The Real Cost of a Facelift in Brazil
By Dr. Scott W. Mosser
Recently a colleague referred to me a new patient, a successful San Francisco professional woman in her late forties who had combined a vacation in Rio de Janeiro with a facelift. She was now suffering from some minor complications and some major regrets.
Within a few weeks and after a minor corrective procedure this patient was back on the path to recovery and greatly relieved. During her initial and follow-up visits to my office she related to me some of her experiences during her trip that I thought should be passed along to anyone contemplating plastic surgery outside of the US.
Her complications were due to misunderstanding post-operative instructions, combined with unsuccessful attempts to contact the Brazilian surgeon who performed the facelift, and a delay in consulting her family doctor out of embarrassment. If she had waited longer her complications could have resulted in permanent disfigurement. She was lucky her family physician recognized the seriousness of her problem and sent her to me immediately.
What clearly had seemed like a good idea at the time turned out to be a stressful and costly medical misadventure…not to mention a spoiled holiday.
Let’s Find Out For Ourselves
The advertisements for plastic surgery procedures in Brazil are enticing. The price quoted for a procedure can often be half the usual price in the US. Many Brazilian plastic surgeons enjoy international reputations which are well-deserved. That, plus the lure of sandy beaches, a secluded private clinic and luxury accommodations can be very convincing. But what is the real cost?
I asked a friend of mine to check out the real cost of a facelift or breast augmentation in a well-known clinic near Rio de Janiero, Brazil, at the highly advertised price of US$1,900. Here’s what she reported:
Additional costs to be considered in addition to the surgeon's fee of $1,900:
- Insurance in case of emergency
Airfare to Rio: $2,468
Based on round-trip tourist class for two. The price is an average of rates quoted from five cities in the US to Rio - Chicago, Seattle, St Louis, NY and Miami (NY lowest at $1,885, Seattle highest at $2,900) – for two weeks in June. Average flight time is 14 hours each way.
Hotel accommodation for two weeks: $1,800
Cost is based on a double room in a 2 ½-star hotel when booked together with the flight. The average was $1800 when booked through Expedia. Rates quoted when booked from the largest cities (with high-volume routes) was lower - $1574 - but the Seattle patient would pay $2613 for the identical hotel.
Taxis/other transportation: $200
Taxi from the Rio airport to either Copacabana or Ipanema averages US$25 each way based on current Real/$ exchange. Conservative estimate is $200 for surgery related travel – preop, day of surgery, postop, and shopping.
Estimated $100 a day per person in moderately priced restaurants for 14 days.
Incidental expenses: $350
Estimated $25/day for bottled water, soft drinks, fresh fruit from the street market to have around the hotel room, movie rentals, mini bar, laundry, tips for the bellhops and hotel staff, during the 14-day stay.
Travel Health Insurance: $50 plus a risk of thousands of dollars…
Travel insurance runs about $1.50-1.80/person/day, and nobody travels abroad for any reason without it. However, no travel insurance firm she could find would cover any medical emergency arising as a result of an elective plastic surgery procedure at any price. This means that traveling outside the US for elective plastic surgery puts the patient at a definite risk for out-of-pocket costs if a complication occurs.
So, what about your existing US-based health insurance coverage? Will your policy cover a complication created as a result of an elective procedure performed outside US borders? According to my friend’s survey, “maybe they will and maybe they won't”. And even if the insurance company does cover it, coverage is generally limited to "life-threatening" emergencies (i.e., they won't let you die in Rio). The patient would pay out of pocket first, and negotiate with their US-based insurance company after returning to the US.
Total cost (with no complications): $9,568
Keep in mind these are based on lowest air fares and modest hotel, food, and transportation with no frills. And remember, these are just Rio estimates. If you want a breast augmentation in Phuket, Thailand, it's US$3000. And the airfare will run around $3000 for two, plus hotel and all the above items.
The Money Factor: How Does This Compare to a Local Facelift or Breast Augmentation?
Is this estimate cheaper than the US? Certainly not for a breast augmentation. Perhaps…depending on where you live in the US…for a facelift (see http://www.drmosser.com/financing for San Francisco plastic surgery fees).
Of course with the foreign option, you get a vacation thrown in…assuming you feel up to it. In most cases, however, enjoying the usual tourist activities of sun and fun is a very optimistic assumption for a post-operative plastic surgery patient. No matter how well the surgery went you won’t feel like running around the first 10 days afterwards. And I'm quite certain that a 14+ hour airplane trip won’t add to a comfortable recovery either.
