INTERNATIONAL JOURNAL OF AESTHETIC AND ANTI-AGEING MEDICINE

Nov/Dec 2011

Volume 1 ❙ Issue 6

No

v/Dec 20

11 ❙ Vo

lum

e 1 ❙ Issue 6

prim

e-jou

rnal.co

mIN

TE

RN

AT

ION

AL

JOU

RN

AL

OF

AE

STH

ET

IC A

ND

AN

TI-A

GE

ING

ME

DIC

INE

Facial Aesthetics ❚ Sleep Disorders ❚ Treating Acne ❚ Prime People ❚ Industry News

VOLUME RESTORATION

coNseNsus recommeNDatIoNs

PRPaN objectIVe

eValuatIoN

HyALURONIC ACID

safety aND effIcacy

stressreduction

Novel approaches to

Sample

Batch PDF Merger

ANALYSIS | medical tourism |

12

❚ November/December 2011 | prime-journal.com

Ashley yeo, Principal Analyst, Informa Business Information

email ashley.yeo@informa.com

MedIcAL tourISM —travelling away from local medical specialists, usually to a foreign destination, to take

advantage of surgical procedures not readily accessible at home — is growing in importance. It is not a new concept by any means, but it has taken on a growing significance in the last 5 years as patients’ knowledge of global healthcare systems and of services available beyond their national borders has improved.

this affects cosmetic surgery too. But whereas surgeon and/or procedure quality, or even availability, is generally the driver for medical tourism — as well as cost in certain cases — for aesthetic surgery, cost is the main consideration. in addition, some patients are lured by access to surgery denied them by their domestic health service on health grounds.

in the past, medical tourism has suffered negative connotations, and still does in some circles. it has more often than not been associated with poor quality of care, lack of follow-up and potential costs to the national health provider in the patient’s country of origin.

industry associations such as the london-based British association of

aesthetic Plastic surgeons (BaaPs) are sceptical about such businesses, which they see as offering a cheap but risky option for patients seeking such elective procedures. they highlight the dangers of individuals using untrained or unspecialised surgeons, against the sound advice of professionals. (a recent high-profile episode, in February 2011, involved a British woman who died after travelling overseas for buttock enhancement.)

in some cases, the established industry feels that warnings are necessary, as in the case of the controversial PiP (Poly implant Prosthesis) breast implants (now off the market), which were being sold under a different name in some of the most popular cosmetic surgery tourism destinations around europe, and regularly visited by patients seeking low-cost procedures.

Safety: the key issueindeed, for prospective patients, the draw of lower-priced surgery can be powerful, hence the inexorable rise in the popularity of cosmetic surgery tourism. Furthermore, the latter is becoming more accepted as an option as local practitioners increasingly recognise the value and, crucially, safety, of cosmetic surgery procedures accessed abroad.

rising standards in medical tourism:

threat or opportunity?

Medical tourism often incites polarised views — defensive attitudes among established professionals whose services are being eschewed versus enthusiastic endorsement from users who have found a less expensive way of accessing cosmetic surgery. Will these two ends of the industry ever meet

in the middle? Ashley Yeo investigates

| medical tourism | ANALYSIS

prime-journal.com | November/December 2011

❚ 13

the trend for potential uK patients to look to surgeons overseas may disappoint local practitioners, but it is a function of a free market. 'i wish the uK market was a bit broader, and was able to decrease its hefty prices,' says dr mcKeever. While that remains the case, her advice is that prospective patients looking overseas check that they are dealing with an ethical company. the BaaPs’ advice is to spend time choosing the surgeon. While this is accepted practice in the us, the average patient invests little time in this process, says BaaPs president Fazel Fateh.

the trend for potential uK patients to look to surgeons overseas may disappoint local practitioners, but it is a function of a free market.

dr Geraldine mcKeever, a specialist trained in general surgery, is among this group. after 22 years as an NHs GP, during 16 of which she also specialised in acupuncture, she left in 2004 to set up a business in cosmetic medicine, in Kent, uK. Her clinic, step Back cosmetic medicine, run jointly with dr chris davies, prides itself on high cosmetic surgery standards and aftercare across a wide range of procedures.

speaking to PRIME, dr mcKeever said that for certain surgical cosmetic procedures she is unable to undertake (e.g. sun-damaged skin), she recommends local plastic surgeons that she has done business with. However, patients often return to her from a consultation with the local surgeons saying they cannot afford their prices.

cheaper surgery is offered in parts of europe, and dr mcKeever has been approached by surgeons in Poland and the czech republic, which offered to work with her if she referred patients to them. on a visit to inspect the former’s business, however, she found that standards were not as high as had been claimed.

