The Dangers Of Medical Tourism

Melbourne account manager Tyra* could hardly stop smiling as she packed the sunscreen and thongs for her 2009 dream holiday in Thailand. It wasn't the shopping or sightseeing she was most looking forward to, but a daytrip to a Bangkok hospital where she'd get a flat new tummy, slimmer thighs and fuller breasts. In Australia, the surgeries would have set her back about $36,000 - but in Thailand, she could get the lot for around $10,000. "At that price, I could just stretch to the cosmetic surgery after taking out a loan and I could enjoy a break away as well," says Tyra, 36."

Three days after checking in to her Bangkok hotel, Tyra took a taxi to Yanhee Hospital. That's when she started having second thoughts. On arrival, she was given a number and told to wait with about 60 other people. "I felt like I was in a production line," recalls Tyra. "The people from the Australian tour company weren't there with me, as they'd promised, and I had to pay for the entire procedure before I'd even seen the doctor. It seemed very dodgy."

Photos: Worldwide face transplants

Hours later, the surgeon finally saw Tyra, but only for five minutes. "He could barely speak English, and as he drew all over my gown indicating things about my procedures, I worried he may not have fully understood what we'd discussed," she says. "I felt a little panicked, but I'd already come all this way and paid my money so I went through with it."

Today, the attractive brunette wishes she'd cut her losses and left. The surgeon botched every single procedure; where her tummy should be flat, there's now a huge bulge caused by damaged muscles; where she just wanted a few centimetres trimmed off her thighs, the skin is now uneven and lumpy. And her new breasts? "They look freakish," says Tyra, tearfully. "The nipples are so high they sit above the top of my bra. I can barely look in the mirror."

Tyra still sobs every day and her emotional pain has been intensified by serious financial consequences. She tried to make the now-defunct tour company at least pay to have the problems corrected. "But because the operation was overseas, they weren't legally bound to," adds Tyra, who has since had corrective surgery in Melbourne, but needs more. "I'm now $36,000 in debt and paying $600 a month in interest."

Cosmetic surgery is no longer the realm of the affluent. Around 15,000 liposuctions are performed in Australia yearly and, according to the Australasian College of Cosmetic Surgery, the rise in local breast augmentation is likely to rival Britain's increase of 275 per cent since 2002. There's also been a boom in so-called "nip-tuck holidays". In countries like Thailand, India, Borneo, Sri Lanka and Malaysia, increasing numbers of mostly female "medical tourists" from all over the world can be found lazing poolside with a cold drink in one hand and painkillers in the other. "We have no idea how many people are travelling overseas for cosmetic surgery, but anecdotally, cosmetic surgeons think the figure is going up every year," says Dr Andrew Pesce, President of the Australian Medical Association.

To satisfy demand, specialist travel companies like Restored Beauty Getaways in Perth and Surgery Getaways in Sydney have sprung up. "These companies get kickbacks from the doctors, hospitals and hotels they're linked to," points out Dr Pesce. "That means there's a risk they could promote a super-size mentality, encouraging people to have multiple procedures that could put their bodies under quite a bit of duress."

It's a trend that has Australian cosmetic surgeons gravely concerned. "Cosmetic surgery overseas is not regulated as carefully as it is in Australia," states Dr Craig Layt of the Australasian Society of Aesthetic Plastic Surgeons. He says risks are compounded by lack of face-to-face consultation to assess the patient, explain the operation and ensure informed decisions are made. "In Australia, surgeons undergo stringent training that takes years and they see cosmetic surgery patients several times before a procedure," explains Layt. "Overseas, it's common to only briefly meet your surgeon on the day he's going to operate."

Victorian marketing executive Sienna* agrees. Her 2007 Thai nip-tuck was botched when she was given someone else's name tag and ended up with a facelift she didn't even want. She'd booked an upper-eye lift and liposuction on her thighs, but woke from the anaesthetic to realise with horror that neither procedure had been done. Instead, her face had gone under the knife. "The surgeon had done a shocking job," says Sienna, 51, ruefully. "The actual facelift was not extreme, but he'd made the incision in front of my ears so it was fairly visible, and he had sewn my ear lobes down so tightly onto my face I could feel my ears moving whenever I spoke. I was shattered."

Despite the tour company's claims they guaranteed their work and would pay to fix problems, Sienna hadn't read the fine print, which contained a waiver absolving the company of any responsibility. "I was quickly told there was no appointment available for me to see the surgeon," says Sienna, who declined to name the travel firm. "But I didn't want that butcher to touch my face again."

