Nov 01

Cosmetic surgery is not a commodity. All facelifts are not created equal. And “How much is a facelift in Mexico?” … or in California, or Costa Rica, or Malaysia is not, are not questions that have tidy, brisk answers. You pay for the experience of the surgeon. You pay for geography. You pay what the market will bear.

Chapter 4 Page 2 | Cosmetic Surgeries and Procedures

Despite the efforts of my editor to wring specifics from me on cosmetic surgery prices, I held to broad ranges when characterizing what cosmetic surgeons charge in different countries — or even within one country, or in your neighborhood. As such, the information I gathered in 2004-2005 is probably just about as relevant now as it was then. Surgery prices have no doubt risen for some, declined for some and stayed about the same for others. Fluctuations of the dollar and exchange rates have mostly been unfavorable for overseas surgeons who operate on U.S. residents — but not extraordinarily so.

There are some changes, surely … and I hope readers will enlighten me as we go.

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Oct 17

Chapter 3 Page 1A Brief and Selective History of Medical Tourism

(A (necessarily) brief history of traveling for health care)

My dear Athos,

I wish, as your health absolutely requires it, that you should rest for a fortnight. Go, then, and take the waters of Forges, or any that may be more agreeable to you, and recuperate yourself as quickly as possible.

Yours affectionate,
de Treville

From The Three Musketeers
Alexandre Dumas

***

The history of cosmetic surgery, and of traveling extended distances for medical care or health reasons, goes back to the beginning of recorded time. Reconstructive plastic surgery procedures were performed in India at least as far back as 600 B.C. (1)

Literature and history are replete with stories of people who have traveled for health reasons; the healing and recuperative powers of bathing in the hot mineral springs around the world is documented in both fact and in fiction. School children are taught that the Spanish explorer Ponce de Leon allegedly went in search of the Fountain of Youth and found Florida and death by an Indian arrow instead. I say “allegedly” because a number of scholars dismiss the Fountain of Youth part of the story as myth. In more recent history, Franklin D. Roosevelt received therapeutic baths and muscle treatments for his debilitating pain from polio in Warm Springs, Georgia during his administration from 1933-1945, making the place sort of a southern White House for months at a time.

You could say that President Roosevelt was a pioneer of modern health tourism, the precursor of medical tourism, though the two are distinct, historically and even today. Health tourism is the business of spas selling weekend or week-long indulgences of luxurious massages, exotic baths, healthy foods, beauty makeovers, and soothing or exhilarating scenery for an even more exhilarating price. Some even have a spiritual component. The actual medicinal value of much of this has long been debated, though many medical professionals vouch for their therapeutic benefits.

Medical tourism, on the other hand, is entirely recent and has become the more narrowly applied term for traveling abroad for the services of a doctor or surgeon. Recuperating in a spa or vacation-like setting is an option, and an attractive embellishment for many. While, no doubt, there are scholars who could step forward with examples from history of people who traveled great distances for the services of a particular doctor or a particular treatment or surgery, they would also acknowledge that medical tourism is mostly a modern phenomenon. It tracks very closely with the 20th century refinement of cosmetic surgery as a medical specialty spawned from necessity during World War I when reconstructive techniques were developed to treat those maimed in combat.

By the 1950s, the groundwork for what was to become modern cosmetic surgery had been laid. Though far from common, surgery for purely aesthetic reasons had become less peculiar. Initially there was little competition. Through the 1950s and 1960s cosmetic surgery was the province of the United States and Europe; the clients, whatever nationality, were mostly wealthy. Quick, affordable international air travel was the first precondition for medical tourism to emerge and international patients started to head for the great hospitals of the United States and Europe, as they still do today. The main difference today is that the international competition to provide medical services has become fierce.

In addition to the patients, however, an ever-increasing number of medical students, doctors, and surgeons from around the world converged on the United States and Europe seeking medical training. As time passed, more information was exchanged and spread; more technology was were shared. Some of the medical students stayed in the United States as part of the infamous “brain drain” that was attracting the best and the brightest from around the world, to the detriment of efforts to modernize and improve economic conditions abroad. But some went home to build medical practices in their own countries and to found new institutes, hospitals, and centers of learning. Among the skills they took with them were cosmetic surgery techniques.

In time, inevitably, other destinations for patients besides the United States and Europe arose.

