Botched Cosmetic Surgery – In an interview with Schweiz am Wochenende, Dr. Kelly Vasileiadou discusses the risks of cosmetic surgery abroad.

Cosmetic surgery abroad is booming. What is marketed as an affordable all-inclusive package, however, can result in complex follow-up operations. In the end, the costs are borne by the Swiss healthcare system.
By Stephanie Schnydrig

According to estimates, around 100,000 cosmetic procedures are performed in Switzerland each year. Worldwide, the number of cosmetic surgeries has increased by 40% since 2020. In Switzerland, the most common aesthetic procedure is skin smoothing through wrinkle injections. Cosmetic surgery abroad can cost up to 70% less. The follow-up costs of a failed cosmetic procedure amount to CHF 10,000 to 20,000 per hospitalised patient.

“We have people on the phone every week who are desperate.”
Kelly Vasileiadou, board-certified surgeon

It was just over six years ago when a friend of Isabelle* booked a tummy tuck in Turkey. She suggested that Isabelle should come along and showed her the website of the cosmetic clinic. “The clinic looked modern,” Isabelle recalls. “The photos online promised discretion and professionalism. It sounded like a holiday with a nice side effect.”

Rather spontaneously, Isabelle decided to accompany her friend – and to take the opportunity to undergo an aesthetic procedure herself. She opted for a so-called Brazilian Butt Lift, a procedure in which fat is removed from other parts of the body and injected into the buttocks to make them appear fuller and firmer.

Before travelling, Isabelle asked the provider whether the procedure would even be possible in her case. “I am very slim and initially sceptical about whether there would be enough fat,” she says. She sent a photo of herself to those responsible and quickly received a reply: no problem.

Once on site, however, she was told that she did not have enough fat for a classic Brazilian Butt Lift and that the procedure could not be carried out as planned. She was presented with two alternatives: buttock implants or the injection of a gel that was said to dissolve again after seven years. It was a so-called Aquafiller called Los Deline. “I was completely desperate,” Isabelle says. She had already paid, the operation was scheduled for the next day, and there was hardly any time to think.

The Aquafiller seemed to her the less invasive option compared to implants. She decided to proceed, signed the consent forms and underwent surgery the following day. “Right afterwards, I really liked the result.” What Isabelle did not know at the time was that Los Deline is a filler material that is not approved in Switzerland and has even been explicitly banned in many other countries due to severe complications.

Yellowish fluid mixed with blood

One year later, back in Switzerland, Isabelle noticed a hardening in her leg. An ultrasound revealed that the Aquafiller had clumped together, migrated through her body and caused inflammation. At Zurich University Hospital, the findings were examined in more detail. An MRI revealed the full extent: the highly inflammatory material had spread between the skin and muscles into both thighs.

Drainage tubes were inserted. Almost half a litre of yellowish fluid mixed with blood drained from her body every day. Yet her condition did not improve. Two weeks later, Isabelle developed a fever, felt nauseous and her hip swelled severely. She had to undergo emergency surgery again due to the formation of an abscess.

What followed, Isabelle describes as a medical nightmare. New inflammations occurred roughly every four weeks. She was given antibiotics and underwent repeated surgeries – 14 operations in total. She was unable to work for four months. Only during the final procedure did doctors discover the cause of the recurring abscesses: a hospital-acquired germ resistant to several antibiotics had embedded itself in the tissue. With the appropriate medication, the inflammation disappeared within hours. But the damage had long been done. The wound remained open, and material continued to leak for more than two years.

The cost of botched surgery abroad is rising

Such stories are no longer isolated cases. Medical tourism for cosmetic surgery is flourishing. In Turkey, every third aesthetic procedure is now performed on foreign patients. The industry promotes all-inclusive packages, arranged through agencies that compress flights, hotel stays, surgery and follow-up care into just a few days.

According to the association Swiss Plastic Surgery, annual spending on cosmetic surgery in Switzerland amounts to several hundred million Swiss francs. Complications, particularly following procedures performed abroad, account for a growing share of follow-up costs.

Kelly Vasileiadou, board-certified surgeon, is well acquainted with this darker side of cosmetic surgery. She is the founder of a clinic specialising in plastic surgery in Hünenberg See and regularly treats patients who return from procedures abroad with complications. “We have people on the phone every week who are desperate,” she says. “They complain that they are suddenly left alone: the surgeon is far away, and the agency that arranged everything is no longer reachable.”

The complications are most commonly wound-healing disorders, infections, bruising, thromboses or conspicuous scarring. “Medically, these are fortunately often manageable conditions,” Vasileiadou says. “Psychologically, however, patients go through an enormous ordeal.”

Pre- and post-operative care are critical

International registries show that mild complications occur in around five to ten percent of all cosmetic procedures, while severe events such as thrombosis occur in less than one percent of cases. The risk increases when implants are used. “As soon as a foreign body is involved, we automatically see more problems.”

Vasileiadou also advises against treating multiple body areas at the same time, as this increases the risk of thrombosis and electrolyte imbalances. The latter can destabilise circulation and require hospitalisation. Every cosmetic procedure, she emphasises, is an intervention on a healthy body – and therefore never risk-free.

