
Overseas tummy tucks or face-lifts carry special risks
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.
Maybe you've seen ads for all-inclusive vacations to exotic places all over the world that include cosmetic surgery. In the past decade, cosmetic-surgery tourism has grown in popularity. If you're tempted to sign up for one of these trips, please listen first to my guest, Dr. Sara Neimanis. She's a plastic surgeon at the University of Rochester, and she recently gave an educational talk to primary care providers at Upstate all about cosmetic-surgery tourism.
Welcome to "The Informed Patient," Dr. Neimanis.
Sara Neimanis, MD: Thank you, Amber, for having me.
Host Amber Smith: Plastic surgery procedures that are quote-unquote cosmetic, that would be things like face-lifts, liposuction, breast augmentation, things that are not medically necessary. Is that right?
Sara Neimanis, MD: Yes. That is mostly correct. People can travel anywhere for any sort of medical treatment, but that's specifically what we're talking about today: cosmetic.
Host Amber Smith: So, what are the most popular procedures for cosmetic-surgery tourism?
Sara Neimanis, MD: What types of procedures we see patients for that come back from these places, are things like breast augmentation; liposuction; fat grafting to the buttocks, which is also known as a Brazilian butt lift; abdominoplasty, or tummy tuck -- mainly those few things. And then some combination of them, which a lot of people will call a "mommy makeover."
Host Amber Smith: So are we talking mostly about females and and what age range?
Sara Neimanis, MD: We are definitely talking about mostly females. Men are not exempt from any of this, but in my experience, it tends to be women in the, like, 20 to 50 age range.
So some pretty young women, and then some women who are doing these things after having kids and trying to reclaim their bodies.
Host Amber Smith: Does health insurance help pay for these trips?
Sara Neimanis, MD: No, this is all cosmetic, not considered medically necessary. And insurance is not involved in any of this.
Host Amber Smith: If part of the attraction is that it's cheaper to take this trip and go to this exotic location and have a mini vacation than it is to stay in the United States and have the surgery done when you're paying out of pocket, I can see where it would be a popular draw for people.
We're going to talk about the things patients should consider aside from the cost. But first, I'd like to understand why surgery costs so much in the U.S. in the first place.
Sara Neimanis, MD: There's a lot of factors that go into that. When you are paying for a surgical procedure in a hospital or a surgery center, for example, you're paying a surgeon's fee.
You may be paying if you're having breast implants for the actual implants themselves, which are expensive. You're paying for an anesthesiologist. A facility fee for using that operating room, which needs to be cleaned, for instruments that need to be sterilized. So it's not just the surgeon pocketing all of the money.
There's a lot of factors that go into it. And that is why things cost so much.
Host Amber Smith: Well, the world is full of skilled and qualified surgeons, but how can a patient make sure that the doctor that they'll have at whatever location they're going to has the proper training and credentialing?
Sara Neimanis, MD: That's one of the difficult parts about this. In the United States, we have the American Board of Plastic Surgeons, and it's always good to know that your surgeon is board certified in their specialty. In other countries, there are similar , of board-certifying programs, but a little bit harder to keep track of what's what, and there are so many, even in the United States, I don't want to say fake board certifications, but people who are, say, board certified in cosmetic surgery, which is not the same thing as being board certified in plastic surgery. You don't have to have done an entire plastic surgery residency to say that.
So that's one of the difficult parts of this whole thing is keeping track of what sort of training your doctor has had, are they qualified to do these procedures, and anybody can put anything on the internet. That's one of the difficult parts about this.
Host Amber Smith: So that regards the physician.
What about the facility and the staff? How can you verify ahead of time that they follow accepted guidelines for safety?
Sara Neimanis, MD: Also very difficult in other countries. In the U.S., we have specific certifications and rigorous checklists (for) surgery centers, including some plastic surgeons have ORs (operating rooms) in their offices. And even those have checklists and certifications to go through to be considered safe. For example, if you're not at a hospital and you have a patient who has an anaphylactic reaction or has problems breathing and needs to be transferred to a higher level of care.
