Cosmetic tourism (travelling overseas for cosmetic surgery) is becoming increasingly popular due to shorter wait times, less strict regulations, and lower costs, however this trend brings about noteworthy concerns regarding quality of care, expired or counterfeit products, patient safety, as well as poor results and complications upon return to Australia.
Cosmetic tourism companies are advertising to Australian consumers promising a ‘cosmetic surgery holiday’ and that ‘we take medical procedures and surgeries and turn them into your holiday of a lifetime’ but the reality can be very different. All surgery carries risk, whether it is performed in a state-of-the-art facility here in Australia, or overseas. However, there are additional risks that you must be aware of when you choose to have cosmetic surgery, or any surgical procedure overseas.
1. Air Travel increases risk of blood clots
If you are travelling on a long flight for your cosmetic surgery overseas and then flying back to Australia, you need to be aware of the risks of air travel post surgery. Air travel more than 4 hours has been found to increase the risk of developing clots in the leg and lung.
Cosmetic surgery operations like abdominoplasty (tummy tucks), body lifts or large volume liposuction, where your mobility after the operation is limited or restricted, further increases your risk of clots.
During a flight, you are at risk of developing Deep Venous Thrombosis (blood clot in the legs) and Pulmonary Embolism (blood clots travelling to the lungs) as a result of air travel.
Understanding DVT and PE
Deep Venous Thrombosis ( DVT)
This is a condition where blood clots form in the deep veins of the legs. Symptoms can include swelling, pain, and redness. 90% of DVTs are silent and hence have no symptoms.
Pulmonary embolus PE
Is a severe life threatening condition where a clot travels to the lung and restricts blood flow. 90% of patients who have a clot in the lung ( PE) present with symptoms like Pain, shortness of breath that need urgent attention.
Aircraft cabin factors that increase risk of clotting
- Reduced air pressure in the cabin causing low oxygen saturation
- Low humidity in the cabin
Patient factors that increase risk of clotting
- Immobility during the flight
- BMI greater than 30
- Genetic disorders of clotting
- Use of Oral contraceptive pills and HRT
- Smoking
- Surgery
Combining air travel with surgery can significantly increase your risk of clot formation. While Deep Venous Thrombosis is usually not fatal if treated in time, a pulmonary embolism can be a medical emergency, with a risk of fatality.
2. Overseas surgery locations may not have the same standards and quality controls as Australia
When considering cosmetic surgery overseas it is essential to understand the differences in standards and regulations compared to Australia. Here are some key points
Accreditation of Hospital Facilities
All hospitals in Australia have to be accredited for safety and hygiene on a regular basis. There are government mandated safety guidelines regarding cosmetic surgery in Australia, including accreditation of staff, nursing ratios and discharge planning and after care.
The overseas facility may not have the same stringent controls that you see in Australia that may potentially impact your overall quality of care and your outcomes following cosmetic surgery.
Licensing of cosmetic surgery facilities
In addition to this, all facilities in Australia that perform cosmetic surgery must be licensed for cosmetic surgery ensuring a level of oversight and quality control
Aftercare considerations
Post operative care is critical for recovery. Ensure that you have a clear aftercare plan including follow up appointments, essential phone numbers to call for support (English speaking).
3. Overseas surgeon’s do not have the same accreditation process as Australia
In some countries, the training, accreditation and registration requirements to become a Surgeon may be different overseas than in Australia. This can mean that the recommended criteria and standards that a Surgeon has to fulfil to maintain their registration and licence to practise overseas, may vary.
Surgeons overseas may undergo different training and educational pathways that impact their skills and expertise in cosmetic surgery. This can affect the quality of care and aftercare provided.
4. Antibiotic resistant bacteria can make cosmetic surgery dangerous.
All medical procedures have a risk of complications, but surgery specifically carries an increased risk of wound infections and sepsis. If you are in a tropical country, the bacteria and viruses that inhabit that environment will be different to those present in the Australian hospital environment. Since you may not have been exposed to these bacteria during your lifetime, your body may not have had the opportunity to develop natural immunity or antibodies, which puts you at a disadvantage compared to someone who has developed natural immunity from that country. Certain overseas countries have a higher incidence of blood borne diseases such as hepatitis B, hepatitis C and HIV.
What is antibiotic resistance or antimicrobial resistance?
Antibiotic or antimicrobial resistance occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.
Antibiotic resistance is a major problem caused by the indiscriminate use of Antibiotics.
You are more likely to encounter antibiotic resistant bacterial infections overseas, and if you do so, the normal antibiotics will not be effective against the infection. Foreign infections often require mega doses of strong antibiotics to get the infection under control. There is a small risk of the infection not responding necessitating escalation and in some cases, admission to intensive care.
5. Language barriers and communication issues can impact surgery outcomes
There is a potential for misunderstanding and miscommunication due to language issues. In a cosmetic surgery setting this could lead to problems. Most places would have made arrangements for English speaking staff, but it will be different to what you expect here in Australia.
It is equally important that you have access to English speaking staff after the procedure should you have any questions regarding your aftercare.
When planning a surgical procedure, it is of utmost importance that the patient and practitioner are completely aligned on the patient’s wants and needs, to prevent an unsatisfactory outcome.
6. Overseas surgeries are harder, and often expensive to fix should they go wrong.
All cosmetic surgical procedures carry risks. These include both anaesthetic complications and surgical ones such as wound infections, bleeding, sepsis and even death due to complications.
After care, follow up and timely interventions can minimise the risk of complications. But circumstances beyond your control may not make this possible when you are overseas. Sometimes complications manifest a few weeks later, once the patient has returned to Australia, which can make finding specialist care more complex.
Treating complications is expensive. If you require hospital or intensive care admission following your surgery, you are at risk of increased costs. Prior to your travel, patients should ensure that all travel insurance policies cover emergency medical care, and medical retrieval back to Australia. Be sure to check the terms of your travel insurance in fine detail, if the trip is for a surgical procedure.
7. High risk of ‘surgery ghosting” and “ghost surgeons”.
Surgery ghosting is when a surgery is performed by a surgeon different to the one who has consulted you, prior to the operation without your knowledge or consent.
This can happen when the surgeon decides to swap with another practitioner, once the patient is under general anaesthesia, without the patient’s consent, also known as: “Ghosting victim”, “ghost doctor,” or ‘ghost surgery’.
There are a number of reasons why a practitioner may choose to do this, for example, one surgery may be overbooked, or may wish to use a less experienced (and less expensive) surgeon to perform the procedure. This betrayal and violation of the trust is not just unethical, it is illegal and undermines the relationship of trust between the doctor and patient.
In South Korea following the death of a patient in 2016 following jaw surgery partially conducted by a ghost doctor, the Government passed a bill in 2021 in part due to public pressure to install security cameras in operating rooms. The Korean Society of Plastic Surgeons estimated that there were about 100,000 victims of ghost surgery in South Korea between 2008 – 2014. Five patients died during ghost surgeries between 2014-2022 in South Korea.
Dr Naveen Somia, PhD., FRACS, Specialist Plastic Surgeon, is a specialist plastic surgeon and an ASAPS Member with extensive training and experience in his field.
