ASPS Recommendations on Medical Tourism

SINCE MNB'S INCEPTION FIVE YEARS AGO, WE HAVE PLACED ABSOLUTE PRIORITY ON YOUR HEALTH AND SAFETY WITHOUT COMPROMISE. OUR MISSION WAS TO CREATE AN OPPORTUNITY FOR THE PATIENT AS THEIR ADVOCATE, NOT THE DOCTOR'S ADVOCATE. IF THEY DO THEIR JOB WELL AND WITH CONFIDENCE IN THEIR SKILLS, THEY DO NOT NEED AN ADVOCATE.

MNB HAS CREATED THE PROTOCOL AND WORKING MODEL THAT NOW ARE BECOMING THE MINIMUM RECOGNIZED STANDARDS ON HOW A "MEDICAL TOURIST" SHOULD BE EVALUATED PRE-ARRIVAL, TAKEN CARE OF 24/7 DURING THEIR STAY, AND FOLLOWED UP WITH BY NOT ONLY THE FOREIGN SURGEON BUT ALSO A NETWORK OF SUPPORTIVE DOCTORS IN THE USA TO PROVIDE AFTERCARE IF NECESSARY.

READ WHAT THE ASPS, ASAPS, ISAPS, SBCP HAVE TO SAY ABOUT COSMETIC SURGERY "VACATIONS" AND READ HOW MNB HAS COMPLIED WITH THEIR RECOMMENDATIONS BEFORE THEY WERE CREATED.

The American Society of Plastic Surgeons and The American Society for Aesthetic Plastic Surgery are dedicated to advancing quality care in plastic surgery by encouraging high standards in training, ethics, physician practice, research, and Continuing Medical Education. ASPS and ASAPS members are certified by The American Board of Plastic Surgery® (ABPS®) in the United States and its territories and The Royal College of Physicians and Surgeons of Canada.

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AMERICAN SOCIETYOF PLASTIC SURGEONS ® THE AMERICAN SOCIETY FOR AESTHETIC PLASTIC SURGERY, INC.

Briefing Papers: Cosmetic Surgery Tourism

Cosmetic surgery tourism is a price-driven phenomenon that has experienced increased growth over the past decade. Numerous companies offering all-inclusive vacation packages that include cosmetic surgery are popping up all over the world and can be easily located via the Internet. The offers generally include private hospital services and tout "highly trained" and "credentialed" medical staff. Since elective cosmetic surgery procedures are not covered by insurance, price is the major selling point of cosmetic surgery tourism, with entire vacation/surgical packages costing less than individual procedures in the United States.

Although there are many skilled and qualified physicians practicing all over world, the ASPS cautions that it may be difficult to assess the training and credentials of surgeons outside of the United States. Patients may take unnecessary risks, when choosing cosmetic surgery vacations, by unknowingly selecting unqualified physicians and having procedures performed in non-accredited surgical facilities. The ASPS urges patients to consider the potential complications, unsatisfactory results, and risks to general health that may occur.

Vacation-related activities may compromise patients' health. Cosmetic surgery trips are marketed as vacations. Although enticing, vacation activities should be avoided after surgery. To properly heal and to reduce the possibility of complications, patients should not sunbath, drink alcohol, swim/snorkel, water ski/jet ski, parasail, take extensive tours (walking or bus), or exercise after surgery.

MNB never markets or implies that your experience in Brazil will be a vacation. You are provided with very thorough post-op instructions in English that detail your restrictions, what to expect in the recovery period, how long before you can return to regular activities, etc. You are monitored DAILY by a Home Health Care Nurse as well as the surgeon himself and will be given clearance by medical professionals as to your approved post-op activities. We KNOW that one popped stitch can compromise your healing and your results. We try to help you avoid that and ask that you comply 100% with these instructions.

Cosmetic surgery is real surgery. At the highest level of care, every surgery, including cosmetic surgery, has some risks. These risks may increase when procedures are performed during cosmetic surgery vacations. Infections are the most common complication seen in patients that go abroad for cosmetic surgery. Other complications include unsightly scars, hematomas, and unsatisfactory results.

Daily sterile bandage changes by our staff of Home Health Care Nurses are key to minimizing the chance of post-op infection which can lead to many unnecessary post-op complications, poor scarring, higher costs, a longer stay and unsatisfactory results. Keeping to our commitment to your health, safety and satisfaction, MNB and our surgeons have combined our expertise and collaborated to create and train a structure of Medically Thorough Care for the patient that includes this for you. However, know that MNB takes all precautions to minimize this risk before you even enter the hospital for your surgery.

