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Traveling for Plastic Surgery
Reviewed by Richard J. Greco, MD, FACS
Patients travel long distances to receive plastic surgery for a variety of reasons. From finances, to limited access in the patient's geographic area, to seeking the most experienced specialists in a given treatment, patients traveling for plastic surgery is a growing trend.
Attractive-sounding travel packages often lure patients abroad. Many patients believe that a vacation can be comfortably coupled with a surgical procedure. This emerging trend raises special concerns you should consider before traveling for treatment. These concerns are especially important when traveling abroad.
The Surgical Vacation Package
For many foreign-travel procedures, you begin with convenient initial consultations online from your home. Arriving abroad at the treatment location, you receive private hospital support with nurses visiting your hotel room, then luxury spa treatments to soothe the nerves and comforting recovery kits to ease the pain. The reduced surgical expense in many foreign sites equates to surgical and vacation costs that are less than the price of surgery itself in the United States.
Many consumers locate surgical vacation destinations through the Internet. The websites of these destinations have contact forms so that the patient can communicate with the practice by email. Patients often scan a photo of the area that they are interested in improving and send it to the doctor for a recommendation.
As part of the preliminary screening process, some patients may complete online medical history forms prior to speaking with the doctor and staff over the phone. They may visit a local doctor to evaluate candidacy for surgery. Ongoing communication with the surgeon is conducted by phone and email. The procedure is scheduled and the comfort list is prepared. Comfort lists may include free transportation from the hospital to the medical facility or to the hotel, and discounts to vacation attractions.
In some cases, the medical facility and rooming accommodations are in the same location. Other times, the medical facility is close to a choice of hotels that have partnered with the medical facility to meet the needs of traveling patients. Depending upon the procedure and the doctor, the patient may stay in a hospital for one or more nights after the procedure. The recovery period after surgery, however, is not always a good time for a vacation. There are also more complications and risks associated with traveling surgery.
Red Flags and Risks
Many of the activities associated with postoperative traveling increase the risk for complications. The patient's ability to reposition the body or face regularly (important in recovery) is limited in a car, airplane, or train. Bag lifting, standing for long periods of time, and limited access to normal comforts may compromise recovery and increase the risk for complications.
According to the American Society of Plastic Surgeons (ASPS), infection is the leading complication among traveling patients. Traveling is also associated with higher swelling, blood-clot, and pulmonary embolism rates. The ASPS also reports that protruding scars, hematomas, and unsatisfactory results occur at a higher rate in surgeries performed abroad.
Compounding the travel-related issues, complications such as infection may require a secondary medical procedure. While surgeons back home may be equipped to perform the secondary procedure, they may not be aware of the initial surgeon's approach to the first procedure or the type of technology or devices (such as implants) used. These factors make the secondary procedure more difficult.
In the United States, there are accrediting agencies that certify medical facilities and medical providers. U.S. hospitals have peer review boards to further evaluate the doctor's surgical skill in given procedures. Doctors must obtain hospital privileges to perform a specific procedure at hospitals in America. Surgery abroad is not necessarily as standardized.
Other countries may or may not have governing agencies to oversee qualifications and credentials. The training of doctors in other countries may be dramatically different than in the United States. After becoming a doctor, the extra training to become a plastic surgeon varies widely as well. Uncertainty in medical skill means uncertainty of results. Many facilities abroad are privately owned and operated not necessarily subject to a certification process.
Most other countries do not have a rigorous approval process for medical technology and devices, which the FDA provides in the United States. For procedures outside the U.S., it may be difficult to evaluate the medical facility, skill of the doctor and staff, the procedure, or the devices used in procedures.
Consultation and Evaluation
An initial consultation in plastic surgery requires about an hour. During this time, the patient will meet with a nurse and the doctor to evaluate the patient's medical history, procedure choice, alternatives, and the doctor's approach to the procedure. The patient may meet with the doctor a second time before the procedure is performed.
During recovery, patients visit the doctor again to evaluate the results of the procedure and discuss any concerns. Stitches and other devices may be removed.
Traveling patients miss the advantages of face-to-face consultations before surgery, and the in-person evaluation during recovery.
Limits on Activity
Patients undergoing plastic surgery receive an instruction list from the doctor that must be followed in order to reduce the risk of complications from surgery. Most plastic surgery patients cannot resume normal activities for one to two weeks. Patients are typically advised not to drive, walk extensively, exercise, sun bathe, swim, or drink alcohol. There may be limits on lifting and other restrictions. In other words, patients going abroad to enjoy a vacation after surgery may be disappointed. postoperative instructions may pose too many obstacles. It is difficult to predict the recovery time until after the procedure is performed, making vacation planning especially precarious.
When It Makes Sense to Travel for Surgery
There are some instances where it makes sense for a patient to travel to a different city in the U.S. or abroad for their selected procedure. One case could be the cost of the procedure, as plastic surgery procedures could be cheaper in different locations depending on where you live. Also depending on where you live, local plastic surgeons may not have experience performing specific procedures. This is often the case with new surgeries such as, especially if the patient lives in a remote area. If traveling for plastic surgery is a must, it is important that you take the necessary precautionary measures to help ensure your safety.
Tips for Traveling
For patients traveling inside the United States or abroad, here are some tips to help make it a successful experience.
- The ASPS recommends postponing travel for five to seven days after plastic surgery procedures involving the body (such as liposuction and breast augmentation) and up to ten days for facial plastic surgery (including facelift, eyelid surgery, rhinoplasty, and certain laser treatments. This means making sure you have an adequate number of days reserved at your hotel after surgery.
- Ask how you can verify medical provider and facility credentials. Be certain to ask specific details about the doctor's training.
- Plan ahead for complications. If a complication occurs after returning home, who will take care of it? If revision surgery is required at a later date, who will perform the procedure? Visit a few doctors in your area to learn more about procedure options.
- Form a relationship with a local doctor who is available to see you in case postoperative concerns must be addressed at home.
- Before you return home from the initial surgery abroad, be sure to collect medical records before leaving the doctor's office. Be sure you know how the doctor performed the procedure and the type of devices used in the procedure. For example, document the specific implant that was used for breast enlargement.
Better Credentialing on the Horizon
U.S. organizations such as the American Association of Accreditation of Ambulatory Surgery Facilities (AAAASF) and its subsidiary, Surgery Facilities Resources (SFR), are now working together to accredit medical facilities outside of the United States. For example, in March 2006, AAAASF representatives traveled to South America to train 16 South American plastic surgeons to be inspectors for medical facilities in South America. AAAASF has partnered with the International Society of Aesthetic Plastic Surgery as well. These efforts may lead to safer procedures and more reliable results in the future of traveling surgery.
George John Bitar, MD
Larry Lickstein, MD
Bitar Cosmetic Surgery Institute
3023 Hamaker Court
Fairfax, VA 22031
George John Bitar, MD
Larry Lickstein, MD
Bitar Cosmetic Surgery Institute
8650 Sudley Road
Manassas, VA 20110
Michael J. Olding, MD, FACS
George Washington University Hospital
2150 Pennsylvania Avenue
Washington DC, DC 20037