{
 "id": "revision-at-home",
 "names": {
  "name": "Revision at home",
  "aliases": [
   "putting it right",
   "corrective surgery",
   "the second operation"
  ],
  "said": "The clinic abroad calls it a touch-up. The unit at home codes it as an emergency admission."
 },
 "region": [
  "global"
 ],
 "facets": {
  "kind": "financial"
 },
 "text": {
  "what": "The second operation, performed in the patient's own country by a surgeon who did not perform the first, on a wound whose details nobody recorded. It is the only part of this subject with a running set of published costs, because a publicly funded system that pays for it has a reason to count.",
  "story": "Five UK plastic surgery units have published their own ledgers, and they agree in shape.\n\nA London teaching hospital reviewed patients surgically managed between 2006 and 2018 for complications of cosmetic surgery abroad: 24 patients, 22 of them women, mean age 36. Gluteal enhancement was the commonest procedure at 38% and infection the commonest complication at 92%. Twenty-one were inpatients, mean stay 8 days with a range of 1 to 49. Total cost to the hospital USD 406,233, mean USD 16,296 per patient, range USD 817 to USD 41,778; abdominoplasty complications cost most per patient at USD 20,404. Most of the procedures had been done in Turkey.\n\nA major trauma centre reviewed January 2013 to August 2017 and found 20 patients. Costed against national tariffs and grouped by severity, the eight minor cases came to £3,448, the eight intermediate to £18,271, and the four major to £42,083.59. All four major complications were gluteal augmentations.\n\nA Manchester breast unit, twelve months across 2022 and 2023: 25 patients, 20 operated on abroad, 15 of those in Turkey, at least £37,000.\n\nA London hospital across 17 months to 2025: 96% of the surgical patients presenting with complications had been operated on abroad, 73% in Turkey, total estimated £110,690.\n\nA Birmingham tertiary centre, 2020 to 2025: 749 records screened, 29 patients, 58 hospital presentations, 82.8% of the procedures done in Turkey, mean inpatient stay 9.2 days, 27 theatre interventions. Nearly half the presentations — 48.3% — were repeat attendances after an earlier complication. Total £518,058.47, mean £17,864 per patient, individual presentations from about £46 to £57,691.\n\n*Inference —* these are counts of arrivals at five doors, not rates. No national system records how many of its residents had surgery abroad, so there is no denominator, and the totals are floors rather than estimates. What they do establish is the direction of the transfer: the fee was paid to a private provider in one country and the correction was paid for by a public system in another, which was never party to the transaction and cannot bill anyone for it.\n\nThe patient's own position is separate and worse documented. A publicly funded system will treat a complication; whether it will redo an unsatisfactory cosmetic result is a different question, usually answered no, and this project has found no published national policy stating the line.",
  "how": "The revision is harder than the original for a reason that has nothing to do with the first surgeon's skill. The operative note is usually missing, the implant or device model is unknown, the organism may be atypical and slow-growing, and the tissue has already been operated on once. Where an implant is involved the second device is bought again. The General Medical Council requires a doctor on its register to say at the outset what revision or routine follow-up might cost; that duty does not travel.",
  "today": "As of 16 September 2026 the five published UK series this record carries total roughly £1.1 million across 123 patients, over periods from one year to twelve, at five hospitals. No country publishes a national figure, and no destination publishes what its own clinics spend on revisions."