Antibacterial wash before surgery

we never use "Clinics" and insist (whenever possible) that plastic surgery procedures are performed in "Clean surgery" hospitals specializing in plastic surgery procedures where there is little to no exposure to staph and other infections that are becoming prominent in USA general hospitals. Due to the volume of plastic surgery procedures performed in certain cities, these types of hospitals (not clinics!) are prevalent in Brazil.

Most patients stay in the hospital 48 hours. Our procedures are not performed on an out-patient basis, why is this important? In the immediate post op period, you are most prone to compromising your incisions and your healing. Proper healing requires adequate pain management, post-op antibiotic therapy and REST. The sooner you are forced to become "mobile" the greater chance of opening a stitch, creating a hematoma or seroma, exposing yourself to chances of infection (outside of sterile accommodations), experiencing greater post op pain, swelling and discomfort, etc.

Bilingual private nurses are available to hire to accompany you back to your hotel room in the immediate post op period to help you avoid having to be mobile and compromising your healing. The surgeon may even insist you take advantage of this support and recommend this care to you as you are discharged from the hospital.

Travel combined with surgery significantly increases risk of complications. Individually, long flights or surgery can increase the potential risk of developing pulmonary embolism and blood clots. Traveling combined with surgery further increase the risk of developing these potentially fatal complications, in addition to, swelling and infection. Before flying, the ASPS suggests waiting five to seven days after body procedures such as liposuction and breast augmentation and seven to 10 days after cosmetic procedures of the face including facelifts, eyelid surgery, nose jobs, and laser treatments.

MNB requires ALL of our patients to undergo a very important embolism screening test within hours of their arrival in Brazil. If it returns positive, further Dopplar Radar screening will be performed to rule out this possibility. You are also required to arrive a minimum of two days prior to your surgery, allowing you to re-establish circulation, re-hydrate your body and minimize post-flight edema (swelling). You must stay the recommended period of time by the surgeon after your surgery. The surgeon will not clear you for the return flight if it will compromise your health and healing. Stitches and drains need to have been removed, swelling minimized and generally antibiotic therapy finished.

Follow-up care and monitoring may be limited. Follow-up care and monitoring is an important part of any surgery. Cosmetic surgery vacation packages provide limited follow-up care, if any, once the patient returns to the United States. Patients who have traveled outside of the United States for cosmetic surgery and experienced a complication may find it hard to locate a qualified plastic surgeon to treat the problem or to provide revision surgeries. Local doctors may not know what surgical techniques the physician used in the initial operation, making treatment difficult or nearly impossible. Revision surgeries can be more complicated than the initial operation and patients rarely get the desired results.

Unlike many other plastic surgery travel destinations, you are NEVER alone when you come through MNB. You are monitored and seen daily by medical professionals and are never more than a phone call away, 24/7, from help. MNB has helped hundreds of our peers who have gone home and shown their doctors their results and shared the care system they experienced and thus we have created a network of supportive doctors around the USA that respect their foreign colleagues' work and will see our patients. MNB is also aligning with other American Physicians networks that share our ideals of attentive care and individualized support of the patient and will see our patients. Just ask!

Perhaps even more importantly, you will receive surgical notes on your procedures to take home with you.  This will include details of the procedures, including lipo and skin removal statistics, anesthesia, pain meds and antibiotics prescribed, etc.

Bargain surgery can be costly. Patients can incur additional costs for revision surgeries and complications that may total more than the cost of the initial operation if originally performed in the United States.

Our surgeons strive for excellence in their techniques used.  MNB and the surgeon collaborate to provide you with the best aftercare and healing therapies while you are with us in Brazil helping to assure the best results possible by avoiding risk of complications.  If a revision is necessary, the surgeon will not charge a fee for his services but there will be hospital charges.  Yes, you would have to return to Brazil, but it would still probably be less costly than the revision surgery stateside.

Surgeon and facility qualifications may not be verifiable. In order for cosmetic surgery to be performed safely, it requires the proper administration of anesthesia, sterile technique, modern instrumentation and equipment, as well as, properly trained surgeons. Vacation destinations may not have formal medical accreditation boards to certify physicians or medical facilities. Many facilities are privately owned and operated, making it difficult to check the credentials of surgeons, anesthesiologists and other medical personnel. There are no U.S. laws that protect patients or mandate the training and qualifications of physicians who perform plastic surgery outside of the United States. There may be no legal recourse if surgical negligence by the physician or institution occurs.

MNB has verified the surgeon’s credentials, memberships, etc.  Copies of any of their accreditation documents are available simply by request.  Links to proper medical websites for you to verify their accreditations are available on our website as well.  Brazil has the most Jaco accredited hospitals of any South American country.  Brazil is second only to the USA in the number of plastic surgery procedures performed per year.  The equivalent of America’s ASPS (American Society of Plastic Surgery) is the SBCP (Sociedade Brasileira de Cirurgia Plastica).  The surgeon’s standing in this Society can be verified on the website.  The SBCP has regular memberships, (“Titulado”) memberships and Chapters for those surgeons specializing and creating innovations in certain techniques.   

