The Hidden Costs of Medical Tourism

I have just read another article about the dangers of medical tourism.

Medical Tourism is a thriving industry and many people from the UK travel abroad to have cosmetic procedures. I completely understand why they do this because it can be seen as having a holiday or having a trip overseas, not to mention the significant saving in costs with the surgery.
However, I cannot recommend it and this is why.
When I get referrals from patients who live overseas or even in other parts of this country, I always recommend that they seek a surgeon closer to home, because whilst there are not that many plastic surgeons in the country, we are represented in most towns and cities. If you know what qualifications to look out for, you should be able to find someone who is appropriately skilled and qualified to do your surgery. In fact, I dedicate a chapter of my book to the risks and benefits of medical tourism or having surgery far from home.
I have read a recent report about patients in overseas cosmetic surgery clinics suffering significant infections following surgery. One of the many problems with having surgery overseas is that the standard of training of the doctors and the standard of cleanliness cannot be guaranteed. The processes and checks that are performed in the clinic may not be to the same level that they are in this country.
Clearly there are many well trained surgeons and excellent clinics overseas but the issue is in knowing who and where they are. The surgery is often significantly cheaper and you should ask yourself why this is?
It may be that the level of indemnity insurance of the surgeon is much less than required in the UK which means that if you do have a problem, you will have less comeback on the surgeon.
It may be that the clinics and the hospitals do not need to invest in stringent and robust infection control procedures and safety checks that are required in UK facilities.
It may also be that the level of aftercare and support following a procedure could be affected as I always stress that it is best to see your surgeon, not only before but after your surgery to put your mind at rest and to make sure things are progressing satisfactorily.
At the end of the day, it is up you, to the patient to make the decision as to where to have surgery, whether it be at home or abroad and the onus is on us as practitioners to make sure you are fully informed about all the risks and the benefits of each.

I go back to my mantra I will always tell patients, which is:

“Do your research and do not be afraid to ask questions”

If you would like a copy of my book which is available now click the link here.

I talk about why Plastic Surgery is cheaper overseas in one of my LIVE Q&A sessions on Facebook every Tuesday night at 7pm, watch it here:
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Just because they look like a plastic surgeon and they say they are a plastic surgeon, doesn’t mean they are a plastic surgeon!

One of my passions is to raise awareness about cosmetic surgery to try and change perceptions so that it is not portrayed as being a branch of medicine that is somehow less worthy than other branches of medicine.

There is an image that all plastic surgeons are unethical, money grabbing cowboys but the reality is very far from that (well I would say that wouldn’t I?).

One of the problems is that for many plastic surgical procedures, patients look for a surgeon by going on the internet or look at advertising and marketing in glossy magazines, rather than the traditional route of going to see a GP and being referred.

This has allowed a huge growth in practitioners who are not fully trained to set up and practice plastic surgery (practice being the operative word).

Whenever I talk to people about this, they are always shocked and alarmed to discover that there are so many untrained doctors performing surgery.

They think that surely there is a law against such a thing and that it should not be allowed, but I am afraid there is no law against this and it is allowed and it is going on all over the UK.

I feel so strongly about it that I have written a book called ‘Never Accept a Lift From Strangers: How to choose the best plastic surgeon for your cosmetic breast surgery’ and it is available from Amazon.

One might ask why I have had to write a book about this as you would have thought that it was obvious to see which surgeons have been trained and which haven’t.

Unfortunately, it is not obvious.

I talk about cases in my book of high profile people, both here and abroad, who have had complications following plastic surgery performed by non-trained plastic surgeons, people like Colin Hendry the Premier League football player and the pop stars, Kanye West and Usher, have all had family members who have been affected and I am sure they thought their plastic surgeons were fully trained.

The problem is that when someone asks me to tell them what to look out for, it is not so clear cut.

That is why many doctors and surgeons have very impressive sounding biographies and you may be fooled into thinking that they are properly trained, but only when you delve deeper do you realise that they have no formal training in plastic surgery or that they may have started it but not completed it.

To be honest I blame us, the professionals. I think that we make it too difficult for people to seek and understand what all the credentials mean.

You see, there are a lot of associations and qualifications that do not count for much, although there are others that mean a lot and stand for many years of specialist training in a very competitive environment and yet to the outside eye, they can all look good.

I do not think it is a problem unique to doctors either.

I talk in the book about a problem I had finding an accountant and only later realising that there are many advisors out there who sound credible but are not qualified chartered accountants.

