The Hidden Dangers of Going Outside the US for Plastic Surgery

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:06):
More than half of patients who travel overseas end up needing additional medical care when they return home, which raises a pretty uncomfortable question. Is surgery abroad actually cheaper or does it just look cheaper at first? So today we're going to dig into the real cost of medical tourism and Hannah, our copywriter here at La Jolla Cosmetic Surgery Center and assistant producer of our podcast is going to help us break it down. Welcome back, Hannah.

Hannah (00:34):
Hi, happy to be here.

Monique Ramsey (00:36):
Thanks. So this is so interesting. I read a statistic that more than half of the people who travel overseas for surgery end up needing additional care when they get home. It was like 53%. Did you see that?

Hannah (00:50):
Yeah. And I'm not surprised, honestly.

Monique Ramsey (00:54):
Why did that not surprise you?

Hannah (00:57):
The level of care here in the US is totally different from what you'll find in most other places. I'm not bashing other countries, but they don't take as many steps and there aren't as many steps in order for things to get approved here, like treatments. There are so many more steps here than in other countries. And also the steps that we take for each individual procedure, there are a lot more safety precautions. And I think people need to kind of keep that in mind that it's not the same. And it's not just the same treatment, but cheaper. It's not. It's a totally different type of experience.

Monique Ramsey (01:41):
I think you can fall into that trap of, I'm going to save money. And everybody wants to save money. And we have to think with our pocketbook in a lot of ways, but we have to sort of remember that our brain has to be in charge also, not just our wallet.

Hannah (01:59):
Yeah. I think one thing is, how soon are you going to be flying home? Because you can't just fly home immediately right after a procedure. You're going to have to stick around in that country for a little bit while you heal if you actually want to fully heal without complications and visit the same doctor. But a lot of times doctors overseas will just be like, "Oh yeah, you can just go on home after a couple of days." And then they totally don't do any post-op care. They might check them the day after surgery, but you're not going to be followed and checked in on ... Doctors here, they'll give you their personal cell phone number. And I know a few of our doctors do that and they literally will check in on you the next morning, "How are you feeling?" And if you're not feeling well, they'll send a nurse or they'll tell you to come in.

(02:57):
If you have any complications, you can send them pictures. HIPAA compliant, obviously. But if you're overseas, you might not be getting that safety. I know that people are like, "Oh, I don't care about safety. It's cheaper." Okay. It's not going to be cheaper if you run into a complication and you have to get that fixed here with a completely different doctor that didn't do the procedure. It's going to cost more because it's going to be more time in the OR because they need to figure out what the heck went wrong and then they have to figure out how to fix it. So that's going to end up being more expensive, getting the cheaper procedure overseas and then getting it fixed here than to just go somewhere here in the first place and have a board certified plastic surgeon do it for you.

Monique Ramsey (03:43):
Yeah, that's a really good point in terms of what people are expecting. They're thinking, "Okay, it's going to cost $8,000 in my airfare and whatever. And here it would be 20." Well, if you have a complication overseas, what are you going to fly all the way back? That's a really expensive thing. Or if you have a life-threatening complication like a big infection, and one of the biggest complications that were described in these papers, and we'll put links in the show notes, was that infection. And specifically, they cited infection with tummy tucks. And a tummy tuck is a big procedure. And so I'm sure that people think, "Oh, it's a lot cheaper abroad, but it takes weeks to recover from and infection can set in. And if you start to get really sick, you're going to be back home. They're going to admit you to the hospital.

(04:42):
Is your insurance going to even cover something from an elective procedure? You didn't have to do this and you didn't have to go somewhere overseas." And so that's what is really scary. And I think when they talk about that, 53% of people who go abroad will end up with some sort of issue. That's a big percentage of people. So you have to think if it's more than half, it might be you. And so then is the math mathing, I guess, because it's not just about money. And let me pull up, I'll share my screen here. So this one here was for the American Society of Plastic Surgeons, and this was a 2017 article, but we have another one that's more recent, but this was showing patients traveling to other countries so that the estimates were 1.3 billion per year, which is a lot. And so in this study, it was a small group of ... It was 36 month review of the records and most were tummy tucks and then followed by liposuction, buttock augmentation and breast augmentation.

