Chapter 2 Page 4 | Sticks and Stones

On one side, we have U.S. doctors and public officials issuing a very real warning: don’t go out of the country for plastic surgery, especially to the Dominican Republic. On the other side, we have the trained medical establishment of the Dominican Republic arguing that they have been unfairly vilified for competitive reasons and with ignorance of the true state of affairs in the country. It would probably pass for journalistic fairness these days if I simply let representatives of the two views slug it out. I have certainly talked to earnest, well-spoken, successful, well-known surgeons who can do just that.

Lost in the shouting, likely, would be the common ground. I could choose a top, board-certified cosmetic surgeon in the United States and a top, board-certified surgeon in the Dominican Republic or another country and wager that they would agree on the following:

  • Schooling, training, and board certification processes are substantially similar. In fact, they are so similar among the United States and other countries with modern medical schools, teaching hospitals, and national peer oversight that a discussion of the differences would only be of academic interest.
  • There are similar personal standards for operating facilities, regardless of what national board is responsible for certifying the facilities.
  • No patient should undergo a cosmetic procedure without fully understanding the risks and having a realistic estimation of the outcome.
  • Cosmetic and aesthetic surgery should only be performed by fully trained, experienced professionals such as themselves.

It is easy to browse the World Wide Web and find successful, board-certified plastic and cosmetic surgeons with lengthy and impressive resumes and glowing recommendations from grateful patients. The only significant difference you will find among the surgeons are geographical location — and price. Both are important factors to a patient.

The attention the don’t-go-to-the-Dominican-Republic-for-cosmetic-surgery scare drew in 2004 and 2005 shows that there is controversy and confusion about medical tourism, in general, and cosmetic surgery, in particular.  The story also added credence to the notion that traveling out of the country for cosmetic surgery is a phenomenon, not an aberration. A dozen or a few dozen serious infections, while disastrous for the individual patients and alarming and confounding to their doctors, is completely unsurprising given the number of surgeries performed. In fact, one can be reasonably sure that there have been quite a few more infections than those reported and that there are many more patients who have been less than satisfied with their results.

Choosing even the best, most experienced, and most expensive cosmetic surgeon, whether it be in the United States or abroad, is no guarantee that a patient will heal perfectly. Certainly it must cross the minds of any person who elects to have cosmetic surgery that there is at least a small chance that he or she will be disfigured or will die. There is a somewhat greater risk that someone will simply be dissatisfied, to some degree, with the results. Top U.S. plastic surgeons complain that too much of their time is spent fixing the poor work of others from the United States and abroad. However, top surgeons in other countries make the same complaint.

The bottom line is that the Dominican Republic scare story made it manifestly clear just how price-sensitive the cosmetic surgery consumer market is. In the minds of an increasing number of consumers, the difference between a $3,000 tummy tuck overseas and a $7,000 one in the United States is, simply, $4,000; and the $4,000 represents not a cost of quality assurance but a cost some people are either unwilling or unable to bear. The fact that the story did not hurt the cosmetic surgery business in the Dominican Republic much, if at all, says that traveling abroad for inexpensive cosmetic surgery is not a fad any more than cosmetic surgery itself is. If the price is right, Americans will shoulder some inconvenience, bear some uncertainty, and weigh risk when considering their medical and health-care options. They are doing it for cosmetic surgery. In lesser but growing numbers, they are doing it for other kinds of medical care, too.

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