Cosmetic Surgery Times: Cosmetic surgery 'vacations': lurid or alluring for potential patients? Conc

Cosmetic surgery "vacations" overseas are becoming more popular for Americans, who are drawn by low prices and the promise of travel to exotic locales.

But surgeons and other U.S. health officials are worried. While some companies provide a patient referral network and are upfront about doctors' credentials and the services, not all are so transparent. Some are fly-by-night operations, with surgeries performed by unlicensed "cowboy" doctors.

"It's like playing Russian roulette," says Rod Rohrich, M.D., a Dallas-based cosmetic surgeon and member of the American Society of Plastic Surgeons. "I'm not saying all of them are bad, but 'buyer, beware.'"

"There's a reason (certain) places are a lot less expensive," says Michael F. McGuire, a Los Angeles-based surgeon and chair of the American Society for Aesthetic Plastic Surgery (ASAPS) Public Education Committee. "Patients have to ask themselves what kind of equipment is being used, who is doing the anesthesia and what kind of standards are being followed."

Drs. McGuire and Rohrich say they each did corrective work on six vacation patients in 2004. Because of the geographical distance, vacation surgery providers offer no access to follow-up care.

Risk for U.S. docs

Correcting the mistakes of unskilled surgeons poses a certain risk of legal liability for U.S. doctors. Because they don't want to be held accountable for the mistakes of others, many doctors will not even see patients who have suffered complications from overseas surgeries, Dr. Rohrich says.

Such a policy, while understandable from a legal perspective, strikes a moral nerve with Dr. McGuire.

"There is a legal risk," he says. "But the bottom line is that we are all physicians. We need to first treat our patients and worry about the legal consequences subsequently."

The trend underscores the deeper and perennial problem of accountability in the cosmetic surgery industry. In the United States, it is comparatively easy to check a surgeon's credentials. All doctors must be licensed by their state, and are certified through the American Board of Plastic Surgery or the American Board of Surgery. Malpractice lawsuits are a matter of public record, and a facility's accreditation with any number of reputable associations can easily be verified. Of course, some doctors inflate credentials by affiliating themselves with professional-sounding but not highly regarded organizations--"phony boards," as Dr. McGuire calls them.

Potential patients who haven't done their homework could easily be duped into believing that a less-reputable doctor is indeed credible. When dealing with doctors in other countries, it becomes very difficult to distinguish between legitimate and meaningless accreditation, Dr. McGuire says. Some doctors who have begun offering surgeries in Baja California, Mexico, are actually American doctors who lacked or lost accreditation in the United States, he says.

Surgery gone wrong

For example, cosmetic surgery vacations gained national attention last June when the Centers for Disease Control and Prevention reported that a dozen Americans--five from New York, two each from Massachusetts, North Carolina and Rhode Island, and one from Puerto Rico--had contracted bacterial infections as a result of surgeries performed in Santo Domingo, Dominican Republic, between May 2003 and February 2004. New York City's Department of Health and Mental Hygiene later confirmed seven more skin infections related to Dominican cosmetic surgeries. The affected patients were all women between the ages of 22 and 59.

Recruiters in the United States typically set up the vacations. In this case, they courted potential clients in hair salons in Dominican sections of the city, telling them they knew of cheap places to undergo liposuction, tummy tucks and breast augmentations. Women flew to the Dominican Republic for surgery, and returned to the U.S. with their new looks--and with new medical problems. The health department responded with a press conference in Manhattan's largest Dominican neighborhood. The agency also began working with a Dominican community group and spoke to several Spanish-language newspapers about the dangers of the procedures.

Bacterial infections are among the most common and dire of complications. Less-serious side effects have included shifting implants and prominent scars.

Not long after, the ASAPS chimed in with its own warning. Many cosmetic surgery "vacations," it stated, aren't all that the name implies. Sunbathing and physical activities like golf or tennis are usually prohibited during the days or weeks it takes to recover from surgery. Then there's a more serious concern: the lack of access to follow-up care if something goes awry.

Vacations attract Brits

The draw of cosmetic surgery vacations is not limited to American consumers. A similar phenomenon has taken hold in Britain, where some patients flock to Eastern Europe or Africa to have their surgeries done.

"There tends to be a coordinator who organizes and is the main liaison person with the foreign surgeons and institute," says Patrick Mallucci, M.D., a London-based surgeon. "They'll get flown over, put up in a hotel and consultations will be arranged with the staff."

The day he spoke to Cosmetic Surgery Times, Dr. Mallucci had a patient with a grossly infected abdomen from a tummy tuck she underwent overseas. The side effects of such vacations--while the magnitude is not fully known--can place an undeserved burden on Britain's state-subsidized National Health Service.

"Over the last five years, I've probably seen one or two cases a year just where we are," Dr. McGuire says. "If you multiply that by the whole of UK, it's not insignificant."

What are the numbers?

How many of these surgeries are being carried out? How many go awry? There's no way of knowing just how many "vacation" procedures are being carried out abroad, or how many have resulted in complications. Even anecdotal evidence is often hard to come by, as Dr. McGuire explains. "Patients are afraid to say where they had their surgeries done," he says. "They're embarrassed that they were duped."

Will cosmetic surgery vacations have an effect on the industry in America? It's too early to say. Surgeons and surgery associations hope that if they educate consumers about the risks, fewer people will head off for potentially dangerous procedures.