So, the big 4-0 birthday is looming, and you’ve decided you’d like a bit of a facelift. Or a straighter nose. Or an enhanced chest. Or maybe you’ve just finished having babies and you want to do some post-baby body repairs.
How do you decide which medical expert or provider to use? And is ‘vacation surgery’ a realistic and safe option?
The cost of cosmetic tinkering and bodily improvements on our home shore can be high, which makes for a billion-dollar business for the cosmetic enhancement industry. For a few years now, many Aussies have been opting to have everything from tummy tucks to eye lifts to dental work performed overseas in tropical destinations such as Malaysia or Thailand.
Whilst the thought of a nip and tuck followed by poolside margaritas may seem glamorous, what are the risks, costs and legal issues that arise when you undertake cosmetic surgery abroad as opposed to going under the knife at home?
Medical tourism refers to the the practice of travelling overseas (away from your country of origin) to have cosmetic or plastic surgery (or any medical procedure) performed. The Southeast Asian medical tourism industry advertises all sorts of cosmetic surgery procedures including dental (implants, crowns, dentures, whitening), eye, cardiac, breast, orthopaedic and gastric bypass or banding surgery. The term also refers to a wider range of wellness, health check and fertility treatments.
International study, The Sun, Sea, Sand, Silicone Project, explored the cosmetic tourism industry as it relates to Britons, Australians and Chinese and estimated that Australians spend $300m a year on cosmetic surgery tourism, with approximately 15,000 Australians heading overseas every year for a range of surgical procedures.
One of the primary researchers, Dr Meredith Jones, says that people generally travel for four (4) different reasons: corrections, investment, repair and anti-ageing.
In his video discussing the project, fellow researcher, Dr David Bell, refers to push factors (the low cost of overseas procedures which often aren’t available under public health, not having to wait for surgery, accessing surgery with added extras or opting for new and emerging procedures) and pull factors (tropical destinations attracting tourists with holiday packages, airlines and hotels making medical tourism affordable with well-priced flights and accommodation).
Proponents of medical tourism refer to the fact that the quality of care and attention in many South-East Asian hospitals is superior to that of western countries.
The Business in Asia website notes that there is less hassle and bureaucracy and more personal, and even reverential care. It reports that an overnight stay in Bangkok’s Bumrungrad or Bangkok International Hospital may include deluxe suite which includes a large bedroom, living room, two complete bathrooms and a city view for $400 a night including nursing, equipment, flat panel TVs, Wifi and meals for three. A single room in a US hospital will run upwards of $800 for the room, not including services and other charges.
According to Australian health insurance comparison website, Choice, many Australian surgeons warn, however, that heading overseas to save a few pennies on cosmetic procedures could come at a high price, including lack of redress when things go wrong and poorer quality surgical outcomes where health or medical regulations are less stringent than in your home country.
Cosmeditour influencer, Sarah Harris in Thailand after surgery.
Surgery can be risky business, no matter what location you’re in (and especially if you’re under a general anaesthetic).
One of the biggest issues with having surgery overseas is if surgical complications arise and revisions or corrections are required. When the kind of expertise you need is thousands of miles away, you could be placing your health and recovery at serious risk.
You could also be stranded in a foreign locale for a lot longer than you bargained for when all doesn’t go to plan. Many major airlines do not allow travel within 24 hours following superficial plastic surgery and require medical clearances one to four days after plastic surgery. In 2017, the New York post even reported that three South Korean women were left stranded in America as their passport photos looked nothing like their puffy and bandaged post-surgery faces.
The health risks may also increase if there’s a long-haul flight home and it falls on the patient to assess and cover these risks. Speaking with Choice, Cassandra Italia, Director of Healthcare Hands (an international patient concierge service) says that it is the patient’s responsibility to do their research in order to reduce the risks.
Other challenges such as under-qualified clinicians, language barriers and holiday packages which encourage patients to ‘shop and play’ rather than rest up after major surgery, are also major contributors to the problem. Not to mention the price tag of returning home for those repairs, especially if there’s no legal redress for your situation.
So what if something goes wrong during the operation or you’re generally unhappy with the outcome? Can you complain to a professional body or obtain compensation?
Poolside mocktails at Amari, Phuket.
Mandatory guidelines set by the Medical Board of Australia in 2016 now require that everyone who performs cosmetic surgery must tell their patients exactly the extent of their qualifications and expertise in performing these procedures as well as the inherent risks and possible complications involved. They are also required to:
All of this information provides the basis of informed consent. There are many layers of care to assist you in seeking redress and to have the surgical work reviewed including GP check-ups, post-op care and medico-legal safety nets.
