Interesting Articles

Cosmetic surgery - Thailand and beyond

There is no doubt that “Medical Tourism” is growing with each year. Companies promote packages promising lovely accommodation after your much-desired cosmetic procedure with an experienced and trained cosmetic surgeon. And all this at a fraction of the cost of having treatment in Australia, Britain or the USA. Granted that some good results have come out of these overseas surgeries but this seems to be more “pot luck” than anything. Just ask the ever increasing number of GP’s who are being presented with the overseas complications or the Australian surgeons who are having to correct the work.

Ultimately the decision is with the patient but it should be an informed decision. Let's examine some of the issues and less well-known facts about medical tourism.

The most obvious question is, why is it so cheap? The answer is because Australia’s health care is regulated so that it can protect the public. All medical products must pass the strict Therapeutic Guidelines Administration standards for safety. This involves all products undergoing extensive research and development, which costs companies’ millions of dollars. When a patient sees a reputable doctor in Australia they get the safest medical products currently available not an untested substitute as they do in countries such as Thailand. Doctors in Australia must undergo appropriate basic training and then specialist training in various fields of medicine. The basic training takes 7 years and additional specialist training another 7 years. Doctors also have ongoing training at their own expense. This is extremely expensive for cosmetic doctors. Overseas doctors basic level of training is often called into question regardless of any specialist training. Doctors in Australia must be registered with AHPRA and be of good standing, ethical, follow a code of conduct which includes providing duty of care for patients and have ongoing medical training. AHPRA has the strictest code of conduct in the world for its doctors and restricts many of the unethical practices seen overseas. It also ensures that doctors take responsibility for their patients. This clearly does not happen in Thailand where patients are operated on and never seen again. Australian doctors must also have appropriate insurances for their field of work, which costs tens of thousands per year and in the case of obstetricians and neurosurgeons hundreds of thousands. Overseas doctors do not have to pay insurances. In Australia surgery can only be performed in licensed hospitals. This license ensures the strictest of safety at a structural, architectural, administration and procedural level. Only the very best in equipment can be used and the sterility protocols are extremely tight. Overseas hospitals might look clean but that’s only surface dirt, which is fixed by the excess of cheap labour. Don’t forget that Thailand is the HIV capital of the world and even a tattoo can risk infection, let alone inappropriately sterilized instruments. There is an increasing risk of getting a "Golden Staph" infection from an overseas hospital and then bringing it back to an Australian one. Golden staph kills patients every year as the infection is resistant to normal antibiotics. This means that a surgical wound may develop a sinus that drains pus for the rest of a person's life, and if treatable will leave large scars. In the least, all patients overseas will need to be screened if they want future surgery in an Australian hospital. If positive they will have to undergo special antibiotic treatments plus re-screening. Proper sterility protocols help control Golden Staph in Australia, HIV and prions that cause the incurable "mad-cow dementia disease". These protocols rarely exist overseas. Don't forget that in Australia medical personnel are highly trained and need to be paid appropriately whilst orderlies, cleaners and PCA must also be paid with at least a minimal wage that Asian countries do not have. This all adds to the cost of your treatment here but increases your chance of a safe and successful outcome.

The cost of overseas cosmetic medicine is thus a reflection of the lack of protocols protecting patients from dangerous products, poorly trained medical personnel, no follow-up care and lack of sterility. You pay for what you get. So what is your health worth?

The one thing that all patients should take with them whether it be a procedure in Australia or one overseas is that all medical procedures have risks and side effects no matter how small the procedure. Surgery of course, runs higher risks including hemorrhage, serious infection, blood clots and even death. No one can give a guarantee of result as so many variables exist when dealing with the human body and no one can guarantee complication free surgery. This makes it even more vital that if something doesn’t go to plan that you have access to your doctor. It is also not uncommon that cosmetic surgery sometimes needs additional procedures to tailor the result to the a patient. That will not be happening if you had the procedure overseas. Here is the first problem we have personally heard from overseas patients. After being discharged within hours after their surgery patients are sent back to their hotel. They cannot of course enjoy the pool or alcohol that goes with holidays so they are just left to watch TV in their rooms. Often they are in pain, having been given only anti-inflammatory or mild analgesia (narcotics are rarely used in Asian countries due to strict laws). They sit in pain for the rest of their time, not knowing if that level of pain is normal or not since the language is a barrier and they do not have access to the doctor. 

