Abstract
Introduction: The purpose of this study was to understand the perceptions of potential complications and motivations among patients willing to travel internationally for cosmetic surgery and to gain insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. Methods: A cross-sectional survey was performed through Amazon Mechanical Turk regarding cosmetic surgery tourism in adults 18 years and older and currently residing in the United States (US). Results: A total of 484 responses were analyzed. Of those, 45.2% of participants would consider having plastic surgery. Among these participants, 67.1% would consider traveling outside of the US to receive cosmetic surgery. Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.1, 95% CI 1.1-8.7, P = .030). Participants reported that the top advantages of traveling outside of the US for surgery were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. The top disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. Although the risk of complications was acknowledged as the top disadvantage, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). Conclusion: These findings support the need for continued awareness of patients considering international travel for cosmetic surgery and increased education of the general public regarding the safety of cosmetic surgery tourism and the importance of selecting board-certified plastic surgeons and accredited facilities.
Keywords: medical tourism, plastic surgery, cosmetic surgery, survey
Résumé
Introduction: La présente étude visait à comprendre les perceptions des complications potentielles et les motivations chez les patients désireux de se rendre à l’étranger pour subir des chirurgies esthétiques et à connaître les perceptions du public à l’égard du tourisme esthétique au moyen d’un sondage auprès d’un vaste échantillon représentatif du grand public. Méthodologie: Les chercheurs ont procédé à un sondage transversal par l’entremise de la plateforme Amazon Mechanical Turk au sujet du tourisme esthétique chez des adultes de 18 ans et plus qui habitent actuellement aux États-Unis. Résultats: Les chercheurs ont analysé 484 réponses. Au total, 45,2% des participants envisageraient la chirurgie plastique et, de cette proportion, 67,1% envisageraient de sortir des États-Unis pour ce faire. Les participants qui se disaient Hispaniques ou Latinos étaient plus susceptibles d’envisager de se rendre à l’étranger (rapport de cotes 3,1, IC à 95%, 1,1 à 8,7, P = 0030). Les participants indiquaient que le tourisme esthétique hors des États-Unis avait comme principaux avantages le prix des opérations, une liste d’attente plus courte et le respect de la vie privée pendant la convalescence. Le risque de complications, l’absence de suivi ou de continuité des soins après l’opération et la distance de la maison en étaient les principaux désavantages. Même si le risque de complications était reconnu comme le principal désavantage, la perception de sécurité liée à la chirurgie esthétique à l’étranger n’était pas associée à la volonté d’envisager une opération à l’étranger (P = 0268). Conclusion: Ces observations appuient la nécessité de sensibiliser constamment les patients qui envisagent le tourisme esthétique et de mieux informer le grand public de la sécurité du tourisme esthétique et de l’importance de privilégier des plasticiens agréés par l’Ordre et des établissements agréés.
Mots-clés : chirurgie esthétique, chirurgie plastique, tourisme médical
Introduction
Medical tourism, where patients travel to obtain medical care, is an option for patients seeking elective procedures. The earliest documented cases of medical tourism date to the fifteenth century Ottoman empire, where consent forms show that foreign citizens presented to an Ottoman doctor for the treatment of inguinal hernias. 1 Today, the phenomenon is particularly relevant to the field of plastic surgery. International cosmetic surgery tourism, a subset of medical tourism, is increasing in popularity.2,3 Patients seeking cosmetic surgery may be drawn to have surgery internationally for many reasons, including significant cost savings relative to having surgery in the United States. 2 While advantages to international cosmetic surgery tourism exist, complications after international cosmetic surgery are well documented and are often handled domestically at significant cost to the physician and healthcare system.4–6
In attempt to characterize the motivations of patients who participate in cosmetic surgery tourism, previous studies have surveyed patients who experienced complications after international cosmetic surgery and attempted to delineate potential advantages and disadvantages of international travel for cosmetic surgery.3,7 Despite these efforts, little is formally known about the motivations of patients who are willing to travel internationally to receive cosmetic surgery. Currently, much of the literature regarding cosmetic surgery tourism focuses on economic outcomes and complications.7–11 While there is speculation and anecdotal evidence surrounding patient's motivations to pursue cosmetic surgery internationally, to our knowledge no study has captured the opinions and perceptions of those considering traveling abroad for surgery. Developing a more formal understanding of the factors that lead patients’ to engage in cosmetic surgery tourism is an essential, upstream step towards minimizing the physical and economic consequences of international cosmetic surgery tourism.
