SUN, SEA, SAND AND SILICONE
Mapping Cosmetic Surgery Tourism
KEY FINDINGS
Patients are ordinary people on modest incomes
They tend to spend as little time away from home and family as is possible/recommended by their surgeon
because want to get home to families/ friends.
Cosmetic surgery pathways often follow cheap flights
Clinics are often located at tourist resorts.
Different patients have surgery for different reasons
Patients don’t make snap decisions
Most of our patients have considered their surgery for 5-10 years before they decide to have it. Once they have
made the decision they want surgery as quickly as possible to minimise the time spent dwelling on the risks.
Patients lack knowledge of the places they travel to
Patients are mostly not well-travelled and have limited foreign language skills.
Patients experience positive outcomes
All but two patients in our study were happy with the outcomes of their surgeries.
Agents are ‘brokers’ between surgeons and patients
Cosmetic surgery tourism agents play a key role in patient experiences of place and surgery and in ‘managing
patient expectations’.
Surgeons are mobile
In addition to surgeons who are based in the destination country, many surgeons travel.
Cosmetic surgery and the NHS/Medicare
16.5% of our patients experienced complications from their surgeries. 8.7% received further treatment in the
NHS or Medicare upon returning home. Most needed stitches replacing/ removing, infections treating with
antibiotics, or seromas draining.
Private surgeons
Surgeons in home countries were characterised as aloof, uncaring and seeing patients as ‘walking cheque books’.
Our Study
Who are the patients?
The first international, multi-disciplinary, multi-site research into
cosmetic surgery tourism
Unlike their representation in much of the academic literature on
medical tourism, our patients were not international ‘jet-setters’.
Our patients were ‘ordinary people’ – administrators, nurses, care
workers, hotel porters, hairdressers, beauticians, students, police
officers, teachers.
Research methods included participant observation, semistructured interviews, photo and video diaries and an online
questionnaire.
Only three in our sample worked in the entertainment industry
and very few mentioned glamour or celebrity as a motivation for
their surgeries.
Types
Number of
interviews
Agents
29
Australia (7), Korea (8), Malaysia (6),
Spain (2), Thailand (1), UK (5)
Most patients simply wanted to look ‘normal’.
British patients
43
Destination
“I didn’t want to be massive, I was something like a 36A and I’m
a 36 small D now, so I’m not like Jordan or anything like that, I
just wanted to be normal, what I would call normal, and I feel a
lot better in my clothes and a lot better in myself”.
Male
Female
Belgium
0
7
Czech Republic
1
0
India
0
1
Poland
4
16
Spain
5
4
Tunisia
0
5
Chinese patients
24
South Korea
4
20
Australian patients
36
Malaysia
0
9
Thailand
1
26
Surgeons
36
Australia (2), Belgium (3), Korea (8),
Malaysia (2), Singapore (1), Poland (6)
Spain (5), Thailand (8), Tunisia (1
Other workers
45
Patient Co-ordinator
5
Marketing staff
11
Others
(Driver, Hospital
owner, Hotel
manager,
Independent advisor,
Interpreter, Lawyer,
Nurse)
29
Why Travel
“I didn’t want them ultra high the really fake look like Victoria
Beckham; like two high up circles. [I just wanted] ‘moderate’,
which is just kind of the average, the standard one, so I thought
sg̀s"hr"“md “Yes I have still got some lines so that when I am out and my
granddaughter is calling me ‘Nan’. I am not going to have
people thinking ‘freak show’ because I didn’t want to do that,
I don’t want to look younger than my daughter. So yes, I am
very pleased with the surgery and I went there for cost effective
surgery didn’t I?”
9% of our interviewees had a higher education qualification.
Chinese patients paid for their surgeries from savings. UK and
Australian patients were more likely to use credit.
When asked what they might otherwise have spent the money on,
most common answers included home improvements or holidays.
Types of Surgery
”I don’t know because I’ve always wanted to go to Thailand and
then when I knew that you could have boobs there, bingo, there
was my opportunity. I think it was mainly because I’d always seen
brochures on Thailand and I’d liked it so I think that was the
main reason why.”
For UK and Australian patients cost was the biggest factor
influencing decisions to travel abroad.
A ‘Tummy Tuck’ in Poland (including travel and accommodation)
is £3,000. The same operation is £6,000 in the UK.
Average cost of Breast Augmentation in Australia is $12,000
compared with $4,000 in Thailand.
