Why are more people traveling abroad for cosmetic surgery, and what are the risks?

In the fall of 2021, Danielle Geohagan woke up in a Turkish clinic, disoriented. Her body was shivering despite the stack of blankets piled on her healing midsection, and she was hungry after going 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 traveled to Istanbul for liposuction that removed fat in her midsection, thighs and arms. While she believes England's publicly funded health care system is "fabulous," she decided on Turkey because of its exchange rate and surgeons' experience with people of color.

"Other than my life, what do I have to lose?" she told U.S. TODAY.

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 on-site throughout the day. The entire trip, including plane tickets, the hotel stay, the procedure, hospital fees, post-op massages and food, cost roughly $4,500.

But when asked if she would recommend the same experience to friends, Geohagan hesitated.

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."

Now that border restrictions have largely evaporated, health experts say medical tourism for cosmetic procedures like Geohagan's is likely picking up. Patients may be attracted to the price tags and travel opportunities offered at clinics outside their home country, but health experts note that traveling so close to a procedure can carry risks.

"I believe we're going to start seeing more and 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's board. As for the safety of international surgery: "You can go anywhere. Just make sure you do your homework and go to (a surgeon) that is well-trained and respected."

Why do people travel abroad for plastic surgery?

Medical tourism had been picking up long before the onset of the COVID-19 pandemic.

More than 3 million Americans traveled for medical tourism outside the country in 2016, largely for dental procedures, according to a survey released last year by the Centers for Disease Control and Prevention. Based on these findings, the University of the Incarnate Word's Center of Medical Tourism Research expects more than 2 million Americans to travel to Mexico for medical tourism in 2023.

Saltz noted 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% to 35% discount on dental or cosmetic treatments compared to the U.S., is one of the most popular destinations for Americans seeking cosmetic procedures, according to a 2019 report from the Iranian Journal of Public Health.

Enrique Cedillo, a board-certified plastic surgeon in Monterrey, Nuevo León in northeastern Mexico, said he has noticed an uptick in U.S. patients this year. He said lower costs are one of the biggest reasons why his patients travel to Mexico for procedures.

"I have patients that come from New York, and also patients that come from L.A. That's crazy for me," he said. "That is like the capital of plastic surgery."

Currency exchange rates can also help; Saltz noted that $1 is worth about 5 reals in Brazil, another popular destination for cosmetic surgery.

But patients should consider how travel expenses and other charges will rack up total costs, Saltz said, especially with airfare 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 said.

That hasn't stopped insiders from noticing an uptick in cosmetic surgery-related travel.

David Vequist, founder and director of the University of the Incarnate Word's Center for Medical Tourism Research, pointed 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 said.

Vacation and surgery all-in-one

Exploring a different country was part of what drew Stacey and Darcey Silva, twin reality TV stars from "90 Day Fiance" and their own namesake show, to get a number of procedures done in Turkey in February 2021. The two spent about a month in Turkey, splitting their time between Bodrum and Istanbul, and had procedures done on their teeth, noses, lips, breasts as well as liposuction.

"We've had surgery before, in Miami and in Beverly Hills, but I feel like going to Turkey was the total package for us," Darcey Silva, 47, told U.S. TODAY. "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 added.

Researchers have also pointed to social media as an influence inspiring travel for cosmetic surgeries. 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 noted that his international clientele started taking off after he started using Instagram to showcase his work.

"I noticed immediately the change," he said. Before, "all my patients were local. ... When I started using Instagram, I started to see people that come in from everywhere."

Vequist said 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 said. 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."

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.

Is it safe to travel for plastic surgery?

There are risks to traveling soon after major surgery.

The International Society of Plastic Surgery warns that sitting for long periods of time on a plane or car ride can increase the risk for blood clots in the legs and lungs. And experts typically advise against common vacation activities that may be tempting in a destination like Mexico—such as swimming, sunbathing and drinking alcohol—after surgery.

The Centers 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 U.S., 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."

Saltz agreed, adding that there are clinics in the U.S. that have issues as well. He and other experts warned 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 traveled 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 $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 said the recovery process has been a "nightmare"—she estimates she spent "well over" $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 said. 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, whether it's inside or outside the U.S., and look for accredited facilities with board-certified surgeons.

"Don't just get attracted by a beautiful page on the internet," Saltz said.

"Followers and likes do not equate to competency," added Gregory Greco, president-elect of the American Society of Plastic Surgery.

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