Plastic Surgery & Medical Tourism

Medical tourism just doesn’t make a whole lot of sense.

In recent years medical tourism has become an option increasingly available to potential plastic and cosmetic surgery patients. These potential patients often imagine that inexpensive, high-quality surgical care can be obtained by traveling to such countries as India, Mexico, Costa-Rica, Thailand, and the Dominican Republic. Add to that the price-conscious “savvyness” of the internet coupon generation, and the options increase exponentially. The guiding principles often celebrated by proponents of medical and cosmetic surgery tourism are the promotion of patient consumerism and, most notably, cost savings.

In the age of global digitalization, outsourcing of various business practices has become commonplace. Beginning with the export of information technology and call center jobs, outsourcing has now extended its reach to include medicine, surgery, and even plastic surgery. Several developments have facilitated this trend. Prohibitive health care costs at home, increasing denials of insurance claims and decreasing provider reimbursement rates, increasing overall demand for plastic surgery, long waiting times, and lastly, and perhaps most importantly, cost savings, have all contributed.

Medical tourism is marketed on the basis that health care can be off-shored much like the production of computers and cell phones or the provision of professional services such as bookkeeping and accounting. Good surgical care, however, involves more than just the technical act of surgery itself. It requires extensive and careful preoperative consultation, deliberate formulation of reasonable treatment plans, and implementation of proper postoperative care. Yet, such goals are unlikely to be achieved when patients fly to a foreign country, undergo surgery, recuperate oftentimes for less than a week, and return home with no plan for follow-up care. Furthermore, with increasing numbers of reports about patients traveling abroad and returning home with serious complications, the merits of “globalizing” health care must be questioned.

All too often I consult with patients who tell me of lamentable stories of “plastic surgery gone wrong” abroad. The informed consent process, a standard component of patient-physician communication in the United States, involving full disclosure of risks and benefits of treatment, risks and benefits of alternative forms of treatment, and consequences of not undergoing treatment, is virtually non-existent. Most of the time, the patient cannot even recall the name of the surgeon, or even identify him/her in person preoperatively. In all of medicine, but especially in elective plastic surgery, in order for choices to be made in a meaningful and appropriate manner, patients need to receive accurate and comprehensive information. Inadequate communication before surgery and the seemingly non-existent culpability lead some patients to have procedures that in health care settings with higher standards would never be deemed as falling within the professional realm of care.

When considering the cost savings purported to be an attractive feature of medical tourism, one must always consider the added costs of revisional surgery and medical care incurred with the potential for adverse outcomes. These costs increase on the whole when one considers the increasing frequency of surgical complications incurred with surgery in health care settings that do not meet the standard of care. Medical travelers often purchase cosmetic surgery packages without physician consultation and without knowledge of the medical implications to their health and well-being. Medical tourism companies and destination health care facilities, often owned and operated by non-physicians, benefit from maximizing profits without the necessary medical knowledge, legal responsibilities, and unfortunately, moral compunctions either.

All in all, elective plastic surgery is a drastic measure to undergo in order to change your appearance. So if you do it, you should have all the support from family and friends that you can get to help you get through it. Being home in a comfortable and familiar environment is also instrumental in proper healing. Going away to a foreign country to get this done just doesn’t make a whole lot of sense. And that’s the bottom line.

Dr. Edward Owen Terino, Pioneer Of The "Somme Lift"

Dr. Edward Owen Terino California Board Certified Plastic and Reconstructive SurgeonDr. Edward Owen Terino shares his visions and innovation with the 'Somme Lift', an upper and midface suspension technique.

Name: Edward Owen Terino, M.D.
Location: Agoura Hills, CA
Website: terinomd.com

That's interesting: Dr. Terino is not only world renowned for his accomplishments as a plastic surgery practitioner, but also as an innovator in the specialized new techniques of three-dimensional facial contouring. He is one of the few pioneers to develop the latest upper and midface vertical lifting and suspension technology, which he calls Somme Lift. He also is the designer of natural looking cheek and chin implants which provide solutions for flat cheeks, small jaw lines, and weak facial contours. 

