Medical Tourism

It started out as an ordinary call. “Dr. Downey, can you help a colleague of mine?” But then the inquiry became anything but ordinary. The patient in question had traveled to Mexico for cosmetic surgery. Now back in Los Angeles she was having complications. The patient’s anxiety level was sky high. She had spent all her available cash on the surgery in Mexico and she had a high deductible on her insurance plan. The first plastic surgeon she had seen had proposed another surgery which was way out of her range financially. Fortunately I was able to hold her hand through several weeks of healing and then do a small procedure to minimize the scarring.

Medical tourism is a term which has been coined by the media to describe a rapidly – growing trend of patients traveling to other countries to obtain health care. Cosmetic surgery tourism is a price driven phenomena. Elective cosmetic surgery procedures are not covered by insurance so cost is the major selling point for patients of cosmetic surgery tourism. In my practice I have noticed that the complication rate or at least the patient’s anxiety over a possible complication is directly related to the distance traveled. How easy it is when a patient calls and says “Is this normal?” To have the patient come in and take a look when they live in the LA area. However if they have returned home many miles away things become much more difficult. Patient’s descriptions can be difficult to understand, emailed photos can be blurry and anxiety levels ride high. Even if I am sure that all is okay and what is being described is a normal or expected part of healing, I never feel as if I can calm the patient down and reassure them over the phone ( not to mention I never feel as confident ) as I would in person.

Some patients on seeing my specialty would then respond “Great now I won’t have scars!” I would then have to explain that plastic surgery is a specialty not a technique and that while plastic surgeons do everything they can to minimize scarring we cannot do surgery without causing scars. Cosmetic surgery as real surgery has risks. These risks may increase when procedures are done while traveling. Infections have been the most common complication seen in patients who have undergone cosmetic surgery abroad. Long flights as well as surgery are associated with increased risk of blood clots and pulmonary embolism. Put together it would seem that the risk is even greater. Standards for physician qualifications, hospital or facility accreditation as well as FDA approvals for cosmetic surgery products or devices are well established in the United States. This may not be true in other countries .Although there are many talented and skilled plastic surgeons throughout the world, it is difficult for patients from outside that country to evaluate the qualifications of a given physician or the facility.

Follow-up care is an important part of any surgical procedure. In the United States the fee paid for a cosmetic surgical procedure covers the postoperative office care. If a patient needs to return to the operating room, the plastic surgeon may absorb the cost or there is even insurance specifically designed to cover complications after cosmetic surgery. Patients who have traveled outside the United States and then experience a complication on their return home may, as my patient did, find themselves facing additional costs which can be substantial. In addition it can be difficult for the plastic surgeon in the United States to figure out what procedure had been done without any records. Revisonary surgery is rarely as satisfactory as surgery done without complications the first time.

Cosmetic surgery is elective. If one cannot afford the procedure then it should be put off until one is in a better financial position. If a patient does consider doing plastic surgery in another country to save money, they should understand the additional risks that they may be undertaking. At the very least I would recommend budgeting additional money to cover the possibility of complications. Preferably I would recommend finding a qualified Board Certified Plastic Surgeon close to home, discussing the procedure you are interested in, finding out the cost and then saving money and planning for the surgery. It may take a while but taking unnecessary risks with your health are too dangerous. Safety and quality should not be compromised by cost.