Many medical tourists are lured by the prospect of international shopping.

Instead, she returned to her hotel room in severe pain. "The tour staff called me once," she reveals, "but then I was left completely alone." Three days later, Sienna was still in excruciating pain; she couldn't get out of bed or keep down any food or fluid. "I started to worry I was going to die," she confesses. "I had to raise the alarm for a woman in a nearby room to call the tour company and insist they send someone to see me. Luckily, the person they sent had some nursing training because she said my blood pressure was dangerously low and I was so dehydrated I could have died."

Sienna has since undergone several corrective operations, bringing the cost of her "half-price" surgery to $50,000 - her entire life savings.

In recent years, Toorak plastic surgeon Dr Chris Moss has operated on 15 women whose surgeries have been bungled overseas. Some have ugly scars, while others have a permanently windswept expression - the result of the surgeon pulling the skin too tight during a facelift without correcting the deep tissue underneath. "It's a cheap way of doing a facelift, but the result can be absolutely awful," says Dr Moss. "So what women often think is a bargain facelift in fact has involved a quarter of the work required to get a good result." Dr Moss has seen women with severed nerves that cause irreparable droopy smiles or facial numbness. "In such cases, I suspect the surgeons may have little knowledge of the anatomy of the face," he states. Nose jobs can prove equally risky. "One woman had been left with a hole as big as half a thumb in her nose," recalls Dr Moss.

Cultural differences are also a factor for the medical tourist. "Often surgeons give women very upturned, piggy noses with scooped out bridge lines, which is a popular look in Asia, but not in Australia," says Dr Moss. Same goes for breasts, with a "bigger is better" mindset that many US medical tourists favour, but is often given to Australian women, too, when in fact they just want to go a size up and look natural. "Complications can occur if the surgeon is working fast to get through a lot of patients or has poor technique and they are rough with the breast tissue," adds Dr Moss. "This can cause an increase in scar tissue that can contribute to capsular contraction, which results in misshapen and painful breasts."

Recently, respected medical journal The Lancet reported on another threat: British cosmetic surgery patients have carried a new type of potentially life-threatening "superbug" back home after operations in India. The same infection has reportedly been detected in a medical tourist from Canberra. "This is a concerning public health threat because these bugs are extremely resistant to antibiotics," says Brisbane plastic surgeon Dr Mark Magnusson. Such bugs can breed in hospitals with poor infection control and be transmitted if staff don't wash hands or use alcohol hand rubs between patients. "There is also a risk of contracting diseases like Hepatitis B or HIV," warns Dr Magnusson.

A sand, surf and sun-soaked holiday is a poor environment for wound healing and preventing infection. "It's plain dangerous," explains Dr David Topchian. "Activity restriction is an important part of the outcome after cosmetic surgery. Swimming in a tropical climate when you have a wound could compromise healing and put you at risk of bacterial infection. If you have had an implant under the muscle in the breast then you should restrict shoulder use and arm exertion, so the implant doesn't move out of position. Tummy tucks take six weeks to heal during which time heavy lifting should be avoided, so clearly carrying shopping from the markets or pulling a suitcase at the airport should be avoided. As for a night on the town – this could put you at risk of a blood clot."

But, according to Gorgeous Getaways marketing manager Louise Cogan, post-operative care and recuperation is what makes medical tourism such a great idea. "You don’t have to rush to work or try to hide your surgery from friends, and in a lovely environment you can kick back and really indulge yourself," she says. "We offer special day tours for our ladies when they're in Malaysia, but some just want to relax in their hotel room after surgery. Others enjoy a spot of shopping and sightseeing." While she concedes that companies like hers operate on kickbacks from overseas doctors, resorts and hospitals, Cogan says Gorgeous Getaways is extremely careful about the services they offer and emphasise the need for recovery. "We do make sure that the women realise that it's important to rest and not overdo it," she explains. "That does mean in some cases they may not be able to go swimming, but they enjoy lazing by the pool."

Photos: Worldwide face transplants

It's an attitude that Sienna laments. "I think the desire to constantly renovate your appearance is a sign you need to address your sense of self worth," she says. "Ending up with a facelift I didn't want was a wake-up call. It forced me to realise I need to value myself for who I am. If I'd wised up earlier I would be $50,000 better off and wouldn't have had to undergo months of counselling."