Travelling to Another Country for an Aesthetic Treatment: Follow-Up, Flight Timing and Safety Questions

Why does having a procedure abroad change the risk?

The United States Centers for Disease Control and Prevention (CDC) states that travelling to another country to receive healthcare can be risky, and lists the main problems as follows: infections and antibiotic-resistant germs, licensing and inspection standards that vary from country to country, counterfeit or substandard medicines and devices, misunderstandings due to the language barrier, the risk of blood clots linked to flying after a procedure, and a break in the continuity of care.

These risks are not specific to any particular country; they arise from a person being far from their own health system, their language and their regular physician. The United Kingdom’s association of aesthetic plastic surgeons has likewise published separate guidance for its members, recognising that being treated in a different country carries additional risks in terms of travel before and after the procedure, follow-up and communication.

This article focuses mainly on injections, laser and similar non-surgical procedures. If you are planning surgery, the risks and the periods required increase markedly; the principles below apply but are not sufficient.

Questions you need to answer before deciding

The United Kingdom’s health service (the NHS) recommends being cautious about websites that offer a procedure together with a holiday, insisting on speaking to the physician rather than a salesperson, and not paying for a facility you have not seen and a physician you have not met. For the general principles on who is authorised to carry out treatments, see our article “Who Can Perform Medical Aesthetic Treatments? What You Need to Know as a Patient”. Because rules vary by country and are updated over time, you need to verify the current position in the country you are going to with that country’s health authority or with the facility that will perform the procedure. For assessing a facility and a physician, the questions in our article “A 10-Point Safety Checklist for Choosing a Clinic and Physician for Medical Aesthetics” can be used in any country.

Before you go: speak to your own physician

• The CDC recommends seeing your own physician or a travel health specialist at least 4–6 weeks before the journey.
• Prepare a written summary of your chronic conditions, medicines and allergies; if possible in a language understood in the country where the procedure will be carried out.
• Take enough of your medicines to last the whole journey, in their original boxes and with copies of the prescriptions. Do not stop any medicine on your own for the procedure.
• Before you go, decide which physician or facility you will turn to if there is a problem when you return to your country and, if possible, let that physician know of your plan.
• Find out in writing whether your insurance covers the procedure abroad, problems afterwards and, if necessary, medical repatriation.

We explain what to watch out for with medication and chronic conditions in our article “Medical Aesthetics for People on Medication or with Chronic Conditions: What to Watch Out For and What to Ask Your Physician”.

The plan for follow-up and complications

With aesthetic procedures, some problems appear not during the procedure but afterwards: signs of vascular occlusion after filler can appear within hours or days, infection within days, and late reactions weeks or months later. If you are in another country at that point, it becomes harder to reach the physician who knows which product was placed where, and to be examined face to face.

The UK association’s guidance lists the following principles for patients having surgery: the patient should be checked at least once by the physician who performed the procedure before returning home; should know how to reach the physician and the facility; follow-up by telephone or video consultation should be planned for after their return; and it should be explained to them in advance how to obtain emergency treatment in their own country and what to do about a problem requiring another specialty. Although these principles were written for operations, they are also a useful guide for non-surgical procedures.

• Ask for a face-to-face follow-up examination before you leave.
• Obtain in writing whom you can reach, by what means and in what language, out of hours and after you return.
• Find out with which symptoms you should call the physician, and with which you should go, without waiting, to an emergency department in the country you are in.
• Take photographs of the treatment area in the first days; they are useful for assessment at a distance.
• Remember that a remote consultation does not replace an examination; if you have a worrying symptom, see a physician near you.

How soon after the procedure can I fly?

For non-surgical aesthetic procedures there is no generally accepted, institutional answer to this question. The existing recommendations relate mainly to operations and are based on the risk of clots linked to sitting still for a long time.

There is a separate point for filler: an expert consensus report on facial injections notes that signs of vascular occlusion can also appear in the first days after the procedure, and therefore recommends avoiding filler just before a journey during which the dissolving enzyme (hyaluronidase) could not be accessed quickly. In other words, the problem is not so much the aircraft itself as being far from the physician who performed the procedure when symptoms begin.

Ask the physician who will perform the procedure how many days you need to stay for your own procedure, before the procedure and before you buy your return ticket. If the answer is 'you can fly the same day', also ask what you should do if a symptom occurs during or after the journey. Moving about often and drinking enough water during the flight are general recommendations; if your risk of clots is high, consult your own physician.

More than one procedure on the same day

Fitting a large number of procedures into a short trip may seem attractive. However, each additional procedure increases the overall risk, the burden of recovery and the difficulty of working out the cause if a problem arises. The association’s guidance places long operations on more than one area in the high-risk group requiring a longer stay and stricter precautions. With non-surgical procedures too, carrying out some treatments in the same session is not recommended; for example, it has been stated that filler should not be given at the same time as laser, a deep peel or dermabrasion.

• Which procedures are done together and which in separate sessions should be decided by the physician who examines you, not by a list purchased in advance.
• You should be able to withdraw from a procedure that is found unsuitable for you at the examination; find out the terms for this before you pay.
• For procedures that may require a second session or a touch-up, discuss in advance where and how this will be done.
• Set aside time to rest after the procedure. The NHS states that a holiday programme straight after a procedure is not realistic, and that alcohol, sun, swimming and a busy sightseeing schedule increase the risk of problems.

The documents and product record you need to take with you

The CDC recommends obtaining a copy of all records from the facility where the procedure was carried out before you return to your country, and having them translated if necessary. These documents make the work of any physician you see in the future easier.

• The name, title and contact details of the physician who performed the procedure; the name and address of the facility
• The date of the procedure, the areas treated and the amounts used
• The name, active substance, manufacturer and lot (batch) number of the product used; if possible, a copy of the box label
• The local anaesthetic used and any other medicines given during the procedure
• Written aftercare instructions and a list of warning signs
• A copy of the consent form you signed
• The active substances of the medicines prescribed and how long to take them

For a facility that is reluctant to give you the product record, review the warning signs in our article “Counterfeit Products and Unlicensed Treatments: Risks, Warning Signs and What to Do”.

After you return to your country

• Tell your own physician which procedure you had, where and with which product; show your documents.
• When you attend a healthcare facility for any reason, mention that you have recently had a medical procedure abroad. This information is particularly important when infection is being assessed.
• Do not miss the remote check-ups planned with the physician who performed the procedure.
• Do not have a corrective procedure on the same area somewhere else before the problem has become clear.
• To distinguish expected from unexpected symptoms, see our articles “Aftercare Following Medical Aesthetic Procedures: General Principles and Warning Signs” and “What Should You Do If a Complication Occurs after an Aesthetic Treatment? A Step-by-Step Guide”.

For details of the emergency signs specific to filler, see our article “After Fillers: When Is It an Emergency? Vascular Occlusion and Other Warning Signs”. Telling the emergency department which procedure you had, when and with which product helps the right treatment to start quickly.