Abstract
Background:
Medical tourism for cosmetic surgery is expanding due to demand for high-quality, safe, and affordable procedures. This study built on prior research by analyzing a larger cohort of plastic surgery patients in Colombia, a leading destination for international patients seeking superior quality, service, and value. We presented the largest review to date on safety and outcomes in plastic surgery medical tourism, comparing our results with benchmark publications from board-certified plastic surgeons in the United States.
Methods:
A retrospective observational study was conducted on 2324 international patients (7141 procedures) who underwent cosmetic surgery at a private practice in Cartagena, Colombia, from 2013 to 2024. Patient demographics, procedures, and surgical sites were recorded. Postoperative outcomes were analyzed using medical charts of 1363 patients (4244 procedures) treated from 2020 to 2024.
Results:
Patient demographics and procedure trends align with data from the International Society of Aesthetic Plastic Surgery. Eighty-nine percent of patients traveled from the United States or Canada, and the majority were well-educated professionals. The overall complication rate was 6.2% per patient (2.2% per procedure), which compares favorably with published benchmarks from board-certified plastic surgeons in the United States.
Conclusions:
Plastic surgery medical tourism, when performed in high-volume, well-regulated centers, can achieve outcomes equivalent to leading practices in the United States, reinforcing its viability as a safe and effective option for international patients. A center of excellence model and strict safety protocols contributed to these favorable outcomes.
Takeaways
Question: Can plastic surgery medical tourism provide safe, high-quality outcomes comparable to those of board-certified plastic surgeons in the United States?
Findings: This retrospective study analyzed 2324 international patients who underwent 7141 cosmetic surgery procedures in Colombia. The overall complication rate was 6.2% per patient (2.2% per procedure), comparing favorably to published US benchmarks. A center of excellence model and strict safety protocols contributed to these favorable outcomes.
Meaning: Plastic surgery medical tourism, when performed in high-volume, well-regulated centers, can achieve outcomes equivalent to leading practices in the United States, reinforcing its viability as a safe and effective option for international patients.
INTRODUCTION
Medical tourism has emerged as a growing sector in both travel and healthcare, offering patients enhanced value and quality.1,2 Plastic surgery medical tourism has grown rapidly, attracting patients seeking superior service, quality, and affordability abroad.3 Cosmetic surgery is the most popular choice among medical tourists, accounting for approximately 25% of the US $47 billion global medical tourism market.4,5
Colombia has emerged as a top destination for plastic surgery medical tourism, offering world-class expertise, affordability, and a tourism-friendly environment.6–8 We previously published 2 large studies on patient demographics (658 patients) and satisfaction (458 patients) in a private practice in Cartagena.9,10 This study significantly expands on that work, analyzing 2324 international patients undergoing 7141 procedures over 12 years. It broadens the scope to assess safety and outcomes for patients traveling to Colombia for plastic surgery. This is the largest consecutive series of plastic surgery medical tourism patients reviewed to date, and we compare our findings with benchmark publications on plastic surgery outcomes in the United States.
MATERIALS AND METHODS
This retrospective observational study reviewed the records of 2433 consecutive international patients who underwent cosmetic procedures at a private plastic surgery practice in Cartagena, Colombia, between 2013 and 2024. Patients residing in Colombia, regardless of nationality, were excluded.
Data on patient age, sex, country of origin, profession, procedures, and surgical sites were extracted from medical records. Professions were classified according to the International Standard Classification of Occupations.11 Each procedure was counted once, regardless of the number of treated sites (eg, breast lift, face lift, and liposuction).
Postoperative outcomes were analyzed retrospectively for all patients treated between 2020 and 2024, comprising 1363 patients and 4244 procedures. Local surgical complications included seroma, hematoma, infection, wound breakdown, and implant loss. Systemic complications included deep vein thrombosis, pulmonary embolism, blood transfusion, spontaneous pneumothorax, and cardiac events.
Statistical Analysis
Statistical analysis was performed to compare patient demographics between our cohort and International Society of Aesthetic Plastic Surgery (ISAPS) 2023 global statistics, and to compare our complication rates with those benchmark data from US plastic surgery literature reported by Schafer et al,12 using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database. For categorical variables, such as gender and age distributions and complication rates across procedures, chi-squared tests were used to assess differences in proportions. The Fisher exact test was applied when expected cell counts were less than 5. P values are reported in the respective tables to indicate the statistical significance of observed differences, with statistical significance defined as a P value less than 0.05. Analyses were conducted using the Statistical Package for the Social Sciences version 28.0 (IBM Corp., Armonk, NY).
