Beauty from Afar

I probably know more about female cosmetic surgery than is common to 50-something males who don’t have a spouse or girlfriend who has had any … or who aren’t cosmetic surgeons.

And people who are interested in having cosmetic surgery have no reason to be interested in my own opinions about the subject. This might be why at least a couple of reviewers have characterized Beauty from Afar as “dispassionate.” I consider it a high compliment. Today, we have a brief update with material on body lifts and buttocks impants and augmentation.

Chapter 4 Page 5 |Body Lifts and Butts

In Chapter 4, I tried to keep my list of  “surgeries for which people travel abroad” down to those which people most commonly seek. Apparently I could not resist butt implants, which are still relatively uncommon … and here one have the one, brief mention of cosmetic surgery of the labia.

Maybe I added that to prove I wasn’t a prude. Or maybe I was titillated. I don’t believe that particular operation to be very common. But I do recall seeing an entire cable TV show about someone who had it sometime in the last couple of years, so I’m not feeling like I’ve given the matter any undue attention.

We’re close to the end of Chapter 4 … just two more web pages, it looks like to me.

The posting of Beauty from Afar resumes this evening with more of my laundery list of cosmetic surgery procedures that many people have done abroad at considerable savings.

Chapter 4 Page 3 | Eyelids, Foreheads, Noses and Peels

Again, please note that I came up with the price ranges in 2004-2005; however, my educated guess is that they are mostly still pretty much on the mark in 2009-2010. I would love to hear from readers who have substantive information on the subject. At some point — after Beauty from Afar is all the way online — I’ll try to revisit and update relative prices again.

Chapter 4 Page 3 | Eyelids, Foreheads, Noses and Peels

Eyelids (Blepharoplasty)

Eyelid surgery is a procedure to remove fat — usually along with excess skin and muscle — from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids, and puffiness or bags below the eyes. Upper and lower eyelid work will cost $4,000 to $6,000, on average, in the United States. Once again, in examining the Web sites of reputable and experienced surgeons overseas and in researching, one will find a range of perhaps $1,300 to $2,200.

Forehead/Brow Lift

A forehead lift can raise the eyebrows to a higher and more (presumably) aesthetic position. It should also improve lateral hoods (the droopy flaps of skin that hang over the outside corners of the eyes.) A forehead lift should also soften horizontal forehead wrinkles and lines between the eyebrows. A forehead lift in the United States costs in the range of about $3,500 to $5,000. The average cost abroad falls into the $1,300 to $2,000 range.

Nose Reshaping (Rhinoplasty)

Reshaping the nose is considered by many plastic surgeons to be one of the most delicate and difficult aesthetic procedures. Prices can vary substantially depending on what the patient wants. A rhinoplasty can cost from $5,000 to $8,000 or more in the United States. In general, median prices abroad, however, are 40 to 75 percent less than in the United States, or from about $1,250 to $6,000.

Chemical Peels (light, medium, deep)

A chemical peel is aimed at destroying outer layers of old skin, inducing the growth of new skin. The lightest of peels may be inexpensive ($50 to $100, even in the United States) and part of some regular beauty regimens. In many states, a medical degree is not required to administer even heavier chemical peels. Having seen people who had deep chemical peels, I for one can only barely imagine allowing a doctor, let alone anyone with lesser training, to do this to me. For days after a deep chemical peel, it’s difficult for someone who has never seen one before to think that they will ever look normal again. But the final results can be extraordinary.

Deep chemical peels in the U.S. can cost $1,500 to $2,500; overseas, they can cost from $300 to $800.

(Next)

(Previous)

In Beauty from Afar, I refer to Dr. Prof.  Ivo Pitanguy of Brazil as perhaps the father of both modern cosmetic surgery and of medical tourism.

Chapter 3 Page 2 | The Pioneers

I had originally hoped the Dr. Pitanguy would write the foreword for my book, but that wasn’t going to happen without my taking a trip to Brazil that I wasn’t able to take on my budget at the time. However, his office, in the person of Pitanguy’s then-assistant, Henrique N. Radwanski, M.D., was generous with time and information.