Can you share your career path as a plastic surgeon?

My private practice has always been that of general plastic surgery including reconstructive surgery. During the first 20 years, we took care of the accidents and injuries around the Conejo Valley of California in a radius of 60 miles. I also attracted patients by referral all the way from San Diego, Palms Springs, and North of Santa Barbara.

I embraced the latest medical plastic surgery technologies as they were developed including liposuction, carbon dioxide laser resurfacing, and up-to-date skin care management. Because of my experience at the Fort Sam Houston Burn Unit during the Vietnam conflict, I had

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Steven J. Pearlman MD, FACS, Facial Plastic Surgery In Manhattan

Dr. Steven J. Pearlman is a plastic surgeon practicing in the heart of Manhattan.

Name: Dr. Steven J. Pearlman
Location: New York, NY
Website: MDFace.com

That's interesting: Dr. Pearlman is the Founding President of the New York Facial Plastic Surgery Society — a society founded in 1993 to promote advanced education for Facial Plastic Surgeons in the New York Metropolitan area. It provides a forum for accomplished, practicing physicians to exchange ideas, new techniques and procedures on a continuing basis.

How did you end up as a plastic surgeon in Manhattan?

I did my Otolaryngology training at Mount Sinai Medical Center. Our clinical training was heavily weighted in head and neck oncology and facial plastic surgery. Mount Sinai ENT department has been running courses in facial plastic surgery, including rhinoplasty, facelift, blepharoplasty and browlift since

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Dr. An Po Chung, Plastic Surgeon Performing Fat Transfer In Taiwan

Dr. An Po Chung Taiwan Plastic Surgeon

Name: An Po Chung M.D., MSC
Location: Taipei, Taiwan
Website: 4flower.com.tw

Dr. An Po Chung is a professional member of Taiwan Surgical Society of Specialist, Taiwan Plastic Surgery Medical Association, Physicians Cosmetic Surgery in Taiwan Medical Association specialist Deputy Secretary-General of facial plastic surgery Medical Association and International Cosmetic Surgery Medical Association.

Can you tell us what is it like practicing cosmetic surgery in Taiwan in comparison with what you see in other countries?

From my experience of attending several international conferences, I noticed that cosmetic surgery in Taiwan is not so different from the other countries. However, the patients in Taiwan prefer minimal invasive cosmetic surgery. Some of them have unrealistic high expectations of non-invasive treatment such as filler and Botox.

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Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 1

Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MDPart 1 of our interview with Marc Scheiner MD, an Allergan Certified Botox Cosmetic Trainer and the physician instructor on Botox Training MD.

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website: oleigh.com
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online botox training site for clinicians. 

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

In part 1 we discuss Botox indications, complications and some treatment techniques.

Let's talk a little bit about differentiation between Botox and fillers. Can you give me a kind of a overarching framework of how it is that you decide which is going to be better treatment for an individual patient?

Well, certainly, to determine whether or not you're going to treat someone with Botox versus fillers really requires that you have an understanding of facial ageing right from the beginning. So typically when you evaluate the face

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Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 2

Allergan Certified Botox Cosmetic Trainer and the physician instructor on Botox Training MDPart 2: Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website: oleigh.com
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online Botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

And how about for filler injections? Are there different levels of expertise in treating different areas?

Filler injections also have this kind of heirarchy of possible complications. If we just review briefly where the fillers are used commonly, and then we can kind of discuss which is the most elementary to the advanced techniques

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Interview With Certified Allergan Botox Cosmetic Trainer Marc S. Scheiner MD: Part 3

Botox TrainingPart 3: Complications with Botox & Filler Injections

Name: Marc S. Scheiner, MD
Clinic: O'Leigh Aesthetic Surgery Center
Location: Elkton, MD
Clinic Website: oleigh.com
Training Website: Botox Training MD

I this three part series we're discussing Botox and fillers with Marc Scheiner MD who trains clinicians through 14 credit CME two-day hand's on seminars with the American Society of Aesthetic Medical Professionals and Botox Training MD, an online botox training site for clinicians.