RESULTS
After applying the exclusion criteria, 109 patients of various nationalities but living in Colombia at the time of surgery were excluded. A remaining cohort of 2324 international patients traveled for surgery and underwent cosmetic procedures at the practice during this period.
Demographics
Among the cohort, 1938 patients were women (83.4%) and 110 were men (16.6%). The majority (84%) were aged 25–59 years, whereas 98% fell within the 20–69 years age range (Table 1).
Table 1.
Patient Demographics: 83.4% of Patients Were Women and 98% Fell Within the 20–69 Age Range
| Number | Percentage | |
|---|---|---|
| Total patients | 2324 | |
| Sex | ||
| Female | 1938 | 83.40 |
| Male | 386 | 16.60 |
| Age, y | ||
| ≤19 | 13 | 0.60 |
| 20–29 | 378 | 16.30 |
| 30–39 | 638 | 27.50 |
| 40–49 | 620 | 26.70 |
| 50–59 | 432 | 18.60 |
| 60–69 | 205 | 10.60 |
| ≥70 | 38 | 1.60 |
Patients traveled from 49 countries across 6 continents (Fig. 1), with the majority being from the United States (76.1%) and Canada (12.7%), followed by the Caribbean (5.6%), Europe (2.3%), and Australia (1%). US patients represented 48 states and the District of Columbia, with the highest numbers from Florida, New York, California, Texas, and New Jersey (Fig. 2). Canadian patients came from 7 provinces, primarily Ontario, Alberta, British Columbia, and Quebec. Professionals (28.1%) and managers (17.2%) were the most represented occupations, followed by service and sales workers (12.8%) and technicians/associate professionals (11.4%) (Table 2).
Fig. 1.
Patients traveled to the authors’ practice in Colombia from 49 different countries spanning 6 continents, with 89% of patients coming from the United States and Canada.
Fig. 2.
US patients represented 48 states and the District of Columbia, with the highest numbers from Florida, New York, California, Texas, and New Jersey. Canadian patients came from 7 provinces, primarily Ontario, Alberta, British Columbia, and Quebec.
Table 2.
A Diverse Range of Occupations Was Represented, Led by Professionals, Managers, Service and Sales Workers, and Technicians
| Profession | Patients | Percentage |
|---|---|---|
| Professionals (doctors, lawyers, nurses, engineers, teachers, sales, marketing) | 654 | 28.10 |
| Managers (chief executives, senior officials, business managers) | 400 | 17.20 |
| Service and sales workers (cooks, waiters, hairdressers, shop sales persons) | 297 | 12.80 |
| Technicians and associate professionals (medical technicians, service agents, skilled technicians) | 264 | 11.40 |
| Retired | 132 | 5.70 |
| Homemaker | 112 | 4.80 |
| Students | 94 | 4 |
| Clerical and support workers (secretaries, tellers, customer service representatives) | 82 | 3.50 |
| Plant and machine operators, trade workers, skilled agricultural, elementary occupations | 80 | 3.40 |
| Armed forces occupations | 40 | 1.70 |
| Unknown | 169 | 7.30 |
Procedures
The 2324 patients underwent a total of 7141 cosmetic procedures involving the face, breast, and body (Fig. 3). Most patients (79%) had combination procedures (an average of 3.1 per patient), whereas 21% had a single procedure.
Fig. 3.
The 2324 patients underwent a total of 7141 cosmetic procedures involving the face, breast, and body. Most patients (79%) had combination procedures, with an average of 3.1 per patient.
Body contouring procedures were the most common, totaling 4099 procedures (57.4%), including liposuction (360 cases), buttock augmentation (fat transfer), tummy tuck, arm lift, thigh lift, and posterior body lift. Facial cosmetic procedures followed with 1749 cases (24.5%), primarily eyelid surgery, facial fat grafting, face lift/neck lift, and rhinoplasty. Breast procedures accounted for 1295 cases (18.1%), including breast lift, augmentation, lift with implants, and implant exchange.
