The Risks, Rewards, and Deadly Reality of Traveling For Plastic Surgery
It has been a year since Sharae Terry last spoke to her sister, Shacare. On April 11, 2022, Shacare traveled from Indianapolis with a friend to the Dominican Republic for a Brazilian butt lift and tummy tuck. "Since we were young, she had always wanted to get her butt done," Sharae says of her sister, who she describes as beautiful but also rife with common body insecurities. She was supportive and proud of Shacare for saving up to make her cosmetic goals a reality — and never imagined that she wouldn't return home.
Shacare was discharged after what was thought to be a successful surgery, performed at the Instituto Medico San Lucas in Santo Domingo. However, Sharae told reporters at the time she felt something wasn't right when she FaceTimed her sister a few days after the procedure. She says Shacare was experiencing extreme discomfort and lethargy and was ultimately admitted into the Centro Medico Escano SRL clinic in Santo Domingo where she was sedated, provided supplemental oxygen, and put on dialysis. Days later, she died.
As reported by WRTV, an autopsy performed by examiners in the DR concluded that Shacare died of pulmonary edema (abnormal buildup of fluid in the lungs), cerebral edema (swelling of the brain), and respiratory failure. Her family thinks there's more to the story, noting a postsurgical infection and jaundice-like symptoms. "To go to another country and think that she was coming back with what she always wanted and instead for her to never return was shocking," Sharae says. "She was completely healthy before the surgery." (POPSUGAR has reached out to Instituto Medico San Lucas for comment.)
Sadly, Shacare's experience is far from unique. In May 2022, Tandra Bowser-Williams, of New York City, suffered a stroke and ultimately died after receiving fat transfer surgery in Santo Domingo. Though her death is not currently under investigation, Hector Cabral, the doctor who performed the procedure, was previously indicted in New York for operating without a medical license and coaxing patients to the Dominican Republic for discounted cosmetic surgeries and subsequently pleaded guilty to unauthorized practice of medicine.
Of course, complications from cosmetic surgery are not limited to the Dominican Republic. In fact, medical tourism is a market that's seeing rapid growth at a rate of 15-25 percent, according to Patients Beyond Borders, and it's estimated that millions of Americans will assume the risk, traveling abroad to areas in the Caribbean, South America, Southeast Asia, and Europe for plastic surgery procedures this year alone.
Why is Plastic Surgery Tourism on the Rise?
Plastic surgery tourism has, without a doubt, made surgical enhancements accessible to an increasing number of people, but the lack of adequate data, absence of international regulations, and limited health resources to help patients make informed decisions leads to an element of risk that's not seen domestically. "What's fascinating is that plastic surgery, in general, is very similar around the world," says Ryan Neinstein, MD, board-certified plastic surgeon and founder of Neinstein Plastic Surgery in New York City, explaining that it consists of complex technical procedures performed by creative medical professionals. "What's different throughout the world is the regulatory environment."
The U.S. is one of the most regulated medical industries in the world, and that extends to plastic surgery, says Steven Williams, MD, a board-certified plastic and reconstructive surgeon and president-elect of the American Society of Plastic Surgeons. George Bitar, MD, a board-certified plastic surgeon in D.C., adds that the credentialing process is complex and can take up to nine years after the completion of medical school. Continued medical education is also required as part of maintaining board-certification.
What's more, plastic surgeons in the U.S. are subject to state and federal regulations on everything from medical devices used and sterilization procedures to truthful advertisements, as well as strict standards set by medical organizations such as the American Society of Plastic Surgeons. The system isn't perfect, but it is widely considered the safest in the world and the regulatory oversight is meant to ensure a level of predictability when undergoing surgery here in the states, something you cannot always count on overseas.
Still, the truth is that for many Americans, the reward of traveling overseas for plastic surgery outweighs the risk — and statistics show that medical tourists are overwhelmingly satisfied with their results. Mark, of Los Angeles, says he has no regrets when it comes to his decision to travel abroad for plastic surgery. After becoming discouraged by the options available in his area, though admittedly one of the best in the country, he booked a consultation with Belo Medical Group in the Philippines. In January 2020, he boarded a flight to Manila where he received rhinoplasty (a nose job).
"This surgery was something I had contemplated since my mid-20s, and I probably wouldn't have done it if I didn't have the option to do so in the Philippines," he says, citing both financial and cultural reasons. "I'm very happy with the results, and as cliche as it sounds, it's given me more self-confidence." In January 2023, he traveled back to the country for additional procedures, including buccal fat removal and chin implants.
Medical tourism is full of nuances, so to help you navigate the big, wide world of plastic surgery specifically, we've put together a comprehensive guide below.