Chapter 3 Page 2 | The Pioneers

Brazil, in particular, gradually became known internationally for the expertise of its aesthetic and plastic surgeons, but it was not a fame that extended to the mass consumer markets of the more economically developed world. Prof. Dr. Ivo Pitanguy is not a household name outside of his home country, where he is revered. Dr. Pitanguy has performed or guided thousands of surgeries in a storied, five-decade career and has trained more than 500 plastic surgeons from more than 40 countries who practice internationally, making cosmetic surgery expertise and technique one of Brazil’s best-known exports.

Among his peers, Dr. Pitanguy is regarded as the father of modern cosmetic surgery. He also has become the father of modern medical tourism, for those he has trained are among the most sought after surgeons in the world. Yet his name and his work, outside Brazil and South America, are familiar primarily only to other plastic surgeons, Brazilians living abroad, and the families and friends of his patients — not to the millions of potential plastic surgery patients in the United States who are far more likely to know the names of surgeons on Dr. 90210 or The Swan.

In the United States, if one had to name a doctor who was famous in international medicine during the 1960s, perhaps the only household name was Christiaan Barnard, M.D., the South African who performed the world’s first heart transplant in 1967. Notably, Dr. Barnard trained in the United States, as did Dr. Pitanguy, before heading home to eventual renown.

I cite Dr. Pitanguy and Dr. Barnard as pioneers not so much for their unquestioned skill as surgeons but because they achieved the kind of international fame that, for most of the 20th century, was reserved for doctors and scientists only in the West (North America and Western Europe) and, to a lesser degree, the East (mostly the former Soviet Union). Patients in Eastern bloc countries frequently traveled to the then-USSR and its allied nations for advanced medical care. For all of the 20th century, and even into the beginning of the 21st century, the vast majority of medical tourists were not jetting to South America or Africa, let alone the Far or Middle East. They were coming to the world’s great doctors and hospitals in the United States and in Europe.

From the perspective of the United States, in particular, this state of affairs served, and still serves, to reinforce the generally held belief that the United States has the finest medical care in the world. In the last 50 years, only Dr. Barnard’s achievement challenged this notion in the popular imagination. People were oddly comforted when Drs.  and Michael DeBakey started transplanting hearts in Houston, Texas, almost in the same way they were when the United States finally answered the Soviet space challenge of Sputnik.

Meanwhile, Dr. Pitanguy just kept doing what he was doing. Patients spread the word. Brazil was and is the mecca of plastic and cosmetic surgery, challenged only recently by Southern California. The surgeons Dr. Pitanguy trained spread out through South and Central America and around the world. Over time, a second essential precondition for medical tourism to emerge as big business was met — medical talent spread out, belonging less exclusively to the developed world. In economically emerging nations, improving health care was a priority — which meant building more modern medical facilities.

The quality of care in the less-developed world rose steadily, at least in metropolitan areas, but prices for medical services remained low, relative to the United States and Europe.

(Next)

(Previous)

Prices for cosmetic surgery vary widely based on a number of factors, as I point out in the concluding segment of Beauty from Afar‘s Chapter 2:

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

Being a surgeon, particularly being a surgeon for uninsured, elective procedures, is a business, wherever one is located.  And the global recession has had an impact on the business of cosmetic surgery. This report is from January 2009, but I rather doubt that cosmetic surgery is less recession-proof than the rest of the economy:

Cosmetic surgeons suffer recession, says new survey

Well-established practices are weathering the storm. Not-so-well established practices are not, and some are not surviving.

Anywhere in between? Whether in the U.S. or abroad, cosmetic surgeons are getting more creative about marketing to patients and that means, often, that patients have some bargaining power when it comes to price.

No sane person chooses a surgeon solely on the basis of price. But discounts can be attractive.

That finishes up Chapter 2, hooray! I have no idea if anyone is following along day by day, but the visitor count has been rising steadily. On to Chapter 3 … which is a brief history of medical tourism.

Dr. John Corey, an aesthetic plastic surgeon in Scottsdale, Arizona, was kind enough to write the foreword for Beauty from Afar. I found him on the web long before I asked him if he would do that. There are not many cosmetic surgeons in the United States who are openly admiring of the work and advances made in other countries.