Complications
Among 1363 patients undergoing 4244 procedures, 86 patients had a total of 99 complications, affecting 6.3% of patients and 2.2% of procedures (Table 3). The majority (93%) were local complications, and 5% of patients required surgical reintervention. Complication rates by procedure type are detailed in Table 4.
Table 3.
Surgical Outcomes in 1361 Patients and 4244 Procedures
| Number | Percentage | |
|---|---|---|
| Total patients | 1361 | |
| Total patients with complications | 86 | 6.30 |
| Local complications | 80 (93%) | 5.90 |
| Systemic complications | 6 (7%) | 0.40 |
| Total procedures | 4244 | |
| Total procedures with complications | 99 | 2.20 |
| Local complications (surgical site) | Percentage risk per patient | |
| Seroma | 9 | 0.70 |
| Hematoma | 17 | 1.30 |
| Superficial wound disruption | 6 | 0.40 |
| Deep wound disruption | 39 | 2.90 |
| Surgical site infection (cellulitis, wound infection) | 20 | 1.50 |
| Implant loss | 2 | 0.20 |
| Systemic complications | Percentage risk per patient | |
| Deep vein thrombosis | 2 | 0.20 |
| Pulmonary embolus | 1 | 0.10 |
| Spontaneous pneumothorax | 1 | 0.10 |
| Blood transfusion | 1 | 0.10 |
| Atrial fibrillation | 1 | 0.10 |
| Treatment | Percentage risk per patient | |
| Oral antibiotics | 20 | 1.50 |
| Wound care | 6 | 0.40 |
| Percutaneous drainage clinic | 3 | 0.20 |
| Surgical reintervention | 68 | 5 |
| In-hospital care | 6 | 0.40 |
Table 4.
Surgical Outcomes by Procedure
| Patients | Complications | Percentage | |
|---|---|---|---|
| Breast | |||
| Breast lift | 244 | 12 | 4.90 |
| Breast augmentation | 173 | 2 | 1.20 |
| Breast lift with implants | 119 | 5 | 4.20 |
| Change of implants | 74 | 2 | 2.70 |
| Breast revision | 56 | 0 | 0 |
| Gynecomastia | 53 | 2 | 3.80 |
| Body | |||
| 360 liposuction | 947 | 3 | 0.30 |
| Buttock augmentation (fat grafting) | 402 | 0 | 0 |
| Tummy tuck | 439 | 24 | 5.50 |
| Arm lift | 115 | 8 | 7 |
| Thigh lift | 114 | 17 | 14.90 |
| Posterior body lift | 83 | 6 | 7.20 |
| Labiaplasty | 18 | 0 | 0 |
| Butt implants | 6 | 1 | 16.70 |
| Face | |||
| Eyelid surgery | 386 | 0 | 0 |
| Facial fat grafting | 329 | 0 | 0 |
| Face lift/neck lift | 193 | 6 | 3.10 |
| Rhinoplasty | 101 | 0 | 0 |
| Lip augmentation | 74 | 0 | 0 |
| Buccal fat excision | 39 | 1 | 2.60 |
| Brow lift | 39 | 0 | 0 |
| Otoplasty | 10 | 0 | 0 |
| Chin augmentation | 7 | 0 | 0 |
Systemic complications occurred in 6 patients (0.4%), including atrial fibrillation, blood transfusion, deep vein thrombosis, pulmonary embolism, and spontaneous pneumothorax. All cases were managed in hospital, and all achieved a full recovery and successful return home without long-term morbidity.
DISCUSSION
In 2019, we published a review of 658 international medical tourism patients who underwent 1796 cosmetic procedures at our private practice in Cartagena, Colombia. The study highlighted the widespread appeal of traveling for aesthetic surgery across diverse demographics. A year later, we reported on patient satisfaction among 460 medical tourism patients, finding that 98.2% would refer us to friends and family.
Since then, the cosmetic surgery industry has continued to expand. The ISAPS 2023 global statistics report showed a 39.2% increase in global cosmetic surgical procedures from 2019 to 2023.13 Medical tourism has grown significantly, with 16.4% of global plastic surgery patients traveling abroad for procedures. ISAPS ranks Colombia as a global leader in plastic surgery tourism, with 35.9% of patients coming from abroad, surpassing Mexico (35.1%), Turkey (30.7%), and Thailand (25.4%).