 },
 "metrics": {
  "note": "Mean cost per patient of correcting complications of cosmetic surgery abroad, from five single-centre UK series: USD 16,296 (Royal Free London, 2006-2018, 24 patients); £3,448 minor, £18,271 intermediate and £42,083.59 major (Royal London, 2013-2017, 20 patients); at least £37,000 total (Wythenshawe breast unit, 2022-2023, 25 patients); £110,690 total (a London hospital, 17 months to 2025); and £17,864 mean per patient on £518,058.47 total (Queen Elizabeth Birmingham, 2020-2025, 29 patients over 58 presentations). Each is a count of who arrived at one hospital. There is no denominator, so no rate can be computed from any of them.",
  "as_of": "2026",
  "source": "s:mafi-cosmetic-tourism-cost-2026",
  "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/"
 },
 "kin": [
  {
   "to": "when-it-goes-wrong",
   "as": "The step this is the bill for.",
   "rel": "step"
  },
  {
   "to": "aftercare-at-home",
   "as": "The step it interrupts.",
   "rel": "step"
  },
  {
   "to": "follow-up-gap",
   "as": "Why the second surgeon operates without an operative note.",
   "rel": "kin"
  },
  {
   "to": "revision",
   "as": "The word, and what it covers when a package says it is included.",
   "rel": "term"
  },
  {
   "to": "turkiye",
   "as": "Named as the country of the first operation in most of the UK series.",
   "rel": "place"
  },
  {
   "to": "united-kingdom",
   "as": "The system that published its own ledgers, which is why this record has numbers at all.",
   "rel": "place"
  },
  {
   "to": "bbl",
   "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two of the series.",
   "rel": "procedure"
  },
  {
   "to": "abdominoplasty",
   "as": "The highest cost per patient in the Royal Free series.",
   "rel": "procedure"
  },
  {
   "to": "breast-augmentation",
   "as": "The commonest procedure in the Manchester breast unit series.",
   "rel": "procedure"
  },
  {
   "to": "uk-nhs-treatment-abroad",
   "as": "The entitlement that does not cover any of this.",
   "rel": "governed-by"
  },
  {
   "to": "surgical-site-infection",
   "as": "The complication driving 92% of one series.",
   "rel": "kin"
  },
  {
   "to": "implant-excluded",
   "as": "The second device is bought again, in a second country.",
   "rel": "kin"
  }
 ],
 "links": [
  {
   "label": "Thacoor et al., Aesthetic Surgery Journal 2019",
   "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/"
  },
  {
   "label": "Mafi et al., Cureus 2026",
   "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/"
  }
 ],
 "sources": [
  "s:thacoor-nhs-cost-2019",
  "s:farid-cosmetic-abroad-2019",
  "s:ahari-breast-unit-2024",
  "s:whiteman-nhs-burden-2025",
  "s:mafi-cosmetic-tourism-cost-2026",
  "s:gmc-cosmetic-interventions",
  "s:cdc-yellowbook-2026-medical-tourism",
  "s:cdc-yellowbook-medical-tourism"
 ],
 "provenance": {
  "default": {
   "tier": "cited",
   "source": "s:mafi-cosmetic-tourism-cost-2026"
  },
  "fields": {
   "text.story": {
    "tier": "cited",
    "note": "the paragraph on denominators is marked inline as this project's reasoning"
   },
   "text.how": {
    "tier": "tradition",
    "note": "the operative account is the trade's; the GMC duty is cited"
   },
   "metrics": {
    "tier": "cited",
    "source": "s:mafi-cosmetic-tourism-cost-2026"
   }
  }
 },
 "confidence": "high",
 "schema": 1,
 "type": "risk",
 "updated": "2026-09-16",
 "blurb": "The second operation, performed in the patient's own country by a surgeon who did not perform the first, on a wound whose details nobody recorded.",
 "region_terms": [
  {
   "key": "global",
   "name": "Everywhere",
   "note": "use for a node that belongs to no one country — a standard, a word, a risk"
  }
 ],
 "kin_out": [
  {
   "to": "when-it-goes-wrong",
   "type": "pathway",
   "name": "When it goes wrong",