Better pressthe other end of the spectrum — and part of the reason why cosmetic surgery tourism is seemingly getting a better press of late — are the businesses that guarantee standards of care. the 1-year-old secret surgery is an example. the business is run by angela chouaib, who was a plastic surgery patient herself and decided to set up her own company when she saw gaps in the market for enhanced levels of care for patients.

dr mcKeever plans to visit the facility used by secret surgery, the emc instytut medyczny unit, in Wroclaw, Poland, to inspect the standards of surgery in theatre and postoperative care. she has an open mind but told PRIME that she remains to be convinced about the ability to access high quality surgery at prices 5–6 times lower than that in the uK. the company’s growing list of patient testimonials bears witness to a satisfied customer base, however.

the company complies with us anaesthesiology standards to distinguish healthy and unwell patients, and asks practitioners, such as dr mcKeever, to do a preoperative check involving respiratory, cardiovascular and kidney function. if, after the patient returns home, there are complications, the company has sought to set up arrangements whereby dr mcKeever and others can offer postoperative care for minor complications on a private basis.

ANALYSIS | medical tourism |

14

❚ November/December 2011 | prime-journal.com

But cosmetic surgery traffic is increasingly moving outside the uK. dr mcKeever says that nowadays approximately half of her consultations result in patients eventually going abroad for surgery. 'only 4–5 years ago, i would have never seen a patient go abroad,' she says.

she endorses the BaaPs’ exhortations for patients to check that their chosen surgeon has received advanced training, but also observes that overseas surgeons can do most procedures that uK-based surgeons offer. she recommends that patients remain in the eu, and stresses that they should check what is available in terms of before and after care.

ms chouaib’s secret surgery company has recognised the need for and value of such an approach. Her business operates a service for females that essentially comprises a consultation in Harley street, london, and the surgery done in Poland, with a fully female team including a female anaesthetist.

every patient is different, and catering for individuals’ preferences is vital. they must be offered all options and be able to feel relaxed and confident about what is going on, including asking questions. Giving over control, or at least joint decision-making, is part of the reason why practices today become commercially successful.

For certain surgeries, overseas travel packages can be several thousand pounds cheaper than equivalent procedures offered in the uK. that has been the experience of ms chouaib, who offers solutions for patients who do not feel accommodated by local practitioners.

the established operators see such businesses as a competitive threat, which potentially remove part of their client base. But others see it as an opportunity. For instance, secret surgery began in November 2010 when ms chouaib crystallised what was initially a hobby into a business. Her website-based company seeks to facilitate surgery overseas by making all the arrangements, interacting with surgeons and helping with the predictable language barriers for prospective cosmetic surgery patients.

Patient care 'Patients need large amounts of support and mentoring. You need to feel able to talk through your concerns — including moral concerns,' says ms chouaib. this can happen both during the consultation and at the hospital in Wroclaw. the unit offers a full range of plastic and cosmetic surgeries, including hair transplants, as well as services such as obesity surgery.

the focus is customer service and price. 'a lot of people cannot afford uK prices. a 3-night hospital stay for a tummy tuck in Poland costs £2800 with secret surgery, against £8500 at comparable uK prices,' says ms chouaib.

demand is apparent from the 180 000 hits that her website received in the November 2010–January 2011 post-launch period.

With a view to tailoring the package to the customer, secret surgery also addresses niche markets, such as the 'Pink Pound' market, for gay consumers; the 'Yummy mummy' market, for mothers with children who cannot depart in term time but who can build, say, a tummy tuck and a breast lift into a 14-night family holiday in Poland during the summer months for

£6000 (against a £10 500–12 000 equivalent price in the uK); and the early retirees market — the 50–60-year-olds who may have higher levels of disposable income.

there may, of course, be cultural issues as well as personal preferences. While these are taken seriously, the extent to which they are not met to

the client’s satisfaction has fuelled the growing trend of niche operators offering medical tourism cosmetic surgery packages.

ms chouaib’s business also caters for muslim customers, who may have special cultural or religious reasons for wanting to keep their surgery low profile.

reconstructive plastic surgery is accepted under islam, but cosmetic surgery is frowned on, so it is something of a delicate matter. these clients can choose secret surgery’s tunisian destination. the company is unique in the uK for offering the service to muslims.

Educating the market'What we are doing is educating people, giving them all the information and making sure they’ve made the right choice. We give them confidence,' she says. 'We’ve shaken up attitudes. our customers are not being ‘sold to’. it’s the little things that make the difference — this is not just a financial transaction.'

such businesses are successfully exploiting a niche that is growing all the time. eventually, market forces will inevitably result in some equalisation of prices, but for the present, cosmetic surgery tourism businesses that offer high-quality surgery overseas and aftercare in their home country, with packages tailored to the patient’s needs, are both innovating and disrupting the market.

every patient is different, and catering for

individuals’ preferences is vital. they must be offered all

options and be able to feel relaxed and confident about

what is going on, including asking questions.