Many cosmetic surgeries outside Australia – particularly in Thailand - target younger people and suggest combining surgery with a holiday. Group bookings are often encouraged.
Patients who recount their overseas surgery experience tell of how they met their allocated surgeon on the morning of surgery. There was no chance to select the surgeon, the hospital or type of device used.
Australian standards suggest a minimum of two consults before and after cosmetic surgery, however in many developing countries, only one post-operative appointment is schedule before flying home. This does not ensure good continuity of care. Post-operative recovery in another country may be hotel based and not in a hospital, where nursing staff are usually available.
Recently, a Perth women was scheduled to have breast implant surgery and liposuction to her thighs and waist. Firstly, the surgeon completed the liposuction, however there were complications and she was woken after several hours without the breast implants being put in. At this stage, she required two blood transfusions. She remained in hospital for a further four days and required four more blood transfusions. The hospital then encouraged her to have the implant surgery performed. After the surgery and when the Perth woman had returned home, she developed potentially life-threatening blood clots. In total, 11 litres of liposuction was performed. The Australian recommended maximum is five litres.
There are no official figures of complication or adverse outcomes. There is often very limited recourse for malpractice and especially in a foreign country and foreign legal system. There are often not even administrative bodies for health care complaints. Astonishingly, neither the hospital nor surgeon may accept liability.
There is no standard to the accreditation of the facility and the competence, qualification, training or experience of the surgeon, anaesthetist or allied medical staff. Medical standards, infection control, implant regulations and control of equipment may not be to adequate standards compared to the Australian rules.
This is also complicated by there being usually no or very little advice on who corrects the adverse results, health insurance issues, and repatriation costs. Travel insurance may not cover these outcomes. Ongoing costs have been known to exceed many thousands of dollars.
Infection have been noted to be caused by a resistance to many antibiotics provided, and difficult to treat viruses may be water borne or from instruments. Hollow liposuction tubes are characteristically difficult to clean and sterilise without specific equipment and techniques.
A vast majority of plastic surgeons in Australia have been involved in corrective surgery for these adverse outcomes. It can be difficult for these surgeons to obtain important details, medical records, operative details, procedure specifics have all been ‘lost’ from these overseas procedures.
My worst experience was a patient that has required 22 operations to correct facial deformities and recurrent facial infections and granuloma. These were all performed at her cost and huge expense to the Australian Medicare System.
Consider very carefully whenever choosing surgery. Check the surgeon’s qualification, training, accreditation, registration and ongoing education. Hospital accreditation and standards should be checked. Quality control, medical standards, acceptance of liability, insurance, and after care should all be considered. This is real surgery with real risks.
By Dr John Kippen