• Posted January 26, 2024

Tummy Tucks, Liposuctions Are Killing Americans Visiting Dominican Republic

Too many American tourists looking for cheap cosmetic surgeries alongside their beach time are winding up dead in the Dominican Republic, a new report finds.

Between 2009 and 2022, 93 people -- almost all young or middle-aged women -- have died after undergoing tummy tucks, liposuction or buttock enhancement procedures in that country's clinics, reports a team from the U.S. Centers for Disease Control and Prevention.

They noted that the number of deceased is probably an undercount, since many deaths linked to procedures performed in the Dominican Republic may not have occurred until after the recipient got back to the United States.

Most of the deaths were linked to largely preventable clots. These clots were either typical blood clots or clots caused when globules of fat entered the bloodstream, the team reported.

Almost all of the deaths occurred in women who were overweight or obese, which raises clotting risks.

Many of the women underwent multiple procedures at the same clinic before their deaths, according to the new report.

Lower costs, greater risks

These deaths also appear to be on the rise: In 2019, 12 Americans lost their lives to cosmetic surgery-linked issues while in the Dominican Republic; by 2020, that number had risen to 19, the CDC team reported.

"The Dominican Republic is popular for medical tourism because it is close to the United States, has an existing tourism infrastructure, and some doctors from the Dominican Republic advertise in the United States,"explained a team led by Dr. Matthew Hudson, of the CDC's Epidemic Intelligence Service.

People are attracted to getting procedures performed in the Dominican Republic "because the cost is lower and wait times for procedures are shorter than in the United States,"they said.

The risks can be far greater, however.

The new report was based on data collected on 29 deaths occurring during 2019 and 2020 to American citizens by the U.S. Embassy in the Dominican Republic. That data included autopsy reports and the decedents' known health histories.

Full records were available for 24 of the deceased, all female, who averaged 41 years of age.

In terms of their personal health before their procedures, almost all of the women were overweight or obese (average BMI was 32), and in 22 cases the patients had conditions that upped their odds for a blood clot. Those conditions included obesity, diabetes and a history of smoking, the CDC team said.

In terms of the procedures they received before their deaths, all received liposuction, while 22 of the women received a gluteal fat transfer, where fat from one section of the body was transferred to the buttocks area.

More than half (58%) of the women got a "tummy tuck"(abdominoplasty) and 46% received some form of breast-enhancement surgery, the study found.

Overall, the deceased women received an average of three different procedures during the same surgical visit.

Illness usually occurred soon after these operations, with death occurring an average of about three days post-surgery. In 58% of cases, death occurred within 24 hours of the surgeries, the data showed.

The new report was published in the Jan. 25 issue of the CDC journal Morbidity and Mortality Weekly Report.

Prevention is key

So many of these tragedies could have been prevented if patients had been better screened and preventive steps put in place, Hudson's group said.

They noted that "fat embolism [clotting] is a recognized risk associated with fat injections, particularly as used in gluteal augmentation."Guidelines have long advised against injecting fat into the deep muscular layers of the buttocks for this reason, the researchers said.

As well, patients should always be properly assessed before undergoing any cosmetic procedure as to their risks, based on their specific health histories, the CDC team said.

Screening patients for risk of a venous thromboembolism (a serious blood clot) "should be considered an expected standard of care."If the risk is considered too high, doctors can refuse to proceed with elective cosmetic surgeries.

Hudson's group noted that in 2019, the Dominican Republic's Ministry of Health did issue new safety and quality recommendations to cosmetic surgeons working there. These included training and licensing requirements and recommendations that patients undergo heart and pulmonary evaluations before any surgery.

The Ministry also recommends that "no more than two major procedures should be scheduled during one operation,"Hudson's group noted.

Nevertheless, they advise that "U.S. citizens considering cosmetic surgery abroad should consult with their primary health professionals about their inherent risk for adverse events after surgery and preventive measures they can take to reduce the risk."

They added one last note: Because flying ups the odds for blood clots, patients who do opt for medical tourism "should allow adequate time between flying to and from a destination for surgery, to reduce the risk for complications."

More information

The U.S. State Department has guidance on safeguarding your health while abroad.

SOURCE: Morbidity and Mortality Weekly Report, Jan. 25 2024