a stepAftercare at home

Wound checks, stitch removal, physiotherapy, drug management and the first sight of a complication happen in the patient's own country, performed by clinicians who were not party to the consent, did not select the implant, hold no record of the operation beyond what the patient carries, and were not paid for any of it.

The asymmetry is stated plainly by the NHS for its own readers: "If you have complications after an operation in the UK, it's the surgeon's responsibility to provide follow-up treatment", while "Overseas clinics may not provide follow-up treatment, or they may not provide it to the same standard as in the UK."

Where the load lands has been counted, in the one specialty where the cases are visible. A cost analysis at Gold Coast University Hospital in Queensland totalled 12 patients presenting in the 2012–13 financial year with complications of cosmetic surgery performed in Thailand: AUD$151,172.52 to that hospital in one year, averaging AUD$12,597.71 a patient and ranging from AUD$1,190.28 to AUD$33,060.02. In the United Kingdom a 2025 review carries the BAAPS national audit figures — UK residents needing NHS hospital treatment after surgery abroad up "by 94% in 3 years", "75% citing Turkey as the origin of their surgery", and an average NHS cost of "£15,000 per person, depending on the treatment required" — alongside an NHS Scotland series of 81 patients over five years costing "£755,559.68, an average of over £9,327.90 per patient".

Those counts are narrow and worth saying so: they count patients who reached a public hospital with a complication of cosmetic surgery, in three health systems, over fixed periods. They are not a complication rate, they have no denominator, and they say nothing about dental, orthopaedic or fertility work.

Inference — the structural fact underneath is that the fee and the aftercare are paid to different systems. The revenue went to the provider abroad; the cost of what follows sits with a public system or a home insurer that never priced it, and with a general practitioner holding a summary they did not write.

Trade practice — packages that name follow-up usually mean visits inside the destination stay. Where a complication policy exists it runs for a defined window and pays for treatment by the original provider, which implies flying back.

What a reader would have to ask before the trip, since the answer cannot be got afterwards: who removes the sutures and where, whether the home system will accept the case, whether the operating surgeon will answer a question from a home clinician, what the implant is, and what the provider undertakes to do if the wound fails at week three.

As of 16 September 2026 the published counts of what returning patients cost their home systems all come from plastic surgery and from a handful of countries. No national system this project could find routinely records, in its own data, that an episode of care was caused by treatment obtained abroad.