Complications of Cosmetic Surgery Abroad

Cost Analysis and Patient Perception

Mohammed Farid, MBChB, PGCE, MSc, MRCS; Dariush Nikkhah, MBChB, MSc, FRCS (Plast); Max Little, MBBS, BA (Law), MRCS; Daren Edwards, MBE, RGN; Wendy Needham; Mohamed Shibu, MBChB, FRCS (Plast)


Plast Reconstr Surg Glob Open. 2019;7(6):e2281 

In This Article

Abstract and Introduction


Background: Cosmetic surgery tourism is rapidly becoming more prevalent in the United Kingdom. We aim to identify the motivational factors underlying patients' decisions to go abroad for their treatment and gather information about the ensuing complications.

Methods: A retrospective review (January 2013–August 2017) was conducted of patients seen at a single major trauma center for complications from cosmetic surgery performed overseas. Cost analysis was performed based on national tariffs. Complications were grouped based on Clavien-Dindo classification and the Clinical Commissioning Group cost. A telephone survey was conducted to evaluate reasons for travel, details of complications, and impression of healthcare at home and abroad.

Results: A total of 20 patients (one male, 19 females) with a mean age 36 years (23–59 years) were included. Lower cost was the most popular reason for travel, followed by lack of expertise and friend's recommendation. Abdominoplasty (n = 9) had the highest number of complications followed by gluteal augmentation (n = 7). All major complications were due to gluteal augmentation (n = 4). The cost was for minor (n = 8, £3,448), intermediate (n = 8, £18,271), and major (n = 4, £42,083.59) complications.

Conclusions: We raise serious concerns about the lack of regulation in cosmetic tourism and the absence of patient follow-up abroad. A particular concern was all gluteal augmentation cases had major complications. An international consensus to regulate surgical practice abroad is crucial to protect patients' interests and promote safe cosmetic surgery.


The cosmetic surgery industry is expanding at such a rate that it has outgrown the regulations that aim to monitor its practice. The International Society of Aesthetic Plastic Surgery (ISAPS) statistics in 2017 revealed an overall 9% rise in cosmetic procedures over 12 months.[1] There is an increasing trend for patients to seek cosmetic surgery abroad for a multitude of factors, including ease of access to surgery, lower costs, affordable airfares, positive marketing, and use of social media for foreign surgeons or even friends' recommendations. However, the exact reasons behind the choice of certain countries over others remain unknown.[2–4] The overarching reason for travel is failure to qualify for free cosmetic surgery under the National Health Service (NHS). The stringent criteria include body mass index (BMI, <25 kg/m2), not smoking and the ability to demonstrate functional impairment or significant psychological distress.[5,6]

There are only a few reports about the outcome, cost, and patient perception of cosmetic surgery abroad.[7–9] None of those articles covered all 3 aspects with patient perception in particular being ignored. The purpose of this study is to determine the complications of these operations, cost implications for the NHS, and patients' views. The main motivation for seeking treatment abroad and the concerns about complications were investigated in the patient survey. Our study is novel as it aims to encompass all of these factors related to cosmetic surgery tourism.