Part 1: Botox injections
Part 2: Filler Injections
Part 3: Complications of Botox and Filler Injections

So Dr. Scheiner, tell me about some of the typical complications you've seen and how you deal with them?

In general, the complications are separated with regard to what product we're using. There are different complications with each filler within the filler class. We're going to see different complications from one filler to the next, but in general all the fillers are going to... Well, let me rephrase that. All the nonpermanent fillers are going to result in similar complications. That is to say that I believe you may experience a different set of complications with

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Georgios Hristopoulos MD: Plastic & Aesthetic Surgery In Germany

Georgios Hristopoulos M.D., Specialist in Plastic and Aesthetic Surgery in Germany

Cosmetic medical technologies offered in Germany are attracting medical tourists. 

Name: Dr. Georgios Hristopoulos
Clinic: Pantheon Aesthetic Center
Location: Cologne, Germany
Website: pantheon-aesthetic-center.de, beethoven-klinik-koeln.de

That's interesting: Dr. Georgios Hristopoulos is employed as Head of the Department of Aesthetic Plastic Surgery of the Beethoven Klinik in Cologne, Germany and at the same time runs his private office, named Pantheon Aesthetic Center. His surgical focus is the Breast Surgery and specifically the complete sub muscular Breast Augmentation (inner Bra) as well as the Dermolipectomies on trunk and extremities.

He speaks German, Greek, English and Spanish. 

How does your surgical practice function? How is it organized? 

I am the Chief of the Department of Aesthetic Plastic Surgery of a small private clinic in Cologne / Germany called Beethoven-Klinik. The clinic is one of the oldest and biggest private Clinics of Plastic and Aesthetic Surgery with government concession in the North Rhine Region and maybe in whole Germany. We have an interdisciplinary occupation with Orthopaedists, Trauma-Surgeons and a Dermatologist.

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Interview With Dr. Bryan B. Fuller, CEO of DermaMedics In Oklahoma

Dr. Bryan B. Fuller, CEO of DermaMedicsThe innovation of natural ingredients in skin care with Dr. Bryan Fuller, founder of DermaMedics.

Name: Bryan B. Fuller Ph.D.
Company: DermaMedics Professional
Location: Oklahoma City, OK
Website: dermamedics.com

One area that is “over-hyped” is the development of skin care products that contain “growth factors”. It is well-known that growth factors are extremely unstable to room temperature and aqueous environments, and in fact, growth factors in water are only stable for 7 days at refrigeration temperatures. Thus, products that are sitting on a shelf at room temperature that are reported to contain growth factors almost certainly contain degraded, inactive growth factors. Further, there is no scientific evidence that growth factors can penetrate the stratum corneum and get to the dermis to produce “anti-aging benefits”. In fact, there is a lot of scientific evidence that no molecule larger in size than 500 mw can penetrate into the skin (see (Bos JD, Meinardi MMHM. The 500 Dalton rule for the skin penetration of chemical compounds and drugs. Exp Dermatol. 2000; 9:165–169.).
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Dr. Herbert Hooi, Cosmetic Physician In Sydney, Australia

Australian Cosmetic Physician  Herbert Hooi MBBS (Syd) LLB (Hons) (UWA) FACEM Dr. Hooi takes center stage as he discusses the prevailing structure of cosmetic medicine in Sydney, Australia.

Name: Herbert Hooi MBBS (Syd) LLB (Hons) (UWA) FACEM
Location: New South Wales, Australia
Website: drhooi.com.au

That's interesting: Dr. Hooi completed an Honours Law degree at the University of Western Australia and obtained further real-world legal experience with a top tier Australian law firm. Dr. Hooi has been admitted to practice as a Solicitor and Barrister of the Supreme Court of Victoria. Although he is no longer practising law, Dr. Hooi maintains a keen interest in legal medicine.