The purpose of this study is to assess the motivations of those willing to travel internationally to obtain cosmetic surgery and gain further insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. To our knowledge, this is the first study to provide insight into the perceptions and motivations of the general public in the United States regarding cosmetic surgery tourism.
Methods
The study was granted exempt status by our Institutional Review Board (Protocol 2021P000643). The survey was created using Research Electronic Data Capture (REDCap) and distributed to participants during August 2021. Study data were collected and managed using REDCap electronic data capture tool. REDCap is a secure, web-based software platform designed to support data capture for research studies.12,13 Survey responses were anonymous and confidential. In this cross-sectional study, participants were surveyed through Amazon Mechanical Turk (mTurk) regarding cosmetic surgery tourism. MTurk is an online marketplace where requesters post human intelligence tasks (HITs) and workers elect to complete them for a nominal fee. HITs include such activities as transcription, tagging images, and completing surveys. 14 This survey was posted to all mTurk workers residing in the United States. Participants were provided a prospective agreement and a link to the REDCap survey. Only complete, unique responses were included in analysis. Participants received $0.25 through the mTurk platform for completing the survey.
Adults 18 years and older and currently residing in the United States were included in the study. The following variables were collected: demographic information, knowledge of and familiarity with cosmetic surgery tourism, willingness to travel abroad for cosmetic surgery, and perceived advantages and disadvantages of traveling abroad for cosmetic surgery. Survey items were developed and pretested by the staff in our research group to ensure clear and concise questions that captured the concerns expressed in the literature.
Statistical analysis was conducted on Stata/IC 16.1 (StataCorp LLC, College Station, TX). For descriptive analysis, categorical variables were presented as frequencies and percentages. For continuous variables, the assumption of normal distribution was made by following the Central Limit Theorem; thus, means and standard deviations were used. A multivariable logistic regression model was constructed to evaluate the association between baseline knowledge and demographic characteristics. Statistical significance was set at an alpha value of 0.05.
Results
Demographic Characteristics
A total of 507 responses were received. Incomplete and duplicate responses were discarded, leaving 484 complete, unique responses for analysis. Of those, 47.5% of participants identify as female, 51.2% as male, and 1.3% identify as another gender identity or preferred not to answer. The majority (71.5%) of participants identify as white. A breakdown of the age, sex, race, ethnicity, geographic location, education level, and income of participants is shown in Table 1. Moreover, 29.1% of participants report speaking a language in addition to English (Table 2). Spanish was the most common other language spoken, with 64 participants (13.2%) reporting speaking Spanish (Table 3). Approximately a quarter (24%) of participants have lived outside of the United States for one month or more and 26.7% of participants report having family living abroad (Table 2).
Table 1.
Demographic Characteristics.
| Characteristic | N | % |
|---|---|---|
| Age | ||
| 18-24 | 29 | 6 |
| 25-34 | 208 | 43 |
| 35-44 | 127 | 26.2 |
| 45-54 | 62 | 12.8 |
| 55-64 | 41 | 8.5 |
| 65 + | 17 | 3.5 |
| Sex | ||
| Female | 230 | 47.5 |
| Male | 248 | 51.2 |
| Other or prefer not to answer | 6 | 1.2 |
| Race | ||
| American Indian or Alaskan Native | 4 | 0.8 |
| Asian | 67 | 13.8 |
| Black or African American | 44 | 9.1 |
| Native Hawaiian or Other Pacific Islander | 1 | 0.2 |
| White | 346 | 71.5 |
| Other or prefer not to answer | 22 | 4.6 |
| Ethnicity | ||
| Hispanic or Latino | 105 | 21.7 |
| Not Hispanic or Latino | 373 | 77.1 |
| Prefer not to answer | 6 | 1.2 |
| Region | ||
| Northeast (NJ, NY, PA, RI, CT, MA, VT, NH, ME) | 90 | 18.6 |
| South (MD, DE, WV, VA, DC, KY, TN, NC, SC, GA, AL, MS, FL, AR, LA, OK, TX) | 196 | 40.5 |
| Midwest (OH, MI, IN, WI, IL, MN, IA, MO, ND, SD, NE, KS) | 97 | 20 |
| West (MT, WY, CO, NM, ID, UT, AZ, WA, OR, CA, NV) | 93 | 19.2 |
| Pacific (AK, HI) | 8 | 1.7 |
| Education | ||
| Less than high school | 3 | 0.6 |
| High school diploma or GED | 75 | 15.5 |
| Associate's degree | 52 | 10.7 |
| Bachelor's degree | 268 | 55.5 |
| Graduate level degree (MD, PhD, JD, Master's degree, etc) | 86 | 17.8 |
| Income | ||
| Less than $49 999 | 191 | 39.5 |
| $50 000 - $74 999 | 148 | 30.6 |
| $75 000 - $99 999 | 83 | 17.1 |
| $100 000 - $199 999 | 55 | 11.4 |
| $200 000 or more | 7 | 1.4 |
Table 2.