(1) Rana RE, Arora BS. History of plastic surgery in India. J Postgrad Med 2002; 48:76-8

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Oct 15

Chapter 2 Page 9 | Prices in the United States and Abroad

Consumers who consider going abroad to save money for cosmetic surgery, dental work, or any other kind of medical care, will hear these bromides, either from voices in their heads or from well-meaning friends and relatives:

  • You get what you pay for.
  • If it sounds too good to be true, it probably is.
  • Quality doesn’t come cheap.

One does not have to have an intimate knowledge of international economics to understand why prices for high-quality cosmetic surgery can be far lower in less-developed countries than in the United States or Western Europe. A good surgeon is an artist, a psychologist, and modern-day wizard of sorts who transforms and restores; but he or she is also a businessperson. Cosmetic surgeons treat patients and are paid fees; cosmetic surgeons whose services are in demand can and do charge higher fees.

Simple, right? You get what you pay for, and quality doesn’t come cheap. However, among other things, geography matters a great deal. In your own town or city, you may find a range of prices from different cosmetic surgeons, as you might expect. Well-known surgeons with years of experience and hundreds or even thousands of satisfied customers will charge the most. A surgeon fresh from his or her residency, just starting out, trained but relatively inexperienced, will charge less. It is not unheard of for surgeons just starting out to offer reduced fees to clients who will agree to provide testimonials or referrals or otherwise participate in marketing the new business.

In your town, there will also be doctors and surgeons who may not be board certified in plastic surgery who nonetheless legally practice it, to an extent. The ASPS warns that such practitioners may be less-safe choices and, generally speaking, one would guess that they are right. Still, it goes on.

The average price of a typical facelift in the United States performed by a board-certified plastic surgeon in an accredited surgical facility, including surgeon’s fee, anesthesia fee, and operating facility fee, is in the $7,000 to $9,000 range, according to InfoPlasticSurgery.com (2005)

That might be the range in your town. But if you live in New York City, the range might be 50 percent higher. If you live in parts of the less-urban South or Midwest, the range might be a little lower. Geography matters, even within the United States. There is more demand for cosmetic and aesthetic surgery and procedures in urban areas and on the coasts; and the costs of living and of doing business are correspondingly higher. So how can board-certified, experienced surgeons working in modern facilities in Mexico, Brazil, Costa Rica, the Dominican Republic, Thailand, India, and other countries charge so much less? While a facelift abroad is more likely to cost between $3,500 and $6,000, including travel, meals, and accommodations, the costs of living and of doing business is correspondingly less in these countries. The top surgeons in the world, those with international reputations, can charge and get U.S. prices wherever they may be, but the many trained and qualified surgeons who aspire to be known as among the elite in the world must charge far less to draw patients from abroad, including the United States. And they can make a good living doing so.

Many think U.S. surgeons are greedy, but I do not think that is the case. They face significantly higher costs than do their counterparts and peers in other countries. In many ways, the reasons prices for cosmetic and other surgeries are lower in other countries than in the United States and western Europe are the same reasons why it is less expensive to produce DVD players or textiles abroad: They have less-expensive land, less-expensive construction costs, lower labor costs, lower taxes, and lower administrative costs. It is a mistake to single out any one thing as being responsible for the difference.

Malpractice insurance costs are also partly to blame. Though malpractice rates vary, depending on amounts of coverage, U.S. surgeons I interviewed said they each pay between $40,000 and $70,000 annually, compared to the less than $6,000 a year a Brazilian surgeon I know pays. This is a substantial difference, yet a small part of the overall equation. About the only business expense that is the same for surgeons regardless of where they live is medical equipment and medical supplies.

Price is relative from country to country, and a patient looking at the possibility of traveling abroad for care can responsibly factor that in. Some prices are so low that one can not help but be suspicious. Substantial inquiries are merited and references should be required. Cosmetic and elective surgery prices in the Far East are, for the most part, somewhat lower than those in South America, which are somewhat lower than those in Central America. I know that there are good surgeons in all those places.

Surgeons in the Far East, in fact, may be more likely to have trained in the United States and be fluent in English, though they have no monopoly on either of those things.

The cosmetic surgeon who charges the highest prices in your town may well be among the best and will almost certainly be among the most experienced. But paying the highest price does not guarantee the best outcome. Is a $10,000 face-lift in New York City better than a $7,000 one in Cincinnati? Is either better than a $3,000 one in Brazil? It depends.

I have talked to people who are unhappy with their expensive cosmetic work and people who are thrilled with the quality of their inexpensive results. For every anecdote, there is another one to give lie to the first. Beyond the borders of the United States, options abound for those willing to take the time to investigate, analyze, and choose.

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