US Edition
A boom in medical tourism is afoot – and the results are increasingly dangerous. At the British Medical Association’s annual meeting last week, senior doctors warned that the NHS was being left to “pick up the pieces” following rogue operations overseas, providing emergency care to those returning to the UK from surgeries including abdominoplasty (tummy tuck), facelifts and even organ transplants. Some hospitals have had to cancel elective procedures as those who had come back in need of urgent care were occupying their hospital bed.
Last year, the British Association of Aesthetic Plastic Surgeons (BAAPS) found that the number of Britons needing medical treatment or corrective surgery following procedures abroad had surged 94 per cent in three years, while in 2023, six British nationals died of complications, bringing the total to 28 fatalities since 2019. All of last year’s fatalities had surgery in Turkey, roundly considered the medical tourism capital, though the Czech Republic and Lithuania are popular, too. BAAPS estimates that the average cost to the NHS of treating a botched operation is around £15,000, in some cases rising up to £100,000, with the total bill at around £4.8m to the taxpayer since 2018.
“My department is regularly taking patients through the on-call system that have serious wound problems,” says Vivien Lees, a consultant plastic surgeon and vice president of the Royal College of Surgeons. This typically occurs in the week or two post-surgery, following procedures such as “breast implants, breast reduction surgery, tummy tucks, thigh lifts… the vast majority of it does seem to be body contouring work,” Lees explains. Those expecting cosmetic procedures to be finished for free will be disappointed, she adds. “It’s our job to get people through the acute phase of a complication” – such as wound healing or infection problems. “Once that’s settled we’re not going to do anything further; that’s that. There is not going to be a lot of tidying up surgery [that] then takes place via the NHS.”
Here are five common operations being undertaken abroad, and what can go wrong.
Tummy tuck (abdominoplasty)
“Excess fat and skin are removed from the lower part of the tummy, leaving a long scar across the lower area, and combined with that there’s usually some tightening of the muscle down the midline,” Lees explains.
Healing typically takes around a fortnight, with a slow return to normal activity in the six weeks post-operation. (This differs from bariatric surgery, which is aimed at the very overweight; liposuction, meanwhile, involves just the removal of fat with no tightening.) In the UK, it costs £5,000-£10,000; all-inclusive packages in the likes of Turkey (covering the operation, flights and accommodation) are often under £2,500.
What can go wrong?
Wound healing problems are more likely with surgeries of this kind, says Lees. She also believes that “case selection may not be as good overseas, so patients are coming back that we would have felt did not meet the indications for surgery” – i.e. their body weight meant the surgery would have been deemed unsafe in the UK, yet clinics overseas carried it out anyway.
Carol Keenan, a 54-year-old grandmother from Fife, died after collapsing following tummy tuck surgery in Turkey – with the presumed cause being a blood clot or embolism. In spite of being “very active,” Keenan had “set her heart on having surgery after seeing stories about other people and celebrities having procedures,” her daughter said. “I don’t know if it was a midlife crisis.”
Hair transplants
Hair transplants range between £1,000-£30,000 in the UK, “depending on the extent of hair loss, the type of procedure you have, and the quality of the clinic and its team,” according to the NHS website.
There are two kinds: follicular unit transplantation, where a thin strip of skin with hair is removed from the back of the head, divided into pieces and then inserted into minute cuts made in the scalp. The second is follicular unit extraction, where the head is shaved, the hairs are removed individually, and then placed into tiny cuts made in the scalp.
Both are usually carried out under local anaesthetic and take around a day, but do not require an overnight stay. For those having large areas grafted, this may require two or more sessions on different days.
What can go wrong?
Complications can include scarring or scalp damage, blighting the potential for regrowth and further treatment, says Bessam Farjo, a hair transplant surgeon with clinics in London and Manchester. He says 75 per cent of his clients with problems have had their transplant done in Turkey, where all-inclusive packages cost around £2,000. “It’s not unusual for somebody to say to me: ‘Can I reverse the hair transplant?... I would rather be bald rather than look like I have abnormal hair’”.
He notes too that young men are signing up at increasing rates due to a lack of confidence, but that they then go on to lose more hair as they age, “and the hairline [created by the transplant] they have looks a bit too harsh, too straight, inappropriate for somebody who is getting a little bit older… if they’re lucky enough they may be able to have corrective surgery but if they’re unlucky then it can be a very difficult problem to correct.” Botched ops exacerbate the problem for the already self-conscious, he adds, giving them “something else to be concerned about.
Dental work
One in 10 Britons has flown overseas for dental surgery, suggests recent research from insurers Canada Life, with one in five having crown procedures, and one in 10 seeking veneers or composite bonding. (Crowns cover the entirety of damaged teeth, while veneers are around half the thickness, and placed over the front only.) A porcelain crown costs from around £600 in the UK, compared to £80 overseas.
What can go wrong?
“Turkey teeth” has become a telltale moniker for those who return from overseas bearing seemingly perfect smiles (one clinic reports adding an additional 100 British patients per month since 2022) – but the reality can be more sinister. Poorly executed surgery can result in infected gums, rotting teeth, and persistent pain. In some cases, this can result in the need for a root canal, or the loss of the affected teeth entirely.
Many UK dentists have warned that “Turkey teeth” will not be fixed by the NHS, as the problems are considered cosmetic, though emergency issues such as open wounds would be treated in A&E.
Facelift
A facelift involves a flap of skin on either side of the face being pulled back and excess skin being removed to create a firmer, more youthful appearance. In the UK, this can cost up to £30,000, while some clinics in Turkey offer the procedure, along with travel and accommodation, for a quarter of that price. Healing time is usually “a couple of weeks,” Lees says, with the affected areas “settling down [in] two to three months.”
What can go wrong?
Wounds, infections and even deformities are potential risks. Judy Willis, who travelled to Turkey in 2021 for a facelift at the age of 54, paid £8,000 for surgery that left her disfigured. She shelled out a further £30,000 when back in the UK on corrective surgery to her eyes, neck, cheek and ears, describing the situation as “a living hell”.
Joint replacements
Over 60,000 NHS patients were waiting more than a year for elective orthopaedic surgery in February 2022, compared to 436 two years earlier, according to the British Orthopaedic Association. Replacement surgery involves damaged parts of the joint being substituted for metal or plastic versions (for knees; hip replacements may involve ceramic parts). According to figures from the Private Healthcare Information Network, self-funded hip replacements have increased by nearly 200 per cent in the past five years – a procedure that can cost around £11,000-£16,000, depending on whether it is a partial or total replacement. Telegraph analysis last year showed that Georgia was among the cheapest countries to have a hip replacement at an average cost of £2,475, including travel, accommodation and insurance.
What can go wrong?
Along with the regular risks such as infection, which, in severe cases, can require further surgery, or blood clots, some have reported that overseas replacements do not include follow-up appointments or physiotherapy, which are key to recovery.
Lees says that the trend for people going overseas for care – and the NHS dealing with the fallout – is likely to continue, as “people will take an optimistic view, particularly if they’ve seen something positive on social media, [and] they will not be able to assess their own risk profile sensibly…. the dynamics which are causing people to go overseas are things that are very difficult for any of us to change, but getting the information out there [about what can go wrong abroad] again and regularly is very important.”
If you are looking for a cosmetic surgeon in the UK, you can check that they are a registered doctor or surgeon on the General Medical Council online register. Some surgeons have a cosmetic surgery certificate from the Royal College of Surgeons (RCS). This means they’ve been assessed and they meet an agreed national standard.