The aircon instantly cools my skin as I walk through the doors – respite from the heat outside. I’m at the new Acibadem Ataşehir Hospital, one of ten Acibadem plastic surgery-focussed sites in Istanbul, Turkey – and I’m far from the first young woman to enter, keen to learn more about having a cosmetic procedure abroad. If the bandaged heads and nose braces at the airport are anything to go by, I won’t be the last either.
For 24 years now, the Acibadem group has proudly said it offers “premium healthcare” and encourages people to travel overseas for more ‘affordable’ surgery (be it for cosmetic reasons or otherwise – the collection of hospitals say 40% of its patients are actually oncology related and many others attend for general surgeries that they aren’t eligible for – or would have a lengthy wait time for – on the NHS). They’re just one of numerous private clinics operating out of the country, catering to a growing market of so-called medical tourists.
Last year, Turkey made an estimated $3bn from cosmetic medical tourism, a figure predicted to soar to $20bn in 2023 – in spite of reports expressing concern that reckless surgeries are being dished out in the country left, right and centre – something Acibadem says it deplores and is keen to challenge the preconception of. This cheap surgery boom has become so popular that some Turkish clinics are now even trying to expand across Europe and into the UK.
But aside from bargain prices and the appeal of a poolside recovery, it’s still easy to wonder if any of these clinics truly offer a positive experience for patients. Sure, quick and easy cosmetic surgery tacked onto the end of a holiday might sound appealing in an increasingly superficial era of TikTok filters and skinny jabs, but horror stories about botched ops and even death following surgery aren’t uncommon either – so why are numbers rapidly rising? And should we be worried about potential expansion?
Hospital or high-end hotel?
Acibadem, which made $120m in revenue last year (with, it says, 1 to 2% of that coming from cosmetic procedures), is one of the clinics plotting to set up home on British soil. It proudly advertises its status as a leading plastic surgery provider in Turkey and four (but not all) of its hospitals are accredited by the Joint Commission International (an independent authority for patient safety).
Each of the four sites I visit on my guided tour are spotless, resembling high-end hotels rather than hospitals. Each department, from oncology to dentistry, has top-of-the-range equipment too – the opposite of a dodgy back alley set-up that can spring to mind when thinking about Turkish clinics.
At the Maslak hospital in Acibadem I meet Associate Professor Erdem Güven, an aesthetic and plastic surgery specialist. We speak – in a slightly clunky manner, due to a small language barrier – about his speciality (breast augmentations) and how he believes that Turkey is the best place in the world for medical tourism. Dr Güven credits this with the “good education” he believes doctors and surgeons receive and speaks fervently of the importance of an in-depth pre-operative consultation to manage expectations (which includes going through possible complications). So far, so good.
But I’m alarmed when Dr Güvem adds that he has “little time for in-person chats” and that these pre-operative consultations are done online. How then, I ask, can he really gain a sense of the patient’s needs, body-makeup, size, and overall health?
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“I can make recommendations for a patient that wants to send images or videos,” he explains. “But if they want to ask something, it doesn’t work for me… because it takes a lot of time. Everybody wants to know about something.”
But this is at odds with Acibadem’s Professor Dr Mehmet Veli Karaaltın, who also adds, “No matter how proficient the online system is, it will never, ever be like a live presentation.” Though he assures that they have become ‘well experienced’ with digital consultations because of the COVID-19 pandemic.
This, a clinic spokesperson later clarifies, was Dr Güvem was simply trying to explain that an “arrangement needs to be made in advance for a face-to-face consultation, because whilst other, smaller clinics in Turkey may promise patients a consultation within hours of an enquiry being made, as a busy surgeon he cannot offer the same”. The offer of a same-day consultation may seem like the sign of a reputable clinic, but in fact, the opposite could be the case, say Acibadem: it could be a red flag as experienced surgeons will likely have a more packed diary.
This uncertainty around in-person assessments is worrying – and at odds with the expectations I had around private medical care. A face-to-face consultation is a legal requirement before any kind of surgery in the UK. In fact, multiple in-person consultations are often put in place before having a cosmetic procedure here, so that patients can give fully informed consent. Seeing your body in the flesh also means a doctor can confirm they are able to safely do the surgery.
