Experts Weigh In On The Risks Of Medical Tourism For Aesthetic Procedures

Medical Tourism, whether it is traveling domestically or internationally, is on the rise. A year ago, several doctors who provided their opinions to the American Society of Plastic Surgeons for a roundtable on the subject pointed to cost as one of the main drivers for this upward trend. While price is certainly a factor, the reasons aren’t only cost-based. Medical Tourism Magazine, the digital publication for the global medical tourism community, points to privacy and anonymity in addition to access to advanced treatments not offered domestically as additional key drivers.

I live in Miami, which is considered as one of the “plastic surgery capitals of the world” due to its high number of plastic surgeons and practices here. So, I thought it would be fitting to tap into an attorney whose law firm specializes in healthcare law and several leading medical providers from the region to get their take on the risks associated with medical tourism, particularly when traveling abroad.

Amanda Howard, an attorney at Florida Healthcare Law Firm who specializes in representing healthcare providers and businesses tells me that she has seen an uptick in consults or cases related to negative outcomes for aesthetic procedures here or abroad. “I have represented clients who have been accused of performing procedures in the US that have resulted in severe adverse effects, attempted to import non-FDA approved drugs into the US to use on patients, or have sought guidance as to their scope of practice and disagreed with limitations,”

Howard continues, “From my perspective, I do think there appears to be some healthcare professionals and businesses lowering or comprising standards to be competitive in the market, particularly among healthcare providers who may not be financially affluent and lack legal expertise, catering to patients facing similar limitations.”

Dr. Paul Durand, MD, a board-certified plastic and reconstructive surgeon based out of Miami shares with me that a big part of his practice is revision surgery for surgeries performed elsewhere. “I see many patients who have gotten procedures performed abroad, particularly South America, Mexico, and the Caribbean. Even though there are some great surgeons abroad, many of which I know personally, there are also many others that are not. The problem with getting plastic surgery abroad is that it is very hard for patients to discern who is a well-trained, safe surgeon from those who are not.”

Even if a patient finds the best surgeon abroad, Durand feels questions about the health standards of the facility, how tools are sterilized, who assists the surgeon, and post-operative care protocols may be questions that are hard to get answers to. “Complications happen to even the best surgeons, so what happens if you experience this while abroad?”

Dr. Michael D. Mirmanesh, MD, a plastic surgeon with a multi-state practice including several locations in Florida who has performed over 3000 surgeries since 2000 tells me that with the explosive growth of aesthetic procedures that it is becoming more mainstream for patients to seek cost-saving options outside the United States.

“Overseas the prices can be significantly cheaper, but they come with a significant risk. There are also certain treatments not regularly used in the United States because of concerns with safety that are performed regularly abroad, which could have permanent disasters effects, the most common one I still see are silicone injections, which often lead to permanent disfigurement.” Like Durand, Mirmanesh acknowledges risks and adverse outcomes can happen even with the best medical hands, but in those cases the complications can be managed by the original surgeon.

Since demand for fillers is on the rise, I wanted to get an opinion from Miami-based Pamela Weinberger, a nationally certified Physician Associate holding licenses in both New York and Florida and renowned as one of the preeminent educators affiliated with the Allergan Medical Institute. With ten years of professional experience under her belt, one of the biggest issues she sees in her practice is lack of education and know-how. “Unfortunately, many practitioners lack adequate training, and in some countries, individuals administer injections without proper licensing or regulation. In my office, I am currently doing 10% corrective injectables as part of my daily workload, from injectors based both in the US and abroad, and who prioritize profits over patient safety and optimal results.”

The other issue Weinberger sees is unknown filler types. “I’ve encountered cases where patients relocate to Miami with unknown lip fillers, sometimes even suspected silicone injections. Addressing such challenges requires careful assessment and, if needed, corrective measures using hyaluronic acid fillers, accompanied by antibiotics and steroids to mitigate risks associated with past silicone injections. Correcting these patients often requires some of the most advanced techniques in the industry. Nevertheless, the right practitioner with corrective experience can achieve amazing, natural looking results.”

When adverse or undesirable outcomes happen in the United States, patients have legal recourse assuming they were given informed consent and agreed to it, which outlines the risks, benefits, and alternatives to the treatment.

“If informed consent wasn’t obtained, you might have grounds for a medical malpractice claim. This is your initial line of defense. Additionally, if the healthcare provider didn’t meet the standard of care or was otherwise negligent during the procedure, you may have a case for medical malpractice,” explains Howard. Although when speaking to me, she is very clear that whether monetary damages are collected is another story. “Patients also have the right to report your concerns to the provider’s licensing board or the state department of health, which could cause such authorities to investigate your claim.”

For patients who travel overseas to have aesthetic procedures done and experience negative outcomes Howards tells me that they are facing unfavorable legal territory and would require filing the case in federal court.

“Establishing personal jurisdiction over a foreign defendant will likely be very difficult if not impossible. What this means is that a court would not be able to enforce any judgment on the foreign defendant. Even if a court can exercise personal jurisdiction and the plaintiff is successful, it will likely be extremely difficult to collect money damages from an overseas defendant. There could be an option to seek recourse in the country where the procedure was performed; however, a patient will have likely signed an informed consent or waiver that prohibits them from doing so.”

So where do the above medical experts’ opinions lie on having aesthetic procedures performed overseas?

Durand doesn’t recommend it. However, if a patient chooses to do so he suggests not only researching the surgeon and their country’s national society of plastic surgeons to check their standing, but also the surgery center or hospital. “When given the option it is always better for their surgery to be performed at a larger private hospital compared to an in office operating room.” Mirmanesh tells me, “I think there are a lot of excellent surgeons overseas who are just as good as or in some cases better than surgeons in the United States.” However, he doesn’t recommend anyone who doesn’t understand the native language or is not from that country to have surgery overseas.

When it comes to getting injectables abroad, Weinberger adds, “If you reside in the United States, there’s an abundance of skilled injectors—Physician Associates, Nurse Practitioners, and Medical Doctors—eliminating the need to venture far for exceptional care. It’s crucial not to prioritize cost when it comes to your facial goals; correcting mistakes is far more expensive than getting it right initially.”

From a legal perspective, Howard tells me that patients should take precaution and do their due diligence whether they choose to have a procedure done here or abroad. “Research the procedure, research the practice, and research the provider. Ask your provider tons of questions. How does the procedure work? What tools are used? What materials are used? From a legal standpoint, refrain from signing any informed consent or waiver until you’re fully satisfied with the above precautions.”