some countries, which reduces labour costs. Surgical materials and equipment may also be cheaper, especially where regulations are relaxed or allow the use of imitation products. In contrast, Australian surgeons must use TGA-approved products, which ensure safety and effectiveness but add to the cost. A lower cost of living in many countries also reduces expenses related to transport, supplies, and healthcare infrastructure, further driving down surgical prices.

Advertising: Australia has very stringent regulations associated with cosmetic surgery advertising, which limit how surgeons can promote their services or educate the public. International providers are often not subject to the same restrictions, allowing them to advertise freely and aggressively. This may lead to patients being unaware of the risks involved in overseas surgery compared to regulated procedures in Australia.

Ease of access: Australia is currently the only country in the world with formal regulatory safeguards for cosmetic surgery patients. These include mandatory steps such as a referral from a GP, two preoperative consultations, a body dysmorphic disorder (BDD) assessment, financial consent, and a seven-day cooling-off period before booking surgery. 

Overseas, such safeguards are often absent, making procedures more efficient, accessible and affordable, even when they may not be clinically or ethically appropriate. In Australia, the decision to offer surgery is guided by a surgeon’s ethical obligations and evidence-based practice, supported by a strong culture of mentorship, training, and regulation. This level of oversight and care may not exist in other countries, increasing the potential risks to patients who don’t have a surgeon willing to say ‘no’ if the procedure isn’t safe or right for them.

How common is overseas cosmetic surgery?

Accurate numbers are hard to determine, as overseas procedures aren’t recorded as systematically as they are in Australia or New Zealand, where surgeries and breast implant use are logged in national databases. However, a large international study estimated that Australians spend around $300 million a year on cosmetic surgery tourism, with approximately 15,000 people travelling overseas annually for procedures.

Is overseas cosmetic surgery becoming increasingly common?

Before the COVID-19 pandemic, Australia and New Zealand were seeing increasing rates of people travelling overseas for cosmetic surgery procedures. While these rates plummeted between 2020-2022 due to the effects of the pandemic, cosmetic tourism has since picked back up again. The most popular destinations for Australians and New Zealanders seeking cosmetic surgery overseas are South East Asian countries, such as Thailand, and more recently, Turkey.

Are there any benefits of going overseas for cosmetic surgery?

Some argue that the benefit of undergoing cosmetic surgery overseas is that certain culturally specific procedures, such as double eyelid blepharoplasty in Asia, are performed more frequently and with greater expertise in these regions. However, this argument is weak, as Australia and New Zealand’s plastic surgery training program is extremely robust with training in a wide range of surgical techniques, including those considered culturally specific. In fact, most Australian and New Zealand plastic surgeons complete an additional year of fellowship after their qualification, often overseas, to refine specific techniques and develop subspecialty expertise. It’s a testament to the expertise and diversity of Australia’s cosmetic surgery industry that many international surgeons who complete fellowships in Australia have commented that the Australian program is among the most comprehensive and broad in the world.

What are the risks of overseas cosmetic surgery?

Having cosmetic surgery overseas carries significant risks that often outweigh the lower costs.