Responses to questions regarding knowledge and perception of cosmetic surgery tourism.
| Question | Responses | % |
|---|---|---|
| Do you speak a language other than English? | English and another language | 29 |
| English only | 71 | |
| Have you ever lived outside of the United States for one month or longer? | Has lived abroad | 24 |
| Has not lived abroad | 76 | |
| Do you have family that lives outside of the United States? | Has family abroad | 27 |
| Does not have family abroad | 73 | |
| Have you considered or would you consider having plastic surgery? | Has considered or would consider cosmetic surgery | 45 |
| Would not consider cosmetic surgery | 55 | |
| How knowledgeable are you about the option to travel abroad for plastic surgery? | Not knowledgeable | 23.8 |
| Slightly knowledgeable | 32.4 | |
| Moderately knowledgeable | 25.6 | |
| Very knowledgeable | 13 | |
| Extremely knowledgeable | 5.2 | |
| How safe would you feel going abroad for plastic surgery? | Extremely unsafe | 13.8 |
| Moderately unsafe | 23.8 | |
| Neither unsafe nor safe | 24 | |
| Moderately safe | 32.9 | |
| Extremely safe | 5.6 | |
| Do you personally know anyone who has travelled outside of the United States for cosmetic surgery? | Knows someone who traveled abroad for surgery | 30 |
| Does not know someone who traveled abroad for surgery | 70 | |
| Would you consider traveling outside of the United States to receive cosmetic surgery? | Would not consider | 32.8 |
| Would possibly consider | 33.8 | |
| Would moderately consider | 22.4 | |
| Would strongly consider | 11 | |
| If you were to travel outside of the United States for cosmetic surgery and experienced a complication, would you return to the country where you had surgery to address the complication? | Would not return | 57 |
| Would return | 43 | |
| N | ||
| What do you perceive as being the top 3 advantages of travelling abroad for cosmetic surgery? | Price of surgery internationally | 339 |
| Shorter waiting list for surgery | 289 | |
| Privacy during recovery | 273 | |
| Environment for recovery | 151 | |
| Level of familiarity with culture | 91 | |
| Level of familiarity with language | 68 | |
| Risks of travel after surgery | 47 | |
| Distance from home | 33 | |
| Distance from friends/family | 33 | |
| There are no advantages | 27 | |
| Risk of complications | 26 | |
| Lack of follow up or continuity care after surgery | 21 | |
| What do you perceive as being the top 3 disadvantages of travelling abroad for cosmetic surgery? | Risk of complications | 271 |
| Lack of follow up or continuity care after surgery | 211 | |
| Distance from home | 195 | |
| Risks of travel after surgery | 193 | |
| Distance from friends/family | 133 | |
| Level of familiarity with language | 96 | |
| Environment for recovery | 75 | |
| Level of familiarity with culture | 70 | |
| There are no disadvantages | 36 | |
| Privacy during recovery | 36 | |
| Price of surgery internationally | 33 | |
| Shorter waiting list for surgery | 31 | |
Table 3.