Surgical quality and technique (not cost) was primary driver for
Chinese patients travelling to South Korea.
UK and Chinese patients stayed in their destinations for the
shortest time possible to minimise costs (5-7 days average).
Australian patients were more likely to combine surgery with a
holiday and to stay longer in their destination country (10-15
days average).
Among our tourists were expatriates, local cross-border travellers
and migrants returning ‘home’ for treatments.
4 different Motives
Correction – young people having ear pinning, nose reshaping.
Investment – cosmetic surgery adds ‘value’ and ‘visibility’ to
bodies without financial or educational capital.
Repair – post-pregnancy, post weight-loss, sporting injuries.
Anti-aging – facelifts, hair transplants.
What does the industry look like?
Where did our patients travel to?
Destinations from UK
All of our Australian patients travelled to Thailand or Singapore.
Our Chinese patients travelled to South Korea.
How do patients choose their destinations?
“It’s not about Poland. It’s not about tourism. To me it’s about
getting a good result from my surgery, and I would have gone
anywhere for that. So it wasn’t a holiday. I didn’t view it as a
holiday. I didn’t base the decision on where the operation was.
I based my decision on the reviews I’d seen, the patients I’d
seen, the comments I’d seen, the results I’d seen. That was my
decision; not that it was Poland. I couldn’t care less that it was
Poland. It wouldn’t have matter to me if it was Africa.”
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Bumrungrad in Thailand) to small clinics occupying one floor
of a tower block with two recovery beds (the most usual model
in South Korea).
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contract. Other hospitals rented space to different medical
teams who leased them just for a few days each month.
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tourists’ travelling abroad to conduct surgeries and
consultations.
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to arrange their trip.
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journey, now running single-person businesses from their own
homes.
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co-ordinators, drivers, translators, hotel managers – to provide
a package.
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commercial aspects of the industry remote from surgeons.
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specific destinations.
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on surgeries, destinations, surgeons’ qualification and patient
testimonies.
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quality of care and hygiene.
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mutual support and group travel for patients.
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– sometimes giving rise to conflicting understandings of their
purpose.
“I don’t know because I’ve always wanted to go to Thailand and
then when I knew that you could have boobs there, bingo, there
was my opportunity. I think it was mainly because I’d always
seen brochures on Thailand and I’d liked it so I think that was
the main reason why.”
All of our patients put the quality of the surgeon as their primary
reason for choosing a specific destination. The reputation of
surgeons was judged mostly by personal recommendation,
although Australian patients were more likely to consider
surgical qualifications. The clinic and destination country was of
secondary importance, though Australia to Thailand was a very
well established path.
Issues for patients
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wrong.
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healthcare and consumerism.
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to patient – it becomes a ‘patient choice’.
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destination and local context.
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from the surgeon.
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that emerge through the process of having surgery.
“
I hadn’t slept the whole time I was there, I only slept one night, because of the morphine and because of
the anaesthetic and I was hallucinating as well and I was so uptight and paranoid about the cleanliness
and because I was so hungry, all I thought was, ‘oh my god… if I don’t die of starvation in Tunisia I am
going to die of an infection’, and to me I really, really was. And then it was so noisy at night, because
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maybe they don’t know that at night you can hear them screaming in pain. Plus, just outside my window
I thought, because I was probably hallucinating, I thought that there were dogs trying to get in to my
room, because all I could hear was [does a tapping/scratching sound] constantly and all I could hear
was what sounded to me like a pack of wolves, a pack of dogs catching its kill and the kill screaming
all night long. But it wasn’t, what it was was a dog had had puppies and the dog was off hunting and it
was the puppies crying, but I didn’t know that. So a combination of things that are; I didn’t eat, I didn’t
sleep, I had one eye open every minute, I had had a lot of drugs, I had had a lot of surgery... but I would
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“
Principal Investigator: Ruth Holliday
Co-Investigators: David Bell, Meredith Jones, Elspeth Probyn and Jacqueline Sanchez Taylor
Research Assistants: Olive Cheung, Ji Hyun Cho, Kate Hardy, Emily Hunter and Hannah Lewis
Additional Interviewers: Almudena Casas and Marcela Kościańczuk
For further information see:
www.ssss.leeds.ac.uk
For all enquiries please contact:
Email: ssss@leeds.ac.uk
Tel: +44 (0)113 3433770
Leeds, United Kingdom
LS2 9JT
Tel. 0113 243 1751
www.leeds.ac.uk
Ruth Holliday
Meredith Jones