(05:57):
So 30 patients of the 42 had an infection and as at least one of their complications, some of the infections involved unusual types of bacteria.

(06:10):
It's not bad enough to have an infection, but then you get some weird something from another country. 11 patient had abscesses, and that's like a infection, but where it's like a boil or like a lump of puss. I'm sorry, sorry to say this. Eight had reopening of an incision and wound dehiscence. A few patients had blood clot related complications, kidney infection, and other serious problems. 20 out of 41 were admitted to the hospital. 13 required surgery. That's insane. And so I think the really scary thing is, here they asked, 18 of the patients said that they were not pleased with their results and they would not go abroad for their subsequent procedures. So then you have to think about finding somebody here who will take on your case. It's going to take longer because that doctor may not know what they're going to fix, especially in something complicated like a rhinoplasty.

(07:17):
What if you're not left with great structure in your nose because maybe the doctor was a little too aggressive. It could take, I don't know how much longer to repair.

Hannah (07:30):
And if you didn't have to have grafts the first time, you're probably going to have to have grafts on the second time if it's a rhinoplasty and that's not fun.

Monique Ramsey (07:40):
Yeah. So this, I'm going to share this tab. So this is the article that first got me going on this topic was in the UK and their national health service, because they have a national health service, spends up to 19,000 pounds, which is like $23,000 to treat people who are suffering from some overseas surgery. And that was in a group of things, including weight loss surgery, so bariatric surgery, breast enlargements, and other operations. And this article just came out in January. This is where that 53% came up, but it kind of falls across the US guidelines as well. And in the UK, they have this national health system that puts a burden on the system. But in the US, we don't have that, but you might not have your health insurance covering it, or maybe Medicare or Medicaid that does put a burden on our system as well.

(08:43):
And then over here, there is, and I'll put again, I'll put this in the show notes, but this talked about cost versus complications. And so this is from 2022, and it was a PubMed grouping of studies, and to understand the perceptions of potential complications and motivations, like why are people willing to go abroad? And I think that this study had more people in it, the 484 responses, and of those 484 people, 45% said they would consider going abroad for a cosmetic surgery. And then of that, the people who said they would, 67%, yes, 67% would travel outside the US, sorry. And then here were their advantages and disadvantages, which I think is hilarious, is the price, right? Okay, that's obvious. A shorter waiting list for surgery.

Hannah (09:51):
Ugh. Isn't that alarming that there's a short waiting list?

Monique Ramsey (09:56):
Very good point.

Hannah (09:57):
Nobody else wants to go.

Monique Ramsey (09:58):
But the other thing I thought was really interesting is then when they asked them, what are the disadvantages? They said risk of complications, lack of follow up or continuity of care and distance from home. But then although the risk of complications was acknowledged as the top disadvantage, so these people understood in their brain that complications are my biggest risk if I do this, they were still willing to go do it. And so I think that the perceived danger, they're not making the decision with their head, they're making it with their wallet.

Hannah (10:42):
Also, what if it's like a bacterial infection that doesn't exist in the United States? So then the United States doctor sees it and they're like, "What is this? I've never treated this before." And then they have to figure out how to treat that. So you're just causing so much confusion and so much money to lose down the road. And it's so common to run into these complications.

Monique Ramsey (11:07):
Yeah. I mean, you can have ... All these are complications that you could have here,

Hannah (11:12):
But- It's not like how doctors here are just like, "Oh, there's a chance that something could go wrong." It's what was the number, 53 or something percent chance? Yeah.

Monique Ramsey (11:23):
And it's like-

Hannah (11:24):
It's not just a courtesy letting you know. That's legit. You are probably going to run into a complication.

Monique Ramsey (11:30):
Yeah. It's shocking. And that's why I had to talk to you about it, Hannah, because I read this literally yesterday morning. I was like, "Oh my gosh, that is so high. That can't be right. That's what I'm thinking. That can't be right." And so if I'm thinking that and I'm in this industry, think about if I'm just like G.I. Jane down the street who wants to have a little tummy tuck and thinking about going overseas, I didn't think it was that high. I would've thought, okay, maybe 25, 30% might have a complication. But if it's that high, that's why I wanted to really explore this topic with you because do you feel because of social media maybe that people, because they see influencers doing this stuff all the time, like people in your age group might be like, "Yeah, sure, that's a great idea."

