A large international study, the Sun, Sea, Sand, Silicone Project, estimated that Australians spend $300m a year on cosmetic surgery tourism, with an estimated 15,000 Australians heading offshore each year to go under the knife. Dr Meredith Jones from the University of Technology, Sydney, who worked on the study, told Australian Associated Press, "Most people are attracted to it because it is cheap overseas but the agents are beginning to tell us that they are servicing people who are choosing to go overseas because they think they will get better work done."
Even Australian health insurer NIB is become a player in the market, offering 'NIB Options'. NIB Options is not a health insurance product but a fee-for-service which, according to their website, provides "safe and reliable choices for consumers wishing to undertake cosmetic and major dental procedures in Australia or overseas".
A spokesperson from NIB said, "NIB Options is all about helping Australians to choose from a borderless network of surgical excellence as well as providing safety assurance".
In Australia, the service only recommends members of the Australian Society of Plastic Surgeons (ASPS) who have at least 12 years of medical and surgical education. For overseas procedures, it chooses only registered and certified surgeons with at least five years of postgraduate training and 12 years of medical and surgical education. NIB Options also offers an 'after-care' promise of 12 months' support after surgery.
Both the Australasian College of Cosmetic Surgery (ACCS) and the ASPS say that cosmetic tourism trivialises invasive surgery and the decision should not be taken lightly.
"Surgical procedures and tourism should not appear in the same sentence," says Dr John Flynn, the ACCS's chief censor. "Surgery used to be very well considered and a serious proposition. It's not something that you can add on to a holiday and it's not something you do simply because this is the cheapest way to go."
Flynn says the way most patients are connected with their surgeon – through a tourism travel company who is receiving commissions for referrals – is also problematic.
"There is no doubt that there are skilled surgeons," he says. "But the issue is that patients in Australia do not have the opportunity to research the good ones overseas. You could potentially leave that choice in the hands of a travel agent."
Surgery is a risky proposition regardless of where it's done, but Australian experts say there are additional risks to getting surgery in countries where regulation may not be as stringent as our own. The outcome could be results that you are unhappy with, or that cause a lot of pain and distress.
"Over the last few years we've seen an increasing number of people arrive as outpatients or at emergency departments with complications often related to breast implants, atypical infections… bad things like losing both nipples," says Dr Anthony Kane, President of the ASPS. Kane says that although there are known complications associated with any surgery, he is seeing an increasing number of patients returning from South-East Asia with problems.
One of the biggest issues with having surgery overseas is if complications arise after returning home, when "the person who is best suited to treat your problem is several thousand miles away", says Flynn. "Even if it might be the same type of complication that you might get in Australia, the most important thing is for the patient and the treating doctor to be in the same place."
Revisions and corrections back home will add significant costs to your original bill, as would the expense of travelling back overseas to see your surgeon, especially if you're unable to seek legal redress.
Australian experts warn of other potential risks of cosmetic tourism, including an increased risk of infections in tropical environments, implants that haven't been through the same rigorous approval process as the Therapeutic Goods Association's in Australia, and the increased risk of post-operative deep vein thrombosis during the long-haul flight home, which can be potentially life-threatening.
"There are surgical risks anytime you have surgery no matter where in the world the procedure is being performed," says Cassandra Italia, managing director of Healthcare Hands, which calls itself an international patient concierge service. "It's a patient's responsibility to do their research in order to reduce those risks."
So, how much can you save?
Often in Australia, cosmetic surgeons do not list pricing on their websites, with the caveat that costs will vary between patients and procedures. There are many costs associated with surgery – not just the surgeon's fee – such as hospital or surgical facility costs, anaesthesia fees, medication and medical tests.
"There is no way that in Australia we can match the cost of surgery in Thailand or somewhere similar," says Flynn. "In many cases it's half the cost."
Cassandra Italia says that patients can save "30–70%, depending on the hospital and expertise of the surgeon", by having their cosmetic surgery done in particular countries.
For example, breast augmentation in Australia can cost around $10,000, while in Thailand you can pay less than $4000.
Travel and accommodation costs also have to be factored in, if they're not part of a package deal, and the ASPS advises avoiding potential hidden fees by getting written financial details, including all out-of-pocket expenses for the surgeon, the anaesthetist, assistant and hospital theatre or facility costs.
"Surprisingly, there's been many cases where costs are not that much different," says Flynn. "And it's surprising that people would save themselves [an amount] as small as a 20% improvement in price as a trade-off for the accompanying risk profile."
What to look for
Before committing to any cosmetic surgery, it's very important to do thorough research, ask for friends' recommendations, and look for the surgeon's qualifications, experience and national or international accreditation.
Most medical practitioners doing cosmetic work will describe themselves as either plastic surgeons or cosmetic surgeons. The names sound similar but they are very different.
Plastic surgeons will:
- have a minimum of seven years' additional training after obtaining their medical degree
- be registered as a fellow of the Royal Australasian College of Surgeons (RACS)
- have the letters FRACS after their name (to indicate Fellow of the Royal Australasian College of Surgeons).
Cosmetic surgery is not a formally recognised specialty in Australia. Any general practitioner (GP) can call themselves a cosmetic surgeon and practise cosmetic surgery – whether they have additional surgical training or not.
While some cosmetic surgeons will be members of the Australasian College of Cosmetic Surgery (ACCS) and may have undertaken training provided by the college or studied overseas, none of this training is formally recognised.
While there are good cosmetic surgeons who have a lot of experience, it's still important to know they do not have the formal qualifications of a plastic surgeon.
Cosmetic surgeons often use the letters FACCS after their name which is not a recognised credential and shouldn't be mistaken for FRACS used by plastic surgeons.
In Australia, look on the ASPS website for an accredited plastic surgeon.
For surgeons overseas, look for one accredited by the International Society of Aesthetic Plastic Surgery (ISAPS). Patients Beyond Borders, a website which offers consumer information about international medical and health travel, and NIB Options are also good places to start your research.
To help avoid the pitfalls of cosmetic tourism – and we've all heard the horror stories – the ASPS has compiled a list of things to look out for when contemplating cosmetic surgery overseas, which include asking the following questions:
- Is my surgeon a member of the ISAPS?
- Are the medical standards of care and quality control requirements at least as good as those in Australia?
- Have I been assured that the devices and products used in overseas hospitals meet Australian standards?
- Were the risks and complications explained to me?
- What will happen if things go wrong? Will the surgeon accept liability?
- Have I been told about post-operative care and what to do if complications arise after the surgery?
For the full list of questions, visit the ASPS website.
Twenty-six-year-old Erica Gordon had a breast augmentation in Bangkok and told CHOICE that she was happy with the result and felt in control of the whole process.
"I decided to have surgery overseas because I had several friends who had done the same and were very happy with the result," she says. "The price was definitely a big factor which made me originally start researching. On [the agency's] global website they had the history and qualifications of each surgeon, with 'before' and 'after' pictures [of their patients].
"Once you've selected your doctor and hospital, you can view their full details on the hospital's website, which include where they studied, what degrees they have and what they specialise in. Also, the hospital I chose (Bumrungrad International Hospital) was listed as one of the top 100 in the world."
Erica said the procedure came with an initial consultation three days before the surgery and another the day before. "Everything was disclosed, all questions were answered and professional recommendations were also made," she says.
"I'm very happy. The only thing that was not perfect was one [breast] looked slightly bigger than the other, due to my chest bone sticking out on one side, which I was told by my surgeon would happen pre-surgery, so I was fine with that."