   "as": "The step this is the bill for.",
   "rel": "step"
  },
  {
   "to": "aftercare-at-home",
   "type": "pathway",
   "name": "Aftercare at home",
   "as": "The step it interrupts.",
   "rel": "step"
  },
  {
   "to": "follow-up-gap",
   "type": "risk",
   "name": "The follow-up gap",
   "as": "Why the second surgeon operates without an operative note.",
   "rel": "kin"
  },
  {
   "to": "revision",
   "type": "term",
   "name": "Revision",
   "as": "The word, and what it covers when a package says it is included.",
   "rel": "term"
  },
  {
   "to": "turkiye",
   "type": "destination",
   "name": "Türkiye",
   "as": "Named as the country of the first operation in most of the UK series.",
   "rel": "place"
  },
  {
   "to": "united-kingdom",
   "type": "destination",
   "name": "United Kingdom",
   "as": "The system that published its own ledgers, which is why this record has numbers at all.",
   "rel": "place"
  },
  {
   "to": "bbl",
   "type": "procedure",
   "name": "Gluteal fat grafting",
   "as": "Gluteal augmentation was the commonest procedure and the source of every major complication in two of the series.",
   "rel": "procedure"
  },
  {
   "to": "abdominoplasty",
   "type": "procedure",
   "name": "Abdominoplasty",
   "as": "The highest cost per patient in the Royal Free series.",
   "rel": "procedure"
  },
  {
   "to": "breast-augmentation",
   "type": "procedure",
   "name": "Breast augmentation",
   "as": "The commonest procedure in the Manchester breast unit series.",
   "rel": "procedure"
  },
  {
   "to": "uk-nhs-treatment-abroad",
   "type": "rule",
   "name": "NHS funding for treatment abroad",
   "as": "The entitlement that does not cover any of this.",
   "rel": "governed-by"
  },
  {
   "to": "surgical-site-infection",
   "type": "risk",
   "name": "Surgical site infection",
   "as": "The complication driving 92% of one series.",
   "rel": "kin"
  },
  {
   "to": "implant-excluded",
   "type": "risk",
   "name": "The implant is excluded",
   "as": "The second device is bought again, in a second country.",
   "rel": "kin"
  }
 ],
 "source_list": [
  {
   "id": "s:thacoor-nhs-cost-2019",
   "kind": "paper",
   "title": "Surgical Management of Cosmetic Surgery Tourism-Related Complications: Current Trends and Cost Analysis Study of the Financial Impact on the UK National Health Service",
   "publisher": "Aesthetic Surgery Journal 2019;39(7):786-791 (Thacoor A, van den Bosch P, Akhavani MA), Royal Free Hospital, London",
   "url": "https://pubmed.ncbi.nlm.nih.gov/30590431/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:farid-cosmetic-abroad-2019",
   "kind": "paper",
   "title": "Complications of Cosmetic Surgery Abroad — Cost Analysis and Patient Perception",
   "publisher": "Plastic and Reconstructive Surgery Global Open 2019;7(6):e2281 (Farid M, Nikkhah D, Little M, Edwards D, Needham W, Shibu M), Royal London Hospital",
   "url": "https://pubmed.ncbi.nlm.nih.gov/31624684/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:ahari-breast-unit-2024",
   "kind": "paper",
   "title": "The impact of cosmetic tourism across one year on an NHS breast surgery unit",
   "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2024;99:462-467 (Ahari D, Zaccariah ZR, Preston M, Highton L), Wythenshawe Hospital",
   "url": "https://pubmed.ncbi.nlm.nih.gov/39476527/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:whiteman-nhs-burden-2025",
   "kind": "paper",
   "title": "The rising NHS burden from cosmetic surgery procedures performed abroad and non-surgical procedures performed in the United Kingdom",
   "publisher": "Journal of Plastic, Reconstructive and Aesthetic Surgery 2025;102:39-41 (Whiteman E, Romain K, Welman T, et al.)",
   "url": "https://pubmed.ncbi.nlm.nih.gov/39892185/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:mafi-cosmetic-tourism-cost-2026",
