Plastic surgeons report surge in reoperations for patients treated abroad

BMJ 2017; 359 doi: (Published 06 October 2017) Cite this as: BMJ 2017;359:j4643
  1. Anne Gulland
  1. London

Plastic surgeons are warning about a rise in the number of patients needing treatment for complications after travelling abroad for cosmetic procedures.

A review of patients at the Royal Free Hospital in London found that between 2015 and 2017 plastic surgeons saw 21 patients who had been abroad for treatment. The complications resulted in 18 episodes of inpatient admission and 46 operations. The total cost for the 21 patients was £282 000 (€314 610; $368 610), with an average of £13 500 per patient.

Patients went to a range of countries, with Eastern European countries being the most common. Infection (42% of cases) was the most frequent complication, with breast procedures being the most common operation (47%).

Ash Mosahebi, professor of plastic surgery at the Royal Free, told The BMJ that in recent years his team had noticed that more patients were seeking help after being treated abroad. He said that the next step would be to look at the numbers across England.

“The main issue is infection—if we don’t treat them they may end up with sepsis. Most patients come to the emergency department and we can’t turn them away. All of them need revision surgery but we don’t do that on the NHS,” he said.

He said that one patient lost half her abdominal skin and stayed in hospital for nearly a month.

“The problem with going abroad is that it’s difficult to get care post-operatively when you’re not in the same country as the doctor. I’m not saying that all these surgeons are careless or unethical—even if they wanted to give patients post-operative care, they can’t,” he said.

Mosahebi said that it was difficult to regulate cosmetic procedures abroad but some surgeons come to the UK as a way of marketing their services to patients. “They come here and get a room in a hotel and give free consultations. Patients will follow them a few days later. That’s how they lure patients. They’re not registered as a doctor in this country but they give medical advice,” he said.

The results of the review were presented at this year’s British Association of Aesthetic Plastic Surgeons’ (BAAPS) conference in London. To coincide with the conference, the association conducted a straw poll of its 230 members and found that many reported a rise in the number of patients coming to them with complications after cosmetic procedures—about 30% of the rise was because of the growth in cosmetic surgery tourism, the poll showed.

BAAPS president Simon Withey, a consultant plastic surgeon at the Royal London and University College Hospital, said that around 40% of his work in 2016 was revision.

“There is currently—perhaps unsurprisingly, in these turbulent times—a measure of financial uncertainty in the UK. Thus, affordability is one of the biggest drivers in the rise of ‘cosmetic medical tourism’ deals offering all-inclusive package holidays and the promise of a high quality service at heavily discounted rates.

“However, these promotions conveniently gloss over the increased risk of complications post-surgery, less robust regulations and credentialing, and the lack of follow-up,” he said.

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