At one point, Professor Doctor Karaaltın also shared that even under his ‘premium’ care, it’s normal for the process to feel anything but smooth for the patient. “I’m a little bit crazy,” he says, “So, sometimes I can change all the plans and the patient looks like [pulls a shocked face]. I might add something [hinting at a procedure] and then the guys who [price the procedure] say ‘Doctor, we didn’t tell these numbers to her’.” The doctor then laughs: “That’s not my problem.”
When Cosmopolitan UK contacted Acibadem to follow up on these comments, a spokesperson said the doctor was “clearly joking” and that “the costs and treatment plan do not change without a patient being aware”. They also wanted to highlight Professor Doctor Mehmet Veli Karaaltı’s past work, which includes successfully leading a team that separated conjoined twins and carrying out a pioneering face transplant. “The financial side is not in the professor’s remit,” they added. “It is recommending the correct treatment with patient safety being paramount.”
It’s clear that Acibadem looks the part, is proud of its high calibre of doctors and all the clinics I saw were immaculate, but the possible disparity in what we consider to be standard pre-operative care rings alarm bells – and despite there being on-site translators available, I still worry that language barriers could pose issues for patients.
“We would like to understand the UK system”
Later in my visit, I’m invited up to the swanky top-floor offices to watch a presentation on Acibadem’s plans to better establish themselves in western healthcare markets. “In 2017, our first western market hospital opened in Amsterdam,” a spokesperson says, explaining they’ve already become the largest private healthcare provider in Bulgaria.
“We would like to understand the [UK] system,” adds Rasim Topuz, the medical group’s chief executive officer and general manager. During the presentation they explain that over the past 3 to 4 years they have “learnt a lot” about the European market, from the regulations, to the different needs and cultures – and their bidding to enter the UK market has already started, with the opening of a new ‘contact centre’ in London, where prospective patients can ask questions about possible nips and tucks overseas.
David Rowland, Director of the independent, non-party affiliated think tank, Centre for Health and the Public Interest (CHPI), tells Cosmopolitan UK that any new private clinic would have to be licensed and registered to provide services in the UK. “It’s a legal requirement. They couldn’t dodge that,” he continues, “But, there are quite a number of legal loopholes, particularly around non-surgical cosmetic interventions…”
Medical tourism: a well-oiled marketing machine
Once upon a time, this idea of shopping for a new image was for the rich and famous alone, but in recent years, cosmetic surgery has become both more accessible and normalised. TikTok is awash with influencers and celebrities with newly curved behinds, shrunken noses, flattened stomachs and the hashtag #TurkeyTeeth now has over 273m views. The price difference between domestic surgery and surgery abroad really is staggering (for context: a nose job in the UK costs between £4,000 and £7,000, but in Turkey starts at £1,800).
While Turkish regulations prevent direct-to-customer marketing in the private healthcare sector, indirect (i.e. via influencers) is permitted, incidentally making this normalisation of surgery more insidious and covert than we’re led to believe, and, when we do see the bad side (e.g. BBLs gone wrong), our brain’s natural optimism bias makes us think it will never happen to us, creating a perfect storm.
This acceptance along with the commodification of medical tourism means that, today, we’re at risk of treating procedures like fast fashion – and they’re being marketed to us in much the same way too, as though drastically changing our bodies is a simple ‘cure-all’ self-esteem boost.
In essence, medical tourism is a fast-paced, well-oiled marketing machine that knows exactly how to convert ‘patient enquiry’ into paying customer at pace. Anecdotally, there’s also evidence that many offer lightning speed, easy booking methods too, with plenty of correspondence conducted over the ever-so-casual platform of WhatsApp (yep, you don’t even need to call to lock in a boob job).
This is creating concern among psychologists, explains Stelios Kiosses, MS GMBPsS BACP reg. psychotherapist and instructor at Harvard University. “It is crucial to understand that plastic surgery does not solve or act as a substitute for dealing with underlying emotional or psychological issues,” he tells Cosmopolitan UK. “I would advise seeking therapy or counselling if you are struggling with body image concerns.”