   "kind": "paper",
   "title": "Recurrent Clinical Burden and Cost of Cosmetic Surgery Tourism Complications: A Five-Year Retrospective Study From a UK Tertiary Centre",
   "publisher": "Cureus 2026;18(5):e109006 (Mafi P, Patel K, Hoque-Uddin S, Warner R), Queen Elizabeth Hospital Birmingham",
   "url": "https://pubmed.ncbi.nlm.nih.gov/42311717/",
   "accessed": "2026-09-16"
  },
  {
   "id": "s:gmc-cosmetic-interventions",
   "kind": "org",
   "title": "Guidance for doctors who offer cosmetic interventions — in effect 1 June 2016, updated 13 December 2024",
   "publisher": "General Medical Council (United Kingdom)",
   "url": "https://www.gmc-uk.org/professional-standards/the-professional-standards/cosmetic-interventions",
   "accessed": "2026-09-16",
   "note": "paragraph numbers cited on this site are from the sections Communication, partnership and teamwork (paras 14-45) and Maintaining trust (paras 46-56)"
  },
  {
   "id": "s:cdc-yellowbook-2026-medical-tourism",
   "kind": "org",
   "title": "Medical Tourism — CDC Yellow Book 2026, chapter by Rhett J. Stoney and Laura Leidel, page dated 23 April 2025",
   "publisher": "US Centers for Disease Control and Prevention",
   "url": "https://www.cdc.gov/yellow-book/hcp/health-care-abroad/medical-tourism.html",
   "accessed": "2026-09-16",
   "note": "the 2026 edition of the chapter registered as s:cdc-yellowbook-medical-tourism, read in full at the URL above; the named outbreaks, the pathogen list and the ten-day flying rule are quoted from this page"
  },
  {
   "id": "s:cdc-yellowbook-medical-tourism",
   "kind": "org",
   "title": "Medical Tourism — CDC Yellow Book: Health Information for International Travel",
   "publisher": "US Centers for Disease Control and Prevention",
   "url": "https://wwwnc.cdc.gov/travel/yellowbook/2024/health-care-abroad/medical-tourism",
   "accessed": "2026-09-16",
   "note": "the standing public-health account of what travelling for treatment involves and what goes wrong"
  }
 ],
 "tiers": {
  "text.what": {
   "tier": "cited",
   "source": "s:mafi-cosmetic-tourism-cost-2026"
  },
  "text.story": {
   "tier": "cited",
   "note": "the paragraph on denominators is marked inline as this project's reasoning"
  },
  "text.how": {
   "tier": "tradition",
   "note": "the operative account is the trade's; the GMC duty is cited"
  },
  "text.today": {
   "tier": "cited",
   "source": "s:mafi-cosmetic-tourism-cost-2026"
  },
  "metrics": {
   "tier": "cited",
   "source": "s:mafi-cosmetic-tourism-cost-2026"
  }
 },
 "primary_image": null,
 "tag_facts": [],
 "recognition_facts": [],
 "acclaim": 0,
 "kin_in": [
  {
   "from": "australia",
   "type": "destination",
   "name": "Australia",
   "as": "Who fixes it, and at whose cost, once the patient has landed.",
   "rel": "risk"
  },
  {
   "from": "dominican-republic",
   "type": "destination",
   "name": "Dominican Republic",
   "as": "Fourteen of 19 in the first cluster were admitted in the United States for it.",
   "rel": "risk"
  },
  {
   "from": "hungary",
   "type": "destination",
   "name": "Hungary",
   "as": "Who refits a crown that fails after the second flight home.",
   "rel": "risk"
  },
  {
   "from": "mexico",
   "type": "destination",
   "name": "Mexico",
   "as": "Who fixes it, and what that bill looks like: $193,445.08 a patient in the San Diego series.",
   "rel": "risk"
  },
  {
   "from": "turkiye",
   "type": "destination",
   "name": "Türkiye",
   "as": "The bill that lands on another health system when a graft or a sleeve needs doing again.",
   "rel": "risk"
  },
  {
   "from": "united-kingdom",
   "type": "destination",
   "name": "United Kingdom",
   "as": "The operation the NHS performs and did not price.",
   "rel": "risk"
  },
  {
   "from": "united-states",
   "type": "destination",
