High Volume Clinics Make Miami a Medical Tourism Hot Spot, but at What Cost?

Goals/Purpose: There have been substantial increases in cosmetic surgery demand and medial tourism since the start of the Coronavirus-19 pandemic in 2020. Miami is the largest medical tourism destination for cosmetic surgery in the United States, well-known for its high-volume budget clinics that offer reduced pricing and short wait times. There has been growing concern that patients do not receive the expected standard of care for preoperative assessment and postoperative management. We have seen an increase in the number of patients presenting to our local emergency departments with postoperative complications after cosmetic procedures in the community. The aim of this study is to determine whether the majority of these patients presenting to our institution receive surgery at one of the local budget clinics.

Methods/Technique: We conducted a retrospective review of cosmetic surgery patients presenting to the emergency departments at University of Miami Health System or Jackson Memorial Hospital between September 2020 and November 2022. Patients were identified from a prospectively maintained database of plastic surgery consults. Inclusion criteria required patients who have had a recent cosmetic surgery procedure in Miami. Chart review of these patients provided information on patient demographics, state of permanent address, procedures performed, final diagnosis, treatments initiated, as well as the name of surgical clinic and operating surgeon. Web-based searches determined the ownership of each clinic and the board certification status of the operating surgeon according to the American Board of Plastic Surgery (ABPS).

Results/Complications: Our prospectively managed database identified 58 patients that fit our inclusion criteria. All patients were female (100%) with an average age of 34 years (range 22-55). Patients traveled for surgery from nine different states, with most patients presenting from other counties within Florida (n=26). Forty-five percent of patients (n=26) had multiple cosmetic procedures completed at the time of operation. Most patients presented to our institution with complaints of pain, syncope or lightheadedness, and weakness (n=47). The greatest number of complications were related to gluteal fat grafting, known as “Brazilian Butt Lift” (BBL) (n=37), followed by breast augmentation or mastopexy (n=8). Anemia was the diagnosis in 40% of cases (n=23), while infection was diagnosed in six patients (10%). Hypotension or severe dehydration was diagnosed in seven patients (12%) and hypovolemic shock in two patients (3%). Forty patients received a total of 47 red blood cell transfusions throughout all visits. Emergency department visits resulted in surgery 22% of the time (n=13). Seventeen total cosmetic surgery clinics were identified by patients, of which 71% were budget clinics not owned by a board-certified plastic surgeon. Sixty-six percent of patients that reported a clinic name had surgery at one of the same four budget clinics (n=25). Of the 20 surgeon names provided by patients, 65% were board-certified plastic surgeons (n=13).

Conclusion: Miami is a hot spot for cosmetic surgery medical tourism. Majority of patients that presented with complications to our institutional emergency departments had surgery at a high-volume budget clinic that is not owned by a board-certified plastic surgeon. Anemia, hypovolemia, and infection were frequent diagnoses, suggesting a potential lack of presurgical patient optimization, intraoperative precautions, and/or postoperative follow-up and care. Practices of Miami budget clinics may pose a greater risk to patient safety than the standard of care provided at practices owned and operated by board-certified plastic surgeons. This may also have implications on the overall cost to our healthcare system.