In the autumn of 2021, Danielle Geohagan woke up in a Turkish clinic, disoriented. Her body was shivering despite the blankets piled on her healing midsection, and she was hungry after more than 12 hours without food. Surrounding her were nurses donning blue scrubs, speaking a language she didn’t understand. The 30-year-old Londoner travelled to Istanbul for liposuction that removed fat in her midsection, thighs and arms. While she believes England’s publicly funded healthcare system is “fabulous”, she decided on Türkiye because of its exchange rate and surgeons’ experience with people of colour. “Other than my life, what do I have to lose?” she says. Overall, Geohagan was happy with the outcome of her procedure and had a positive experience at a recovery hotel, where nutritionists, nurses and doctors were available throughout the day. I believe we’re going to start seeing more [medical] tourists – even more than we saw before Covid Renato Saltz, former president of the International Society of Aesthetic Plastic Surgery The entire trip, including plane tickets, the hotel stay, the procedure, hospital fees, post-op massages and food, cost roughly US$4,500. But when asked if she would recommend the same experience to friends, Geohagan hesitates. The staff at the clinic spoke little English, which meant Geohagan had to use makeshift sign language to communicate. There are also communication issues ahead of the visit; she learned only after arrival that she should have planned to spend five to seven days recovering. She went home after four days. Geohagan sat on her knees throughout the four-hour flight, trying to keep her stomach flat to ease the pain. “I’m very happy with my results. However, when asked by my friends if I’d recommend it, I say don’t do it,” she said. “If you’re going to go, bring someone who speaks the language with you.” Surgeon to stand trial over plastic surgery death of Hong Kong heiress Now that border restrictions have largely evaporated, health experts say medical tourism for cosmetic procedures like Geohagan’s is likely to pick up. Patients may be attracted by the prices clinics outside their home country charge and the opportunity to travel, but health experts say travelling so soon after a procedure can carry risks. “I believe we’re going to start seeing more [medical] tourists – even more than we saw before Covid,” said Renato Saltz, former president and current board member of the International Society of Aesthetic Plastic Surgery. As for the safety of international surgery, he says: “You can go anywhere. Just make sure you do your homework and go to [a surgeon] that is well-trained and respected.” Going to Türkiye was the total package for us. We got to see a new country, meet amazing new people Darcey Silva, who had cosmetic surgery in Türkiye Medical tourism had been picking up long before the onset of the Covid-19 pandemic. More than 3 million Americans travelled for medical tourism outside the country in 2016, largely for dental procedures, according to a survey released last year by the Centres for Disease Control and Prevention. Based on these findings, the Texas-based University of the Incarnate Word’s Centre of Medical Tourism Research expects more than 2 million Americans to travel to Mexico for medical tourism in 2023. Saltz notes that cost is a leading incentive for patients who leave their home country for surgery. It’s no coincidence that Mexico, which offers a 25 per cent to 35 per cent discount on dental or cosmetic treatments compared to the US, is one of the most popular destinations for Americans seeking cosmetic procedures , according to a 2019 report from the Iranian Journal of Public Health. Guest services with your gastroscopy: medical staycations in Hong Kong Enrique Cedillo, a board-certified plastic surgeon in Monterrey, Nuevo Leon in northeastern Mexico, says he has noticed an uptick in US patients this year. He says lower costs are one of the biggest reasons his patients travel to Mexico for procedures. “I have patients that come from New York, and also patients that come from Los Angeles. That’s crazy for me,” he said. “That is like the capital of plastic surgery.” Currency exchange rates can also help; Saltz notes that US$1 is worth about 5 reals in Brazil, another popular destination for cosmetic surgery. Through Western influences and globalisation, several Asian countries have also become popular hubs for cosmetic surgeries. Places like Thailand have even supported such procedures as national medical tourism, while South Korea has long been called the aesthetic surgery capital of Asia. Japan performs the fourth highest number of cosmetic procedures, according to a global survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS) in 2020. Like other popular medical tourism destinations, these countries also provide high-quality services at significantly lower prices than in Europe and the US. In Thailand, Bangkok Hospital Medical Centre provides package deals for patients, inclusive of medications, operating room facilities and other relevant services, at a fraction of US prices. A facelift alone in the US costs around US$8,000 on average, which is more expensive than the roughly US$6,800 for a face and neck lift procedure in Bangkok Hospital. New you: staycations offer wellness reboot, fantasy fashion experience However, Saltz