Beauty Series #5: Travel Beauty

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. Today's episode is another in our beauty series. The title of today's episode is Travel Beauty. Tell us about the focus in this episode, Dr. Bass.

Dr. Lawrence Bass (00:29):
So this is about traveling to get surgery. There's been tremendous growth in this activity and not just in cosmetic plastic surgery. It's happening in other cosmetic treatments like dental implants and hair transplant, traveling for less expensive joint replacement and even coronary artery bypass surgery.

Summer Hardy (00:54):
Okay, but what are the motivations?

Dr. Lawrence Bass (00:57):
The main reason for traveling for surgery is trying to save money. Another big reason that's less common but understandable is to get a special option that's not locally available or in some cases is to get something that's not FDA approved in the United States but is available in another part of the world. Occasionally it's traveling somewhere to be treated by a particularly famous surgeon or some combination of those options. So some people will go to a smaller town and have the chairman or chairperson treat them in a less expensive city rather than going to a big metro area where just because of staff salaries and rent and the expense of running a practice in that area, the price is necessarily higher. And I have experience with this. People travel from out of town to visit me in New York City and receive surgery in my setting, and I have people come from all over the northeast, from certainly the Washington DC area, Florida, California, London. So people will travel to get surgery in New York City by someone who's particularly skillful in a particular procedure because then they feel like they're getting the best.

Summer Hardy (02:35):
All right. There are a lot of advantages, but there has to be a flip side. What are some of the disadvantages?

Dr. Lawrence Bass (02:41):
So certainly that's a reality of life, that everything has pluses and minuses so when you travel to a different place, it's harder to know what the qualifications are, the surgical skill, the knowledge and experience of the surgeon you're seeing. And in many cases, just because you're out of town, you have less contacts in a different place, even if it's another place in the United States. And it's harder to verify if you're in some place that's not the United States. In New York state where I practice, you can go online to the state licensing board and see that every surgeon has an active license. You can see if they've had disciplinary activity. You can go to the boards of the American Board of Plastic Surgery and you can see if the person was certified and has maintained their certification. All of these things are easy to find and when you're going to another part of the world that can be a challenge.

(03:51):
The regulations in a different countries also may be significantly different than what they are in the United States, and those regulations act as kind of a safety net for ensuring that minimum standards are being followed. So this varies tremendously in different parts of the world. We practice medicine a certain way in the United States, and there are many similarities to how medicine is practiced here with other parts of the world. But there are many standards of care that are different. And I'm not saying they're better or worse, but they're definitely different in other parts of the world. And oversight, the degree of government surveillance of what's going on in the medical system is very different in other parts of the world. And this is, again, all about safety, and safety is always number one. The American Society of Plastic Surgeons and the Aesthetic Society both have a commitment that all of their activities are first and foremost about a culture of patient safety because that has to be the first and foremost attribute to how care is delivered always, always. A number of other places, the malpractice systems work differently, and so the ability to have any kind of recourse if something doesn't work out the way you're expecting is different. And that creates different incentives also placed with active malpractice. Even though doctors are not fond of malpractice, they know that they're going to be held to account for what they do. And in places where that is not so active, they're still trying to do a good job, but they don't feel quite as much pressure to do a good job. So those are some of the disadvantages of traveling in particular to another part of the world to receive plastic surgery.

Summer Hardy (06:08):
That makes sense. Are there other concerns?

Dr. Lawrence Bass (06:11):
There are a few other administrative kind of factors. So if you're getting surgery in another part of the world, you traveled there, follow-up care is going to be more limited. You're going to stay there for a certain period of time after the surgery, and once you go home, it's harder to get follow-up care. This is a little easier now with all the telemed options. You can talk with your surgeon. The surgeon can take a look at you on video, but there's still no hands-on options once you're back home. And so if you needed a revision or you needed some kind of treatment because something healing slowly, the revision options are more limited and they're going to require you to travel back at your expense to the place where you received your care. Now, even if you go to another city in the United States, that's true. We have ways of dealing with that in my practice for our travel patients to come from other cities in the US or abroad. But it does make it a little more limited, a little more challenging, even with the best of intentions on all sides.