The same is true in the legal profession as I was talking to a friend of mine who for many years I thought was a lawyer, but in fact I discovered he was neither a solicitor nor a barrister and actually had a paralegal qualification, and I have to be honest I still do not quite understand the difference which leads to the next question:

Does it matter?

Well in surgery, yes it does matter because surgical training is very long, very competitive and very hard.

It is an extended apprenticeship which takes many years, it took me thirteen years of training after becoming a fully qualified doctor (which in itself takes 6 years) to finally finish and receive my certificate for specialist training in plastic surgery, FRCS (Plast).

There are exams to take, culminating in a final exit exam which tests whether you are safe and skilled enough to be put in charge of patient care independently once the training is finished.

If you are accepted to become a full member of the BAAPS, The British Association of Aesthetic Plastic Surgeons, then there is an audit every year where we must submit our figures on the number of operations we have done and any complications or revisions we have had to perform.

We have a strict code of conduct to which we must adhere and we have a peer group that we are accountable to.

However, there are many doctors out there who are performing plastic surgery who are not a member of one of the plastic surgery associations (BAPRAS and BAAPS).

Not only does this mean that may not be fully trained in plastic surgery, it also means that they will not be held accountable to the same rules and ethical guidelines which they are bound to practice within.

I don’t think we are going to solve this problem overnight because I think there must be something inherent with people in a profession that they keep it shrouded in mystery to make it look impressive and worthy of their stature.

I would love to be able to say to you look for this one thing to be certain that your doctor is fully trained in plastic surgery and surely that would make sense.

It might help to stop the horror stories you hear about rogue practitioners working out of their front room.

The media love to pick up on these stories and report how terrible it is, but I think the real piece of news is that they are usually not doing anything wrong and it is perfectly within the law for people to perform treatment and practice out of their front room, even people with no qualifications, that is the real story.

I don’t think we will be seeing any legislation any time soon. We cannot rely on the Government to protect us from this, certainly not at the moment, so I see my job as a plastic surgeon to do what I can to inform and educate people as much as possible.

So, what should do if you are thinking of having plastic surgery?

Unfortunately, there is no easy soundbite but I would say do your research, look for reviews and ask for a personal recommendation for anyone who is a full member of BAPRAS or BAAPS, anyone who has FRCS (PLAST) after their name and anyone who is a consultant plastic surgeon in the NHS will be fully trained in plastic surgery.

I am always happy to answer questions and to help and advise. You can see me on Facebook live every Tuesday night at 7pm and you can get hold of a copy of my book here.

If all you have is a hammer everything looks like a nail

There are a lot of different surgeons who perform cosmetic surgery.

They range from plastic surgeons to general surgeons, ENT surgeons, maxillofacial surgeons and even people who are not surgeons at all such as GPs or dermatologists.
This is not a problem in itself as long as the doctor is working within their scope of practice.
It may be that an ENT surgeon will be just as competent to perform a rhinoplasty as a plastic surgeon would. The problem comes when surgeons start working outside of their scope of practice and this is something that The Royal College of Surgeons is trying to address by credentialing surgeons which means they will assess them to make sure they are only working within areas that they have been trained to be competent in.
The problem with this is that first of all it has not been launched yet and secondly, it is a voluntary process so unless you know to ask or check whether your surgeon has the appropriate credentials then

untrained doctors will continue to be able to perform procedures on unsuspecting patients who may not know or feel comfortable to ask the necessary questions.

I am always surprised when I talk to people about some of the topics in my book.

They are shocked when they hear that there are surgeons out there performing breast surgery whose formal surgical training may have been in ENT surgery or accident and emergency surgery.  While it might sound unbelievable, it is happening and there is absolutely no law against it.
Unfortunately many surgeons do not make what their area of specialist training is, if it does not fit with the more lucrative cosmetic procedures that they mainly perform. You cannot assume that just because your surgeon is working in a plastic surgery clinic and is talking to you about having breast implants that they are a plastic surgeon or have any specialist training in cosmetic breast surgery.
We are very fortunate that the complication rate of most cosmetic surgery is very low but this allows untrained surgeons to get away with performing surgery on patients.
However, the problem comes when there is a complication or if the patient has a complex problem such as a breast asymmetry or a chest wall deformity.
It is in these situations where a surgeon who has experience of not only cosmetic breast surgery but also reconstructive breast surgery will have the necessary skills and experience to be able to foresee potential problems and tackle any issues that may arise.