Hannah (12:22):
Oh yeah, they are. I've had friends talk to me about it and I'm like, "No, no." So I know that it's a very convincing thing when influencers do it because I've run into people who are believing that it's totally okay and it makes so much sense, but it's really dangerous. I mean, there are some countries that are pretty close to the United States safety-wise, and I could trust, but you really have to do your research before you choose a specific country if you're going to go out. And also some of them think, "Oh, it's going to be a little vacay in this foreign country." And I think some influencers try to make it seem like that, but when you're recovering from a procedure, you're not going to be in the mood to sightsee and go try a bunch of food. You're going to be on medication that's going to make you not want to try different foods.

(13:18):
You're barely going to be able to drink a protein shake, but you better drink your protein. And you're just not going to be feeling great about being ... And you can't even do things like going to the beach and stuff because you're going to get an infection. So it's just like, it's not a vacation. And then you have to think about the flight tickets. Does it really end up being cheaper when you have to pay for flights and hotels and stuff like that?

Monique Ramsey (13:45):
And your baggage, and $50 for that bag and $50 again and picking up Uber to the airport and Uber back. And I mean, if you really add up all the stuff, I'd rather honestly go on vacation with my new body the following year. And if I'm going to go to somewhere fun and exotic, let's go after surgery.

Hannah (14:07):
Yeah.

Monique Ramsey (14:08):
Where you can really enjoy it. And I do think there's that glamorizing of the medical tourism because of the influencers and you see it on TV and you see it on all these reality shows too. And what's interesting also is there's a lot of really like fancy surgeons who are from the US or from the UK and then they go down to Dubai and they're doing surgery down there like, "Oh, I'm there one day a month or I'm there two days a month." Well, how about you just see them at their office here instead of like chasing them halfway around the world? I think the other thing that when we were talking about this yesterday with Brittany, who's our project manager, podcast scheduler, helper, she was saying that we just had a patient, what was she saying this week who had-

Hannah (14:59):
I think she called in because she had a seroma from, was it a seroma from going to someone out of the country, I forget which country it was, but-

Monique Ramsey (15:11):
And that's like a fluid buildup, like a pocket of fluid, which could then turn yucky or it could not ... It usually needs to be drained because it's like this buildup of fluid in a spot and it's not the worst thing in the world, but it needs to be evacuated or drained so that it doesn't turn hard because sometimes your body doesn't want to kind of let go of it. And so then this person's calling all around trying to get somebody to help her and nobody wants to take on that kind of case. And we had one a couple weeks ago come through social media where they were asking about suture removal. And I think maybe the medical, these clinics abroad might say, "Oh yeah, and you can just get the sutures removed when you get home." And they make it seem super easy, but for the doctors here, if they touch you in terms of doing some service for you, you're now their responsibility.

(16:10):
So let's say you went to Mexico for something and now you have an issue and Dr. Brahme, you're asking him to take on your case. Once he touches you, now you're his problem. So a lot of doctors don't want to do that because it is risky. They don't know how the doctor did the surgery. They don't know what's going on with you. And just doing something that you would consider simple, like a suture removal, what if things start coming apart and then thing after thing after thing or there's wound ... Oh, you were talking about wound healing. One of your clients has a wound healing, but this is something where it was mentioned in that article about wound dehiscence. If your wound starts pulling apart or if your skin gets a little bit gray looking and cloudy, your tissue could be dying, you could have tissue loss. It's bad. It's really bad. And something like a tummy tuck, I think, or even like a facelift because like behind the ear or anytime there's tension, right?

Hannah (17:14):
Before we hit record earlier, I was just saying how I think tummy tuck is the riskiest procedure to choose to do overseas because like you said earlier, it's like at least three weeks of recovery. Are you planning to hang around there for three weeks? You're barely going to be able to do a lot. You can't really sit normally or do anything normally after tummy tuck. I'm not swaying you away from getting a tummy tuck by any means. I'm sure it's very life changing. I haven't had it, but you have to understand that it's already like a super complex procedure here for doctors here to do and to prevent complications from happening. So imagine where there aren't as many safety considerations and then they're not even near you if something does go wrong when you get home. I also can't imagine jumping on a plane less than a week after getting a tummy tuck.

