Oct 20

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.



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Oct 12

Chapter 2 Page 7 | The Best of Both Worlds

John J. Corey, M.D., a prominent plastic surgeon in Scottsdale, Arizona, is an ASPS member. However, he also advertises a Brazilian influence on his practice and his technique; Dr. Corey traveled to Brazil in 1993 and studied under the aforementioned Ivo Pitanguy, M.D.

“Brazilian surgeons seem to have a different “eye” for aesthetic surgery … a different way of analyzing beauty and the human form. We Americans have a tendency to be very technical. We want to know exactly how much to contour and how much to measure. Brazilians seem to approach procedures more artistically. They don’t rely on applying the same measurement to every woman. They really believe in sculpting the form and creating the curves and lines of the feminine shape.”

Dr. Corey doesn’t deny the obvious implication of his own words — that many Brazilian surgeons are incredibly good and that U.S. surgeons can and do learn a lot from them. And, like many other surgeons in the United States and abroad, he has used the Internet in building and extending his own practice. He has patients from out of state and out of the country. He also knows that not all patients can afford his prices, and that excellent surgeons, board-certified in Brazil and other countries, charge far less than he does in Scottsdale.

“The ASPS is going to come down on the side of caution and safety,” Dr. Corey said. “And I don’t think anyone can fault them for doing that; it is what doctors do. But at the same time, of course, there are well-qualified surgeons around the world. We interact with each other; we learn from each other. And economic conditions, and the cost of doing business, are different in other countries.”

Dr. Corey looks at medical tourism from a pragmatic point of view. “I think we have to look at more ways to cooperate, more ways in which we can serve patients better,” he suggested. “Clearly, overseas surgeons who are able to charge less are meeting a need in the market, and the market is evolving. There are ways in which doctors in the United States can be part of that, and in which patients will benefit.”

The ASPS, he points out, does list on its Web site “corresponding members” from overseas; there are not that many surgeons who have chosen to affiliate, however, and the ASPS notes that it can not vouch for their credentials.



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Oct 06

Chapter 2 Page 3 | A warning lives on, mostly unheeded

The costs for common cosmetic surgery procedures in the Dominican Republic are roughly 40 to 70 percent less than they are in the United States. Dominican surgeons, particularly members of the Society of Plastic Surgery, felt that they were under assault by the U.S. media, by U.S. doctors, and by U.S. politicians because of their success in attracting U.S. patients. They thought that their skill and medical facilities had been unfairly maligned.

Their suspicions were raised by the fact that their statement went unreported in The New York Times or anywhere in the United States and that the initial story lived on in news releases and through references in other stories. As of January 2006, the U.S. State Department was still posting a warning on its travel advisory for the Dominican Republic:

The U.S. Embassy in Santo Domingo and the U.S. Centers for Disease Control and Prevention are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s Web site contains further information for all patients seeking elective surgery overseas at http://www.cdc.gov/travel/other/elective_surgery_2004.htm.

Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgery (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

A similar report posted on the CDC’s Web site had been taken down months before, but the scare lived on. I assumed that business for plastic surgeons in the Dominican Republic had to have gone down the tubes. Negative publicity is bad enough when it involves a single doctor but the Times’ story was directed at the cosmetic surgeons and doctors of an entire country! What damage did it do to the country’s cosmetic tourism business? Surely, I thought, it had slowed to a trickle.

Not so.

If anything, business is better, Roberto Guerrero, M.D., of Santo Domingo told me a year after the story was published. Dr. Guerrero is a plastic surgeon who trained under Brazil’s Ivo Pitanguy, M.D.; it is a credential most U.S. plastic surgeons would love to have. “People heard more about us, about what we do. If anything, the story helped us.”

Dr. Guerrero, in a lengthy phone interview, defended the quality of surgery and the facilities available in the Dominican Republic. There are roughly 60 board-certified surgeons, and the requirements for certification are every bit as stringent as in the United States.

“The infections — they can happen anywhere. They happen in the U.S.,” he said. “We have doctors here who are not board-certified, who do cosmetic procedures … and you have that in the U.S. as well.”

But by then, Dr. Guerrero was telling me what I already knew — that there are supremely talented cosmetic and aesthetic surgeons working in the Dominican Republic in modern facilities, just as there are in Brazil, Costa Rica, Argentina, Mexico, and, of course, in the United States, and around the rest of the world. Like one woman told the Times: “There are good and bad doctors everywhere.”

(Author’s note: The CDC Internet page cited  above no longer exists in 2009. However, the State Department warning about cosmetic surgery is still up, here; and the dated CDC report lives on, herefive years later.  My guess is that it is a bureaucratic nightmare to get the State Department to remove such information.)



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Sep 14

(February, 2006)

At first blush, it may seem a bit odd that a board-certified plastic surgeon living and practicing in the United States is writing a foreword for a book detailing the ins and outs of getting cosmetic treatments outside of this country. What’s next? Major airlines offering insight into bus travel? At the risk of being called a heretic, however, there are several reasons why I think education about cosmetic medicine abroad is useful and why this book, Beauty from Afar, can be helpful for people considering surgery outside the United States.

First, let me say that I support the cautious position of the American Society of Plastic Surgeons (ASPS), detailed in this book, on travel abroad for cosmetic surgery. It is sound advice that I feel is inarguable. At the same time, the ASPS has been very good about including and cultivating the input and instruction of very talented surgeons from around the world. Their techniques are frequently included in ASPS journals and educational meetings.

On a personal note, I have been extremely fortunate to have spent time training with very gifted physicians practicing outside the United States, among them Dr. Ivo Pitanguy in Brazil. The techniques that I acquired while observing these doctors are an integral part of my practice today and are used on an almost daily basis. I have personally seen quality surgical skills outside of our borders.

When we talk about travel abroad for medical services, we are almost always involving an aspect of medical economics. We Americans know that we have an extremely competent medical system. But we also know that in relation to the rest of the world, we have the most expensive. Health care in America can come at a very high cost. This means that, at times, many Americans are unable to afford the highest level of health care services that they feel they may want or deserve. This is true of the aesthetic medical field as well. While my advice would always be to have your surgery done domestically if you can afford it, there are many people who simply would not be able to have a procedure done if they had to pay U.S. prices. In today’s global market where multiple companies and individuals are outsourcing to save on costs, it comes as no surprise that this phenomenon has surfaced in the medical industry.

Ultimately, however, quality and safety must be the top priority, whether you are seeking medical attention here or abroad. Unfortunately, in the United States as well as in other countries, there seems to be no shortage of unscrupulous practitioners who portray themselves as experts in their field, but who have never completed a recognized training or credentialing process. The medical experience for a patient is daunting enough, even in a qualified and legitimate familiar environment. Stepping over the border for equally qualified and legitimate care requires guidance. That’s why Beauty from Afar is so essential. This book provides individuals the necessary tools to make an informed decision when seeking out individual health-care options. Its solid principles apply to anyone searching out quality health care, whether across town, a border or the ocean …

John J. Corey, M.D.
Aesthetic Surgeon in private practice
Scottsdale, Arizona

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