key: cord-0969828-vdo9c16g
authors: Varma, Parvathi; Kiely, John; Giblin, Anna Victoria
title: Cosmetic tourism during the COVID-19 pandemic: dealing with the aftermath
date: 2021-11-14
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2021.11.013
sha: 8512c197bc60ba95862523f36b89bf9626add1f8
doc_id: 969828
cord_uid: vdo9c16g

BACKGROUND: Despite government restrictions during the coronavirus (COVID-19) pandemic, cosmetic tourism continued to occur. The authors present the impact of cosmetic tourism on their plastic surgery unit. METHODS: Retrospective case note review of two cohorts was performed: COVID-19 (March 2020 – April 2021) and a pre COVID-19 comparator (January 2019 – February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed. RESULTS: Seven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n=5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence. CONCLUSION: Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care.

Retrospective case note review of two cohorts was performed: COVID-19 (March 2020 -April 2021) and a pre COVID-19 comparator (January 2019 -February 2020). Patients presenting with complications from cosmetic tourism were included and their hospital notes were reviewed.

Seven patients were identified in the COVID-19 cohort compared with four patients in the comparator. In the COVID-19 patient group, six underwent their procedure overseas. The final patient was operated on in the UK by a visiting surgeon. Cases consisted of two abdominoplasties, two breast augmentations, two gluteal augmentations, and the final patient had a hernia repair. The most common presenting complaint in the COVID-19 cohort was a post-operative wound infection (n=5), of which two had deeper associated collections, with two further wound dehiscences. In the pre-pandemic group, four patients underwent their procedure overseas. Cases consisted of an abdominoplasty, a blepharoplasty, a breast augmentation and a gluteal augmentation. Two patients presented with a wound infection, and two with simple wound dehiscence.

Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. These patients are a potentially vulnerable group who exhibit risk-taking behaviours, such as going abroad amidst a pandemic and acceptance of not having appropriate follow up care. Table 1. 2 There are several factors that may make patients seek cosmetic surgery abroad, including reduced costs, patient dictated operations and consumerism. 3 These patients are a potentially vulnerable group who exhibit risk taking behaviours, demonstrated by travel abroad during a pandemic without a plan for adequate follow up. Many cosmetic surgery services abroad 6 were offering package deals of an operation combined with a holiday which was attractive to patients, especially amidst the UK lockdown and social distancing measures. The most popular destination in both cohorts was Turkey. As is often the case in the aesthetic sector, we do not have the denominator of the number of patients undergoing such procedures.

There was an upward trend in the number of UK cases of COVID-19 after December 2020, which is when three of the patients underwent their operation. Similar to Long et al., we highlight several concerns, such as practitioner neglect of EASAPS guidance and the increased risk of peri-operative COVID-19. 4 Postoperative pulmonary complications occur in half of patients with perioperative COVID-19 infection and is associated with a higher mortality. 5 We are unable to comment on the pre-operative COVID-19 screening programme and the immediate post-operative care, however we are unaware of any cosmetic surgery tourism deaths associated with COVID-19 at time of writing. At a time when the NHS was already stretched, the additional burden of complications from such procedures undertaken abroad was more difficult to manage.

Cosmetic surgery tourism is a growing industry with an increasing number of patients presenting with complications to NHS services. With the easing of restrictions for elective private surgery and air travel, we are likely to see an increase in the number of such cases. To ensure patient safety, surgeons should follow the guidance set out by aesthetic associations and ensure adequate COVID-19 screening. One could argue that such patients seeking surgery abroad should undertake additional insurance to account for possible complications that would need to be treated in the NHS on their return, although this would be difficult to enforce. Plastic surgery training should also include a robust grounding in aesthetic practice, as patients experiencing complications of these procedures are most likely to present to their departments.

The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article Funding: Not applicable 

European Association of Societies of Aesthetic Plastic Surgery. COVID-19 -E(A)SAPS Recommendations

The Clavien-Dindo classification of surgical complications: five-year experience

The Ever-Present Costs of Cosmetic Surgery Tourism: A 5-Year Observational Study

Cosmetic tourism amidst the Covid-19 global pandemic

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Ethical approval: Not required