Monique Ramsey (18:15):
No. So let's talk about what are the things that could go wrong. And one of them we talked about, which is infection, right? So that's like an obvious one. Your wound coming apart or pulling apart a seroma, which is that pocket of fluid. But there's also, what are the other things that could happen? You could have-

Hannah (18:38):
Like your skin and tissue dying, and we already covered that. But also if you're getting a BBL, there's a chance the fat ... You have a higher chance of the fat not sticking around than if you had it here, especially if you're like-

Monique Ramsey (18:54):
Yeah.

Hannah (18:55):
How are you going to get on a plane?

Monique Ramsey (18:58):
And sit

Hannah (18:58):
After a BBL?

Monique Ramsey (18:59):
You're not allowed to sit on your tuckus for like six weeks. You're supposed to have your little donut or ... I don't know. I haven't had one.

Hannah (19:08):
So there's a chance that the whole procedure that you got is just going to go to waste because all the fat's just not going to survive.

Monique Ramsey (19:14):
Yeah. If you're not babying that fat, it's going to die and that's a problem. And one of the riskiest things is to have a blood clot. A pulmonary embolism is when you have a clot that gets thrown to your heart and you can have a really bad outcome if you come out at all. And it's not unheard of only because when you're doing long flights and we have patients, if they're coming to us and they've had a long trip very recently, we're really careful about how long that they're on the ground prior to having surgery because your risk for pulmonary embolism goes way up if you've been on a plane for a long time because you're not moving, you're not moving as much, your blood's not flowing as much. So if you think about, let's say you're going to go to the Dominican Republic or you're going to go to Turkey or you're going to wherever you're going, for surgery, you're on this long plane flight that's a stress on your body no matter what age you are.

(20:18):
And then how long are you on the ground prior to having the surgery? Then how long are you in town before you have to go home because maybe you don't have the money to stay longer.

Hannah (20:28):
Also, are you getting enough protein in those days leading up to it? If you're on a plane and stuff, are you just eating the pretzels that they give you on the plane?

Monique Ramsey (20:38):
They don't even give you peanuts anymore where you could have like a little something, the protein, but there's a lot of risks to surgery. And I think your point about some of these bigger procedures, especially like a tummy tuck, where you sneeze wrong and you might have like, "Ah, did I ... " I think the other thing is like, what's the mental stress if you're abroad and then you're going home and then you're worrying like, "What if something goes wrong? Where am I going to go? Who's going to take care of me? " Or if you start to feel like something's wrong, do you end up in the ER and then will your insurance cover it? There's all this mental stress.

Hannah (21:19):
I think it was Dr. Swistun who mentioned when you are stressed out mentally, you heal or you won't heal as fast. You need to have a peace of mind while you're healing in order for your body to heal itself faster. And if you're worried, like you're overseas and you're like, "Oh, I don't know if I'm going to get home safe. I don't know if this doctor is going to help me if anything goes wrong." Or you're home and you're like, "What do I do if something goes wrong? My doctor's not here." You're causing extra stress on your body, which could cause you to heal slower.

Monique Ramsey (21:52):
Yeah. I think you're right that you have to be in the right head space and putting yourself in the best possible situation for recovery. And a lot of times we've had Kathleen Lisson on the program a few times who she's a lymphatic drainage massage therapist and she teaches it and she is one of our patients. And so she talked about being a patient and then she also has explained about what lymphatic drainage does, that special kind of massage. Those are the other things where you want to have a budget for those things. And if you're abroad, do they have those services for you? Are those people trained in the right techniques to keep it, to keep everything safe, to keep you healing well? That's another thing that I don't know that people are thinking of as they approach this.

Hannah (22:47):
Right. Lymphatic massage does make a big difference in your healing for these body contouring procedures and even facelift. So if you're not ... I mean, I know you can't start immediately after the procedure, but is your doctor getting you in touch with the right type of people? Our doctors here, they have references of who to send you to for lymphatic massage. So they know who's good, but those people out of the country, they probably don't know anyone who offers lymphatic massage to refer you to. And also, what are their pre-op instructions? Are they giving you detailed pre-op instructions? Do you know which medications that you're not supposed to take leading up to it?