Specifically, John has trained at one of the most renowned cosmetic surgery facilities in Brazil He talks about how that has influenced his work in today’s segment:

Chapter 2 Page 7 | The Best of Both Worlds

I’m grateful to have had the benefit of John’s point of view and experience.

One of the great things about being a writer is that it gives one lots of opportunities to talk to interesting people one would otherwise never have met. For me, over the past 25 or so years, this has meant chatting with people ranging from accused murderers to U.S. Senators, the infamous and the celebrated.

For Beauty from Afar, I got to talk to doctors and surgeons. Lots of them. And they are a fascinating bunch. In today’s segment:

Chapter 2 Page 6 | Point, Counterpoint

… I compared and contrasted statements from two doctors, one from Texas and the other from Brazil, both renowned plastic and cosmetic surgeons.

I remember thinking that Dr. Rod Rohrich of Texas probably wanted to hang up on me while we were chatting on the phone and that I wouldn’t really have blamed him if he did. I was clearly writing something that was going to be at least somewhat at odds with his public pronouncements about going overseas for plastic surgery. I remain grateful that he took time to talk.

The Brazilian surgeon, Dr. Luiz Toledo, is now apparently working in Dubai! Links for both surgeons are provided in the segment.

The web site and staff of the International Society of Aesthetic and Plastic Surgeons (ISAPS) were both very helpful in my research. Sometime after Beauty from Afar came out, ISAPS published its own briefing paper on medical tourism which was rather less negative than the one put forth by the American Society of Plastic Surgeons.

The American Society of  Plastic Surgeons (ASPS) released in April 2005 what amounted to an acknowledgment that medical tourism exists, in the form of a briefing paper that got some media attention. This was when I was in the middle of researching Beauty from Afar and was pure gold, as far as I was concerned. In the end, I quoted and commented on the entire document — which makes today’s “page” pretty long. But I thought it best to keep all the material together.

Chapter 2 Page 5 | American Doctors Speak Out

By that time, I’d spoken with enough doctors and surgeons with varying opinions on the subject of medical tourism that I was pretty sure I had a more complete and nuanced view of the subject than the ASPS could possibly put out, given that they had to present a united view … and given their constituency. I felt qualified to comment despite my lack of medical credentials.

To the credit of the ASPS, they have updated their information and resources on medical tourism over the past few years. A new link for them is in the “author’s note” for the page … and also here.

(Author’s Note: The ASPS briefing paper referenced below has been revised and augmented with audio and video since 2005. Please visit this page at plasticsurgery.org for current information. However the overall advice remains true to the original briefing paper. If I were preparing a new edition of Beauty from Afar, this section would be rewritten … but would say many of the same things.)

Chapter 2 Page 5 | American Doctors Speak Out

What are the real risks against which to weigh the considerable cost savings? In April of 2005, the American Society of Plastic Surgeons (ASPS) issued a briefing paper that overwhelmingly cautioned against traveling abroad for surgery, though not in the stark terms used regarding going to the Dominican Republic. If one read nothing else, one would conclude that traveling overseas for plastic surgery is a poor idea. In the broadest context, however,the ASPS statement is full of sound advice for anyone considering cosmetic surgery. I offer the entire briefing paper, interspersed with commentary and context.

Cosmetic surgery tourism is a price-driven phenomenon that has experienced increased growth over the past decade. Numerous companies offering all-inclusive vacation packages that include cosmetic surgery are popping up all over the world and can be easily located via the Internet. The offers generally include private hospital services and tout “highly trained” and “credentialed” medical staff. Since elective cosmetic surgery procedures are not covered by insurance, price is the major selling point of cosmetic surgery tourism, with entire vacation/surgical packages costing less than individual procedures in the United States.

This is entirely true. Clearly, however, the ASPS disapproves of cosmetic surgery being a “price-driven phenomenon,” even as its member surgeons continue to work on devising lower-cost, less-invasive techniques and procedures and to compete with each other. U.S. cosmetic surgeons, however, in almost all circumstances, are unable to compete on price with their counterparts in the nip-and-tuck nations of Central and South America and Asia.