You need to have the appropriate equipment on site to manage that patient in the interim before they can get to a hospital, for example. How you could know that your surgery center has that when you're going to a foreign country that may not speak the same language as you is extremely difficult.
And I don't even know how you would necessarily find that out.
Host Amber Smith: Well, the U.S., we also have the Food and Drug Administration that approves medical products and devices. Does Thailand and Brazil and Costa Rica have the same sort of standards for devices and equipment?
Sara Neimanis, MD: They do. I mean, every country that I'm aware of, and I don't know each individual protocol, has some version of that.
You often hear in Europe that a drug might be approved before it's approved in the U.S., so there are some differences in, for example, breast implants, which types of implants are approved for use in different types of patients in different countries. But in general, there are regulations for these things, but whether people follow them or not, we don't know.
Sara Neimanis, MD: And that's true in the U.S., too. This is not exempting plastic surgeons and people performing plastic surgery procedures in the United States that are not following the rules, either.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith, talking with Rochester plastic surgeon Dr. Sara Neimanis about some things to consider about plastic-surgery tourism.
Now these cosmetic-surgery vacations are usually at beautiful resorts. Would that help the healing process? If you go there and you have your surgery, and then you're recovering there. You're not having to make your own meals and do your own laundry and things like that. Would that be a benefit?
Sara Neimanis, MD: Having help when you're recovering from surgery is wonderful, and making sure that you have people that are assisting you with heavy lifting, making sure that you're eating well, all of that is great.
But oftentimes when you're at these exotic locations and resorts, it's tempting to go out and lay by the pool or go for a swim or do activities that are probably not a good idea to do immediately after surgery. So, what's the point in being in a beautiful place if you're inside a hotel room all day?
Sara Neimanis, MD: So, it's not the recovery inside that I'm worried about. It's what people might be doing in addition to recovery.
Host Amber Smith: And what happens if you don't speak the language?
Sara Neimanis, MD: Well, the informed consent process is part of the basic principles of practicing medicine. I haven't been part of any of these sorts of consultations in foreign countries to know what the interpreting process is, but here, if we have a patient that doesn't speak English, we make sure that we have an appropriate interpreter before providing the risks and benefits of surgery and obtaining consent.
The other problem with this in terms of consent is that sometimes these people sign up for surgery and haven't actually met the person who's doing the surgery. And they haven't even determined if they're a good candidate. So you're signing up for something, and you may not even be an appropriate candidate for that procedure. And then you show up and they either do it, and you're not appropriate, or you might be switching plans, and that can be really confusing and not necessarily great for your understanding of exactly what is happening.
Host Amber Smith: I know there's a risk of complication for any surgical procedure. What happens if a patient at one of these resorts develops, say, an infection after surgery? Do you hear about people who end up having to be sent to the local hospital?
Sara Neimanis, MD: Honestly, the biggest problem with this that we see, or at least that I see, here in Rochester, is that these people are not actually recovering where they had the surgery.
They're actually getting on planes and coming back almost immediately after, even the next day, so they haven't even had the opportunity to have a problem wherever they had the surgery, which is the scary part. I imagine if they did, then they would go to a local hospital, but the issue that we're seeing here is they are showing up in our emergency room in Rochester days later and having just flown back from what could be a pretty lengthy procedure with a long recovery.
Host Amber Smith: I thought there was a risk of blood clots or pulmonary embolism, where a blood clot lodges in the lungs. I thought people were generally advised not to fly soon after surgery because of that risk, but you're seeing patients that are doing that and coming back home to Rochester?
Sara Neimanis, MD: Absolutely. I think this is one of the scariest things about this whole process. It's not necessarily the surgery or the surgeon or the hospital where this is taking place. It's the hours afterwards. And a long plane flight is a risk for a deep vein thrombosis, or a DVT, in the legs, especially in people who have recently had a surgery that also predisposes them to that. So abdominoplasty is a surgery that comes with a risk of DVT. So you're compounding those two things. And then sometimes these patients may be on a hormonal birth control or some other medication that may also predispose them to DVT.
