7 Crucial Questions to Ask Before Booking Cosmetic Surgery Abroad

Preparation for a consultation in a foreign cosmetic surgery clinic is quite different from preparation for an appointment with your family doctor. After all, you need to assess the quality of the medical team that you may not be able to return to in case something goes wrong, the infrastructure of the facility and its accreditation status and the legal system which governs the actions of doctors there. The questions you ask are very important for your future health and safety.

International aesthetic procedures have seen tremendous growth in recent years, and that growth brings an immense variation in quality. There are clinics of a world-class level and then there are those which use the power of marketing to draw patients who haven't made proper checks on their own. So what separates a clinic with good outcomes from one with poor outcomes is usually whether or not you were cautious enough to ask the right questions to start with.

Here are seven of them.

What are your board certifications, and where can I verify them?

You should start off with this question first thing and make sure it gets answered without any delay. Board certification means that a surgeon received special training in his or her specialty and passed the corresponding examinations. Then, they get monitored by their peers on their further education and knowledge base to make sure they stay updated with the newest developments. But that certification system varies from country to country and some certifications might seem official but are not so in practice.

Ask specifically if the surgeon is a member of the International Society of Aesthetic Plastic Surgery (ISAPS). ISAPS is the only international society which requires board certification. In the US, there are ten different boards to get the certification from, ISAPS recognizes seven of them. Additionally, ask about the operating room privileges of the surgeon and medical malpractice coverage (hopefully they have it). The latter may sound unusual but in countries which practice socialized medicine, you sometimes have to pay separately for non-covered procedures and related supplies. A legitimate specialist will not be offended by your request to confirm his credentials.

How many times have you performed this exact procedure on patients with my anatomy?

performed is more important. That is like the difference between knowing how to change a tire and knowing how to do it on your specific car. Most surgeons try to avoid admitting their inability to do a particular procedure and that is why it is crucial to ask them questions which help clarify the limits of their experience.

Ask to show you a portfolio of the pictures of patients who had undergone this procedure before. Pictures taken four to six weeks post-op reflect swelling and not the result. Pictures taken six to twelve months after surgery are the ones which really show how the tissue settled in place. If a surgeon cannot show you such pictures, that speaks volumes. Ask whether any of his patients had the same anatomy as yours. If you want to have your surgery done in South Korea, ask whether the surgeon has worked on patients with a facial structure similar to yours and what adjustments they made for individual anatomy. Experienced surgeons will be able to answer such questions directly and others may give vague statements.

Who administers the anesthesia and where exactly is the surgery conducted?

This point is often overlooked, yet anesthesia is involved in many surgical complications. Ask whether a certified anesthesiologist will be supervising the procedure. In some countries, there is an immense difference in the training of certified anesthesiologists and nurse anesthetists (in other words, non-physician anesthesiologists).

Also ask whether the procedure is going to be conducted in the in-house operating room of the clinic or in the hospital. The difference between those two can be life-saving in case of any complication arising mid-procedure.

This point also provides an opening to ask about the clinic accreditation. JCI accreditation is an international certification that indicates a facility meets standards similar to those of hospitals in the USA in terms of infection control, equipment maintenance, staffing ratio and emergency protocols. If the clinic is JCI-accredited, they will tell you. Otherwise, ask about the certification which they do have.

What does the pre-operative and post-operative timeline look like?

Many patients underestimate the length of this timeline, yet the preparation for the cosmetic surgery consultation abroad includes realization that the procedure itself is only one stage of medical treatment and shortcuts at either end are dangerous.

Reputable international clinics demand that their patients come for surgery several days before it takes place, so that they can be evaluated prior to the procedure. At minimum, that evaluation includes the blood work and EKG. The results of those have to be checked by a professional to make sure that you are a good candidate for anesthesia. That is a safety measure, not simply extra hotel days.

Similarly, ask about the number of days you should wait before flying after the procedure. The known danger associated with most of the procedures is development of post-surgical deep vein thrombosis (DVT). Flying is one of the most risky activities after surgery as the long distance flights are the leading cause of DVT (blood clotting condition which is exacerbated by immobility and cabin pressure). If your clinic pushes you to get on the flight three days after breast augmentation, consider their priorities carefully.

Finally, ask about the availability of any of the advanced recovery modalities. For instance, some clinics provide hyperbaric oxygen therapy. It is not necessarily a must-have but the availability of such services may indicate the clinic's level of patient support.

What is the true all-inclusive cost, and what is the revision policy?

What is presented on the website as the surgical fee rarely equals the total cost. You have a right to know the full range of expenses you may face. Ask for an itemized list of all your expenses which will include such things as pre-op blood tests, anesthesiologist fee (or the fee of the operating room), cost of drugs post-op, post-op compression garments (and how many of them), additional visits and extra accommodations if needed.

Also, ask about less obvious things which often turn out to be a surprise for the patients: airport transfers, interpreter services, extra accommodation if needed because of unexpected delays, airport transfer for any necessary post-op treatment and the cost of additional procedures (if you have a complication).

The revision policy is another thing you have to discuss before going ahead. There is a percentage of cases where a revision is needed no matter how professional your surgeon is. In this case, you have a right to know what the cost of this revision will be. Will you have access to your patient coordinator, room and board and other amenities of the clinic if your revision is a responsibility of your surgeon? Is it covered in the initial price? If it is, are there any other terms to this clause (that they cover the procedure but the facility fee is not included)? Is the follow-up care solely your financial responsibility, or do they completely stop providing assistance once you leave the country?

What happens if there is a medical emergency during or after my procedure?

Sometimes direct questions work best and can reveal the clinic's approach. For example, you can ask such questions as: what is the protocol if you go into cardiac arrest during the outpatient procedure? What hospital do they have a formal transfer agreement with? How quickly can you be transferred there? Do they even have an ICU?

Clinics such as Banobagi (บาโนบากิ), a multi-specialty cosmetic surgery hospital in South Korea with international patient programs, should be able to provide this kind of information. They will be able to provide you with their accreditation documents, hospital affiliations and information about the recovery room staffing as those are important for your pre-operative planning.

That is how you can distinguish a well-prepared clinic from one that does not have such a patient management system.

How will we communicate after I return home?

Your relationship with the clinic doesn't end the day you leave. Complications, healing irregularities and other concerns can arise after the in-country recovery window is over. That is why you have to find out what happens if you contact the clinic after you return to your home country.

Ask whether the clinic has a dedicated aftercare coordinator, what kinds of post-discharge consultations (virtual or otherwise) are available and how quickly they will respond if you have any questions. Whether the consultation will be in your language matters too, as a language barrier in the post-operative period is inconvenient and can be dangerous for your health.

Also ask how the clinic wants your concerns to be managed with your local physician. A well-run international clinic will provide you with the full set of discharge documentation: surgical notes, list of medications and instructions on wound care which will allow any local physician to understand what was done. If the clinic cannot describe this process, that indicates some flaws in the clinic's patient safety model.

Before you leave your home country

One of the steps of your preparation which is usually omitted is the conversation with your primary care physician prior to your departure. Oftentimes the pre-op tests required by the overseas facilities can be done in your home country and can help reduce the chance that your procedure is cancelled because of an unexpected test result. Have that conversation with your physician as early as possible. Inform your physician about the procedure, your medications and other health related information.