Necrotizing Soft Tissue Infection of Abdominal Wall After Lipoabdominoplasty

Complication Following Medical Tourism

Sabi Shrestha, BSA; Melinda Lue, BA; Howard T. Wang, MD


Plast Reconstr Surg Glob Open. 2022;10(7):e4416 

In This Article

Abstract and Introduction


Necrotizing soft tissue infection (NSTI) is an acute life-threatening complication of cosmetic surgery. We present a case study of a 48-year-old woman diagnosed with NSTI of the abdominal wall following liposuction, abdominoplasty, and ventral hernia repair performed in Latin America. In the operating room, bowel perforation at the hepatic flexure was observed requiring emergent fascial debridement, bowel resection, and broad-spectrum antibiotics. She required multiple washouts and split-thickness skin grafts. Complications such as NSTI are possible after lipoabdominoplasty and are prevalent in cosmetic medical tourism, due, in part, to varying institutional standards and accreditations, and in some cases lack of consistent adherence to set standards. Complications after medical tourism contribute a significant burden to medical staff and the healthcare system in patients' home countries. Patient education by their surgeons and plastic surgery societies should be prioritized. It is important for domestic emergency physicians, plastic surgeons, and other care providers to understand complications postcosmetic surgery to promote timely management.


According to the International Society of Aesthetic Plastic Surgery, surgical and nonsurgical aesthetic procedures increased in 2019 by 7.1% and 7.6%, respectively, compared with 2018.[1] Cosmetic medical tourism saw a concurrent increase during this time. Countries receiving the highest percentage of foreign patients were Thailand (33.2%), Mexico (22.5%), and Turkey (19.2%).[1] Many patients travel abroad due to reduced cost, cultural similarity between patient and providers, easy accessibility, and availability of procedures not performed in home country.[2,3] However, foreign regulations and safety standards for facilities, drugs, medical products, and devices may vary, and in some circumstances, be more lax than in the United States, increasing risk of postsurgical complications.[2] Additionally, patients who travel for procedures often lack follow-up with their surgeons, delaying timely detection of complications.[3] Common complications following cosmetic surgery performed abroad include wound infection, poor wound healing, wound dehiscence, and thromboembolic events.[2–4] Patients are also at risk of postsurgical infection associated with foreign pathogens.[2,4] This case highlights a patient presenting with serious surgical and medical complications post-lipoabdominoplasty performed in Latin America, emphasizing burdens on home healthcare system and importance of patient education.