Summer Hardy (07:20):
Got it. That seems intrinsic to the travel approach. Is there anything else?

Dr. Lawrence Bass (07:25):
Now we get to the big safety issues. So even though plastic surgery is very safe, that's not an accident. It's the result of that culture of safety I was talking about in training and education and continuing education at the plastic surgery societies, the establishment of standards of care by the plastic surgery societies as well as government regulators and a lot of hard work behind the scenes by the highly trained and experienced people, the doctors and nurses and surgeons who deliver plastic surgery care. So this is not an accident that it's very safe. And as soon as all of those things don't happen, the safety profile may not be the same. And so there are a few big areas where this is potentially noticeably different. Infection control is a big issue. It's about cleanliness in the facility, but also most of the United States is a temperate zone, and that works to our advantage in terms of infection control, anesthesia safety is probably the biggest issue, and that's partly about who's giving the anesthesia.

(08:43):
In my practice, I have board certified anesthesiologists as the only individuals rendering anesthesia care. So these are MDs who have completed the residency and passed a board certification in anesthesiology that are watching the vital signs, administering the anesthetic meds, assessing the response to that making ensure the patient is safe and comfortable during the procedures. That is not the way anesthesia is delivered in many other parts of the world. Sometimes it's in the practice delivering the anesthesia. Sometimes it's some other kind of anesthesia provider who's not an MD or the surgeon is directing someone to give some of the anesthetic medicines or while they're also trying to concentrate on during the operation. The equipment that's required and the standards of using equipment in an anesthesia setting in the United States are very well defined, and that's made anesthesia extraordinarily safe, even though we worry a lot about anesthesia.

(09:52):
If you look at the statistics like clean travel, it's extraordinarily safer. Part of that is very good quality equipment and safety monitors that are watching the vital signs of patients and maintaining that equipment in accredited American operating rooms. That equipment is periodically inspected, tested, calibrated, and there's specific requirements on the scope of equipment that must be present. And that's all designed to ensure maximum patient safety. In other countries in the world, those requirements may differ sometimes quite substantially, and particularly in out of the hospital settings in clinics and surgery centers and office surgery, not in the United States. In most of the United States, accreditation is required in office surgery, plastic surgery. As a society, both the big plastic surgery societies have mandated accreditation for the last 20 years plus in office based surgery for sedated procedures, procedures where anesthesias given. So that's important because if you get some surgery when you travel, that maybe isn't quite what you hoped. It may be able to be revised, but if you have a devastating complication from anesthesia, someone can't fix that later. So those are the big safety issues that make us worry a little bit about travel, particularly outside the us.

Summer Hardy (11:36):
Okay. Thanks for covering all of that. Can you share your takeaways with us, Dr. Bass?

Dr. Lawrence Bass (11:42):
So to summarize and to backtrack a little bit, the United States has very detailed and extensive standards of care that people have spent decades training to understand how to produce and achieve, and that ensures as much predictability, as much safety as we can build into the process. It's hard when you're traveling because you don't have good local sources of information, and the internet is not really a good source. There's no fact checking on the internet. And most of what you're looking at in people's websites or in discussion on the internet, you don't know who's posting. You don't know what their motivation is. So it's very hard to know what's true and what's real. And even a testimonial from an acquaintance who sometimes isn't what you think may be highly deceptive. Travel surgery may be okay if there's some kind of oversight or accreditation like in the United States and one of the United States, accrediting bodies QUAD A, formerly American Association for the Accreditation of Ambulatory Surgical Facilities does have international accreditation. But whether they go on site and do as extensive an inspection as they do in the United States is hard to know. I don't know how they approach that process. So overall travel, particularly just to save money may really be a false economy and plastic surgery. Your safety is not the ideal place to look for a bargain.

Summer Hardy (13:33):
Thank you, Dr. Bass, for sharing this information about travel beauty. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.