Monique Ramsey (23:31):
Do they know? Do they know what your normal medications are that you're taking? And-

Hannah (23:37):
Are they even asking you if you smoke and how long you need to stop doing that before? You have to think of these things.

Monique Ramsey (23:45):
So one other thing that I noticed is that, and we've talked about complications. They could be minor, it could be major, but something that is not fun to talk about is that CDC data showed that at least 93 citizens died in the Dominican Republic between 2009 and 2022, following cosmetic surgery. Four also died from a fungal meningitis outbreak linked to a cosmetic procedure in Mexico. That's a lot of people, and I know that's a big timeframe, but that shouldn't be happening. And I think if you looked at what were the statistics here, especially under the care of a board certified plastic surgeon and a MD, anesthesiologist on top of that, but you're not going to find numbers like that. And that is an uncomfortable truth that I think people have to really take into consideration.

Hannah (24:53):
That's a good point about the anesthesiologist. I think I've heard horror stories where it's not actually an anesthesiologist offering, doing the anesthesia for these procedures out of the country. Yeah. It's just like a nurse practitioner or something doing it and that's just not ...

Monique Ramsey (25:09):
Yeah.

Hannah (25:09):
It's not the same.

Monique Ramsey (25:10):
Well, and there was years ago, a couple years or three years ago maybe in the summer, there was like an ambassador's wife, a US ambassador to some other country who went down to Mexico for surgery and the place that they were doing the surgery was not the place she thought was going to be where the surgery was. And it was in an old like shutdown hospital that was like not supposed to be used for anything and she lost her life and presumably she's a smart lady who has resources and for whatever reason chose to go down that path. So that's something else that I think needs to come into the conversation. And then the other thing I thought was really interesting in that PubMed, ASPS, which is the American Society of Plastic Surgeons, they did a survey of those plastic surgeons in America, board certified, and 80% of them have treated a patient with complications who had come from a medical tourism reason.

(26:27):
And now there's only, let's say there's 7,000 board certified plastic surgeons in the US, but 80% of them have seen somebody. That's crazy.

Hannah (26:40):
And to your point, you don't even know if they're doing it in the place that they're putting on their website or their Instagram. That could be a totally like a stock image or an image of somewhere they worked in the past, or they could have stolen it from someone else's website. If they're so far away that you can't even visit them ahead of your surgery, you don't know. Yeah. And that's really scary.

Monique Ramsey (27:09):
Well, and sometimes you're not meeting the doctor till that day.

Hannah (27:12):
Yeah.

Monique Ramsey (27:13):
So that's not ideal.

Hannah (27:15):
You at least need a pre-op appointment.

Monique Ramsey (27:17):
Right, right. And I think you brought up earlier too, follow-up care. I mean, just think about a procedure that you've had and how many times you see the doctor afterwards and the staff.

Hannah (27:29):
Right. And if they don't have a buddy surgeon who's here in the United States who can check in on you, that would be all right. If he knew someone or she and they could reference you over, if you run into any complications when you get back, here's someone that can take care of you. If they don't have a reference, then that's a red flag because you're just alone and then you have to search for yourself who's going to-

Monique Ramsey (27:54):
Well, and that's what ... We've had two calls that I know of in three weeks, let's say, one this week and one a couple weeks ago and people are going to ... This poor person might have thought, "Oh yeah, this is no big deal and somebody will help me. " And then they end up in the ER. And say you end up in the ER for the abscess or seroma or whatever. Who's going to be fixing you there? They're not going to call in the board certified plastic surgeon to the ER to fix you. It's going to be the general surgeon or the traumatologist or whoever's on call.

Hannah (28:31):
And they're not thinking about aesthetics.

Monique Ramsey (28:33):
I was just going to say-

Hannah (28:34):
So when you fix it-

Monique Ramsey (28:36):
They're not going to make it pretty.

Hannah (28:38):
It's not going to be pretty. So it's going to ruin the point of the whole procedure.