Given the growing adoption of medical tourism, we expanded our research to a much larger cohort of 2324 international patients undergoing 7141 procedures from 2013 to 2024. Patient demographics at Premium Care Plastic Surgery (PCPS) were closely aligned with ISAPS 2023 global statistics in sex, age, and common procedures (Tables 5, 6). The gender distribution showed a slightly higher proportion of men at PCPS (16.6% versus 14.5%, P = 0.031). Age distributions were also similar, though PCPS patients were older on average (P < 0.001), notably in the 51–64 (24% versus 8%) and 65 or older (5% versus 1%) age groups, reflecting a more mature clientele seeking medical tourism. Most of our patients were highly educated managers and professionals, suggesting that plastic surgery medical tourists are informed, discerning consumers seeking high-quality care, service, and value abroad.
Table 5.
Comparison of ISAPS (2023) Statistics and Data From the Authors’ Practice (PCPS)
| ISAPS, % | PCPS, % | P, % | |
|---|---|---|---|
| Sex | 0.031 | ||
| Male | 14.50 | 16.60 | |
| Female | 85.50 | 83.40 | |
| Age, y | <0.001 | ||
| ≤17 | 2 | 0.10 | |
| 18–34 | 52 | 31 | |
| 35–50 | 37 | 39.90 | |
| 51–64 | 8 | 24 | |
| ≥65 | 1 | 5.00 |
P < 0.05 indicates statistical significance.
Table 6.
Comparison of Top 10 Plastic Surgery Procedures From ISAPS (2023) Statistics and Data From the Authors’ Practice (PCPS)
| Top 10 Procedures | ISAPS | PCPS |
|---|---|---|
| 1 | Liposuction | Liposuction |
| 2 | Breast augmentation | Buttock augmentation |
| 3 | Eyelid surgery | Tummy tuck |
| 4 | Breast lift | Breast lift |
| 5 | Abdominoplasty | Eyelid surgery |
| 6 | Rhinoplasty | Facial fat grafting |
| 7 | Lip enhancement | Breast augmentation |
| 8 | Buttock augmentation | Face lift |
| 9 | Facial fat grafting | Arm lift |
| 10 | Face lift | Thigh lift |
P < 0.05 indicates statistical significance.
To evaluate safety and outcomes, we conducted the largest known retrospective review of plastic surgery medical tourism, analyzing postoperative results for 1363 patients who underwent 4244 procedures from 2020 to 2024. Using this robust dataset, we calculated overall and procedure-specific complication rates and compared them with benchmark studies on cosmetic surgery outcomes in the United States. Our overall complication rates (6.2% per patient, 2.2% per procedure) compare favorably with large single-center studies by Stevens et al14,15 and outcomes studies from the TOPS database (Table 7).12,16,17 The TOPS data are particularly valuable, as they represent the largest known cohort of US plastic surgery patients, making our findings directly comparable to outcomes among board-certified US plastic surgeons. Complication rates for individual procedures were compared with data from the TOPS database reported by Schafer et al12 (Table 8). Tummy tuck complication rates were significantly lower at PCPS (5.5% versus 9.7%, P = 0.009), as were liposuction rates (0.3% versus 5.9%, P < 0.001), suggesting superior safety outcomes in these procedures. In contrast, breast lift/reduction (4.5% versus 6.7%, P = 0.267) and breast augmentation (1.2% versus 2.6%, P = 0.424) showed no statistically significant differences, indicating comparable safety profiles to US benchmarks.
Table 7.
Comparison of Outcomes in Combination Procedures
| Study | Number | Source of Patients | Procedures Examined | Complication Rate, % |
|---|---|---|---|---|
| Stevens et al14 | 248 | Single private practice | Tummy tuck + breast and/or facial procedures | 9–16 |
| Stevens et al15 | 415 | Single private practice | Tummy tuck±breast surgery | 10–26 |
| Khavanin et al16 | 14,133 | TOPS database | Tummy tuck, combined procedures | 10 |
| Schafer et al12 | 6515 | TOPS database | Combination procedures | 8 |
| Chopan et al17 | 286,826 | TOPS database | Face, breast, and/or body procedures | 6 |
| Campbell et al, 2025 (this study) | 1363 | Single private practice | Face, breast, and/or body procedures | 6 |
Table 8.
