Travel for surgery

It has become increasingly common for people to travel from near and far to have plastic surgery. I have recently had to care for three patients who had plastic surgery done internationally, but had to return to the States with some pretty serious complications. So what were the cases? One patient had a breast augmentation done in Colombia and then had a hematoma or blood clot in the breast a month after surgery (which is quite rare). The two other patients, interestingly, had very similar operations: both had tummy tucks done with liposuction and fat transfer to the butt. They were both done in Mexico, in different cities, by different surgeons.

There’s so much to talk about here, because it’s very easy to say, “Oh my God, get work done anywhere else in the world and it’s going to be a disaster!” And you know what? It’s not entirely true because I know of some incredible surgeons throughout the world, in Mexico, in Colombia, in Argentina, all over, and they’re the best you can get. But here’s one of my big problems about international plastic surgery:The problem is that it can be very difficult to know how good your surgeon is. Again, there are incredible people out there – I know that because of personal conversations with them, because of the work I see them do everywhere, and in meetings internationally, and so much more. But a lot of the consumers, the patients who go to international surgeons, do so without knowing very much about who they are.

Now in the United States, there are some things that we have in place to help assure the quality of the surgeon; and even then, it’s really hard. I mean, look, we have board certification, we have reviews on Yelp and things like that. For better, for worse, we have the evidence you see on social media (and you have heard me talk about how much you can tweak that), we have word of mouth. We have so many things, but even then it’s hard to ensure that your surgeon is the real deal. That challenge of finding your perfect surgeon is even more difficult when they’re thousands of miles away, may speak a language you don’t, don’t meet you until the day of surgery and so many other problems. Now what is the main impetus, I see at least, in patients who travel internationally, at least from the United States outside to get work done? It’s pretty easy.

In the vast majority of cases, it’s because it’s cheap.  And not just a little cheap, but really, really, really, really less expensive – and obviously that’s compelling. You spend a fraction of the money and you theoretically get the operation you want. Butit’s not always the best idea, and very often,you get what you pay for. The challenge is that there ARE many cases where people will go outside of the country, they’ll get their operation done and heal well. They’ll end up home, save a couple bucks and move on with their lives. BUT, the danger lies in those cases where there are problems – and let me tell you, that’s when it can get really, really bad.

Wait, hold on. You can have complications with surgery? Yes, absolutely. Any surgeon, every surgeon has complications.  It’s actually the way that your surgeon manages the complications that truly can show you how great they are, because they can very easily prevent a small problem from becoming a huge disaster.  A well trained surgeon can help you move on from a complication and take you to the incredible result you wanted.

An issue I have seen time and time again in patients who’ve had international surgery done, is that they may have a complication (often severe ones) that is simply poorly handled. It could be immediately postoperatively in the country that they’re getting worked on at, or later on when they come home and their surgeon is nowhere to be found. I’ve got to tell you, that happened in all three cases I dealt with this week and it was really terrifying. The patients were left with nobody to care for them. I’ve seen this particularly in the two tummy tuck patients, these are cases where little problems weren’t handled properly, and they became very, very big problems.

The other issue is one that is even scarier. My other concern goes back to the quality of your surgeon. Look, I am open about this, I know many amazing international surgeons. But I have seen some patients get work done that is absolutely terrifying. Forget about unattractive, but overtly scary. The things that I have seen some of those patients undergo is not acceptable care; it’s simply not safe and it’s sometimes a miracle they’re still alive.

As an example, the two tummy tuck patients I cared for both lost so much blood during their operations that they needed multiple blood transfusions.  BLOOD TRANSFUSIONS? For a tummy tuck?That’s never OK.  And this goes back to the root of elective cosmetic surgery. It’s elective. So with these procedures, we are held to a really high standard where the risk of complications better be very, VERY low.  Things like blood transfusions and hospitalization should not happen after cosmetic surgery.

This discussion of travel for plastic surgery also leads to another very important, and honestly, kind of conflicted point in my practice. And that is that I have a very large number of patients who fly in from all over the world to get care in my office.

So my belief, my approach when dealing with international or even out of town patients, is to thoroughly explain to them every detail about my operation, and then extend that to talk to them about the possibility of complications that may occur, that may require them to seek care and have care later on when they’re at home.

The first and most important aspects of that approach is to do safe work, to properly evaluate the patients before surgery, to know that they are at the lowest possible risk for complications afterwards. Also, it means you have to do good work. You have to be at the cutting edge of what is safe and what will minimize complications down the road. That may include things like giving the appropriate blood thinners for longer, bigger surgeries to prevent blood clots. That may include any number of technical details that will optimize the long-term results of your patients and minimize the risk for problems. Results matter.

And the other thing, and this is so important, is having a clear plan with your patient of what happens if there are problems, if there are complications. That may mean they may need to stay in Beverly Hills with me for a little bit longer than anticipated or they may require care when they go home. And that is a very specific plan that we put into place to find the appropriate care for them to ensure that they are properly taken care of.

I say this as a matter of pride.  I am open and honest about this – I’ve had some patients who HAVE had complications (I promise you, any surgeon who says otherwise is lying or doesn’t operate), and have required that care after their procedure. Some of these patients have actually required care from other doctors in other places. But I was fully involved with that care with their local doctors, and the patients did beautifully. By being prepared for complications and managing them appropriately, disaster can easily be avoided and little problems can be made to simply go away.

Look, this is an important topic. You really need to be careful when you travel for surgery, but when done right, this can be an incredible experience.  The quality of the experience and your result is truly dependent on the skill, training and preparation of your surgeon and their staff.  Be prepared. Do your research.  Your health is too important not to!