The gov website belongs to an official government organization in the United States. Matos, MD3; Bianca Alvarez, MD4; Jacqueline Safstrom, MPH1; Francisco Torres, MD3; Sharmeen Premjee, MPA4; Luis Bonilla, MD, PhD 4; Benjamin Park, MD1; Elizabeth Bancroft, MD1, *; Macarena Garcia, DrPh4, * (See author affiliations) What is already known about this topic? Infections occur regularly after cosmetic surgery performed outside the United States, but deaths are rarely reported. What are the implications for public health practice? People interested in cosmetic surgery should discuss the risks with their regular healthcare provider. Public health authorities can support educating providers about the importance of preoperative patient evaluation and the potential danger of performing several cosmetic procedures in a single operation.
Traveling to another country for medical care (medical tourism), including travel related to cosmetic surgery, is increasingly common among U.S. residents. In the United States, because the cost is lower and waiting times for procedures are shorter than in the United States (. The Dominican Republic is popular for medical tourism because it is close to the United States, has an existing tourism infrastructure, and some doctors from the Dominican Republic advertise in the United States.
Since 2003, the CDC has been documenting adverse events that occur in the U.S. UU. Citizens after cosmetic surgery in the Dominican Republic (. Most reports of adverse events after medical tourism for cosmetic surgery have cited infections; deaths have rarely been reported (. Liposuction was performed in all 24 fatal cases (100%), gluteal fat transfer in 22 (92%), abdominoplasty in 14 (58%) and breast augmentation in 11 (46%).
During the surgery, an average of three procedures were performed (range = two to four) for each deceased. In 14 cases (58%), death occurred within 24 hours after surgery; the average interval from procedure to death was 2.8 days (range = 0-18 days). Nine surgical clinics were related to deaths; two clinics were related to two or more deaths. Autopsy reports were available for 20 cases (83%) with medical records; all deaths confirmed by autopsies were attributed to intraoperative and postoperative complications.
The cause of death was fat embolism in 11 (55%) of the 20 cases and pulmonary vein thromboembolism in seven (35%). The findings in this report are subject to at least three limitations. First, reliable statistics are not available on the number of U.S. citizens who undergo cosmetic surgery in the Dominican Republic each year, making it impossible to estimate the risk of perioperative death.
Second, this report could underestimate the number of deaths in the U.S. UU. Citizens who undergo cosmetic surgery in the Dominican Republic because they only include deaths that were reported to the U.S. Other researchers have documented adverse outcomes of cosmetic surgeries performed in the Dominican Republic that were only recognized after the patient returned to the United States (1,.
Finally, perioperative deaths are rare complications of cosmetic surgery, and this report does not address other well-documented adverse effects, such as post-surgical infections, which can cause significant morbidity (1,. As a result of this research, the U.S. The Department of State updated the notice on medical tourism and elective surgery on the website of the U.S. Embassy in the Dominican Republic§§ to provide a list of measures to be taken to reduce the risk of adverse outcomes, including the recommendation to obtain international travel insurance that covers medical evacuation back to the United States.
Citizens considering cosmetic surgery abroad should consult with their primary care professionals about the inherent risk of adverse effects after surgery and about preventive measures they can take to reduce that risk. They should consult a medical specialist for travel one month or more before the trip and, since air travel and surgery independently increase the risk of blood clots, patients should allow sufficient time between the flight to and from the destination where they are going to have surgery to reduce the risk of complications (. All authors have completed and submitted the form of the International Committee of Medical Journal Editors for the disclosure of potential conflicts of interest. No potential conflict of interest was revealed.
The MMWR and the Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. UU. The use of trade names and trade sources is for identification purposes only and does not imply approval by the U.S. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply approval of these organizations or their programs by the CDC or the U.S.
The CDC is not responsible for the content of the pages found on these sites. The URLs listed in the MMWR were current as of the date of publication. All surgeries, including cosmetic procedures, carry risks. If you have obesity or diabetes, you may be at greater risk of complications.
Complications can include problems healing wounds, blood clots, and infections. Smoking also increases risks and slows healing. Before the procedure, you meet with a health professional to discuss these risks and others that may be related to your health history. Your surgeon will likely tell you about specific procedures, what to expect, benefits, risks, and possible complications. You may also be told about other types of surgery.
Your surgeon may recommend more procedures to improve your overall result. It's important to follow the instructions given to you by your healthcare team. This can help minimize the risks and complications of surgery. You are asked to sign a consent form that shows that you understand the risks of surgery. The form also confirms that you understand the risks of medications to prevent pain, called anesthetics. You may be asked to sign a consent form so that you can take pictures before and after surgery.
The photographs serve as a reference for the surgeon during the procedure. They also become part of your medical record. Hematoma is a risk in almost all surgeries. Treatment sometimes includes additional operations to drain the blood if the blood pool is large or growing rapidly.
This may require another procedure in the operating room and, sometimes, additional anesthesia. As with any surgery, blood loss is expected. However, uncontrolled blood loss can lead to a drop in blood pressure with potentially fatal results. Blood loss can occur while on the operating table, but also internally, after surgery.
Although post-operative care includes measures to reduce the risk of infection, it remains one of the most common complications of plastic surgery. For example, infections occur in 1.1 to 2.5 percent of people who undergo breast augmentation. Cellulitis, a skin infection, can occur later of surgery. In some cases, infections can be internal and serious, and require intravenous (IV) antibiotics. The possibility of nerve damage is present in many different types of surgical procedures.
Numbness and tingling are common after plastic surgery and may be signs of nerve damage. In most cases, nerve damage is temporary, but in some cases it can be permanent. Most women experience a change in sensation after breast augmentation surgery, and 15 percent experience permanent changes in nipple sensitivity. Hypertrophic scarring, for example, is an abnormally red and thick bulging scar.
Along with smooth and hard keloid scars, it occurs in 1.0 to 3.7 percent of tummy tucks. General anesthesia can sometimes lead to complications. These include lung infections, strokes, heart attacks, and death. Being aware of the anesthesia, or waking up in the middle of surgery, is very rare, but it's also possible.
These complications are relatively rare and affect only 0.09 percent of all patients undergoing plastic surgery. The trend in aesthetics is clearly towards minimally invasive surgeries and techniques, as can be seen in the statistics of the American Association of Plastic Surgeons.