Studies also show that complications occur significantly more frequently after cosmetic surgeries performed abroad than after procedures in Switzerland. A research team at Zurich University Hospital found that of 228 patients treated for complications, 82 percent had undergone surgery abroad – primarily in Turkey, the Czech Republic, Brazil or Germany. The most commonly affected were women after breast surgery, followed by body contouring procedures such as liposuction or tummy tucks, as well as facial procedures.

Experts stress that the higher rate of complications abroad has little to do with the quality of individual surgeons. “There is no doubt that excellent surgeons also practise abroad,” Swiss Plastic Surgery states. Vasileiadou likewise says she knows many outstanding surgeons worldwide. “The procedure itself can be technically well performed anywhere.” What is often lacking, however, is thorough pre-operative assessment and reliable aftercare.

In Switzerland, she explains, part of the cost is justified by exactly this: accessibility. “You can always reach us – at weekends and in the middle of the night. This is not a lifestyle surcharge, but part of medical care,” Vasileiadou emphasises.

Good preparation includes clarifying which medications a patient takes, whether there are underlying conditions, whether they smoke or are overweight. Such information can hardly be reliably gathered through agencies, brief chat exchanges or first consultations on the eve of surgery.

Even more serious, however, is the lack of aftercare. “The operation is not over when the surgeon puts the scalpel down.” Patients are strongly advised to strictly avoid physical exertion during a defined recovery period and to consistently take prescribed medications such as antibiotics and, if necessary, cortisone. Fixed follow-up appointments are standard in Switzerland. Abroad, by contrast, patients are often put back on a plane just two days after hours-long surgery – with the return flight alone further increasing the risk of thrombosis, according to Vasileiadou.

The Bern-based agency Medicaltravel, which arranges cosmetic surgery trips to Turkey, emphasises its high standards. The company states that consultations begin already in Switzerland, with interested individuals able to attend consultation days and meet surgeons in person. Aftercare is structured through photo and video updates, standardised questionnaires and personal follow-up consultations. There are also clear guidelines regarding minimum lengths of stay after surgery. Should problems nevertheless arise, the agency coordinates further medical care in Switzerland.

Ultimately, Switzerland pays

The pull towards surgery abroad is further amplified by social media. “Influencers have surgery abroad and tell their community how great everything was,” says cosmetic surgeon Vasileiadou. Their followers rarely hear about complications. “Some openly tell me they do not want to talk about it.” Yet they have enormous reach – and therefore responsibility.

Swiss Plastic Surgery advises that anyone who nevertheless chooses to undergo cosmetic surgery abroad should first consider key questions:

Where will follow-up care take place?
Who is responsible if complications occur?
Who is liable if something goes wrong – and who pays?

By raising issues of payment and liability, the association addresses two particularly sensitive points. While basic health insurance does not cover cosmetic surgery, it does cover the treatment of medically necessary consequences – from abscesses and thromboses to the risk of blood poisoning or chronic wounds. Aesthetic reconstructions may also be considered medically necessary if patients suffer severe psychological distress.

Those responsible abroad usually escape liability, as the legal effort required for successful claims is high and the chances of success vary greatly depending on the country.

Bern University Hospital estimates the cost per hospitalised patient with complications following cosmetic surgery at CHF 10,000 to 20,000. The total follow-up costs for health insurers cannot be precisely determined, as these cases are not recorded as “complications of cosmetic surgery” but are billed, for example, as wound-healing disorders or infections – without reference to their actual origin.

The biggest mistake of her life

Isabelle’s treatments were also covered by health insurance, minus the deductible. “Together with the surgery in Turkey, it cost me well over CHF 10,000,” says the woman in her mid-thirties, who recently became a mother for the third time. She is grateful that pregnancy and childbirth went well despite her ordeal. The consequences of her experience in Turkey, however, will remain: the nerves in her left leg are permanently damaged, and she has developed resistance to two antibiotics. Today, Isabelle wears compression stockings and compression garments.

“It was the biggest mistake of my life,” she says. When she meets young women considering cosmetic surgery abroad, she becomes angry. “I warn everyone strongly against it. Pay a bit more – this is about you and your body.” For herself, there will be no more cosmetic surgery. Even a harmless beach holiday in Turkey is no longer conceivable. “As soon as I even hear the word Turkey, I see red.”

How AI makes us more beautiful

Artificial intelligence is changing our perception of beauty. This is demonstrated by a recent study from the United States.

A research team applied the TikTok filter “Bold Glamour” to portrait photos of young women and analysed how their appearance changed. The results show that skin appeared smoother, wrinkles and dark circles were reduced, and faces looked more symmetrical and younger – without appearing artificial. Remarkably, the filter altered faces by only a few percentage points.

This effect already seems to be reflected in growing demand for minimally invasive treatments. Many of the changes created by AI can be replicated through comparatively mild procedures such as skin smoothing, lip injections or eyebrow lifting.

According to market research institute Data Bridge Market Research, the Swiss beauty industry is expected to grow by more than 11 percent by 2030, primarily due to the “increasing demand for non-invasive and minimally invasive procedures.”

The cosmetic surgeon from Zug, Kelly Vasileiadou, also confirms this trend:
“Patients used to bring pictures of actresses or influencers. Today, they bring selfies that have been edited with an AI filter.”

————————————

*Name changed

————————————

Learn More about Dr. Kelly® Vasileiadou