• Air travel shortly after surgery significantly increases the risk of blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). In Australia and New Zealand, patients are advised not to fly for 6–8 weeks post-surgery for this reason.
• Overseas facilities often lack the strict safety standards, accreditation, and hygiene protocols required in Australia, where we have one of the most stringent healthcare regulatory frameworks in the world. Australian clinics must meet national standards for equipment, qualification of staff, and infection control, whereas many overseas providers are not held to the same level of scrutiny.
• Surgeon qualifications can also vary overseas. Australia’s surgical training is standardised, comprehensive, and includes ongoing education (CPD). In some countries, surgeon titles aren’t protected (meaning you can actually call yourself a surgeon if you are not appropriately qualified as one), and training may be unverified. The same applies to anaesthetists, whose role is critical to patient safety.
• Infection risks can be higher overseas due to local bacterial strains and higher rates of antibiotic resistance. Some regions also have increased prevalence of bloodborne diseases like hepatitis B, C, and HIV. This is particularly risky if a severe complication occurs and blood products are required in an emergency, potentially increasing your risk of life-threatening blood-borne infections.
• In countries where English is not the primary language, language barriers may lead to miscommunication about expectations, risks, and postoperative care, affecting safety and satisfaction. It can also severely impact the postoperative recovery period, where patient-practitioner communication is essential for ensuring good clinical outcomes.
• If patients experience severe complications, they may require sophisticated healthcare support such as intensive care, transfusions and use of blood products, care from specialists from other disciplines (e.g. heart, lung or infectious disease specialists), or, at worst, air-retrieval back to Australia or New Zealand to receive the required care.  Many countries might not have the level of healthcare needed to address the complication, whereas if the surgery was done in Australia, all these services are a phone call away and available locally.
• If complications arise after returning to Australia and New Zealand, the primary surgeons may be unable to provide follow-up care. Many complications emerge weeks later, and revision surgeries, which may occur in up to 7% of cases, may require returning overseas. When the primary surgeon is located overseas, this also severely limits the ability for the patient to receive longer-term follow-up assessments that ensure the best surgical outcomes. 
• In some countries, the surgeon you meet may not be the one who performs your operation, also known as a ‘ghost surgeon’. This is rare in Australia or New Zealand due to the stringent medicolegal framework that all cosmetic surgeons must adhere to.
• Finally, Australia is the only country with mandatory patient safeguards for cosmetic surgery, including psychological assessments, cooling-off periods, and mandatory referrals. These protections often don’t exist overseas, which can leave patients at risk of undergoing surgery that won’t meet their expectations, is unsafe, or where the risk outweighs the benefit.

How significant are the risks of overseas cosmetic surgery? 

The risks of having cosmetic surgery overseas can be serious, and in some cases, life-threatening. From blood clots caused by flying too soon after surgery, to inadequate infection control, unverified surgeon qualifications, and lack of follow-up care, the consequences can be complex and costly. 

Unlike Australia, many countries don’t have strict regulations, safety protocols, or patient protection frameworks in place. Without these safeguards, patients are more vulnerable to unethical advertising, complications, miscommunication, and unsafe practices such as ‘ghost surgeons.’ While not every overseas procedure results in harm, the lack of oversight significantly increases the risk.

How much money can you save on overseas cosmetic surgery? Is the money saved worth the risk?

Australians and New Zealanderws are often drawn to cosmetic surgery overseas due to the significant cost savings, which can be substantial. The savings largely come from lower labour costs, less stringent regulations, and a lower cost of living in some countries. However, these financial savings can come at a price, such as lower surgical standards, inadequate post-surgery care, and increased risks to their health and well-being. While the upfront savings may seem appealing, patients may find that what they saved in cost, they paid for in the quality of their surgical outcomes and, in some cases, their health.

What sorts of things have ASAPS members seen go wrong with overseas cosmetic surgery?

Complications can occur with any cosmetic surgery, regardless of whether it is done overseas, in Australia or New Zealand. However, there are some specific issues that we see in patients who have had surgery overseas:

1. The biggest issue associated with providing care for patients who undergo cosmetic surgery overseas is the lack of information. We often don’t know what techniques were used, what was done during surgery, or what prosthesis/implant was inserted. While some patients have records, most do not, and obtaining them from overseas can be difficult. This makes it difficult to diagnose the issues causing the complication or decipher the appropriate revision surgery for best results.
2. Delayed presentations are common, as patients often aren’t followed up closely after surgery or their issues have been assessed and managed via telehealth with their overseas surgeon. This means patients tend to present later with complications that might have been managed better if treated sooner.
3. Some infections are caused by bacteria not common in Australia or resistant to multiple antibiotics.
4. Surgical techniques used overseas may differ from Australian and New Zealand standards, making it difficult to assess and address potential issues.
5. Prosthetics, like breast implants, may not be approved for use in Australia or New Zealand due to not meeting our stringent standards. Patients can also be subjected to surgical methods and techniques that may not be evidence-based and thus not associated with long-term cosmetic benefit, or techniques that are out of date and superseded by better surgical alternatives. Australian and New Zealand surgeons must perform to standard, and this means our practice is up-to-date and based on clinical evidence.

