Q: Dr. Eppley, I am thinking about having some overseas plastic surgery (breast augmentation and liposuction) done in Costa Rica. I currently live in Indiana but I can get it done over there for about half the cost of here. Do you think this is safe or a bad idea? The idea of having the surgery in a warm climate seems appealing, particularly when it comes to getting a new shapely body!
A: While the appeal of low cost or inexpensive plastic surgery certainly has its appeal, as evidenced by a booming medical tourism industry, it is important to also look at its downsides. Like any aspect of plastic surgery, from the procedure to the plastic surgeon to the facility, one has to calculate the risks as best they can.
While complications of all sorts certainly occur amongst plastic surgery procedures in the U.S. (fortunately most are aesthetic in nature) there are less safeguards when traveling overseas particularly to third world countries. One major issue that most patients don’t think about it is the sterility of the procedure and how medical equipment and supplies are handled. (and even reused) The lack of following adequate sterile surgery protocols and the re-use of medical supplies is one way to keep down costs but place patients at increased infection risks. Just like you might not drink bottled water in some countries, would you really trust something much more important like actually entering your body?
You are also hedging your bet that you will have a complication-free surgical outcome, whether it be a medical or aesthetic problem. In lands that are not teeming with lawyers and medico-legal oversight, your far away surgeon may have little regard for a patient once they leave the operating room…and certainly has no obligation once you return home. (other than what you might say on the internet) When the long-term outcome appears to have little real consequence, what level of detail and attentiveness might your far away surgeon hold themselves to?
While this discussion may seem negative about medical tourism and there are undoubtably many good experiences and results, it is really to provide you with the flip side of the coin of lower surgical prices. Like most things in life, it is all about how you want to hedge your bet on your plastic surgery outcome and what would happen if all does not go well. The most recent report of mycobacterial infections from plastic surgery done in the Dominican Republic by the CDC illustrates that point.
Dr. Barry Eppley
Q: Dr. Eppley, I have a couple of questions about doing a genioplasty to reduce the length of my chin. First of all a vertical shortening of the chin would require an intra-oral approach, correct? Or could it be done via submental approach? Where would you rank this procedure in terms of potential risks and permanent negative outcomes? Als, how is it with European patients? Have you had people fly over from Europe before? And if so, how is the process concerning consultation, surgery and post-surgery follow-up? Is it possible to fly over for a consultation followed by surgery on the same, or one of the next few days? Or is an online consultation enough for you to assess the patient? Maybe an x-ray exam. is required for a procedure like the one I'm heavily contemplating?
A: In answer to your questions:
1) A vertical chin reduction osteotomy needs to be performed intraorally. The only risk of this procedure, besides have we achieved the aesthetic goal, is some temporary lip and chin numbness from the mental nerve which will be exposed in doing the procedure. While some permanent sensory loss is possible, that is not something that patients have reported to me.
2) We have many far away patients from all over the world so we are very familiar with how to manage them. As we are now doing, all of the details of diagnosis and treatment planning can be done by e-mail. My assistant will arrange for a Skype consultation as it is always good to talk, if possible, face-to-face from afar although this is not absolutely necessary. Surgery is arranged and then the patient arrives the day before and then we can meet in person at that time. Surgery is performed the next day and you should be able to return home within 48 hours. There are no sutures to remove and no real physical restrictions after surgery. Follow-up is done just as we are doing now by e-mail. From a chin osteotomy, expect some significant swelling for a few weeks after surgery but usually no bruising.
3) The only preoperative test that I would need is a lateral cephalometric x-ray so I can take measurements and see how much chin bone can be safely removed/reduced.
Dr. Barry Eppley