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Safari surgery 'Cosmetic tourism' complicates stateside care

Article-Safari surgery 'Cosmetic tourism' complicates stateside care

National report — For American patients pursuing cheaper cosmetic procedures in locations from Mexico to Brazil and beyond, serious complications remain relatively rare, sources say. However, those that do occur often leave domestic doctors with little or no knowledge of the materials and procedures employed, while patients are often left without legal, financial or even medical recourse.

Rising demand

Dr. Matarasso
"Increasingly, we see U.S. citizens participating in medical tourism and seeking care outside the United States," Maureen Potter, executive director of the Joint Commission International (JCI), tells Cosmetic Surgery Times. JCI operates under the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and offers an accreditation program for international facilities. Last year, for example, Ms. Potter says that more than 300,000 tourists worldwide visited Singapore for everything from facelifts to heart surgery.

"For cosmetic surgery," Ms. Potter adds, "Americans may be seeking what would be considered cost-effective, quality services outside the United States because they're paying out of pocket."

Location, location, location

Dr. Kaufman
"Ten years ago, this would have been almost unheard of," says Brian Kinney, M.D., president of the Plastic Surgery Education Foundation (PSEF) and clinical assistant professor of plastic surgery at the University of Southern California and the University of California, Los Angeles.

But now, he says, "At least three to five times yearly, we see a result that needs to be redone."

Experts say coastal and border states tend to see such patients most frequently. Nevertheless, Bruce Cunningham, M.D., says he sees one to two acute cases yearly in his capacity as professor of plastic surgery at the University of Minnesota.

Dr. Waldorf
On average, fewer than 10 percent of Minnesota's cosmetic surgeons see semi-acute postsurgical problems — most commonly from longer incisions such as those required for abdominoplasties, body lifts and mastopexies — in patients who have been treated abroad, he adds.

In such cases, he says, "Patients need to take it easy for a while, but in fact, they're often put on a plane after two or three days."

More commonly, Dr. Cunningham says, "Many of us see patients a couple years later when things haven't worked out. Or sometimes, they want to get something else done and they mention incidentally that they had a breast augmentation in Brazil, for example."

Liabilities and limited data

When patients go abroad, "One of the biggest problems is absence of continuity of care," says Ed Lack, M.D. He is president of MetropolitanMD in Chicago and president-elect of the American Academy of Cosmetic Surgery (AACS).

Patients who return home and become disenchanted with their results usually have nowhere to turn, he notes. Similarly, Dr. Lack says, "If we need to know whether something was or was not done at the time of surgery, it's virtually impossible to get that kind of information."

When patients present with postoperative problems, "We have to clean up afterwards," says Seth Matarasso, M.D., clinical professor of dermatology, University of California, San Francisco School of Medicine.

"Frequently, one doesn't know what one is battling," he says.

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