And then you have a lot of factors coming together, and that can be life-threatening. So that's really one of the scariest and deadliest concerns that we have about plastic-surgery tourism.
Host Amber Smith: If I understand you correctly, though, these people may have a complication that has to be dealt with immediately, but they could also have a bad outcome from the surgery they went to have.
Do you see patients like that, that come to you for help fixing something that was broken by going to another country to have the surgery done?
Sara Neimanis, MD: Yes, we do. So, caveat, I work in a university, at the University of Rochester, and I mainly do pediatric plastic surgery. I don't do cosmetic surgery on a regular basis, so the patients that I'm seeing are ones that come to us through the emergency room while I'm on call.
And yeah, we have patients who have two issues, exactly as you said, infections, wound breakdown, things that happen in the early post-op period that are more medical problems. And then you do have patients who just aren't pleased with their outcomes, mostly because they had one of those complications.
A lot of them are actually really happy with the way things turned out, and they may have an infection or something that you deal with in the immediate post-op period. But there are a lot of people who have unfavorable outcomes, and they don't have their surgeon to just pop into their office and talk to about it. We do see a lot of patients who are actually coming from Florida lately, which is clearly not a foreign country, but similar situation where they have surgery, and then they come home, and they don't really have contact with the surgeon anymore. And I ask the patients sometimes, have you talked to the surgeon who did this? And I either get "No" or "I tried, and they didn't answer" or "They said to come to the emergency room."
Host Amber Smith: Does health insurance typically pay for medical care related to problems that developed from cosmetic surgery when they get back home?
Sara Neimanis, MD: This part's a little dicey. For the most part, from what I've seen, yes. If somebody has an infection that they could become septic from and have a serious problem, I have seen insurance covering problems related to complications, but if somebody just didn't like how their tummy tuck looked, for example, then that certainly would not be covered by insurance.
Host Amber Smith: If someone is adamant about wanting to have their work done in another country, because they can save a lot of money by doing that, do you have any advice for what they can do to increase their chances of having a good experience?
Sara Neimanis, MD: Obviously, I think it's in the patient's best interests not to travel for surgery for the reason of not having good follow-up, which is important in post-op care. However, there are people in other countries who are excellent surgeons and do great work. So, I don't mean to discredit them in any way. The best that you can do is do your research, find out more information about the facility, about the surgeon, how they've been trained, are they actually trained to do these operations?
What we see a lot of is, the patients here, they're not dumb. They've had friends and family who have gone to these same people and have had good outcomes. So, I can see why this happens. It's not like somebody is like, "I just want to save a few bucks, I'm going to go to this clinic that is horrible."
They've had friends and family who have gone to these people. And so, why wouldn't they have a similar outcome? And what I would advise people to do is to take time to recover while you're there, ideally, because flying back is one of the really dangerous parts. Also, be honest with whoever is taking care of you if you do have a complication when you come home, because there are pathogens and microbes and types of bacteria that we don't tend to see infections from here, but people, for example, that have surgery in the Dominican Republic may have a different type of infection. And so it's important for us to know where the surgery was done, not to judge you, but to be able to best treat you and understand what might be going on. But not flying home days after an abdominoplasty is probably my best advice, and something that seems like it's going to save a few bucks might end up costing you more in the long run.
Host Amber Smith: I appreciate you making time for this interview, Dr. Neimanis.
Sara Neimanis, MD: Thank you very much for having me. It's an important topic, and I want to make sure that people are informed of their decisions before they do them.
Host Amber Smith: My guest has been Dr. Sara Neimanis. She's a plastic surgeon affiliated with the University of Rochester medical system. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed.
This is your host, Amber Smith, thanking you for listening.