Languages in Addition to English Spoken by Participants.
| Language | N | % |
|---|---|---|
| Spanish | 64 | 13.2 |
| Hindi | 19 | 3.9 |
| Arabic | 5 | 1.0 |
| French | 30 | 6.2 |
| Chinese | 17 | 3.5 |
| Japanese | 3 | 0.6 |
| Other | 14 | 2.9 |
Perspectives on Cosmetic Surgery Tourism
Of those surveyed, 45.2% have considered or would consider having plastic surgery (Table 2). When asked which body part a patient was considering for surgery, 124 participants (25.6%) selected face/neck, 64 participants (13.2%) selected abdomen/midsection, 74 (15.3%) selected breast, 21 (4.3%) selected buttocks, and 33 (6.8%) selected arms/legs. A breakdown of specific procedures considered by participants is shown in Table 4.
Table 4.
Procedures Considered by Participants.
| Body Part | N | % | Procedure | N | % |
|---|---|---|---|---|---|
| Face/Neck | 124 | 25.6 | Blepharoplasty | 30 | 6.2 |
| Facelift or neck lift | 61 | 12.6 | |||
| Rhinoplasty | 40 | 8.3 | |||
| Buccal fat pad removal | 14 | 2.9 | |||
| Brow lift | 21 | 4.3 | |||
| Lip augmentation | 24 | 5.0 | |||
| Chin implant | 12 | 2.5 | |||
| Otoplasty | 6 | 1.2 | |||
| Fat grafting | 11 | 2.3 | |||
| Hair transplant | 3 | 0.6 | |||
| Other | 4 | 0.8 | |||
| Unsure | 5 | 1.0 | |||
| Abdomen/ Midsection | 64 | 13.2 | Liposuction | 38 | 7.9 |
| Tummy tuck | 36 | 7.4 | |||
| Other | 3 | 0.6 | |||
| Unsure | 6 | 1.2 | |||
| Breast | 74 | 15.3 | Breast augmentation | 31 | 6.4 |
| Breast lift | 29 | 6.0 | |||
| Breast reduction | 23 | 4.8 | |||
| Change of implants | 5 | 1.0 | |||
| Other | 2 | 0.4 | |||
| Unsure | 3 | 0.6 | |||
| Buttocks | 21 | 4.3 | Brazilian butt lift | 13 | 2.7 |
| Butt implants | 8 | 1.7 | |||
| Other | 2 | 0.4 | |||
| Unsure | 3 | 0.6 | |||
| Arms/Legs | 33 | 6.8 | Arm lift | 18 | 3.7 |
| Liposuction | 14 | 2.9 | |||
| Thigh lift | 11 | 2.3 | |||
| Other | 2 | 0.4 |
Of the entire cohort, 23.8% of participants rated that they were ‘not knowledgeable at all’ about the option to travel abroad for plastic surgery; 32.4% of participants were ‘slightly knowledgeable,’ 25.6% were ‘moderately knowledgeable,’ 13% were ‘very knowledgeable,’ and 5.2% were ‘extremely knowledgeable’ (Table 2).
When asked about the safety of cosmetic surgery tourism, 37.6% of participants reported they would feel extremely or moderately unsafe going abroad for plastic surgery while 38.5% reported they would feel extremely or moderately safe going abroad for plastic surgery, with only 5.6% reporting feeling extremely safe (Table 2). 29.8% of participants reported that they personally know someone who has traveled outside of the United States for cosmetic surgery (Table 2). Among participants who have considered or would consider having plastic surgery, 67.1% would possibly, moderately, or strongly consider traveling outside of the United States to receive cosmetic surgery (Table 2).
When asked which countries they would consider traveling to for cosmetic surgery, the United Kingdom, France, Germany, Italy, and Japan were the most commonly considered destinations, cited by 104 (21.5%), 100 (20.7%), 82 (16.9%), 67 (13.8%), and 65 participants (13.4%), respectively. A list of countries participants would consider traveling to for cosmetic surgery is found in Supplemental Data 1.
Participants were also asked what they considered to be the top three advantages and disadvantages of traveling abroad for cosmetic surgery. The top three perceived advantages, in order, were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. 27 participants (5.6%) stated there were no advantages (Table 2). The top three perceived disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. 36 participants (7.4%) stated there were no disadvantages (Table 2). Lastly, when asked, ‘If you were to travel outside of the United States for cosmetic surgery and experienced a complication, would you return to the country where you had surgery to address the complication?’ 43.2% of participants answered ‘yes’ (Table 2).
