Dear Sir,
In relation to the recently published letter by Long et al. [1], we have also observed a steady flow of patients presenting with post-operative complications following cosmetic surgery during the COVID-19 pandemic. 8 patients presented to our regional Plastic Surgery Department between September 2020 and February 2021. 5 had cosmetic surgery abroad and 3 in another area of England. This confirms that cosmetic tourism is creating an additional burden on an already saturated NHS throughout the UK, not just in Northern Ireland.
8 patients presented acutely to our Plastic Surgery Department with complications resulting from cosmetic surgery outside our region. The cohort consisted of 7 female and 1 male patients. Our patients were aged between 25 and 45; 2 of these 8 patients attended our unit with complications of cosmetic tourism previously (2019 and 2018). Suggesting, that a previous negative experience was not a deterrent. Half of the patients had travelled to Turkey for their procedures. 3 out of 8 patients (37.5%) travelled to other areas of the UK. (Figure 1 .)
Figure 1.
Pie chart showing location of cosmetic tourism.
Our patients underwent various procedures; including cosmetic breast augmentation (4), lipofilling/lipomodelling (2), abdominoplasty (1) and facelift (1). Patients presented an average of 5 weeks post-operatively. Some complications were managed conservatively, others required surgical intervention (Table 1 ).
Table 1.
Summary of Cosmetic Tourism Complications During COVID-19 2020.
| Location of Surgery | Surgery Performed | Complication | Treatment Offered | Outcome |
|---|---|---|---|---|
| *Turkey | Bilateral breast augmentation. | Wound dehiscence, infection, and implant exposure | Removal of infected breast implant and washout of infection. Antibiotics and admission | Patient declined operative treatment within the NHS, took antibiotics for MRSA grown from wound swabs and planned return to Turkey for implant exchange and further buttock surgery. |
| UK | Bilateral breast augmentation and mastopexy. | Wound dehiscence and nipple necrosis | Dressings management through plastic surgery outpatients | Patient Did Not Attend multiple follow up appointments offered. |
| Poland | Facelift | Infected haematoma | Drainage of haematoma, antibiotics. | Dressings clinic follow up |
| *Greece | Breast reduction, mastopexy and implants | Nipple necrosis and wound infection | Dressings and oral antibiotics | Dressings clinic follow up |
| Turkey | Abdominoplasty | Large seroma and wound dehiscence | Dressings and ultrasound guided drainage arranged. | Dressings clinic follow up. Patient did not attend appointments for drainage. |
| Turkey | Abdominoplasty and liposuction | Seroma | Managed at local referring unit with drainage and dressings | Local follow up |
| UK | Bilateral augmentation and mastopexy | Haematoma requiring return to theatre. | Offered evacuation of haematoma and removal of implant on NHS. | Transferred back to private clinic for implant salvage surgery. |
| UK | Abdominoplasty | Infected seroma, collection, fat necrosis. Sepsis. | Emergency admission under general surgery for IV antibiotics 4 weeks post op, then emergency admission to plastic surgery for debridement and washout of infected seroma 7 weeks post op. | Theatre for washout of infected seroma and debridement. Theatre for second look washout and VAC dressings. Inpatient stay for 1 week. Follow up in private sector. |
*these patients had complications in previous years.
Of particular concern is that two patients had previously required NHS treatment of cosmetic tourism complications. With one patient electing to undergo further surgery at the same unit in Turkey. During the time that our patients presented to hospital (September 2020-February 2021) the UK was still subject to COVID-19 restrictions with a large NHS COVID-19 burden. We note that 3 out of 8 (37.5%) patients declined recommended NHS treatment or did not attend follow up.
Travelling for cosmetic surgery is not a new phenomenon. A BAAPS survey in 2009 highlighted the extent to which the NHS manages complications of cosmetic tourism [2]. However, patients travelling abroad during the COVID-19 pandemic for aesthetic surgery is alarming. Despite our relatively small cohort, the lack of local cosmetic surgery availability seems to have driven patients abroad at a time when the NHS is under critical strain. This lack of individual responsibility needs to be highlighted, to protect the NHS.
Surprisingly, we found 3/8 patients had travelled within England for their aesthetic procedures during the COVID-19 pandemic, despite guidance on avoiding non-essential travel. Local availability of aesthetic surgery varies geographically. It is our recommendation that, advertising campaigns and social media posts to entice patients to travel for surgery within the UK should be temporarily banned when COVID-19 is prevalent.
The strain of COVID-19 on healthcare systems has varied locally and globally during the COVID-19 pandemic. A BAAPs press release on the 6th January 2021 supported the resumption of aesthetic surgery where it can be safely provided without impacting on the national effort or NHS resources. A recent paper by Kaye et al. lead to proposed guidelines from the leading aesthetic associations around the world, on how to safely reintroduce aesthetic surgery [3] with EASAPS emphasising the role of surgeons behaving ethically during the pandemic and COVID-19 consent [4]. The ISAPS page on cosmetic tourism recommends staying in the area where the surgery was performed for at least a week, depending on the procedure – though this may not be enough to avoid an NHS burden [5]. Additionally, the resumption of aesthetic surgery in the UK coincides with an anecdotal increase in the demand for certain cosmetic surgery procedures, the ‘Zoom Boom’, i.e. the demand for facial procedures driven by increased awareness of ones appearance on screen. Additionally, exercise restrictions are likely to increase demand for contouring procedures.
As the national COVID-19 vaccination programme ramps up and restrictions ease we must ensure the NHS is able to cope with the backlog of postponed treatments. An increasing burden of patients with complications from cosmetic tourism needs to be avoided at all costs. We propose a national aesthetic complications database to audit trends and improve patient safety by feeding back to the provider any complications.
Funding
None
Ethical approval
N/A.
Declaration of Competing Interest
N/A.
References
- 1.Long R., Martin S., Hill C. Cosmetic tourism amidst the Covid-19 global pandemic. J Plast Reconstr Aesthet Surg. 2020 doi: 10.1016/j.bjps.2020.08.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sun Sea and Silicone: Cosmetic Surgery Tourism trends revealed at groundbreaking conference. 2009 [cited 2021 January 2nd]; Available from: https://baaps.org.uk/media/press_releases/1323/sun_sea_and_silicone_cosmetic_surgery_tourism_trends_revealed_at_groundbreaking_conference/)
- 3.Kaye K., et al. Elective, non-urgent procedures and aesthetic surgery in the wake of SARS-COVID-19: considerations regarding safety, feasibility and impact on clinical management. Aesthetic Plast Surg. 2020;44(3):1014–1042. doi: 10.1007/s00266-020-01752-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.EASAPS May 2020 Consensus on Resuming Aesthetic Surgery. 2020 [cited 2021 January 2nd]; Available from: https://www.easaps.org/final-easaps-espras-considerations/.
- 5.Medical Travel Guide Plastic Surgery Tourists. 2021 [cited 2021 January 2nd]; Available from: https://www.isaps.org/medical-travel-guide/plastic-surgery-tourists/.