Medical Tourism and Budget Brazilian Butt Lifts: A High Cost to US Healthcare Systems and a Danger to Patients
Marallo, Michael MD; Staudinger-Knoll, Ann BS; Rubin, J. Peter MD
Plastic and Reconstructive Surgery-11(4):p e4913, April 2023.

In 2017, Adabi et al published one of the first studies to examine the complications, management, and medical system cost of medical tourism with a relatively large patient cohort (n = 42). The most common complication was infection, followed by abscess and wound dehiscence. Of the 20 patients requiring hospitalization, over half underwent a surgical procedure for treatment. Cost is the most frequently reported consideration for medical tourism, but the cost of associated complications often far surpasses that of the primary procedure. Average reported cost for treatment of cosmetic surgery complications in the United States ranges from $15,000 to $40,000.This burden often does not fall on the patient, but on insurance companies, hospitals, and public health programs.

To avoid the dangers associated with obtaining cosmetic surgery abroad, patients may elect to have their procedures done at budget clinics in the United States, where low costs are balanced by the high volume of procedures performed by personnel who are, at times, not adequately trained to perform the procedure safely. Unfortunately, the risks of low-cost procedures are not limited to medical tourism alone; the incredibly high mortality rate of up to 1:3000 due to pulmonary fat emboli (PFE) after gluteal fat grafting, or Brazilian butt lift (BBL), performed in an unsafe manner (resulting in fat deposition deep to the muscle fascia) has become a widely acknowledged concern.

A review of fatal BBL PFE in South Florida from 2010 to 2022 demonstrated that 92% of deaths occurred at high-volume, budget clinics; two-thirds of these cases were performed by American Board of Plastic Surgery certified surgeons. There have been 14 deaths since 2018, with six fatal PFE cases and two nonfatal PFE cases in 2021 alone. Despite recent recommendations, enacted legislation, and patient education, patients continue to be harmed from cosmetic procedures performed both abroad and domestically.

In May of 2022, six patients presented to our institution for treatment of complications from BBLs that were performed abroad (Dominican Republic and Mexico) and in the United States (Florida). All patients were women, age range 20–49 years, and none had health insurance at the time of presentation to the emergency department. Four patients experienced postoperative infections, one leading to severe sepsis requiring surgical intervention. Imaging confirmed intramuscular injection of fat in two patients, one with PFE causing severe pneumonitis. There were no mortalities. All patients reported finances as the motivating factor for medical tourism.

The guidelines include procedures only being performed by surgeons with privileges in state-approved or licensed ambulatory surgical centers or hospitals; the use of real-time ultrasound during fat injection; establishing appropriate doctor–patient relationships; comprehensive pre- and postoperative care plans, including availability and direct care for complication management; and prioritizing patient safety and ethical business models over profits.