The review analysed 58 studies comprising 1,249 patients who underwent cosmetic procedures abroad and later received treatment for a complication within their local healthcare system. Findings indicated that infection, implant-related complications and wound dehiscence are the most common problems reported following cosmetic surgery treatments both inside and outside of Europe.

“Complications after undergoing cosmetic surgery abroad represent a substantial treatment burden for healthcare systems,” the researchers wrote. “The available evidence supports recurring patterns in reported procedures, complications, microbiology and destinations.”

A global concern?

The review indicated that a limited set of procedures account for most reported complications, notably breast augmentation, abdominoplasty and liposuction. Retrospective data also showed that combined procedures, especially admonioplasty with liposuction, are associated with a higher rate of post-operative complications versus isolated procedures. Specific destination countries also recurred across studies, with Turkey the most common destination in European studies and The Dominican Republic the most frequently reported in non-European studies.

The researchers said that European studies highlighted the “cumulative financial and system-level burden” on healthcare systems whereas non-European studies emphasised “severe infections and atypical pathogens”. Globally, post-procedure infections were the most common complication.

The difficulty for local healthcare systems, the researchers explained, is the lack of operative reports and information on pre- and post-operative protocols related to cosmetic procedures conducted abroad. “This lack of information complicates clinical decision making and increases inefficiency risk and cost,” they wrote.

On the cost side, they said review data likely underestimates “the true economic burden” of cosmetic surgery tourism, given that most reports only cover direct hospital costs, not costs related to outpatient wound care, primary visits, re-admissions, rehabilitation or productivity loss. The lack of mandatory insurance coverage for post-operative complications following cosmetic surgery abroad also means the financial responsibility for treatment is frequently transferred to public healthcare systems.

Governance and accountability

“Without changes to governance and accountability, the continued growth of cross-border cosmetic surgery will place increasing strain on publicly funded healthcare services,” the researchers wrote.

Data within the review indicates “stable and established travel corridors” within the cosmetic surgery tourism market that should provide some predictability for healthcare systems and patient education.

Writing in a commentary article that responds to the review, Professor Dr Cenk Demirdover, a plastic surgeon based in Turkey and vice president of the European Society of Plastic, Reconstructive & Aesthetic Surgery (ESPRAS), said three structural weaknesses need to be addressed in the medical tourism world: fragmented follow-up, the role of medical tourism agencies, and reporting bias.

Firstly, Demirdover said most international patients return home within days of a procedure and local doctors often publish case reports about complications without any access to original surgical records or clinic-wide success data. Secondly, medical tourism agencies involved in the market “may prioritise profit over patient safety, contributing to suboptimal outcomes”, he said, and thirdly, the reporting in medical journals is often skewed towards adverse outcomes.

Looking forward, the Professor said that guidelines and checklists adapted for patients are required to reduce complication rates for patients travelling to receive cosmetic surgery. He said industry associations like ESPRAS and the International Confederation of Plastic Surgery Societies (ICOPLAST) should organise working groups and collaborate with national authorities to make this happen. “Currently, we have guidelines at the national and international levels. However, they should be adopted for international medical tourism patients,” Demirdover told Premium Beauty News.

The rise of cosmetic tourism

Earlier this year at Cosmoprof Bologna Worldwide in Italy, a panel of experts discussed the rise of cosmetic surgery tourism and, in particular, the rise of wellness tourism. Wellness tourism covers more traditional aesthetic cosmetic procedures as well as preventative treatments for things like sleep health, energy, hormones and ageing.

According to Yarden Horwitz, co-founder of US research firm Spate, wellness travel used to be about spas and relaxation but has now become more about “procedures, treatments and getting diagnosed”. Crucially, more consumers worldwide are engaging in these trips, Horwitz said, fuelling the growing global cosmetic tourism market.

Rina Raphael, journalist and author of The Gospel of Wellness, said there is certainly a “casual injection culture” building globally, combined with a clear expansion of medical tourism that is opening up the market.

Sora Lee, CEO and founder of beauty advisory Kurated Agency, said “beauty-maxxing” is definitely on the rise with more people adding procedures to their list of beauty rituals. Lee said Korea in particular is becoming an increasingly important market for cosmetic tourism given how specialised doctors are for each procedure and the up-front investments many clinics make for state-of-the-art machines.