Comparison of Outcomes of Individual Procedures
| Schafer et al12: 26,771 Patients (TOPS Database) | Campbell et al, 2025: 1363 Patients (Single Private Practice) | P | |
|---|---|---|---|
| Tummy tuck | 0.009 | ||
| Cases | 2997 | 439 | |
| Complications | 290 | 24 | |
| Complication rate, % | 9.70 | 5.50 | |
| Liposuction | <0.001 | ||
| Cases | 4798 | 947 | |
| Complications | 283 | 3 | |
| Complication rate, % | 5.90 | 0.30 | |
| Breast lift/breast reduction | 0.267 | ||
| Cases | 10,992 | 244 | |
| Complications | 735 | 11 | |
| Complication rate, % | 6.70 | 4.90 | |
| Breast augmentation | 0.424 | ||
| Cases | 12,435 | 173 | |
| Complications | 320 | 2 | |
| Complication rate, % | 2.60 | 1.20 |
P < 0.05 indicates statistical significance.
We attribute these outcomes to our dedication to a center of excellence in plastic surgery, upheld by strict standards and safety protocols:
Preoperative evaluation: All patients undergo a comprehensive assessment. After submitting medical information and photographs, they consult with a plastic surgeon via phone or video. Those scheduling surgery provide medical tests and clearances, followed by in-person consultations with their surgeon and anesthesiologist upon arrival. Plans are reconfirmed preoperatively by both specialists.
Qualified staff: All plastic surgeons are board-certified and trained at accredited programs, with anesthesiologists, nurses, and operating room staff meeting equivalent standards.
Advanced facilities: State-of-the-art surgical infrastructure supports a high-volume practice exceeding 1000 procedures annually.
Surgical efficiency: A dual-surgeon approach is used in most cases, optimizing complex combination procedures (average 3.1 per patient) while minimizing anesthesia time. Operative times are kept less than 6 hours, with most combination procedures completed in 4 hours.
Postoperative care: A multidisciplinary team—comprising doctors, nurses, therapists, and support staff—delivers comprehensive follow-up. Nurses escort patients home, providing overnight care postsurgery and daily monitoring thereafter. Aestheticians offer daily therapy and massage. We emphasize adherence to postoperative instructions, a healthy diet, and early mobilization. Patients meet regularly with surgeons, receiving detailed guidance at their final visit on incision care, compression, diet, activity, and follow-up.
Recovery period: Patients typically remain in Cartagena for 7–14 days, with more than 95% departing as scheduled. Extensions are recommended when additional care is required. Long-term follow-up: Telemedicine consultations are scheduled at 1, 2, 6, and 12 months postsurgery, with ongoing access to surgeons for any concerns.
Our close access to patients allows us to provide continual motivation and guidance and to catch issues quickly when they present. When complications occur, our focus is on immediate identification and treatment. All patients receive an insurance policy covering diagnostic, hospital, and surgical fees. Of the 86 patients with complications, 93% had local surgical site-related issues, and 68 patients required surgical reintervention. Six patients with systemic complications (atrial fibrillation, blood transfusion, pulmonary embolism, and spontaneous pneumothorax) required hospitalization at a partner facility, where they received appropriate medical management and all fully recovered before returning home. No patients experienced long-term morbidity from these complications.
This study represents the largest known review of plastic surgery medical tourism patients. Our findings demonstrate that patient outcomes in this high-volume center are equivalent to, and in some cases better than, published benchmarks for board-certified plastic surgeons in the United States. Our data align favorably with US studies, reinforcing that specialized centers of excellence can deliver world-class surgical results while maintaining rigorous safety standards. These findings address common concerns about plastic surgery medical tourism and highlight the benefits of a well-structured, high-volume surgical model.18–21
Our conclusions align with previous research showing that high-volume hospitals achieve superior outcomes for complex procedures.22–27 We confirm this volume–outcome relationship in aesthetic surgery and further validate the center of excellence model as an effective approach to plastic surgery medical tourism.
DISCLOSURE
The authors have no financial interest to declare in relation to the content of this article.
Footnotes
Published online 26 September 2025.
Disclosure statements are at the end of this article, following the correspondence information.
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