Monique Ramsey (28:42):
Yeah. Yeah. So what would you do if you were considering a procedure and you were seriously considering, I know you wouldn't, but if you were serious and considering going abroad, what tools or what series of things would you do to sort of make that decision?

Hannah (29:04):
I would see if they actually have before and after photos, because a lot of times these doctors don't even have before and after photos. I would research the credentials of the surgeon. Do they have credentials? What do they call themselves? Do they call themselves a cosmetic surgeon? Who's actually just a general surgeon? What are they? Who's doing it? Who's doing my anesthesia? You ought to ask these questions during your consultation. Do they even offer consultations or do you just sign up on something online and you have to maybe even ask them to FaceTime you in their surgery center to show you, "Oh yeah, it's real. It's totally..." Be crazy. You can look crazy and ask for ridiculous things because it's your safety. It is a serious thing. So you're allowed to ask really new These ridiculous questions. And if you do see that there are patient reviews, maybe look up that patient, be crazy, look them up on Instagram or something.

Monique Ramsey (30:10):
Yeah, there's a lot of fake stuff out there.

Hannah (30:12):
Yeah, because there are fake reviews. Ask them if they have references. Ask them, what would you do if something goes wrong? What would you do if something goes wrong after I already am on my way home or am home? Yeah. Do you know anyone who can help me? Ask them for pre-op instructions and post-op instructions. Ask if they have those.

Monique Ramsey (30:35):
That's a good idea. And Dr. Salazar, and we'll put a link in the show notes. He talked about, we did an episode called Plastic Surgery Doesn't End When the Procedure's Over. Really good episode. And what happens after can be just as important as the procedure itself and how it's important and things can get complicated. And if your surgeon is in another country, then what's happening? Again, just really wanting, and the purpose of us wanting to do this is just to kind of ... The stats were pretty compelling and I even didn't think that they were that high. And so I really wanted to have a good conversation about ... It's a reality. We see it out there and some people are going to go somewhere and I get it. But just cautioning people to think extra long and hard and think, okay, what if something doesn't go well?

(31:36):
Would my insurance cover the problem? Would I have the extra money if I have to get it redone? So that's like some logical questions.

Hannah (31:46):
Yeah. Those are some questions I missed on my list. Looking at yourself too, not just looking at ... You have to think about you and if you have the backup funds, if anything goes wrong.

Monique Ramsey (31:58):
Dr. Salazar's point in that podcast, he talked about safety needing to come before cost. So just because saving money up front doesn't help you if then you're on the backside with dealing with complications, so then you haven't saved anything.

Hannah (32:15):
And he also preaches on having that safety net after surgery, people nearby, whether it's friends and also a surgeon nearby that you can trust, a team that's dedicated to your case, who remembers you, who knows you by name. And also follow-up visits are everything after plastic surgery. And Dr. Salazar definitely preached on that episode too.

Monique Ramsey (32:41):
Yeah. Yeah.

Hannah (32:42):
He's so right. It's very important.

Monique Ramsey (32:45):
It is. It's not just the procedure. And we had some links in the show notes for that one because I had something else I had read where I was like, "What?" But it is interesting. So we're going to put a bunch of links in the show notes because it has the studies and these review studies. It has the guardian and the national health system, the study that the guardian had cited. Then we've got the ASPS and what studies they cited. So we'll stick all that in there if you're interested in going down the rabbit hole. And we encourage questions. If you hear this or see this and you have questions, we're here. So that's why we're here. So thanks, Hannah. This was a good convo.

Hannah (33:28):
I know. It's always fun with you.

Monique Ramsey (33:30):
Yeah. Yeah. Thanks for doing this with me because I like talking about things that are topical, like relevant now.

Hannah (33:42):
Because some people have no idea what's like. So we're not only ranting and going down rabbit holes like we love to do, but it's about a very important thing that more people need to know about.

Monique Ramsey (33:54):
Right. Exactly. Exactly. Well, thanks everybody and check the show notes. And if you're listening and you have questions, we'll have links for you to contact us. And thanks, Hannah, again, for joining me. And thanks everybody who's listening out there. And we'll see you on the next one. Bye.

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