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The ugly side of medical tourism

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For surgeon Dr Nicholas Moncrieff and his colleagues at Hunter Plastic Surgery, the sight of women disfigured by botched cosmetic operations overseas is a distressingly common one.

Almost every week the clinic, based in Charleston, just outside Newcastle, gets a new patient upset with the results of sub-standard procedures that have left them with collapsed noses, scarred faces, misaligned breasts and nipples or skewed belly buttons.

Among recent cases was a 40-year-old woman who went to Thailand for cosmetic surgery, including the insertion of a silicon implant in her nose to give it more projection.

It subsequently became badly infected and exposed, leaving her with a serious defect (see attached pictures).

Dr Moncrieff had to operate on her in hospital to remove foreign matter, repair the hole and use filler to fill the cavity.

The surgeon said the vast majority of such cases involved patients who had gone to Thailand for cosmetic surgery, lured by cheap prices.

In Thailand it typically costs around $4000 to $6000 to have breast augmentation surgery, compared with $11,000 at Hunter Plastic Surgery.

But Dr Moncrieff said people who chose where to have surgery based simply on price did not fully realise the sort of risks they were taking.

“I think it [plastic surgery] has been a little trivialised because it has become commonplace,” he said. “This is surgery, it is still an operation on your body, and people think it’s like a haircut.”

Often, cosmetic procedures performed overseas are much more radical than clinics like Hunter Plastic Surgery would undertake, such as inserting very large breast implants in women with small frames, leading to complications such as sore backs or infection because sutures are put under enormous strain.

Dr Moncrieff said any surgery, no matter where it was performed, carried with it the risk of complications, but when it was conducted overseas the burden for rectifying any mistakes fell on the Australian health system.

He said patients were often told by their Thai doctors that any complications could be addressed for free in Australia under Medicare, and public hospitals in his area regularly had to treat women who had become badly infected following cosmetic surgery performed overseas.

But he warned that this did not extend to rectifying elective cosmetic problems, such as facial scarring or nipples in the wrong place.

As an example, the woman who had to have her botched nose surgery repaired spent more than $3000 on the repair work – far more than it would have cost to have the procedure performed locally in the first place. She was able to claim back just $750 of the cost through Medicare.

Dr Moncrieff said it could cost up to $19,000 to repair botched breast augmentation procedures, a sum that was prohibitively expensive for many women who had had such work overseas in the first place because of price, and who usually had no private health cover.

He said in this instance, they often had to live with the disfigurement until they could save the money to have it repaired, either in Australia or in the country where the procedure was originally carried out.

Dr Moncrieff said his concern with the cosmetic tourism trade was not driven by self-interest – “we are plenty busy enough without having to fix these problems” – but by the burden it was placing on taxpayers and the health system.

“We think the Australian Government should be asking question about how complications will be managed [under the NIB scheme] once the patient is back in Australia and who will be paying for them, especially those treated for life-threatening illnesses in public hospitals” he said.

Adrian Rollins