How have ASAPS members been able to treat those?

The priority when treating these patients is to ensure patient safety. This may mean dismantling or undoing their cosmetic surgery (e.g. removal of infected breast implants or nose/chin/cheek implants), or performing further surgery to rectify the complication.

Many of these patients are unable to afford private care and further operations, so they are treated in the public system after presenting to emergency departments or consulting their GP. In the public system, we can treat medical issues like infection, bleeding or wound problems, but we can’t redo or revise the cosmetic surgery. For example, we can remove an infected implant but not replace it once the infection resolves.

What is the physical and mental impact on the patient?

Most patients are bewildered and scared when complications arise. They’re often focused on the money already spent and are desperate to preserve their results. Some feel sad or angry, others regretful or ashamed. Many hope to have complications treated and revisions done without further cost.

The physical and mental toll is significant in any surgical complication, but it’s especially stressful after overseas surgery. Their original surgeon is unavailable, and they have yet to establish trust and rapport with the surgeon who is now looking after them. Many feel betrayed and find it difficult to trust their new surgeon as a result. Complications also mean more time off work, often right after the patient has used leave and savings on the initial surgery. All of these things compound the core issue of the surgical complication, making it a difficult situation for them to navigate physically and emotionally.

If someone is considering surgery, what things should they factor in before making a decision?

Start with why: what are your reasons, concerns, and expectations? What do you think surgery will achieve for you?

Then consider when: avoid booking surgery during major life changes, and ensure you have time to recover, ideally with no travel planned for three months.

Next, who: research your surgeon. This is of the utmost importance. Check their qualifications, registrations, affiliations, and meet them in person. 

Then, where: make sure the facility is licensed, accredited, and equipped to manage serious complications if needed. For example, do they have an ICU and a blood storage facility/blood bank?

Finally, ask about postoperative care. Know the recovery plan, understand the instructions, adhere to follow-up appointments, and know who to contact in an emergency.

• If going overseas, what checks should they make?

All the same checks apply to someone seeking surgery overseas as they do to someone seeking surgery in Australia or New Zealand. The problem is that the ‘when’, ‘where’ and ‘who’ become much harder to assess. It’s often difficult for someone outside the country to accurately evaluate a surgeon’s qualifications or the safety standards of a facility without a clear understanding of that country’s healthcare system.

• If staying in Australia or New Zealand, what checks should they make?

If you’re planning to have cosmetic surgery in Australia or New Zealand, you should:

• Check that the facility is accredited and licensed for cosmetic surgery.
• Check that your surgeon is a board-certified plastic surgeon who:
  • Is registered as a specialist plastic surgeon
  • Holds qualifications from the Royal Australasian College of Surgeons (or equivalent)
  • Is a member of the Australasian Society of Aesthetic Plastic Surgeons
  • Complies with cosmetic surgery regulations and ongoing professional development
  • Actively practises cosmetic surgery
  • Upholds ethical standards and professional conduct

You know that your surgeon meets this criterion if they are an ANZBCPS board-certified cosmetic plastic surgeon. The ANZ Board of Cosmetic Plastic Surgery provides annual certification for plastic surgeons who have fulfilled the above criteria. Choose an ANZBCPS board-certified cosmetic plastic surgeon to complete your checklist on your cosmetic surgeon.

Any other tips, advice etc

There’s a reason healthcare costs more in Australia; we have some of the world’s strictest regulations and safety standards. Cosmetic surgery is no different. It should be held to the same high standards as any other medical treatment, with robust checks and balances to protect patient safety and ensure quality care. 

‘Buyer beware’ is applicable when considering overseas surgery because it is a business transaction. In Australia, you are a ‘patient’ because cosmetic surgery is considered to be part of healthcare, subject to the laws, regulations and standards of any other medical treatment. This isn’t the case in many other countries; patients must understand that they will be sacrificing stringently standardised quality healthcare when they undergo cosmetic surgery overseas.