Kiosses adds that this sort of lower-cost surgery is especially dangerous for those with Body Dysmorphic Disorder (BDD, believed to impact 2% of the population), as exposure to this kind of messaging will exacerbate vulnerabilities and for some, could lead to plastic surgery addiction.
“For years, the word ‘ugly’ chipped away at her self-esteem, rattling around her head on loop”
It’s something that Charlotte*, a 35-year-old hair extension specialist from Ayrshire, Beith, knows about all too well. For years, the word ‘ugly’ chipped away at her self-esteem, rattling around her head on loop thanks to BDD. Charlotte knew surgery in the UK wasn’t financially possible, but registering for a new credit card and travelling abroad for it was. Before she knew it, Charlotte had booked her surgery through WhatsApp (not with Acibadem), and was on a plane to Turkey.
Charlotte’s impulsive approach to these cheap nip and tucks, which she attributes to her ADHD, led her to have multiple procedures in the country. And, soon enough, she discovered their true cost when she collapsed on her kitchen floor following severe reactions to prescription painkillers after a botched breast augmentation. She describes screaming through the wall, hoping her neighbours would hear and rush her to A&E. Thankfully, they did. But less than a year later, Charlotte was back on the plane to Turkey, for a ‘final’ facelift.
This time, she was on high alert. “I knew something wasn’t right from the minute I met the surgeon,” she says. But, once the money had been exchanged, Charlotte felt she couldn’t turn back. They don’t offer refunds, after all. Even when persuaded into changing her procedure from a nose job and a facelift, to a skin lift (less expensive than what she had been booked in for), Charlotte didn’t feel empowered enough to say no.
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The NHS can’t always pick up the pieces
In 2018, The Mirror reported that the NHS had been left with a £30m bill, thanks to complications following overseas cosmetic surgery. A year later, research raised concerns about the lack of regulation regarding cosmetic procedures abroad too, and more recent reports of people dying from elective procedures (such as Brazilian Butt Lifts) in Turkey are becoming ever-frequent. So much so, the BAAP (The British Association of Aesthetic Plastic Surgeons) has warned of a 44% increase in complications from cosmetic surgery abroad (100% of which came from Turkey).
The ship-off and shut-up approach is a worrying one. Particularly if it means that patient-doctor relationships morph into consumer-service provider. Commodifying healthcare leads to intensified pressure across the entire healthcare system, leading to higher and preventable patient deaths.
Rowland tells Cosmopolitan UK that, thanks to underfunding over the past decade, a damaging two-tier healthcare system is already emerging in the UK. He explains that underfunding causes unfairness in the system.
“You have people who are waiting for a very long time, and can afford to pay,” he says. “It’s unfair on them because they’ve paid their taxes and they shouldn’t be having to pay for care. But it’s also unfair on those people who can’t afford to jump the queue.”
But this two-tier disparity has a wider knock-on effect. “There’s a small proportion of that, which is feeding the kind of medical tourism industry. That is a problem for the NHS,” Rowland says.
In many cases the NHS can help alleviate patients suffering because of medical tourism’s failings, but it’s not a one-stop-shop for corrective cosmetic surgery and, as we all know, is experiencing unprecedented difficulties with staffing, wait times and funding. So, if the outcome of the surgery doesn’t pose a threat to life (from physical or mental injury), or you haven’t developed an infection, it’s unlikely your local hospital will be able to intervene.
Some people may also feel too ashamed to seek medical attention back on home soil, because of the consumer-based nature of the surgery they’ve had abroad. For those willing to give their original surgeon a second chance (Acibadem stress that “in cases where there’s a medical complication, [we] always guarantee revisional treatment in [our] facilities”), flying back to Turkey carries risks of clotting complications and exposure to infection. The only other option is to suck it up and pay for corrective surgery in your home country.
