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Medical Tourism- Caveat Emptor

Much of medical tourism involves cosmetic surgery. In the overwhelming majority of cases, the reason is financial; it costs much less in many other countries. In fact, the costs are often so reasonable that when combined with the costs of travel, meals, lodging, and, in some cases, even some sight-seeing, it still often comes out cheaper than surgery in the U.S. The appeal is obvious: have your surgery away from the prying eyes of family and friends, combine this with a nice vacation in a tropical paradise, and save money in the bargain. What’s not to like?

Allow me to inject some words of caution regarding this type of medical tourism. If it saves even one person from a potential disaster, it will have been worth the time spent to write this. I am a plastic surgeon, certified by the American Board of Plastic Surgery, with over 18 years of practice experience. I was raised in two cultures: Brazilian and American.

I speak Spanish, Portuguese, and English before I turned 5. I trained in plastic surgery under renowned plastic surgeon, Dr. D. Ralph Millard, Jr., in Miami, Florida. As a plastic surgeon, I have traveled extensively throughout the world performing reconstructive surgery on children in the Philippines, Guatemala, Peru, Brazil, Venezuela and the West Bank. I believe this background gives me a unique perspective on plastic surgery overseas.

Where to Go?

The first decision is where to go. At any one time there always seems to be one place that crops up most often on the radar as the destination of the moment. Brazil has long held an international reputation as a destination for cosmetic surgery. Other popular destinations have been Costa Rica, Belize, Mexico, Guatemala, Brazil, and others in Latin and South America. Europe tends to be more pricey, and both Asia and the orient are often problematic because of the sheer distances and costs of travel.

Africa does not appear to be on anyone’s list. Of course you don’t want to go to a country in the throes of political unrest or in the midst of some crisis. Checking with the U.S. government’s travel advisory ( is usually good idea, however, I have often found that they seem to post a “worst case scenario” about a given country’s situation. Unfortunately, unless you know people personally who live there and can give you a reliable on site assessment, you may have to go with this.

The next challenge is finding a reputable surgeon, which isn’t always such an easy thing to do even in the U.S. I would discount advertising. Anyone can advertise and the best surgeons do not need to. It takes time, and consistency, to build up a base of satisfied patients who will sing your praises to family and friends. Word of mouth is good, but don’t settle for one testimonial, or even two. Even bad surgeons can have a good day now and again. You want to know they have been around for a while and can draw on many happy results.

Make sure the surgeon is certified by the appropriate board of plastic surgery for his or her country. Many claim to be “American trained”. Verify this. They should be willing to give you references from the training program they graduated from. A telephone call should confirm that they indeed trained there and graduated in good standing. Plastic surgery training overseas is not as comprehensive, nor as standardized, as in the U.S.

Ask questions. Some important ones would be: Does the surgeon have hospital privileges? (If they don’t it means that in the event of a serious problem, your care will have to be transferred to a stranger.) Where would you be admitted in the event of a complication? Would there be additional costs? How can the surgeon be reached after hours if you have a problem or question? Make sure you understand all of the costs.

The surgery fee should include the surgeon’s fee, anesthesia, the facility fee, any implants used, and all of your follow up care. Postoperative medications are usually not included. What about fees for any revision work? No plastic surgeon is perfect. Beware of anyone who promises perfect results or claims to never have complications. This doesn’t happen.

Plastic surgery overseas is not the same as here. ABPS surgeons in the U.S. must operate in accredited facilities. This may not be the case overseas. Surgeons overseas can do some things that U.S. surgeons cannot. For example, in some countries, surgeons can legally inject silicone into tissues. In the U.S. this is illegal, and for good reasons. Silicone injections have high rates of complications.

Cosmetic surgery is more than just showing up in an office one day and having surgery the next. Your medical history must be considered and factored into the decision for surgery. This information can be sent in advance, but sometimes a preliminary visit may be necessary to determine that you are a good candidate, another potential expense. Don’t discount the language barrier. While most surgeons speak passable English, their staff often do not. Inability to communicate can be very disconcerting.

Surgery and vacations do not usually go well together. Don’t expect to be out the day after surgery parasailing, scuba diving, or riding horses on the beach. You may not even be allowed to lie out in the sun by the pool, or even feel like it. No operation is truly painless, and some cosmetic procedures are quite uncomfortable for a couple of days. You will probably spend most of your time recuperating.

Finally, if you return to the U.S. and experience a problem related to your surgery overseas, don’t expect plastic surgeons in the U.S. to greet you with open arms. American plastic surgeons do not like to treat complications of their foreign colleagues anymore than they like to treat those of their American ones. You may have a real problem finding a doctor to treat you here. Do your due diligence before embarking on this course.

Richard T. Bosshardt, MD, FACS is a plastic surgeon in Tavares, FL. Dr. Bosshardt has been a plastic surgeon in private practice in Tavares, Florida since 1989. A graduate of the plastic surgery residency at the University of Miami/Jackson Memorial Medical Center, he trained under world renown plastic surgeon, Dr. D. Ralph Millard, Jr. He writes a weekly medical column that appears in the Lake and Orange County editions of the Orlando Sentinel. Dr. Bosshardt is board certified by the American Board of Plastic Surgery and is a Fellow of the American College of Surgeons.

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