Top Destinations For Plastic Surgery Tourism
It's important to note that not all surgery performed overseas is subpar. "Many countries have highly-qualified and reputable plastic surgeons who follow safety standards and regulations similar to those in the United States," says New York City-based board-certified plastic surgeon Ira Savetsky, MD. One way to recognize such facilities is through the Joint Commission International, which uses U.S. standards to evaluate international hospitals.
Mexico is currently the top destination for U.S.-outbound medical travel, due in part to its proximity, well-known cities, and improving healthcare system (a number of its hospitals are now accredited with JCI). Patients Beyond Borders reports that over 1.2 million American citizens traveled to Mexico for elective medical treatments like liposuction and butt augmentation pre-pandemic and expects the market to bounce back quickly with border restrictions lifted.
For similar reasons, Brazil is another country that has long attracted Americans looking to go under the knife. According to the International Society of Aesthetic Plastic Surgery (ISAPS), Brazil accounts for nearly 9 percent of cosmetic procedures worldwide, second to the U.S., and hosts more than 30 percent of the world's total plastic surgeons, many of whom are board-certified. JCI-accredited hospitals are also readily available, with cities like Sao Paulo and Rio de Janeiro hosting world-class facilities. The most popular surgeries include the Brazilian butt lift, butt implants, and tummy tucks.
Of course, as the medical tourism industry continues to grow, more countries are becoming established destinations for plastic surgery. Costa Rica, for example, is a rising leader in the plastic surgery market, especially for procedures like facelifts, dental implants, and eyelid surgery. The country's ministry of tourism recently announced that medical tourism accounts for 6 to 8 percent of the total of tourists who enter the country each year, referencing a shift in education and a health system that ranks first in Latin America by the World Health Organization (WHO).
Turkey is another country seeing a consistent flow of plastic surgery tourists. A report by Medical Departures, an online medical travel agency, shows Turkey is the world's cheapest destination for medical travel. "The cost of treatments in Istanbul is 70-85 percent of the cost in Mexico," says Medical Departures' chief operating officer Jacob Pope, adding that bariatrics, cosmetic surgery, burn treatment, and hair transplants are Turkey's specialties. The country also has a strictly-regulated medical industry with strong support from the Turkish government and is currently second in the number of JCI-accredited health institutes.
According to the CDC, other popular destinations for medical tourism include India, Malaysia, Singapore, and Thailand. Southeast Asia represents a thriving industry, with Thailand being its fastest growing hub, that's driven by new technology adoption and boosted by both domestic and foreign investments in the market. In fact, there are a number of hospitals that are dedicated entirely to medical tourism.
The Motivation For Seeking Surgery Abroad
Plastic surgery tourism is a phenomenon that's currently driven by a combination of societal beauty standards and socioeconmic disparities. While there is a strong desire to meet contemporary standards of beauty, influenced by wealthy celebrities like the Kardashians, plastic surgery is becoming more mainstream. Yet the rising out-of-pocket medical costs associated with the procedures used to attain such characteristics in the U.S. are unattainable for most people, causing them to seek services abroad.
"The medical tourism market is not serving the upper echelon. It's serving people that are being forced out of this country to find affordable care."
While there has never been a lot of reliable data on the demographics of patient flow to other countries, Josef Woodman, founder of Patients Beyond Borders and author of the book by the same name, explains that plastic surgery tourists tend to be vulnerable. "The medical tourism market is not serving the upper echelon," says Woodman. "It's serving people that are being forced out of this country to find affordable care. We call them medical refugees. Complex cosmetic surgeries are simply out of reach in the states for these people." Add to that rural health disparities: "The quality of care in some areas is horrendous and in others nonexistent, so why not explore other countries where the quality of care has been improving?" he says.
So, although the motivations for plastic surgery tourism may vary slightly between patients, the one thing that is consistently sought is value. One study, which examined 21 patient surveys from different countries between 2009-2019, found that the perception of value (i.e. does the cost equal the quality?) contributes more to overall satisfaction than the quality of service or quality of results alone. Below are some of the main factors that contribute to the perceived value in traveling abroad for surgery.
Lower costs: The price of plastic surgery abroad is on average anywhere from 40-60 percent less than in the U.S. This is certainly one of the main motivators for people seeking plastic surgery abroad, as procedures are often significantly less in other countries due to less overhead costs, including labor and technology, and legal fees like malpractice insurance, explains Dr. Savetsky. Hospital stays and medications are also significantly cheaper in other countries. "I couldn't fathom paying what plastic surgery costs in the U.S.," Mark says, noting that his rhinoplasty procedure, medication, flights, and stay in the Philippines totaled at about $5,000. A cosmetic rhinoplasty in the U.S. can cost up to $10,000 alone.