The Risk Factor: The Cost That Doesn’t Have a Price
Some very important factors to be considered regardless of cost:
- Choosing your plastic surgeon
- Your immediate support team
- Your post-operative support team
Choosing a surgeon: Plastic surgery clinics are regulated by local, physician-run medical societies and licensing agencies. When interviewed following the deaths in 2005 of two US citizens as a result of complications following plastic surgery in Brazil, and questioned about the role of the government in taking responsibility, Brazil's Health Minister Jose Gomes Temporao was quoted as saying, “I'm more worried about taking care of our Brazilian patients in our public health system. The day we are able to provide very good care to all Brazilians, then we may be able to take care of foreigners.”
Of course there are excellent plastic surgeons in Brazil, as well in most parts of the world. But why make it so much more difficult to find the surgeon who is right for you and has the credentials, expertise, and experience suited to the surgical procedure you seek?
In the US, checking the educational background, certification, experience, and expertise of plastic surgeons is a simple matter of scheduling a consultation or checking references or referrals.
Sitting in your surgeon’s office discussing your options and viewing results of previous surgeries, knowing that he has made a full physical examination and has a knowledge of your medical history offers a peace of mind that you could never obtain from checking into a foreign clinic following a 14-hour flight to undergo surgery the next day which you’ve already paid for.
US agencies such as the American Medical Association, the American Board of Plastic Surgeons, and US FDA, set and regulate US medical standards and procedures, including anesthetics, cosmetic materials, and prescription drugs. Local, state and federal health departments dictate hygiene and facility standards that you can rely on.
Your immediate support team: Choosing a qualified surgeon is just the first step. Knowing where the surgery will take place and what back-up medical facilities are on hand in case of complications is just as important. As in any sort of surgery, there is a statistical risk of unforeseen complications occurring, and knowing that reliable hospital services and local medical backup is readily available is just good sense.
Problems are rare, but tragedies usually happen when clinics aren't equipped to deal with post-surgical complications. When you choose to have surgery done in a foreign city you are risking not only an unfamiliar surgeon and his clinic but also the local emergency and hospital facilities.
Most people would take a companion along for moral support on a vacation/plastic surgery trip, but unless that person speaks the local language, has medical training or prior experience, and knowledge of the local facilities and customs, he or she will not be of much help in an emergency or complication following surgery.
In the US, even if you choose to keep your surgery confidential, knowing that you have family and friends close by to call upon in case of complications is a wise precaution. In your own country you are in familiar surroundings in the event you would require emergency, medical, insurance, or legal help.
Your post-operative support team: Even if you’ve made it successfully through a foreign surgery, weathered the return flight, the jet lag, and the climate change, you are still in need of post-operative support. How many can afford a trip back to Rio for a 3-month or 6-month check up? Knowing that you are only a phone call or visit away from the surgeon who knows you personally and performed your surgery is a crucial part of your successful recovery, and a very important consideration.
Communications: I think anyone who has ever had an accident or an illness while on holiday in a foreign country that required a doctor’s visit or hospitalization will recognize that feeling of helplessness in the face of an unfamiliar language, local bureaucracy, unfamiliar medical procedures and customs, not to mention insurance red tape.
It Seemed Like a Good Idea at the Time…
The Tourist Ministries of Brazil, Thailand, and several other popular holiday destinations have invested many millions of dollars into promoting “plastic surgery vacations” that combine tropical surroundings and tourist accommodations with plastic surgery. It may sound like a good idea, but from a strictly medical point of view you may be taking an unnecessary risk.
If you wouldn’t have your gall bladder or your tonsils removed in Brazil or Thailand, why does having a breast augmentation or facelift seem like such a good idea?
In order to give yourself the best possible chance for a successful outcome, any surgical procedure you contemplate should be undertaken in safe, comfortable, familiar surroundings with as many stress-free conditions as you can plan for in advance.
My new patient, the San Francisco businesswoman one who started me thinking about the hazards of foreign plastic surgery, agrees with me wholeheartedly. Now she’s contemplating some Botox Cosmetic therapy. But there’s no rush…and my staff and I will be here in San Francisco at her service whenever it’s most comfortable for her.
Copyright © 2008 by Dr. Scott W. Mosser. This article may not be copied or reproduced in any form without the written permission of Dr. Scott Mosser. Internet links to the www.drmosser.com sub-page containing this article are permitted.