   "name": "United States",
   "as": "This is the 'home' in that phrase for most of the traffic on this site.",
   "rel": "risk"
  },
  {
   "from": "los-algodones",
   "type": "hub",
   "name": "Los Algodones",
   "as": "Who refits the crown in Ohio when it fails, and at whose price.",
   "rel": "risk"
  },
  {
   "from": "sopron",
   "type": "hub",
   "name": "Sopron",
   "as": "Who repairs the crown, ninety minutes back across the border.",
   "rel": "risk"
  },
  {
   "from": "tunis",
   "type": "hub",
   "name": "Tunis",
   "as": "Who operates again, in Paris or Lyon, when a result needs correcting.",
   "rel": "risk"
  },
  {
   "from": "all-on-four",
   "type": "procedure",
   "name": "All-on-4",
   "as": "Who remakes the bridge when it fractures, and at whose price.",
   "rel": "risk"
  },
  {
   "from": "bbl",
   "type": "procedure",
   "name": "Gluteal fat grafting",
   "as": "Who treats the complication after the flight, and who pays.",
   "rel": "risk"
  },
  {
   "from": "cochlear-implant",
   "type": "procedure",
   "name": "Cochlear implant",
   "as": "Who reimplants a failed internal device, and on whose bill.",
   "rel": "risk"
  },
  {
   "from": "dental-crown",
   "type": "procedure",
   "name": "Dental crown",
   "as": "Who recements a crown that comes off at home, and what they charge.",
   "rel": "risk"
  },
  {
   "from": "gastric-bypass",
   "type": "procedure",
   "name": "Gastric bypass",
   "as": "Who operates when a join leaks or a pouch fails, in a country that did not do the first operation.",
   "rel": "risk"
  },
  {
   "from": "gastric-sleeve",
   "type": "procedure",
   "name": "Sleeve gastrectomy",
   "as": "Who operates when a sleeve leaks, strictures or has to become a bypass.",
   "rel": "risk"
  },
  {
   "from": "heart-valve-replacement",
   "type": "procedure",
   "name": "Heart valve replacement",
   "as": "Who replaces a tissue valve in fifteen years, and where.",
   "rel": "risk"
  },
  {
   "from": "hernia-repair",
   "type": "procedure",
   "name": "Hernia repair",
   "as": "Who repairs a recurrence, and who deals with chronic groin pain after a mesh.",
   "rel": "risk"
  },
  {
   "from": "hip-replacement",
   "type": "procedure",
   "name": "Total hip replacement",
   "as": "Who operates when the cup loosens, and who pays for it.",
   "rel": "risk"
  },
  {
   "from": "lasik",
   "type": "procedure",
   "name": "LASIK",
   "as": "What an included enhancement is worth once the patient is on another continent.",
   "rel": "risk"
  },
  {
   "from": "phalloplasty",
   "type": "procedure",
   "name": "Phalloplasty",
   "as": "Urethral fistula and stricture are the complications that arrive after the flight, and they need a surgeon.",
   "rel": "risk"
  },
  {
   "from": "rhinoplasty",
   "type": "procedure",
   "name": "Rhinoplasty",
   "as": "Who fixes it, and at what price, once the patient has flown back.",
   "rel": "risk"
  },
  {
   "from": "root-canal",
   "type": "procedure",
   "name": "Root canal treatment",
   "as": "Who retreats a root filling that fails after the flight home.",
   "rel": "risk"
  },
  {
   "from": "top-surgery",
   "type": "procedure",
   "name": "Top surgery",
   "as": "Haematoma and graft loss declare themselves in the first fortnight, often after the flight.",
   "rel": "risk"
  },
  {
   "from": "vaginoplasty",
   "type": "procedure",
   "name": "Vaginoplasty",
   "as": "Who repairs a fistula or a lost depth, and where the price for that is published.",
   "rel": "risk"
  },
  {
   "from": "veneers",
   "type": "procedure",
   "name": "Dental veneers",
   "as": "Who rebonds a veneer that debonds after the flight, and at whose price.",
   "rel": "risk"
  },
  {
   "from": "hospital-angeles-tijuana",
   "type": "facility",
   "name": "Hospital Angeles Tijuana",