All-inclusive convenience: Type "all-inclusive plastic surgery vacation" into a search engine and the results are endless. These packages tout surgeries performed by "credentialed" medical staff and private hospital services, plus the appeal of postsurgical recovery at an international tourist resort — all at a discounted rate that often costs less than an individual procedure in the U.S. It's common for plastic surgery tourists to plan extended stays in their destination of choice, treating the trip much like a vacation.
Bypassing regulations: Patients often seek surgery overseas to bypass rules that are set in place by the U.S. government, including preoperative consultations, in-depth medical evaluations, lab tests, and weight observations that may slow the process. "Many [people] see images on social media, and they want the cheapest, fastest route to those outcomes," says Dr. Neinstein. "In some cases, by traveling abroad, they skip all the important but time-consuming steps."
Domestically-unavailable procedures: Patients who are seeking the riskiest procedures are more likely to go overseas. For example, liquid silicone, which is injected into the buttocks for body contouring, is banned by the U.S. Food and Drug Administration (FDA) for causing serious side-effects including irreversible disfigurement and death. This is also the case for patients who are seeking to have multiple surgeries performed at once, exceeding the safety level set in the states, adds Dr. Bitar. "I've heard of patients wanting to have a facelift, rhinoplasty, tummy tuck, and breast reductions at the same time with the rationale that 'the surgery is cheap, let me get as much done as possible while I'm under general anesthesia,'" he says. "This is not only a bad idea, it also very dangerous."
Shorter waitlists: The demand for plastic surgery is higher than ever, thanks to increased prevalence and social acceptance, says Dr. Williams. This was only exacerbated during the COVID-19 pandemic, creating waitlists for new patients and delays for elective surgeries. "The pandemic saw a massive increase in plastic surgery demand, and with limited capacity, some patients cite care overseas," he says.
Cultural factors: A common belief is that surgical techniques and procedures will be tailored to better suit ethnic patients in their country of origin. "I felt that in going to the motherland, the doctors would be more experienced with the Filipino facial structure," says Mark of his decision to travel abroad for cosmetic surgery. "The result wasn't as drastic as I thought it should've been at first, but I'm very happy with how natural it looks and, more importantly, how it fits my face." Other people cite language barriers, the familiarity of the country, and the fact that they will be close to family and friends who can act as caregivers post-surgery.
Specialized surgeons: Surgeons in different regions of the world have become known for specific skills based on the procedures they perform most frequently, technological advancements, and geographical beauty trends. Therefore, some patients seek out specific surgeons or types of surgeries in another country hoping to get better results, says Dr. Bitar. He lists jawline reduction surgery in South Korea, hair transplants in Turkey, and butt augmentation in Brazil as examples.
Privacy: Some people simply wish to keep their decision to get surgery private without side-eye from nosy neighbors or chatty parents in the pick-up line. Traveling to another country where no one knows you allows you to return home fully recovered with a "vacation glow."
The Risks of Plastic Surgery Tourism
While an element of risk is inherent no matter where a cosmetic procedure is performed, medical tourism brings added dangers and complications, which can in some cases lead to irreversible disfiguration and death. "The patients that get in trouble are often not the ones that go to the high-quality clinics," says Woodman, explaining that clinics that offer substandard care know how to appeal to people who are most vulnerable. Because you do not get to tour the facility, may not speak the native language and have trouble understanding foreign credentials, and often don't even speak with the surgeon for a preoperative assessment, it becomes harder to advocate for yourself upon arrival. What's more, traveling home after surgery poses its own risks.
Dicey destinations: There are renewed concerns about the dangers of going overseas for plastic surgery after four Americans were abducted by a Mexican cartel in March, two of whom were murdered, in a case of mistaken identity. Following the incident, the U.S. State Department issued a "Do Not Travel" alert for Tamaulipas, emphasizing that organized crimes, murder, and kidnapping are common along the border. There are a number of other countries the State Department warns pose a threat to international travelers, including Iran, Iraq, Columbia, Venezuela, China, and Russia, to name a few; and furthermore, if anything is to happen during travel to these countries, the agency notes that the U.S. government may have very limited ability to provide assistance.
Poorly trained surgeons and staff: Performing preliminary research into plastic surgeons abroad can prove challenging, with less understanding of foreign credentials and limited access to medical sanctions, leading many potential patients to trust what they see on social media. "Relying on surgeon advertising when seeking surgical care abroad is fraught with risks," says Dr. Williams, as patient testimonials and images can easily be falsified or altered in countries with lax advertising laws. As a result, providers may not have the specialized training or experience needed to perform certain plastic surgery procedures, which can lead to poor results and complications. "I've even heard from a few patients that the surgeon who performs the surgery is not the one who is marketed and promoted on the website that lures the patient to book," Dr. Bitar says. Another area of concern is poor anesthetic practice, which can have fatal consequences.
