Drawing on advice of former patients, Britons are travelling to Poland, Czech Republic and Tunisia for operations to enhance their looks or to help them feel ‘normal’
Laura had no ambition to be a supermodel. She wanted cosmetic surgery to make her feel normal. She had been 22 stone and morbidly obese, and lost about half her bodyweight after stomach stapling, dropping from a dress size 28 to 14. But it was no longer just her clothes that did not fit, it was also her skin.
“It was like wearing a sumo wrestler suit,” she said. “I felt like an old woman. It doesn’t do your confidence any good at all.”
Laura (not her real name) did not think it was appropriate to approach the NHS, so she turned to the internet, looking for clinics that would offer her a tummy tuck. She browsed websites and started to chat to people on Facebook. When she finally made her decision, it was to go to Wroclaw in Poland for the operation.
Laura is one of the growing band of cosmetic surgery tourists who fly to cities served by cheap airlines such as easyJet and Ryanair for operations at hospitals and clinics. They go to the Czech Republic and Tunisia, as well as Poland, paying about half the price they would have paid for private surgery in the UK, with flights and accommodation included.
Research from Leeds University, funded by the Economic and Social Research Council and due to be released next week, offers new insights into cosmetic surgery tourism. Professor Ruth Holliday and her team expected to find disaster stories and admit they were surprised.
Most of the patients they spoke to were satisfied with their surgery because they had changed something about their appearance that had troubled them for years. And they were administrators, nurses, hotel porters, hairdressers, students, police officers and teachers on modest incomes.
“I’m not trying to be some kind of supermodel. I’m just trying to feel normal, able to wear swimming costumes without people staring at my legs,” said Laura, 37, who has five children and works in the care industry. She has since had further surgery: a breast uplift and liposuction on her thighs.
Even those enhancing their looks rather than undergoing “repair work”, as Laura described it, had a rationale beyond vanity, said Holliday. “For the young, white, working-class woman, getting a boob job is a way of gaining status for people who don’t have any status,” she said. “They are trying to add value to their body. It is quite marketable in a way if you are a receptionist or selling coffee to the public.”
Most in her study said they just wanted to look normal and had spent five to 10 years thinking about getting surgery, and researching where to go. But it can still be a shock: one patient who travelled for surgery to Tunisia lay awake all night in terror.
“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,'” the patient told the team.
“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 definitely go back … because I know the surgeon. I wouldn’t want to risk a different surgeon.”
Surgery tourists go to the Czech Republic for weight loss treatment (because the NHS queues are too long), to Belgium for breast augmentation, to Poland for tummy tucks and to Budapest for teeth, Holliday’s team found. And they make their choice often by word of mouth.
“Surgeons want you to choose them according to their academic credentials and qualifications, but these things are not comprehensible to most patients,” said Holliday. “They choose them in the same way that you choose a tradesman like a plasterer – on the recommendation of their friends.”
Internet forums and Facebook groups are crucial to this process. Would-be patients browse before and after pictures from those who have already made the trip and discuss the merits of different surgeons. Agents, often former patients themselves, book flights, accommodation and surgeons and guide people through the whole process.
Angela Chouaib set up her agency, Secret Surgery, after her own experience. Like Laura, she lost 10 stone following bariatric surgery and found herself living in “a deflated fat suit”.
“You lose your body confidence. You can’t exercise again. Your relationship and work are suffering,” she said. The wait for NHS surgery to remove the excess skin was two years.
Chouaib has travelled and worked abroad. Her last job was in the City in “a very senior level environmental consultancy”. She did extensive research before electing to go to Poland, including checking qualifications, accreditation and what Polish people had said about the hospital she chose.
Now she helps other people choose their surgeon and book the trip. “I can work with any surgeon I want to,” she said. “I don’t work on a retainer basis. The client pays me the booking fee. I arrange it all for them like a travel agent would, booking the consultation and surgery date.”
Some have considered UK clinics first and are put off by the price. Some said they were treated “like a walking cheque book”, the research found. Chouaib said that in countries outside the EU, “there is a higher level of surgeon and better hospitals than you could afford in the UK”.
Yet things do go wrong. Of the 103 patients who gave detailed accounts of their experiences to Holliday’s team – who also interviewed surgeons, agents and others involved – 16.5% said they experienced complications and 8.7% needed further treatment, such as for infections, when they got home. There is little scope for legal redress for those who travel abroad.
“These patients make their journeys because they are deeply unhappy with a body part that they feel needs to be corrected and because they cannot afford surgery at home,” said Holliday. “If their surgery goes wrong or they have a bad experience in their destination, they are blamed for making a poor choice and become an ‘unacceptable burden’ on the NHS.
“In other words the responsibility for the risks involved are transferred on to patients. While their surgical journeys are often later re-imagined as ‘adventures’, and surgical outcomes are experienced positively, most people would probably choose to avoid these adventures by staying at home for their healthcare and being cared for by experts whose interest is only medical and not financial.”