But surgeons and other U.S. health officials are worried. While some companies provide a patient referral network and are upfront about doctors' credentials and the services, not all are so transparent. Some are fly-by-night operations, with surgeries performed by unlicensed "cowboy" doctors.
"It's like playing Russian roulette," says Rod Rohrich, M.D., a Dallas-based cosmetic surgeon and member of the American Society of Plastic Surgeons. "I'm not saying all of them are bad, but 'buyer, beware.'""There's a reason (certain) places are a lot less expensive," says Michael F. McGuire, a Los Angeles-based surgeon and chair of the American Society for Aesthetic Plastic Surgery (ASAPS) Public Education Committee. "Patients have to ask themselves what kind of equipment is being used, who is doing the anesthesia and what kind of standards are being followed."
Drs. McGuire and Rohrich say they each did corrective work on six vacation patients in 2004. Because of the geographical distance, vacation surgery providers offer no access to follow-up care.
Such a policy, while understandable from a legal perspective, strikes a moral nerve with Dr. McGuire.
"There is a legal risk," he says. "But the bottom line is that we are all physicians. We need to first treat our patients and worry about the legal consequences subsequently."
The trend underscores the deeper and perennial problem of accountability in the cosmetic surgery industry. In the United States, it is comparatively easy to check a surgeon's credentials. All doctors must be licensed by their state, and are certified through the American Board of Plastic Surgery or the American Board of Surgery. Malpractice lawsuits are a matter of public record, and a facility's accreditation with any number of reputable associations can easily be verified. Of course, some doctors inflate credentials by affiliating themselves with professional-sounding but not highly regarded organizations — "phony boards," as Dr. McGuire calls them.
Potential patients who haven't done their homework could easily be duped into believing that a less-reputable doctor is indeed credible. When dealing with doctors in other countries, it becomes very difficult to distinguish between legitimate and meaningless accreditation, Dr. McGuire says. Some doctors who have begun offering surgeries in Baja California, Mexico, are actually American doctors who lacked or lost accreditation in the United States, he says.
Surgery gone wrong For example, cosmetic surgery vacations gained national attention last June when the Centers for Disease Control and Prevention reported that a dozen Americans — five from New York, two each from Massachusetts, North Carolina and Rhode Island, and one from Puerto Rico — had contracted bacterial infections as a result of surgeries performed in Santo Domingo, Dominican Republic, between May 2003 and February 2004. New York City's Department of Health and Mental Hygiene later confirmed seven more skin infections related to Dominican cosmetic surgeries. The affected patients were all women between the ages of 22 and 59.