Cosmetic surgery tourism is a gamble

Doctors in the UAE who have to pick up the pieces when cosmetic tourism goes wrong warn that proper research is essential.

Dr Sylvia Angerer, a specialist plastic surgeon at Bodyworx in Abu Dhabi, has serious reservations about cosmetic tourism which she says can lead to "very bad results".

ABU DHABI // The lure of "very cheap" plastic surgery abroad was too great for one woman wanting a breast augmentation and lift. The immediate results, too, left her pleased with the procedure.

But six months later the scars were still spreading and the implants had moved up towards her collarbone, necessitating secondary surgery and highlighting the risks involved with what has been termed "cosmetic tourism". Upon her return to the Emirates, the unnamed patient turned to Dr Nicanor Isse, who is among the UAE surgeons warning of the risks of botched treatments from unqualified practitioners that face people travelling abroad for cheap cosmetic surgery without doing proper research.

Cosmetic tourism has become increasingly popular as plastic surgery becomes more desirable and socially acceptable, particularly in the Gulf region. However, experts say patients who go elsewhere for cheap surgery, which they can combine with a short holiday, may not receive the proper aftercare and run the risk of life-threatening complications. Dr Sylvia Angerer, a specialist plastic surgeon who works at the Bodyworx clinic in Abu Dhabi, has reservations about cosmetic tourism. She said she had seen a number of "very bad results" in patients who had travelled to other countries for cheaper treatment.

"The main problem is aftercare," she said. "There is always a risk of complications and without the proper care, these can be dangerous. "I have seen some very bad results. I have seen totally visible scars from incisions in places no trained plastic surgeon would put them. There have also been some very bad wound-healing problems and infections." Bodyworx has also received patients who have had too much fat removed during tummy tucks and wounds that have become seriously infected and left permanent scarring.

"Travelling abroad for surgery is all about the money. It's very tempting if a company offers you a breast augmentation for a low price, but usually low price means low quality," said Dr Angerer. People were becoming more inured to the reality that cosmetic surgery was still a surgical procedure, she added, and one that posed similar risks to those of non-cosmetic medical procedures. "It is a medical surgery and it can have complications; you should not risk your own body just to save a little money by going to a doctor you know nothing about. Some of the time the doctors are not well trained. It is essential people do their research and not base decisions only on price."

Before opting for any type of surgery, a patient must check up on the doctor and find out what qualifications he or she holds, said Dr Angerer, who is registered with the German National Board of Plastic, Aesthetic and Reconstructive Surgery. Doctors listed as specialists might not be qualified plastic surgeons. Instead they could, for example, be ear, nose and throat specialists or gynaecologists.

Most countries in the West have medical boards with which cosmetic and plastic surgeons can register. Many, such as the American Board of Cosmetic Surgery, require members to undertake a written exam before joining. Dr Isse, an American board-certified plastic and reconstructive surgeon who also works at Bodyworx, warned of other complications associated with travelling abroad for cheap treatment. Most health insurance packages do not cover individuals for surgery performed outside the UAE, so if somebody needed extra care it could result in extra costs as well as extra worry, he said.

"While part of the allure of medical tourism is the 'holiday', it can also be one of the risks," he said. "Drinking, spending too much time in the sun, or just not resting enough can lead to complications with the recovery, including undue swelling, haematoma, scarring, infection, skin slough and other complications." Dr Isse, who also has a clinic in Newport Beach, California, added that there were also some "very serious complications" associated with the journey back home after the surgery. High altitude, sitting still for long periods, recovering from surgery and some medical conditions could cause blood clots and blocked blood vessels, both potentially fatal conditions. He also warned of the possible problems of aftercare, and said if difficulties arose once the patient returned home it could be "very serious and potentially pricey".

Dr Dawood Sulaiman, of the International Aesthetic Medical Centre in Jumeirah, Dubai, said he too had seen a number of patients who had received treatment abroad but not the proper aftercare. "Aftercare is very important," he said. "It is important that a patient returns to the surgeon after one week, two weeks, six months and so on so they can check everything is fine. "Even having another surgeon remove stitches is not ideal. It is much better to have one surgeon doing everything, and this is not always possible if the surgeon is in another country. A patient might not be able to afford to travel for another trip."

Dr Sulaiman, who has a doctorate in plastic and reconstructive surgery, said his registration as a UK board-certified surgeon reassured his patients that they were in safe hands. Regulations governing plastic and cosmetic surgery in the UAE have been toughened in the past few years, and recently the Ministry of Health warned clinics, hospitals and pharmacies that they faced disciplinary action if they were found to be using "unregistered" chemicals in cosmetic surgery.

Last summer the Dubai Health Authority also cracked down on the industry, targeting clinics run by doctors who were not qualified to do so, and those that bumped up prices set by the authority. Dr Ramadan Ibrahim Mohamed, the head of the department's clinical governance office, said it had already shut down a number of clinics and would remain vigilant. He said the case of a woman who ended up in a coma after receiving liposuction and a facelift highlighted the need for stricter regulations.