Cosmetic breast surgery is not easy.

All patients will have some degree of asymmetry to a greater or lesser degree.
It is about identifying this, managing the expectations and knowing when and what to do about it.
It may be putting different size implants in, sometimes to maintain the base width of the implant and different profiles of implants will need to be used in each breast and this requires skill and experience.
It may be the use of internal sutures to redefine the inframammary fold and to ensure that the placement of the implants are accurate.
It may require a combination of a breast lift or possibly surgery to address the chest wall.

This is why I feel it is important to see a specialist for your procedure and to Never Accept A Lift From Strangers.

Here at the Staiano Clinic we are all plastic surgeons who specialise in breast surgery.
We love seeing people who have done their research and welcome questions.
If you do not feel that you are in a position where you can ask questions of your surgeon in your clinic then beware.
If you want to know more, then you can get a copy of the 5 Questions To Ask Your Plastic Surgeon here.
If you have any questions, then you can tune in watch Consultant Plastic Surgeon and  our Director, Jonathan Staiano on Facebook Live every Tuesday night at 7pm for a live Q&A session.  You can join in live or post your questions in advance to using the hashtag #AskJJ.
If you want to know more about plastic surgery training and what it takes to become a cosmetic surgeon.  Check out Jonathan’s book ‘Never Accept A Lift From Strangers – how to choose the best plastic surgeon for your cosmetic breast surgery’.  It is available to buy through our website or on Amazon.

Second Hand Breast Implants on Ebay!

Did you hear about the lady who was selling her 2nd hand breast implants on Ebay?

She said that they didn’t quite fit her, so she got a new pair!

I think the story was a bit of a joke.

I don’t doubt that someone would actually try to sell their old implants,

I mean you can get anything on Ebay these days (how about a hand made suit of armour for a guinea pig?).

But I don’t think that anyone would have actually bought them and seriously thought about implanting them, would they?!

The press love to get hold of a story about dodgy cosmetic surgery and dubious practices, but I think that part of the problem is the lack of regulation in the industry.

The fact of the matter is that there is no law against anyone selling a used pair of implants and perhaps more worrying, there is no law against anyone buying these implants and implanting them in someone.

Of course, if that someone was a surgeon and a member of a professional association (like BAPRAS and BAAPS for plastic surgeons), the association and probably the GMC would take a dim view of this and I am sure there would be disciplinary action.

However, the problem is that that someone does not have to be a member of any professional body and doesn’t even have to be a surgeon.

In fact, that someone doesn’t have to be a doctor at all!

There is more regulation on who can operate on your goldfish than there is on who can operate on your daughter (perhaps goldfish is not a good example and your dog would be better, anyway, the point is that there is no regulation on who can operate on a human).

We are currently relying on patients being able to get enough information about their practitioner to make an informed decision and avoid being treated by non-trained individuals (aka cowboys).

The problem is that it is happening and it is happening to high profile people – Colin Hendry, the premiership footballer and Usher and Kanye West, the music stars have all had family members come to harm having plastic surgery performed by surgeons who were not fully trained and affiliated with the plastic surgery associations.

If it can happen to them, what hope have the rest of us got.

I see that Ebay has withdrawn the listing for the breast implants, but you can still buy dermal fillers from Ebay and you can invite people around to your house and inject them on your kitchen table.
Sounds frightening (and it is), but all perfectly legal.

Totally against good medical practice that all doctors are bound to work within and there is no way the CQC (Care Quality Commission) would approve the facilities in your kitchen table to be suitable to be performing non-surgical procedures.

But the fact is that, because you don’t need to be a doctor to perform these procedures and you do not legally need to work in a facility that has been approved by the Care Quality Commission, these sort of practices go on and we don’t really know the extent of it.

We only hear about it when it goes wrong.

It is good to raise awareness about the perils of this unregulated industry, but it would be nice if there were some positive stories now and again.

Plastic and cosmetic surgery can have a tremendous impact on people’s lives and is a powerful force for good.  It has been given a bad name, but there are still a huge number of appropriately qualified doctors and nurses providing high quality care in an ethical way in safe and clean medical facilities.

Please ask questions and be aware of the level of training and experience your surgeon or practitioner has (check out my book for an in depth guide about surgical training).

Caveat Emptor – Let The Buyer Beware

Oh yes, and don’t buy your breast implants from Ebay!

Non-surgical procedures on the rise.

Jonathan’s interview on BBC Hereford and Worcester this morning with Elliot and Toni at breakfast.