Dr. Hooi is a member of the Australasian Society of Cosmetic Medicine and is an Associate Member of the American Society of Laser Surgery and Medicine. Dr. Hooi’s training and experience led to his award as a Foundation Fellow of the Australasian College of Aesthetic Medicine in 2009.

In 2010, Dr. Hooi was selected to become the national trainer in Australia for the Fibropen System, platelet rich plasma (PRP) and Radiesse.  

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Marguerite Barnett MD FACS PA - Sarasota Institute Of Plastic Surgery & Mandala Medical Spa In Florida

Marguerite Barnett, M.D., F.A.C.S., P.A. Board Certified Florida Cosmetic SurgeonDr. Barnett has integrated her cosmetic and reconstructive techniques with the wisdom of ancient Eastern healing arts to create a new healing vision.

Name: Dr. Marguerite Barnett
Clinic: Mandala Medical Spa
Location: Sarasota, FL
Website: drmbarnett.com, mandalamedspa.com

That's interesting: Dr. Barnett is a double board-certified cosmetic and reconstructive surgeon, licensed in both Hawaii and Florida.

Giving back to the community is an integral part of Dr. Barnett’s philosophy and commitment to health and wellness. She actively participates in local charitable events year-round with the Wellness Community of Southwest Florida; United Cerebral Palsy of Sarasota; and The Women’s Resource Center. One of the most popular ways Dr. Barnett supports charitable events is through her expression of Indonesian and Balinese dance.

Can you give us a picture of how your clinic is organized and runs? 

My clinic for business accounting purposes is split into two sides. The doctor’s practice and the medical spa. The concept was to have the high-tech, scientific “western” doctor’s side balanced by the luxurious ancient rituals of the eastern spa side. Of course there’s an overlap and that’s exactly how I wanted it. If the massage therapist spots a weird mole on their client’s back, the client can run next door to have me look at it. If I encounter a patient who needs skin care for best results, I can shoot herover to the medical aesthetician. Post-op patients benefit from acupuncture to lessen pain and my employees and patients benefit from stress-reducing yoga and meditation. The overall design which has an Asian flavor is comforting and inviting to all. I was nervous at first because it was not the typical doctor’s office but on the day of moving in, I lost my fear completely when one of the movers, a Bronx native judging by his accent, dropped his box and said “Whoa! This place feels healing! You the Doc? What kinda Doc are you?” He got it! 

Hawaii Board Certified Plastic Surgeon Dr. Marguerite Barnett

You're double board certified cosmetic and reconstructive surgeon licensed in both Hawaii and Florida. How do the different states that you practice in differ in terms of medical operations? 

Well, I haven’t lived in Hawaii for almost 30 years but what my friends in the state communicate, Hawaii seems to be ahead of Florida in many aspects. They have a much lower rate of uninsured population and a more cohesive public health initiative, important when you’re dealing with an international, multi-cultural population with extreme disparities in wealth and education.

Florida has these issues as well but we’re not handling them as well as Hawaii. Maybe the fact that Hawaii consists of several small islands sharpens the sense that these issues must be addressed or the lifeboat will sink. It’s harder to ignore these problems on an island. Also they do not have a governor that turns down billions of dollars in federal aid.

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Keeping Your Aesthetic Patients Happy Is Good Business

Keeping patients happy makes sense, both to avoid problems and build your reputation and referral base.

Not all patients that state they had a poor experience from another provider are signaling the proverbial red flag. Most of these patients HAVE had an experience of poor treatment outcome.

And to add salt to their wound,the previous treating provider could care less!

We must keep in mind that for most of our patients, coming in for Medical Aesthetic treatments is an exciting and much anticipated experience.