says patients should consider how travel expenses and other charges will add to their costs, especially with airfares up considerably from 2019. “When you look at the top surgeons worldwide, they charge very well. It’s not going to be any cheaper than surgery in your own country by adding the trip, the hotel, the costs, possible complications, flying back,” Saltz says. Even so, insiders have noticed an uptick in cosmetic surgery-related travel. David Vequist, founder and director of the University of the Incarnate Word’s Centre for Medical Tourism Research, points to pent-up demand as a possible driver. More people may be choosing to get procedures abroad to see more of the world after being stuck at home for two years, he says. Exploring a different country was part of what drew Stacey and Darcey Silva, twin reality television stars from 90 Day Fiancé on TLC and their own namesake show, to get a number of procedures done in Türkiye in February 2021. The two spent about a month in Türkiye, splitting their time between Bodrum and Istanbul, and had procedures done on their teeth, noses, lips and breasts as well as liposuction. Medical tourism brings Asia big bucks despite hiccups in Hong Kong “We’ve had surgery before, in Miami and in Beverly Hills, but I feel like going to Türkiye was the total package for us,” Darcey Silva, 47, says. “We got to see a new country, meet amazing new people. It was a journey, and it’ll be one of the best memories we have together as twins.” “The clinic was top-notch, five-star service,” Stacey adds. Researchers have also pointed to social media as an influence inspiring travel for cosmetic surgery. Not only are patients bombarded with images of models or influencers perfected with filters online , but various physicians are finding ways to attract patients around the world through social media. Cedillo notes that his international clientele started taking off after he started using Instagram to showcase his work. “I noticed immediately the change,” he says. Before, “all my patients were local … when I started using Instagram, I started to see people that come in from everywhere.” Vequist says the pandemic-era “Zoom effect” could also be driving more Americans to cosmetic surgeons. “It’s kind of like staring at a mirror for several hours a day, every day, because you’re on these meetings on Zoom,” Vequist says. People “ ended up seeing these flaws , these crow’s feet next to their eyes, the fact that their neck is starting to get wrinkles or wilting a little bit”. Medical tourism sparks debate over impact of bay area plan on health services That, combined with a lack of self-care during the pandemic and “quarantine 15” weight gain, has led to “a cosmetic perfect storm”, according to Vequist. There are risks to travelling soon after major surgery, however. The International Society of Plastic Surgery warns that sitting for long periods of time on a plane or during a car ride can increase the risk for blood clots in the legs and lungs. And experts typically advise against common holiday activities that may be tempting in a destination like Mexico – such as swimming, sunbathing and drinking alcohol – after surgery. The US Centres for Disease Control and Prevention also notes that you are more likely to get an antibiotic-resistant infection in some countries, and counterfeit medicines and lower quality medical devices may be used in some countries. But Vequist says there’s little proof that procedures abroad are riskier than what patients can find within the US, despite the occasional horror story in the news. “How many times would you think the media reports on the successful procedures?” he asked. “We aren’t finding much evidence that there’s a difference.” ‘We trust Singaporean doctors more’: can Bali become a medical tourism hub? Saltz agrees, and adds that there are clinics in the US that have issues as well. He and other experts warn that patients should be on the lookout for bad actors in any city. The results of a shoddy surgery can be devastating; Sivan Himmelman of Los Angeles says she is still recovering from procedures done in 2019. The 40-year-old travelled to Mexico for a liposuction procedure and breast implants after stumbling across a surgeon on Instagram with an impressive portfolio. The surgeries cost her more than US$6,000. What was supposed to be a five-night stay in a recovery home was extended to 10 nights after she experienced complications. Himmelman said she discovered lipo burns on her stomach and back and scarring, along with a host of other issues. She says the recovery process has been a “nightmare” – she estimates she spent “well over” US$25,000 on follow-up procedures – and is far from happy with her results. “I walked in thinking I’d walk away with a flat stomach,” she says. Now, “I’m having to learn to love myself all over again when I couldn’t master it the first 40 years of my life”. Experts warn that patients should do their research before committing to any clinic or surgeon with promising pictures online, and look for accredited facilities with board-certified surgeons. “Don’t just get attracted by a beautiful page on the internet,” Saltz says. “Followers and likes do not equate to competency,” adds Gregory Greco, president-elect of the American Society of Plastic Surgery. Additional reporting by Julianna Barcela