   "as": "The revision happens on the American side, at American prices, with no record from the Mexican side.",
   "rel": "risk"
  },
  {
   "from": "aftercare-at-home",
   "type": "pathway",
   "name": "Aftercare at home",
   "as": "What happens when the operation has to be done again, by someone else.",
   "rel": "risk"
  },
  {
   "from": "the-discharge-summary",
   "type": "pathway",
   "name": "The discharge summary",
   "as": "Why the implant's make and serial number matter years later.",
   "rel": "risk"
  },
  {
   "from": "bbl-mortality",
   "type": "risk",
   "name": "Death from gluteal fat grafting",
   "as": "Gluteal augmentation accounts for most of the major complications in the published UK readmission series.",
   "rel": "kin"
  },
  {
   "from": "follow-up-gap",
   "type": "risk",
   "name": "The follow-up gap",
   "as": "What the gap costs, once somebody has to operate again.",
   "rel": "kin"
  },
  {
   "from": "implant-excluded",
   "type": "risk",
   "name": "The implant is excluded",
   "as": "When the device fails, the second one is bought in a different country.",
   "rel": "kin"
  },
  {
   "from": "malpractice-recourse",
   "type": "risk",
   "name": "Malpractice recourse across a border",
   "as": "The bill that lands while the claim is still theoretical.",
   "rel": "kin"
  },
  {
   "from": "nontuberculous-mycobacteria",
   "type": "risk",
   "name": "Nontuberculous mycobacteria",
   "as": "All of the documented cases needed further surgery after returning.",
   "rel": "kin"
  },
  {
   "from": "repatriation-cost",
   "type": "risk",
   "name": "Repatriation and medical evacuation cost",
   "as": "What the bill becomes once the patient has landed.",
   "rel": "kin"
  },
  {
   "from": "surgical-site-infection",
   "type": "risk",
   "name": "Surgical site infection",
   "as": "Who pays for the theatre time when the wound has to be reopened.",
   "rel": "kin"
  },
  {
   "from": "insurance-exclusions",
   "type": "rule",
   "name": "Insurance exclusions for treatment abroad",
   "as": "Who pays for the second operation.",
   "rel": "risk"
  },
  {
   "from": "patient-data-transfer",
   "type": "rule",
   "name": "Moving a medical record across a border",
   "as": "The operation planned blind when the note did not travel.",
   "rel": "risk"
  },
  {
   "from": "uk-nhs-treatment-abroad",
   "type": "rule",
   "name": "NHS funding for treatment abroad",
   "as": "The bill the NHS picks up when an operation bought abroad goes wrong.",
   "rel": "risk"
  },
  {
   "from": "us-medicare-abroad",
   "type": "rule",
   "name": "Medicare outside the United States",
   "as": "The care that is covered, because it happens on the right side of the border.",
   "rel": "risk"
  },
  {
   "from": "ishrs",
   "type": "org",
   "name": "International Society of Hair Restoration Surgery",
   "as": "The repair operation its census counts as a share of its members' caseload.",
   "rel": "risk"
  },
  {
   "from": "dominican-republic-ntm-outbreak",
   "type": "event",
   "name": "The Dominican mycobacterial outbreaks, 2013–14 and 2017",
   "as": "Fourteen of 19 admitted in the United States in the first cluster; 14 of 15 needing further surgery in the second.",
   "rel": "risk"
  },
  {
   "from": "mexico-fungal-meningitis-2023",
   "type": "event",
   "name": "The Matamoros fungal meningitis outbreak, 2023",
   "as": "Every counted case was managed by a hospital in the patient's own country.",
   "rel": "risk"
  },
  {
   "from": "revision",
   "type": "term",
   "name": "Revision",
   "as": "The risk this word names, with the published ledgers behind it.",
   "rel": "risk"
  },
  {
   "from": "the-follow-up-nobody-books",
   "type": "story",
   "name": "The follow-up nobody books",
   "as": "The five UK ledgers in full, with each series and its period.",
   "rel": "risk"
  }
 ]
}