For example, if you believe your surgeon has made an error or been negligent in some way, you can complain to the Medical Board of Australia or Australian Health Practitioner Regulation Agency (AHPRA) or the applicable state health care commission or medical board such as the Health Ombudsman in Queensland.
In respect of a health ombudsman complaint, you will generally be required to establish that the medical practitioner owed you a duty of care and that they failed to warn you of a procedure’s material risk of harm (and that the harm caused was directly caused by the breach of that duty).
Speaking with Perth Now, Mark Lee, a Perth-based plastic surgeon and former head of department at Sir Charles Gairdner Hospital, said patients regularly return from overseas operations with infected breast implants and one patient even came back with tuberculosis.
From a practical point of view, it is often far easier to resolve issues with a local and easily contactable surgeon, where you can pop back in for a follow up or corrective procedure if the operation did not go to plan.
If you’re overseas, it’s a whole different legal ballgame.
Firstly, it is an established legal principle that the applicable law is usually the place of the wrongdoing and there is no standard international complaints system. You will most likely need to comply with local complaints mechanisms which may be substantially different to those in Australia.
You may also face challenges around language barriers, gathering reliable evidence and jurisdictional disputes if you wish to file a legal claim either in the country where the surgery was performed or in Australia where you booked the procedure and holiday.
It is advisable to read the fine print of any surgery contract and have it reviewed by a lawyer before you embark on a cosmetic tourism expedition. Certain contracts contain exclusive jurisdiction clauses which expressly exclude Australian courts from hearing contractual disputes.
And if you don’t rigidly follow the tourism provider’s rules, you may fall through a loophole in your contract.
Australian cosmetic tourism provider, Elegance Abroad, notes under its ‘Post-Op Procedures’ section that you “need to adhere to the minimum stay time in Phuket so that adequate post op time is allowed for healing, appointments and post op care. If you do not stay in Phuket for the minimum required time, you will void all post op care and concerns.”
Mother and daughter having surgery together in Bangkok, Thailand.
Surgical costs go well beyond the surgeon’s fee and include the anaesthetist’s professional fees, hospital costs, medication fees and other fees such as medical tests.
Many Australian surgeons don’t list prices on their websites on the basis that the cost depends on the type of patient and procedure. Medical tourism operators are far more upfront about the costs. This transparency (along with the far more affordable fees) is one of the primary reasons people choose to head abroad for surgery.
For example, Lotus Medical in Thailand and Gorgeous Getaways offer various price guidelines with breast augmentation costing around 115,000 baht (approximately $4500AUD). Breast enhancements in Australia can cost $10,000 or more.
Dr Flynn of the Australasian College of Cosmetic Surgeons has said that “there is no way that in Australia we can match the cost of surgery in Thailand or somewhere similar," says Flynn. "In many cases it's half the cost."
The one factor you need to consider are the travel and accommodation costs (even if they form part of a package deal). The Australian Society of Plastic Surgeons checklist recommends that patients get full, written financial details, including all out of pocket expenses for not only the surgeon, but also the anaesthetist, assistant and hospital theatre or facility costs.
All travel insurance policies differ slightly however the industry norm is that travel insurance covers you for unexpected or unforeseen situations such as flight cancellations, loss resulting from travel delays, evacuations, theft and lost baggage (for example) but does not generally cover you for damage or injuries related to your actual hospital procedure.
As noted on Australian insurance website, Finder, any cosmetic or elective surgery you plan to receive overseas would be classed as a pre-existing condition and excluded from cover. Not only will your surgery not be covered, any complications or other expenses arising from the surgery may not be covered.
You are best to explore separate insurance cover for your procedure. For example, the Elegance Abroad website notes that “travel insurance does not cover your hospital procedure, you will need to apply for medical tourism insurance.”
According to Medical Tourism Abroad, you can opt for a premium type of travel insurance coverage which is available for medical procedures that are performed outside the residing country of the patient.
Happy besties post Breast Augmentation who travelled together to Phuket, Thailand.
The international medical community and medical tourism industry appear to be catching up with several accreditation agencies now ensuring minimum quality of care standards for people travelling abroad for surgery and other procedures.
The Joint Commission International (US) and the United Kingdom the Quality Healthcare Advice Trent Accreditation (UK) are focused on improving patient safety and quality of care in the international community. In Australia, health facilities are accredited through the Australian Council on Healthcare Standards (ACHS), which offers offshore accreditation on request through ACHS International.
Before you commit to cosmetic surgery, make sure you:
In Australia, you can find accredited plastic surgeons on the ASPS website for an accredited plastic surgeon.
For overseas surgeons overseas, look for one accredited by the International Society of Aesthetic Plastic Surgery (ISAPS).
As with any procedure, informed decisions are best so do your research and reach out to accredited and professional bodies to make sure you’re confident with your surgery choice.