Complications of Cosmetic TourismMatthew J. Carty, MD

Staff Surgeon, Division of Plastic Surgery

Brigham and Women’s Hospital

Associate Professor of Surgery

Harvard Medical School

I have no disclosures or conflicts of interest.

Medical Tourism

The practice of traveling to another

country in order to receive health

care

Top Medical Tourism

Destinations

• Costa Rica

• India

• Malaysia

• Mexico

• Singapore

• South Korea

• Taiwan

• Thailand

• Turkey

• United States

Approximate worldwide value: $439

billion/year

Source: Dalen JE, Alpert JS. Medical tourists: Incoming and outgoing. Am J Med (2019); 123(1): 9-10

Most Frequent

Conditions Treated in

Medical Tourism

• Dentistry

• Cosmetic surgery

• Cardiac

conditions

• Infertility

• Weight loss

• Dermatology

• Organ transplants

• Spine surgery

Source: Dalen JE, Alpert JS. Medical tourists: Incoming and outgoing. Am J Med (2019); 123(1): 9-10

Source: Alizadeh K. Commentary on: Complications after cosmetic surgery tourism. Aesth Surg Journ (2017); 37(4): 483-484

VQ + S

$=

(VALUE)

(QUALITY) (SERVICE)

(COST)

Promise of Reduced

Cost

• Limited or no prospects to

meet physician or specialist

nurse in advance

• Limited or no prospects of

having standard follow up

• No clear definition as to

who will manage

postoperative

complications or revision

surgery

Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast

Recon Aesth Surg (2012); 65: 22-28

Promise of Equivalent or Improved Outcomes?

• Consent

• Agency

• Responsibility

LIMITATIONOUTCOME

PARAMETER

Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast

Recon Aesth Surg (2012); 65: 22-28. Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in

a U.S. academic medical center. Plast Reconstr Surg (2018); 141: 517e

Source: Miyagi K, Auberson D, Patel AJ et al. The unwritten price of cosmetic tourism: An observational study and cost analysis. J Plast

Recon Aesth Surg (2012); 65: 22-28. Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in

a U.S. academic medical center. Plast Reconstr Surg (2018); 141: 517e

Complication

Rate

Number of Patients

with Complications

Number of Patients

Treated

=

Source: Klein HJ, Simic D, Fuchs N et al. Complications after cosmetic surgery tourism. Aesth Surg Journ (2016); 47(4): 474-482

Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with

medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347

• M. abscessus and M.

fortuitum among most

common species

• Notoriously resistant to most

antibiotics

• Most frequently detected in

nonsterile water sources

• Prolonged (24 day) incubation

period

• Classic cutaneous symptom:

painful nodules that develop

into persistent draining

abscesses

• Less frequent systemic signs

Rapidly Growing Mycobacterium

Rapidly Growing Mycobacterium

Source: Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in a U.S. academic medical

center. Plast Reconstr Surg (2018); 141: 517e

Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with

medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347

Source: Gaines J, Poy J, Musser KA et al. Nontuberculous mycobacteria infections in U.S. medical tourists associated with plastic surgery

– Dominican Republic, 2017. MMWR (2018); 67(12): 369-370

Source: Schnabel D, Esposito DH, Gaines J et al. Multistate US outbreak of rapidly growing mycobacterial infections associated with

medical tourism to the Dominican Republic, 2013-2014. Emerg Infec Dis (2016); 22(8): 1340-1347

• Incision and drainage

• Debridement

• Delayed closure or skin

grafting

• Implant removal

• Image-guided drainage

• Prolonged antibiotic

therapy (>3 months)

Treatment Requirements

Institutional Costs

Miyagi et al

Klein et al

• £10,878 loss per patient (UK)

• $1,300 gain per patient

(Switzerland)

STUDY FINDING

Source: Ross KM, Moscoso AV, Bayer LR et al. Plastic surgery complications from medical tourism treated in a U.S. academic medical

center. Plast Reconstr Surg (2018); 141: 517e

Personal Costs

• Pain

• Compromised mobility

• Permanent disfigurement

• Social isolation

• Financial strain

• Lost productivity

• Remorse

Mortality

Guidance, Warning

and Oversight

• CDC

• ASPS

• ISAPS

• AMA

• TJC

Estimated Global Medical Tourism Market Size by

Country

2015-2026(in $US billions)