Willingness to Participate in Cosmetic Surgery Tourism
Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.11, 95% CI 1.11-8.70, P = .030), as did participants who felt more knowledgeable about the option to travel abroad for plastic surgery (OR 1.61, 95% CI 1.16-2.22, P = .004). Participants who have family living outside of the united states had decreased odds of considering surgery abroad (OR 0.42, 95% CI 0.18-0.98, P = 0.045). The perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268) Multivariable analysis of factors related to willingness to travel abroad for cosmetic surgery is shown in Table 5.
Table 5.
Multivariable Analysis of Factors Related to Willingness to Travel Abroad for Cosmetic Surgery.
| Variable | Odds Ratio | 95% Confidence Interval | P-value |
|---|---|---|---|
| Age | 1.21 | 0.92-1.59 | 0.173 |
| Gender | |||
| Female (reference) | |||
| Male | 1.09 | 0.55-2.17 | 0.794 |
| Ethnicity | |||
| Not Hispanic or Latino (reference) | |||
| Hispanic or Latino | 3.11 | 1.11-8.70 | 0.030* |
| Language | |||
| English only (reference) | |||
| English and another language | 1.09 | 0.49-2.46 | 0.822 |
| Previously lived abroad | 0.69 | 0.29-1.69 | 0.422 |
| Has family living abroad | 0.42 | 0.18-0.98 | 0.045* |
| Prior cosmetic surgery | 1.47 | 0.49-4.39 | 0.490 |
| Knowledge of cosmetic surgery tourism | |||
| Low (reference) | |||
| High | 1.61 | 1.16-2.22 | 0.004* |
| Perceived safety of cosmetic surgery tourism | |||
| Unsafe (reference) | |||
| Safe | 1.24 | 0.88-1.82 | 0.268 |
Discussion
The primary goal of this study was to gain insight into the public opinion of cosmetic surgery tourism. We utilized a large, cross-sectional survey of adults in the United States to explore public knowledge and perceptions regarding traveling outside of the United States to receive cosmetic surgery. Our study found that the public opinion of cosmetic surgery tourism is mixed, with 37.6% of participants reporting they would feel extremely or moderately unsafe going abroad for plastic surgery and 38.5% reporting they would feel extremely or moderately safe going abroad for plastic surgery. However, among participants who are considering having cosmetic surgery, 67.1% would consider traveling outside of the United States to receive surgery. Interestingly, a 2010 survey of 197 members of the general public in the United Kingdom found that 97% of those considering plastic surgery would entertain having the surgery abroad. 10 Compared with our survey results, these findings may represent temporal or geographic differences in the public perception of cosmetic surgery tourism. The US has more plastic surgeons than any other country in the world, providing more options for patients to have surgery domestically. 15 Nevertheless, plastic surgeons should be aware of the likelihood that potential cosmetic surgery patients may entertain the idea of having surgery internationally and be prepared to counsel patients appropriately.
Currently, very little is known about the overall population of patients who travel abroad for cosmetic surgery as research has focused on patients who experience a complication related to undergoing cosmetic surgery abroad. However, the broader literature on medical tourism suggests that diasporic or transnational medical travelers may represent a substantial portion of medical travelers. 11 Based on these trends in medical tourism, we hypothesized that those with more familiarity with countries other than the United States, such as those who had lived abroad, those with family living abroad, or those who speak a language in addition to English, may express greater willingness to receive cosmetic surgery outside of the United States. In fact, we found that those who have family living abroad had decreased odds of considering cosmetic surgery abroad (OR 0.42, 95% CI 0.18-0.98, P = 0.045). Otherwise, we did not find any association between these factors and willingness to travel internationally for cosmetic surgery.