The number one reason patients state they no longer go to their previous provider is, "He was a jerk!" Oddly enough, the number one complaint I hear regarding a female provider is "I had to wait too long." This is not to say there are no female jerks or that patients don’t have to wait too long to see a male provider. These statements are simply the most common that I hear from (from) my patients.

No one is perfect. I don’t care how good you are at fillers, Botox, lasers, and surgery. We’re human, and we have bad days too. Bottom line: If you did achieve a less than desirable outcome, fix it for heaven's sake! With a smile on your face. If you're running more than 15 minutes behind, be prepared to apologize profusely and don't let it happen again. At both our clinics over 50% of our new patients are by referral. The most common reason for these referrals: “They're so nice!” Patients in general have a sense of helplessness when it comes to being treated by a provider. Do not tell a patient what they have to do. This is not life or death nor a dictatorship. Our patients know that we truly love what we do and we care. You don’t have to be all hugs and kisses, but, you'd better have a smile and a few jokes up your sleeve. You must keep in mind that this is the grown up version of a trip to Disneyland. It’s an E ticket ride with a high price tag. This is not an area of medicine of need.

This is completely a "WANT" this treatment situation. We encourage our patients to tell us what they are looking to have done and then offer safe, sane treatment options for them. This gives the patient a greater sense of control, and a decreased sense of possibly being pressured. If they can't afford all of the treatments at one time, what ever you do, never pressure a patient! If they like the one treatment you do and you personally, they’ll be back. And that’s how you keep your patients.

Dr. Sufan Wu, Plastic Surgeon In China

Chinese Plastic and Reconstructive Surgeon Sufan Wu, M.D., Ph.DPlastic surgery is gaining momentum in China, but in different ways than in the West.

Name: Sufan Wu, M.D., Ph.D
Location: Zhejiang, China
Website: prschina.com

Dr. Sufan Wu is the Chief of Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, China. Chairman of the Association of Plastic Surgery of Zhejiang Province. Committee members of Chinese national Association of Plastic Surgery, Association of Aesthetic Medicine. Active member and faculty member of ISAPS.

Can you tell us what is it like practicing cosmetic surgery in China in comparison with what you see in other countries?

Compared with the other countries – the US and Europe in particular – cosmetic medicine in China has the following differences:

1. The history of cosmetic surgery in China is

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Nick Carr MD, FRCSC, Canadian Plastic Surgeon & Educator

Dr. Nick Carr shares his thoughts on the medical education system in Canada as a plastic surgeon and eductor.

Name: Dr. Nick Carr 
Location: Vancouver, Canada
Website: skinworks.ca

That's interesting: Dr. Nick Carr is a Royal College Examiner in Plastic Surgery.

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Painless Neurotoxin Injection Method? Join the Discussion!

What injection methods are most useful and reliable for neurotoxin injections: Botox & Dysport.

I have been in clinical private practice going on 14 years now and enjoy a busy and healthy cosmetic surgery practice.  Injectables, both fillers and neurotoxins, remain an integral part of my practice and I suppose that the loyalty my patients show by continuing to return to me as their injection provider is testament that my skills must be competitive with the many other local physicians who offer the same procedures.  I definitely do not price cut to keep the volume or attract new patients, and I believe I price fairly taking into consideration both my training and experience with typical pricing in my area by "mainstream" cosmetic providers.

I continue to strive to offer the least painful experience for my patients and have tried multiple different methods to decrease the degree of injection discomfort for my patients.  From topical anesthetics, icing, slow injection delivery, and currently vibration-distraction techniques, I have yet to find the WOW approach. I do use lidocaine-treated fillers and believe that these have advanced our patients' injection experience to an appreciable degree.

My intent for this entry is to stimulate a healthy community discussion on what methods the readers have found useful and reliable for neurotoxin injections (to keep this discussion focused I am not encouraging discourse on filler injections but perhaps this can be a future topic of discussion), in addition to disregarding any approach that they have found particularly not beneficial.  We all want to make our injections as easy as possible for our patients, so I am hopeful that this topic can generate healthy dialogue!