Devices and products used may not meet U.S. standards. Cosmetic surgery products or devices used in other countries may not have been tested, proven safe and effective, or been approved by the U.S. Food and Drug Administration (FDA). For example, an implant used in the United States must meet standards of safety and effectiveness, a process regulated by the FDA. Other countries may not have similar regulations.

MNB surgeons use only devices and products (implants, facial plaques, etc) that are internationally recognized, available in the USA and US FDA approved.  If for some reason, some prosthesis is not, you will be informed so you can make a decision. Most of the time, the approval process for these products goes faster in Brazil and so they have often many more years of experience using these devices than a US surgeon that has had to wait for the FDA approval before being allowed to begin using it on patients.  Such has been the case with the new cohesive gel breast implants (gummy bear implants) only recently approved last year, 2006, by the FDA for use in the USA.  They have been in widespread use in Brazil for well over 6 years already and are even coming out with newer versions/different profiles of implants that might not be available in the USA for many more years. 

Cosmetic Surgery Patient Safety Check List:

To help ensure optimal results and to limit risks and complications, the ASPS offers the following tips to anyone considering cosmetic surgery IN the United States. MNB encourages you to use these same guidelines as you choose a foreign destination and assures you that you will have just as much, if not more, medical attention to detail with our system.

Do Your Homework: Research the procedure, the benefits, and the risks. Refer to www.plastic surgery.org for the latest information on plastic surgery procedures.

Realize that certain techniques and procedures are exclusive to a surgeon. Sometimes terminology is different. When considering surgery abroad, be aware of the language barrier. Always ask for clarification. For example, LipoAbdominoplasty is not a standard "tummy tuck." The "Laser Bra" technique may be called something different by different surgeons. A "Brazilian Butt Lift" is not called a "Brazilian Butt Lift" in Brazil although it IS a Brazilian technique!

Have Realistic Expectations: Ask your plastic surgeon questions about how the surgery will work for you: identify expectations and understand side effects and recovery time.

Also make sure your Medical Concierge can clarify and answer your specific medical questions regarding the surgeon's technique and medical terminology. Make sure you are provided with comprehensive post op instructions, information on scarring and surgical waiver information.

Require a Medical Evaluation: Consult with your plastic surgeon for an evaluation and discuss your full medical history to determine the most appropriate treatment.

MNB collaborates with the surgeon to provide an individualized, medically thorough Treatment Plan (US$100) for each patient.  It is created upon submission of pre-op pictures, a Health History form, and pre-op lab work required by the surgeon.  It is your pre-op consultation and evaluation.  You will, of course, meet with the surgeon in person once you arrive in Brazil.  This in-person consultation will determine your ultimate surgical plan.  It will state the procedures that you will need to achieve the results you want, their prices, a discussion of any issues from your labwork and/or health history, how long you will need to stay, what to expect in the post op period and any recommended treatments or therapies that may be necessary to your healing.  It will also provide an estimation of your TOTAL costs (including lodging, etc) and will recommend a “Medical Basics Package Plan” for an additional fee that will include most all of your post op care and medications and other medical necessities.  Many patients overlook this all important “post op care” and medications when comparing the costs of this journey and end up spending much more than they thought they would.  We try to help avoid this and be as transparent as possible.

Be Informed: Talk to patients who have had your procedure so you know what to expect.

Choose an ASPS Member Surgeon: Why? ASPS Member Surgeons are qualified, trained, properly certified, experienced in your procedure, and only operate in accredited facilities.

Ask Questions: Are you an ASPS Member Surgeon? Are you certified by the American Board of Plastic Surgery? Do you have hospital privileges to perform this procedure? If so, at which hospitals? How many procedures of this type have you performed? Am I a good candidate for this procedure? What will be expected of me to get optimal results? Where and how will you perform my procedure? Is the surgical facility accredited? What are the risks involved with my procedure? How long of a recovery period can I expect, and what kind of help will I need during my recovery? Will I need to take time off work? If so, how long? How much will my procedure cost? Are financing options available? How are complications handled?

For referrals to ASPS Member Surgeons, call the ASPS at 888-4-PLASTIC (888-475-2784) or visit www.plasticsurgery.org. Additionally, consumers seriously considering traveling abroad for cosmetic surgery can go to www.plasticsurgery.org for referrals to international ASPS Member Surgeons.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 5,000 members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. This document is designed to provide accurate and authoritative information on the topic covered as of the date of publication and is subject to change as scientific knowledge, technology advances and practice patterns evolve. The views expressed represent the collective, but not necessarily the individual, views of members of the American Society of Plastic Surgeons.