Understanding why patients travel outside of the United States to receive cosmetic surgery can help surgeons identify areas for improvement to retain patients in their own practices and better counsel patients who may be considering international travel for surgery. Not surprisingly, our study revealed that the top perceived advantage of traveling abroad for surgery was the lower price of surgery internationally. Internationally, prices for cosmetic surgery may be as low as 20% of prices in the United States, even with airfare and travel included. 3 Cosmetic surgery tourism destinations may accommodate post-surgical patients in resort-like settings with nurse to patient ratios exceeding United States norms, thus offering a level of luxury during the surgical experience that is not readily available in the United States, especially not at a reduced price. 16 Accordingly, low and middle income countries are leading medical tourism destinations as favorable exchange rates benefit cost-conscious international patients. 16 Interestingly, our study revealed that, among participants who would consider traveling outside of the United States to receive cosmetic surgery, European countries were the most commonly cited destinations, followed by counties in Central and South America and Asia. The preference for European counties, where potential savings may not be as significant, implies that patients considering having cosmetic surgery abroad are not exclusively motivated by cost savings in their selection of a destination. In light of this, it is likely that potential cosmetic surgery tourists weigh a myriad of factors in their selection of a destination, including both advantages and disadvantages of international travel for surgery. As elaborated further in our later discussion of the perceived disadvantages of cosmetic surgery tourism, the risk of complications was the top cited disadvantage. Participants may associate certain countries with greater safety or regulation and thus may have selected countries where they perceive there to be fewer disadvantages to participating in medical tourism. Given that only patients who experience complications from cosmetic surgery tourism ultimately present to domestic plastic surgeons and are thus represented in the literature, the true frequency of each country as a cosmetic surgery tourism destination remains unknown, as does the complication rate associated with medial tourism overall and to specific destinations. However, case reports suggest that the Caribbean and South America, namely the Dominican Republic and Colombia, are popular destinations for US-based tourists.4,17
While the price of surgery internationally was the number one stated advantage of cosmetic surgery tourism, a shorter waiting list for surgery and privacy during recovery were the second and third most cited advantages, respectively. In the United States, the time to an initial consult appointment for cosmetic surgery may be only 2-3 weeks.18,19 Given this relatively short time, the time from consultation to surgery may be thought of by patients to be more expeditious internationally. Further research is needed to better understand relative waiting times for surgery domestically and internationally. Moreover, the third most cited advantage of cosmetic surgery tourism was privacy during recovery. Traveling internationally allows patients to undergo and recover from surgery in private, under the guise of a vacation. While cosmetic surgery is increasingly discussed in the popular media and demand for cosmetic surgery continues to rise, 17 the stigma surrounding cosmetic surgery still persists in some circles. This stigma, which may represent an American cultural phenomenon, 20 contributes to the allure of traveling internationally to have and recover from cosmetic surgery in a private environment. Emphasizing confidentiality and patient privacy, as well as providing thorough explanations of what to expect during the recovery process, may serve to reassure potential patients who are concerned about privacy during their surgical experience.
Respondents were also asked to share the disadvantages of cosmetic surgery tourism. The top three perceived disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. While these identified disadvantages imply that the general public acknowledges the risks of having cosmetic surgery abroad, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). For some patients, the safety of surgery may not be a primary consideration when deciding whether or not to undergo a cosmetic surgery. Fadavi et al found that individuals who feel cultural or social pressure to attain a certain body shape may accept higher levels of risk to improve their looks. 21 While our study did not specifically examine cultural or social pressure to attain a certain body shape among participants, it did reveal that participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.11, 95% CI 1.11-8.70, P = .030).