Quality of the facility: Healthcare system standards vary widely between countries, and specifics you do not get to see before traveling, such as the condition of medical devices used and the level of cleanliness, play a crucial role in ensuring patient safety. "Once inside the operating room, we rely on a dedicated surgical cleaning team. A division of my office is dedicated to instrument sterilization, a well trained synchronized staff and facilities that are not just regulated but a home for detailed obsession," says Dr. Neinstien, warning that "if any of these areas of the facility or team is compromised to save money there will be increased risks of infection, bleeding, and death."
Medical negligence: "I once received a call from a woman at Dulles Airport upon arrival from a central American country, where she had had multiple surgeries performed back to back over a two-day period and was then cleared to fly home two days later," Dr. Bitar recalls. "Thankfully, she was okay, but her surgeries were botched badly and would require a lot more time, money, and emotional energy to correct." Like many people traveling cross-border, this patient was conned into trusting a low-cost clinic that was intentionally performing unsafe surgeries with grave consequences.
Language barriers: While many foreign doctors speak English or offer translators, this is not always the case. "Language barriers can make it difficult for patients to communicate effectively with their healthcare providers, which can lead to misunderstandings and other issues that lead to complications," says Dr. Savetsky. In some cases, he adds, when English is not the primary language spoken, medical tourists may not be fully aware of the risks involved in the procedures they are seeking and the medical staff may not have a full understanding of a patient's medical records.
Postsurgical complications: The importance of postsurgical care cannot be emphasized enough. "Receiving proper postsurgical care is essential to ensure proper healing and reduce the risk of complications, including infection, bleeding, and scarring," says Dr. Savetsky. Patients should receive constant monitoring once surgery is completed and follow-up appointments to monitor their progress. A review of cosmetic surgery tourism, published in the Journal of Travel Medicine, found that a rise in the number of case complications between 2008-2018 was due to "the lack of continuity of care and patient follow-up." If you cannot be transferred quickly to a hospital or if the nearest facility does not have ICU-level care available, complications can quickly become life-threatening or lead to permanent disfiguration.
Complications caused by travel: "Traveling after surgery can also increase the risk of complications, particularly if the patient is traveling long distances or undergoing a long flight," Dr. Savetsky says. "Sitting for extended periods of time can increase the risk of blood clots while changes in altitude and air pressure can also increase the chances of swelling and bleeding."
No legal recourse: "The United States has a very active medical legal environment where malpractice is aggressively pursued," says Dr. Williams. Not only does this guarantee legal recourse in the event of malpractice, but it also creates positive pressure for surgeons to perform the safest standard of care for their patients, he says. Should you experience complications from surgical error or medical dosage in another country, you may not be able to seek compensation or justice for wrongdoing.
What to Consider Before Traveling Abroad For Plastic Surgery
At the end of the day, plastic surgery tourism is successful for millions of patients each year. However, "patients considering cosmetic surgery abroad should take extra precautions to ensure their safety and minimize the risk of complications," says Dr. Savetsky. When traveling overseas for surgery, it becomes increasingly important to understand a foreign country's laws, credentialing processes, and healthcare system. Patients should research the healthcare professionals, including surgeon and staff, the facility where the procedure will be performed, and the specifics of postoperative care, including transportation, lodging and follow-up appointments.
Obvious red flags, Dr. Savetsky says, include unsanitary conditions, unlicensed providers, a lack of transparency or communication, undiscussed changes in care, and negative testimonials from prior patients. Woodman adds that another red flag is a clinic advertising astronomical savings. "In Mexico, for example, you don't want to save more than 70 percent," he says. "Because there are less regulations, if a clinic is advertising savings of 90 percent, there is almost a certainty you are going to a clinic that will provide substandard care. Don't fall for it."
Medical tourists should also insist on a virtual consultation, Dr. Bitar adds, during which you should ask the following questions: What are the regulatory standards in the country where the procedure will be performed? Who is the surgeon performing the surgery, what are their qualifications, are they experienced in performing the specialized procedure you seek, and do they hospital privileges? Where will the procedure be performed? Does it have a track record for safety, and is it a JCI or similarly accredited facility? What is the rate of complications at the facility, and how does the medical staff handle follow-up care? What kind of postoperative care will be provided?
Once you have answers to these questions, Dr. Bitar suggests running them by a board-certified plastic surgeon in the states, even if you have to pay for a consultation. "Within 10 minutes of learning about a plastic surgeon abroad, I can decide whether or not I trust them," he says. A thorough pre-travel evaluation is crucial to making an informed decision prior to seeking cosmetic surgery cross-border.
Finally, it's important to go with your gut. "If the reviews seem too good to be true, run. If you feel like you are meeting with a car salesperson, run. If the doctor is not a licensed specialist, run. If the facility is not clean or up-to-date, run," Dr. Neinstein says. "There are amazing surgeons around the world, but you have to do your homework and advocate for yourself."