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Terry Maguire Wonders If The Increasing Popularity Of Medical Tourism For Cosmetic Procedures Is Putting A Strain On Local Waiting Lists In Terms Of Follow-Up Care.

I had a short trip back to Istanbul this June. When I last visited in 2016, I had cause for concern. My concern was, it seems, ill-founded and poorly-judged, and my hopes that things would improve were granted. In 2016, there had been an attempted military coup and since then, things generally have gotten worse; an economic crisis in Turkey created by the financial ignorance of its for-life president Tayyip Erdogan, the proximity to a tragic war in Ukraine, and the creep of more extreme elements of Islamic culture and values. The liberal ideals of Ataturk are sadly being eroded, manifest in a favourite restaurant no longer serving wine and a complete absence of female staff front-of-house. Yet the crowds have returned, the bazars are doing great business, and the mood is optimistic. On my previous visit to Istanbul in 2016, I got five lira to the pound; this time I got 20. Not good, however, for those living and working in a city where inflation is at a staggering 78 per cent. 

For me, the stand-out feature of this trip was the explosion in medical tourism. On the Turkish Airlines flight out from Dublin, I talked with two 30-somethings from Belfast who told me they could not eat or drink on the flight, as they were due to have “a procedure” a few hours after arrival. They were both having breast augmentation, and the price “was a bargain” compared to UK clinics. On checking, this procedure costs about £7,000 in the UK, where it is £3,250 in Turkey — a price which includes air fare, airport transfers, and accommodation. Their stay was only a few days “if all goes well” and there would be little time to experience the delights of the historic city. They weren’t friends meeting for the first time at the airport, having found each other in an online support group set up by the Turkish clinic. They looked so alike I thought they were sisters, when my better-informed wife pointed out that their lips, eyebrows, and cheekbones had all been ‘done’ — a standard design that risks a dull conformity to an idealised beauty. They identified two men at the back of the plane who were also getting procedures, but were unsure what. 

They were both having breast augmentation, and the price “was a bargain” compared to UK clinics

We arrived at the new Istanbul Airport (Istanbul Havalimanı) on the Black Sea coast, opened in 2019 and now one of the world’s biggest and busiest. It is impressive by any standards and certainly compared to the old Istanbul Ataturk Airport on the Aegean Sea coast. Istanbul Havalimanı is planning to be a major travel hub and already is a medical hub. 

In Sultanahmet, the historic part of the city, the level of medical tourism is starkly obvious. Men arrive at cafés with untidy and bloodied bandages across the nape of their necks where hair follicles have been harvested and inserted into skin on their hairlines, and which is still stained iodine-brown with disinfectant. There are many males and females sporting neat bandages on their noses. These are the obvious ones, and hair transplants are the most popular procedure listed on advertisements posted by the city’s surgeons. This is followed by rhinoplasty (nose jobs), then breast augmentation, dental implants, bariatric surgery (stomach-cutting) and IVF (fertility). We met a Swedish couple in the Grand Bazar looking for cheap Gucci luggage and passing a few hours before each getting a nose job. The female was strikingly beautiful and I did wonder, ‘why fix it if it’s working’. 

I’ve no doubt that the clinics in Istanbul are properly regulated, but I just don’t know. I certainly have concerns that some of these procedures might need after-care that cannot be provided in the short time the patients spend in the city. All surgical procedures have risks and it is likely some will end up being dealt with on return by the NHS. Indeed, Mr Alastair Brown, consultant in plastic surgery Ulster Hospital, has warned about the dangers. In a BBC news report in 2019, he claimed to be treating six women within a short time who had each returned from Turkey having had breast augmentation or reduction. One young woman told of the shocking pain that alerted her to the infection which eventually resulted in mastectomy of her left breast. She told the reporter that she had done her homework on Istanbul clinics before travelling, but was significantly influenced by celebrity endorsements who claimed the procedures were risk-free. 

She only received minimal after-care, being transferred from hospital to a sparsely-furnished villa for three nights before being discharged and travelling home. BBC reporters contacted the Istanbul-based clinic, and the reply was that infection can happen to anyone in any country after surgery. They were happy to provide “free correction” at any time. Alastair Brown cautioned those thinking about a procedure in Turkey to be very careful, making the point that it might seem inexpensive, but in the long-term it might cost a lot more. 

That was back in 2019, but surgery tourism has only increased. Relating my Istanbul observations to work colleagues, I was given a long list of alleged botched operations linked to Istanbul, including a 20-something female currently in Belfast City Hospital with severe stomach complications from bariatric surgery. Dentists too are concerned with the procedures that produce the ultra-bright ‘Turkey Teeth’. They feel Turkish dental clinics are much too aggressive in cutting back good teeth, leaving only residual stumps that often fail after a short time. 

We need to be realistic. Cosmetic procedures are becoming more common and are big business, so they are not stopping anytime soon. What we need to do is protect patients who decide to get surgery in regions where standards are perhaps more difficult to assure. We also need to ensure that such procedures do not become a major burden on our overstretched health system. Could we insist that the health service is insured against any complications in another country? 

There is also the potential impact on medical waiting lists here. If I were waiting for a procedure with Mr Brown, which funny enough I just happen to be, and waiting for nine months with a red flag, then it seems unfair that his valuable time and considerable skill is spent dealing with botched cosmetic procedures performed by his colleagues in Istanbul. Okay, Dupuytren’s contracture is hardly life-threatening — it’s sometimes painful and it impacts to a small degree on my work but makes my right hand look like a grotesque claw, which makes me think perhaps I’m just being totally vain and bloody selfish in complaining about the wait. Maybe I should not be so mean and go privately. I wonder, can it be dealt with while I enjoy another trip to my beloved Istanbul?