Additionally, the cited disadvantages suggest that respondents anticipate a degree of difficulty in addressing potential post-surgical complications. Nevertheless, 43.2% of participants answered that they would return to the country where they had surgery for treatment if they were to develop a complication. In reality, follow-up care after international surgery may be minimal or non-existent and international travel to return to the operating surgeon after the development of a post-surgical complication is not feasible. There is a robust body of literature describing the domestic treatment of complications following cosmetic surgery tourism. Complications after cosmetic surgery tourism represent a significant health risk to the patient and are morally and financially taxing on the treating domestic surgeon and healthcare system. 4 A 2011 survey of members of the American Society of Plastic Surgeons found 80.4% of respondents had experience treating patients with complications from cosmetic surgery tourism and that the majority of respondents were not compensated at all. 9 A 2021 review of medical tourism in aesthetic breast surgery found infectious complications and rates of re-operation were significantly higher than expected, signaling that that having these procedures abroad significantly increases the risks involved. 22 Venditto et al reported cases of infection, wound breakdown, drain issues, and seroma resulting from international cosmetic surgery tourism and Cusumano et al reposted four cases of rapidly growing mycobacterial infections in patients who presented after having cosmetic surgery in the Dominican Republic.4,23 The true complication rate after international cosmetic surgery is unclear since the number of patients traveling for surgery is unknown and only patients who experience complications ultimately present to domestic plastic surgeons. Still, regardless of the quality of the international surgeon or facility, there are inherent risks to international travel for surgery, including exposure to foreign pathogens and the thrombotic risk of air travel in the immediate postoperative period. Despite these risks, among respondents considering plastic surgery, the majority (67.1%) would consider traveling outside of the US to receive cosmetic surgery.
Although we gained a broad understanding of patients’ perceptions, our study was only able to address the motivations of those potentially considering international travel for cosmetic surgery, not those of patients who ultimately proceed with the decision to have surgery abroad. As a survey of the general public, our study was also unable to address the prevalence of international travel for cosmetic surgery. This critical question remains unanswered in the broader literature regarding international cosmetic surgery tourism and is a key area for future research. Additional limitations of our study are the survey design and the limitations of the mTurk system. As with any survey, we were limited in the ability to determine disingenuous responses. Participants only receive compensation for their time through the mTurk system when their responses are approved as legitimate and are therefore incentivized to provide genuine responses. Additionally, the mTurk system may overrepresent the younger and less wealthy portions of the US population. Further, the demographic breakdown of participants in this survey may not be representative of the demographics of cosmetic surgery patients as the majority of respondents in this study were males. While the mTurk platform has been widely utilized for studies of public opinion and can provide reliable and representative data,14,24 the findings from this study should be interpreted in the context of this potential demographic difference. A major strength of this study is the large sample size. To our knowledge, this is the only study surveying the general US public on their perception of cosmetic surgery tourism and the largest survey study on this topic.
Conclusion
Our study suggests that interest in cosmetic surgery tourism is prevalent among people seeking cosmetic plastic surgery. It is paramount for plastic surgeons to remain aware of patients considering international travel for cosmetic surgery and to continue to enhance public education regarding the selection of a certified plastic surgeon and the risks and benefits of cosmetic surgery tourism.
Supplemental Material
Supplemental material, sj-docx-1-psg-10.1177_22925503221134817 for Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism by Natalie E. Hassell, Valeria P. Bustos, Nicholas Elmer, Carly D. Comer and Samuel M. Manstein, Samuel J. Lin in Plastic Surgery
Supplemental material, sj-docx-2-psg-10.1177_22925503221134817 for Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism by Natalie E. Hassell, Valeria P. Bustos, Nicholas Elmer, Carly D. Comer and Samuel M. Manstein, Samuel J. Lin in Plastic Surgery
Footnotes
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article
IRB Approval Statement: The study was granted exempt status by the Beth Israel Deaconess Medical Center Institutional Review Board (Protocol 2021P000643).
Informed Consent Statement: Prospective agreement was obtained from all individual participants included in the study.
ORCID iDs: Natalie E. Hassell https://orcid.org/0000-0001-7613-7300
Valeria P. Bustos https://orcid.org/0000-0001-6682-4246
Nicholas Elmer https://orcid.org/0000-0002-4878-3660
Carly D. Comer https://orcid.org/0000-0002-7016-0048
Samuel M. Manstein https://orcid.org/0000-0003-3686-847X
Supplemental Material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-psg-10.1177_22925503221134817 for Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism by Natalie E. Hassell, Valeria P. Bustos, Nicholas Elmer, Carly D. Comer and Samuel M. Manstein, Samuel J. Lin in Plastic Surgery
Supplemental material, sj-docx-2-psg-10.1177_22925503221134817 for Costs Versus Complications: Public Perspectives on International Cosmetic Surgery Tourism by Natalie E. Hassell, Valeria P. Bustos, Nicholas Elmer, Carly D. Comer and Samuel M. Manstein, Samuel J. Lin in Plastic Surgery