All patients must undergo an informed consent procedure in Australia before any procedure is undertaken. In this process patients are told the risks, side effects and realistic results from their chosen procedure. Inadequate consultation is one of litigating patient’s major complaints and yet some people consider complex surgeries by surgeons where a language barrier exits. How can anyone be fully informed in this situation?

Do you really know who is doing your surgery? Even after a patient is satisfied with all their research how can they be sure who is really doing the procedure once they are asleep? We saw a group of 5 women who had procedures together overseas. Three were satisfactory; the other 2 had a deformed look around the eyes. The scarring revealed that clearly two different surgeons had been working that day. The women thought they were all having the same doctor. Obviously the same less trained doctor had treated the two poor results since the deformity looked the same. The result was that these two women were referred onto an Australian plastic surgeon and underwent corrective surgery to improve the result. Note the word “improve” rather than correct since once the human body undergoes trauma it will never be the way it was prior. This cost the women twice as much as they paid in Thailand. In reality it would have originally cost them only 25% more to have it done in Australia correctly with all the follow-up care. Another one of my colleagues’ patients, who featured her story in Women’s Weekly, has already spent $50,000 in attempts to repair her overseas surgery experience. These women were lucky they could even find a surgeon in Australia willing to take on the correction since generally most Australian doctors do not want to get involved with poor overseas work and an already angry, unreasonable patient. Many patients get stuck with their poor results for this reason or because they cant afford the fix up.

Having a general anaesthetic has particular risks since a machine is controlling breathing, and a patient’s life is in the hands of an anesthetist? Australian doctors are well trained for this but even then patients occasionally die. How do some patients put that much trust into a doctor with questionable training, experience and one they cannot speak fluently with?

Interestingly we had a patient recently who was quoted a price for an overseas surgery and when they got to Thailand the price became 3x higher. The doctor assumed that the patient was now there and would go through with it regardless. They didn’t though as they had the intelligence to realize that it was just another scam. It would appear that overseas doctors are getting wise about the growing demand for their services. The price of overseas surgery is going up.

Many of my colleagues in general practice, as well as cosmetic medicine, are reporting an increase in patients presenting post overseas surgeries with complications. These range from infections (some very severe), to nerve damage, thrombosis including pulmonary embolism and poor cosmetic results, which range from large liposuction divots to odd breast shapes. So if there are so many of them why are we not hearing about it in the media? The answer to that is obvious. There is already a stigma about going overseas for cosmetic medicine, which ranges from being a “cheap skate” to being gullible about believing all the promotional hype. People are just embarrassed. They feel depressed and often angry at themselves more than the overseas surgeons. They realize that there is not much they can do. Litigation is almost impossible against the overseas doctor or the hospital. Their best hope is to sue the promotional company here in Australia. But that isn’t going to fix the poor outcome that they will now have for the rest of their lives.

At the end of the day, it is up to the patient to make the best decision that suits them. Having an Australian surgeon do your work is no guarantee that things will go perfectly but it certainly reduces the risk of serious complications, improves the chance for a satisfactory result and may actually save a patient money in the long run. It’s also the peace of mind to have access to your surgeon post operatively. Sometimes for safety and quality sake it is better to save and wait a little longer. Decisions for surgery should never be based upon finances alone. 

Our final advice to any patient that is considering cosmetic surgery is this:

  1. Do their research looking for training and experience – past and ongoing
  2. Have a fully informed consultation with the surgeon discussing realistic results, positive and negative outcomes, risks, side effects and follow-up care
  3. Feel that they have a good rapport with the surgeon that includes trusting that their doctor knows their work and has a passion for it, that they care about their patient to allow appropriate post procedure access in the case of any concerns and that the patient feels comfortable to ask questions.
  4. Look at the facilities that will service the surgery and be satisfied that they are adequate and meet the highest safety and sterility protocols.
  5. Remain a realistic and reasonable patient at all times who is happy to follow all aftercare instructions and ask questions if they are unsure.


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