Home or Away?

Choosing whether to have surgery at home or abroad is a very important subject for us as it involves your safety.

Cosmetic Surgery Abroad | The Harley Medical GroupWe completely understand the appeal of having a cosmetic procedure abroad. Going away for a holiday and coming back a new person sounds fantastic, and let’s be honest most of the time surgery abroad is cheaper than undergoing it in the UK. But the question is, why? Or rather, what is the real cost of having cosmetic surgery outside of the UK?

In the last few years we have seen an increase in patients who have had their first procedure abroad and come to us subsequently. Each person had their own story, which we listened to and learned from; they asked for our help but sadly we couldn’t assist everyone, some cases were untreatable.

We sat down with our Medical Director, Mr Simon Smith, to learn more about cosmetic surgery tourism and his information was very insightful. So, if you’re thinking of going abroad for your surgery please take a minute to read our interview. Afterwards it may be that you still feel that going abroad for your surgery is the right thing for you, but please don’t base your decision on price alone. Please think about the wider implications to your health and safety if you choose to travel for your surgery. 


What would your main concerns be if a patient stated they were thinking of going abroad for a procedure?

Who is operating on you – whilst many surgeons might be competent, there are many countries where the accreditation of surgeons is less rigorous than the UK. Any surgeon who operates on you in the UK must be registered with the General Medical Council, which means that they will have met the UK standard in terms of their original training. They will also have had to partake in ‘revalidation’ which means that they will have had to have undergone yearly appraisal, at which their current practice is assesses to ensure the quality of their surgical outcomes, and that they are staying up to date in their specialist field. Appraisal also addresses any complaints / litigation / other major issues in a surgeons practice, which means that an overall view of how a surgeon is performing, and how they might be dealing with any short-comings, is assessed. This process is not guaranteed in other countries.

Similarly, is your surgeon insured? Even in the best hands, things can go wrong on rare occasions. It is important that your surgeon is insured, and that their insurance is valid for you as an overseas patient. Should litigation arise, is there a clear pathway for you to seek compensation from the foreign surgeon or clinic. Often, it is very difficult to bring actions against surgeons or clinics from abroad.

What happens if you have a complication when you get home. Whilst some complications arise within the first few days, most complications occur in a week or so, sometimes much later. If you are in the UK, and the clinic is a flight away, who is on hand to deal with you. If you need to return to theatre, does the clinic have a facility in the UK to look after you in. Or will you simply be handed over to the NHS, where you may not see a cosmetic specialist? The NHS deals with more and more patients who are victims of cosmetic tourism complications.

Any facility in the UK which undertakes cosmetic surgery is highly regulated. All hospitals and clinics have passed CQC inspections, which ensure a level of safety, cleanliness and overall standard of care. Many other countries do not have this sort of rigorous inspection, hence there is no way of telling how safe or clean the facility is, and whether they have basic safety equipment and protocols should you suddenly become unwell. Similarly, you cannot be certain as to what type of implant is being used in some countries. And the quality of general medical care in the country in which you are having surgery needs to be considered – if you have a blood clot in the lungs following a flight and surgery, or if you have a major complication (there are stories of bowel perforations following liposuction) then the trouble will go far beyond the cosmetic outcome, but might threaten your life as a whole. If you have a major complication, will your holiday insurance pay to repatriate you if you have elected to undergo cosmetic surgery whilst on holiday?

 

What are the benefits of meeting your surgeon weeks prior to your surgery, rather than the day before or on the day?

Most people spend a long time working up to the point where they decide to have surgery. Patients are all different, and surgeons are too! Meeting your surgeon, clearly explaining what it is that you are not happy with about your body, and how you would like to address that, is key to enabling them to assess what is possible. The surgeon then needs to discuss with you what options you have, and how best they might address the issues that you have presented with. Then, you need time to consider what they have said, and decide whether what they are offering is going to address your concerns. In the UK, the surgeon’s code of conduct means that we always insist on a two week cooling off period between consultation and the surgery itself. Allowing patients (and surgeons) time to reflect on what has been suggested, and whether and how the patient’s expectations can be adequately met. Consulting one day before the operation does not give any time for patients to consider in depth the pros and cons of a particular type of surgery, and is likely to lead to a higher rate of long term dissatisfaction with the outcome.

 

Can a skype or telephone consultation be a sufficient alternative to face-to-face meeting? Are there any significant limitations to them?

Telemedicine can be helpful, but nothing really replaces a face to face discussion. A lot of the success or otherwise of cosmetic surgery relies on how a client’s tissue feels, stretches, scars etc. This can only be assessed adequately by examination, which clearly cannot be achieved on a skype call.

 

Is it possible to be certain of the calibre, qualifications and insurance of surgeons based abroad?

Depends where! USA surgeons, and many European ones are of the highest quality. But many of the cheaper places may be harder to ascertain what the individuals training has been, and what the meaning of the letters after their name means in practical terms i.e. how does a particular qualification translate into practical skills and outcomes.

 

What level aftercare do you think it would be realistic to expect following a procedure – after the patient has returned to the UK?

Many tourist companies do not have doctors back in the UK. Some do not even have nurses – just sales people.

After a procedure, you want easy access to aftercare, ideally the surgeon who did your procedure, or if not, then someone skilled in the procedure which you have undergone. In the UK, ignoring the companies who still use ‘fly in fly out’ surgeons, this would be the norm. If you have, for example, had a procedure in Thailand, and return to the UK, there may be no one here to help.

 

Do you have any concerns about travel after surgery i.e. after a couple of days or a week? 

We know that surgery is a risk factor for blood clots in the legs, which can travel to the lungs. As is airline flight!  So combining the two increases the risk. Our flight recommendations are as follows. 

 

Short haul flight

  • Pre-operative: do not fly less than 24 hours prior to surgery
  • Post-operative: do not fly for 2 weeks post surgery, plus your sutures should be removed.

Long haul flight (over 5 hours)

  • Pre-operative: do not fly fewer than 2 weeks prior to surgery
  • Post-operative: do not fly for 2 weeks post surgery, plus your sutures should be removed.

Long haul flight (smoker, history of DVT or large procedure)

  • Pre-operative: do not fly fewer than 3 weeks prior to surgery
  • Post-operative: do not fly for 2 weeks post surgery, plus your sutures should be removed.

 

You should also check that your travel insurance covers you during and after your procedure. 

 

Have you encountered patient who have had a procedure abroad? What are the common complaints or concerns that lead them to seek further surgery?

The most commmon complaints are:

  • Infection 
  • Implant loss 
  • Wound breakdown  
  • Poor cosmetic outcome

 


Mr Simon Smith

Mr Smith is the Medical Director of The Harley Medical Group and is a Consultant Breast Surgeon on the specialist register in general surgery. Mr Smith qualified as a Medical Doctor in 1993 and, following 12 years of postgraduate surgical training, including a Masters in Surgery at Imperial College, London, has been a Consultant Breast Surgeon since 2005. He is currently the Clinical Lead at the Chelmsford Breast Unit which is one of the UK's leading oncological and reconstructive breast units, as well as being Lead Cancer Clinician at his NHS Trust.

PROFESSIONAL MEMBERSHIPS

  • Member of The Association of Surgeons of Great Britain and Ireland 
  • Fellow of The Royal Society of Medicine
  • Member of the Association of Breast Surgeons
  • Member of the British Association of Endocrine and Thyroid Surgeons
  • Member of the British Medical Association