Although there are many skilled and qualified physicians practicing all over (the) world, the ASPS cautions that it may be difficult to assess the training and credentials of surgeons outside of the United States. Patients may take unnecessary risks, when choosing cosmetic surgery vacations, by unknowingly selecting unqualified physicians and having procedures performed in non-accredited surgical facilities. The ASPS urges patients to consider the potential complications, unsatisfactory results, and risks to general health that may occur.

Yes, it can be difficult to assess the training and credentials of surgeons outside the United States. Surgeons and facilities overseas that are marketing to prospective patients in the United States, however, have made it considerably easier. Overseas surgeons offer their credentials online, and ways of verifying them are available via Internet and telephone. Prospective patients can consult directly with surgeons and staff from other countries online; references can be provided and evaluated; consultations can be conducted by phone, e-mail, Internet chat, and even via Internet video. Indeed, many ASPS members are building Internet practices in exactly this way to draw patients from around the country and from abroad.

Plastic-surgery professional organizations, no doubt, would agree whole-heartedly that the ASPS certainly can not be faulted for urging patients to consider all possible risks and to be aware of selecting unqualified physicians who operate in substandard facilities. To that I would even add a further cautionary note: People who are considering the option of going overseas for cosmetic surgery, or any other kind of health care, should keep solidly in their minds that they must be ready and willing to walk away from the decision at any point: If they come to believe they have been misled about the surgeon’s expertise, the quality of the medical facility, the procedures involved, the price, or other terms, the right decision in the end may be to walk away. A patient who has done sufficient research is very unlikely to end up in such a position, but one must be mentally prepared to not go through with surgery if one develops serious doubts — even if it means cutting your losses on the expense of traveling there.

Vacation-related activities may compromise patients’ health. Cosmetic surgery trips are marketed as vacations. Although enticing, vacation activities should be avoided after surgery. To properly heal and to reduce the possibility of complications, patients should not sunbathe, drink alcohol, swim/snorkel, water ski/jet ski, parasail, take extensive tours (walking or bus), or exercise after surgery. Yes, some firms are marketing cosmetic surgery as vacation trips, and it is also true that some patients who go abroad allow for some vacation time by arriving early or extending their stays past the period of enforced recovery. Patients can certainly arrange to recover in comfortable, even luxurious, surroundings. But your surgeon abroad is going to tell you the same thing as well. Further, patients should budget extra time at the end of their trips, bearing in mind that complications and infections are possible and that you can not absolutely count on being physically ready to go home on a pre-arranged schedule.

Cosmetic surgery is real surgery. At the highest level of care, every surgery, including cosmetic surgery, has some risks. These risks may increase when procedures are performed during cosmetic surgery vacations. Infections are the most common complication seen in patients that go abroad for cosmetic surgery. Other complications include unsightly scars, hematomas, and unsatisfactory results. Travel combined with surgery significantly increases risk of complications. Individually, long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots.

Traveling combined with surgery further increases the risk of developing these potentially fatal complications, in addition to swelling and infection. Before flying, the ASPS suggests waiting five to seven days after body procedures such as liposuction and breast augmentation and seven to 10 days after cosmetic procedures of the face including facelifts, eyelid surgery, nose jobs, and laser treatments.

All good points, but it is also the same advice you would get from a qualified surgeon in any other country. Patients shouldn’t ignore this advice. I don’t mean to place blame, but far too many cosmetic surgery horror stories can be traced, in part, to patients not following a doctor’s orders for the recovery period.

Travel can be stressful and exhausting, and attempting it too soon after surgery can impede recovery. Despite the ominous tone of this caution, individual surgeons I talked to agree with this sentiment: Follow your doctor’s orders if you want your best chance at a trouble-free recovery. Don’t travel until your doctor says it is safe to do so.

In addition, airlines make special provisions for patients who are traveling with disabilities, and that includes travelers who have had recent surgery. If you have a long trip with flight changes, for example, it may be prudent to call the airline in advance and arrange for wheelchair service.