“Cheaper can sometimes prove far more expensive in the long run,” says Dr Paul Banwell, a UK-based plastic and cosmetic surgeon, who has performed numerous corrective surgeries. “There are, of course, a plethora of first-class surgeons abroad, who will do an excellent job, but that isn’t the point,” he says. “It’s about the recovery period. Complications can occur with any surgery, the issue is how to manage them. If you are abroad, they cannot be managed properly.”
This concern is shared with Rowland, who explains that our exit from the EU has put more people seeking surgery abroad at risk, because we’re no longer protected by the laws designed to help keep us safe. “You don’t know who the providers are; you don’t know how well trained they are. You don’t know what happens when something goes wrong,” he says.
“Cheaper surgery can sometimes prove far more expensive in the long run”
Risk aside, for some people going abroad is a last resort and their only hope – and despite knowing of and experiencing some of the shortcomings (language barriers, cash payments and a dizzyingly quick turnaround from arrival into theatre), along with issues on the aftercare front, many still say having surgery in Turkey changed their life for the better. Lorna, 31, a Senior Graphic Designer from Suffolk, is one such person.
She says she found herself ‘drowning’ and miserable after trying to address weight-related health issues in the UK. Explaining that she felt trapped in her body after years of trying everything at her disposal, including seeking a UK-based referral for bariatric surgery (a group of weight-loss surgery operations that change your digestive system), when she was unable to afford private UK healthcare, she decided to take out a small loan and travel to Turkey instead, for keyhole gastric sleeve surgery at VM Medical Park Hospital (which did not respond to a request for comment), in Mersin, Adana.
“After months of research I contacted a hospital, who gave me a consultant based in the UK, who I then WhatsApped,” she explains, “I had a phone call with her which took about an hour and a half, going through every single question I could possibly dream of. From there, all I had to do was arrange my flights.” Despite having to speak through Google Translate to her medical team and not being seen in the flesh by a doctor until arriving in Turkey, Lorna says “with regards to my quality of life, it’s just a no-brainer – I would do it again in a heartbeat.”
But Lorna hasn’t heard a word from her surgeon, or the hospital she visited, since – meaning aftercare has been placed firmly in the hands of her local GP.
A week after my own trip to Turkey, Charlotte shows me her latest botched surgery scar, an open wound behind her ear, as we sit with our tea on Zoom. Even now, after her collapse, she tells me she couldn’t shake the feeling that if she just nipped and tucked one more time, she’d finally be happy with herself. It’s hard to hear. And harder still is that Charlotte is also facing legal action from the hospital she visited, after speaking out on TikTok – but is unable to find legal representation because of clauses in her contract with the hospital that state she’s unable to speak about the clinic negatively on social media.
Sadly, her story isn’t an isolated incident. Findings by the OECD (Organisation for Economic Co-operation and Development) report a disquieting trend of patients unsuccessfully prosecuting for negligence abroad, thanks to sneaky clauses. Another red flag to be mindful of.
I went to Turkey hoping to find accountability for the continued failures that the medical tourism industry inflicts on desperate people. Instead, I’ve been left feeling that behind the flashy veneer of the country’s medical tourism industry, and its picture perfect ‘before and afters’, is still a money driven machine with great risks. But I can appreciate why some people feel going abroad for an op is the right decision for them. As for Acibadem’s potential future move to the UK, I’m conflicted.
If even the best clinics in Turkey, like Acibadem, don’t provide mandatory follow up appointments and comprehensive aftercare on home soil, where does that leave people who are frequenting cheaper, less regulated clinics? How safe can that flight be after major surgery, if you have no-one checking up on your recovery?
There’s no doubt cheap plastic surgery is a seductive proposition – and shouldn’t everyone get to decide what they do with their bodies? But at the same time, it’s deeply sad that societal pressures have helped to create such a huge industry in the first place, with demand that’s only increasing. More should be done to help people, like Charlotte, who are vulnerable to this kind of body-perfect messaging.
We need tighter regulations and standards on a global scale that all clinics can be held accountable to. But the truth is, right now those don’t exist – so, you have to ask yourself: how much are you willing to risk to board that plane?
*Name has been changed
This story was updated on 24 July 2023 following further conversations with an Acibadem spokesperson
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