Follow-up care and monitoring may be limited. Follow-up care and monitoring is an important part of any surgery. Cosmetic surgery vacation packages provide limited follow-up care, if any, once the patient returns to the United States. Patients who have traveled outside of the United States for cosmetic surgery and experienced a complication may find it hard to locate a qualified plastic surgeon to treat the problem or to provide revision surgeries. Local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible. Revision surgeries can be more complicated than the initial operation and patients rarely get the desired results.

In general, this is true and should be considered carefully, especially regarding follow-up care. Some patients are afraid to tell their family doctors what they are going to do, or have already done. It’s best to be as prepared as possible for complications. Many experienced patients recommend consulting with your family doctor before going overseas. Also, reputable overseas surgeons are available for consultation with you or with your doctor at home via e-mail and telephone. This is not a deal-breaker, but it is something to think about.

Bargain surgery can be costly. Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the United States.

Well, yes. That can happen. Bluntly, it can happen in the United States as well, and you’ll be out far more money in the end. Choosing a qualified and experienced surgeon is your best chance at minimizing the risk of bad surgery that can lead to additional rounds of expensive surgery. Good cosmetic surgeons overseas often charge far less than good cosmetic surgeons in the United States. The ASPS cannot really quite get around that fact.

You should ask your surgeon in advance what his or her policies are on revisions, should you be dissatisfied. Some will do revisions for free, in certain circumstances, or for a reduced charge. A cosmetic surgeon’s best advertisement is satisfied customers.

Surgeon and facility qualifications may not be verifiable. In order for cosmetic surgery to be performed safely, it requires the proper administration of anesthesia, sterile technique, modern instrumentation and equipment, as well as properly trained surgeons. Vacation destinations may not have formal medical accreditation boards to certify physicians or medical facilities. Many facilities are privately owned and operated, making it difficult to check the credentials of surgeons, anesthesiologists, and other medical personnel. There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside of the United States. There may be no legal recourse if surgical negligence by the physician or institution occurs.

If the surgeon’s credentials and the quality and standards of the surgical facility can’t be reasonably verified and vouched for, you shouldn’t go. Simple.

As to legal remedies, should a patient be dissatisfied with surgery — or maimed or killed by it — it is true that it is easier and far more convenient to sue a U.S. doctor in the United States than it is to attempt to litigate outside our borders. However, suing a plastic surgeon in the United States is far from a slam-dunk, and reputable surgeons here and abroad are generally willing to extend themselves to produce a happy patient rather than a disgruntled one who will call a lawyer.

Devices and products used may not meet U.S. standards. Cosmetic surgery products or devices used in other countries may not have been tested, proven safe and effective, or been approved by the U.S. Food and Drug Administration (FDA). For example, an implant used in the United States must meet standards of safety and effectiveness, a process regulated by the FDA. Other countries may not have similar regulations.

Patients should, of course, check on what substances are injected and what devices are being inserted into their bodies. However, one of the reasons many American women have gone abroad for breast augmentation is the availability of silicone implants, banned by the FDA in 1992 but popular in other parts of the world. It is possible that silicone implants may again be widely available in the United States because the ASPS says silicone is safe and that the FDA should drop the ban, arguing that patients should have the option of choosing silicone. The ASPS says silicone implants are safe and the FDA, at this writing, seems inclined to allow wider testing. The ban could well be lifted at almost anytime.

(Author’s Note: The ban was lifted in November 2006, five months after Beauty from Afar was published.)

The ASPS briefing paper goes on to name Argentina, Brazil, Costa Rica, the Dominican Republic, Malaysia, Mexico, the Philippines, Poland, South Africa, and Thailand as cosmetic-surgery trip destinations, noting that these countries offer everything from “safari and surgery” to “tropical, scenic tour” vacation packages. It concludes with a useful checklist of questions to ask when choosing a cosmetic surgeon, clearly advocating the selection of an ASPS member. Point by point, however, the briefing paper offers advice no different than one would get from a qualified surgeon overseas — and, the ASPS, however briefly, acknowledges there are many of them.

(Next)

(Previous)