Destination weddings? Old news. But destination plastic surgery? A movement in the making, cultishly trending among thousands of prospective patients. This is not medical tourism, mind you—that’s a topic for another time. What we’re talking about here is crossing state lines for a nose job or tummy tuck.
Traveling far from home for plastic surgery involves some serious strategizing—both logistical and budgetary. In addition to the cost of your surgical procedure (including anesthesia and OR time), you’ll be paying for round-trip transportation between your state and your surgeon’s, plus Ubers or a rental car for getting around town during your stay—and, unless you have friends or family in the area, you’re likely looking at a handsome hotel bill too. Oh, and the private-nurse fee—can’t forget that.
Yet, according to our first-ever Cosmetic Treatment Travel Report, 45% of RealSelf members (based on a sample of more than 1.75 million users) who searched for an aesthetic provider during the first half of 2019 were seeking one outside their home state. The top destinations were Florida (no surprise there), California and New York (now we’re intrigued!).
So what motivates patients to go the distance, despite the obvious hurdles? As far as Florida is concerned, “I think price tends to be the primary draw, though it absolutely shouldn’t be,” says Miami-based plastic surgeon Dr. Adam Rubinstein. “Compared to national pricing, South Florida prices are lower than average, and our state has unfortunately become known for high-volume clinics that offer deep discounts.” While low prices are alluring, he notes, “we have seen how that sometimes plays out poorly for patients.”
(One might assume any money saved on cheap labor would be lost to travel costs, but Dr. Rubinstein finds that Miami-bound patients will frequently shack up with local friends or find a budget Airbnb.)
While surgery seekers from small towns may have no choice but to expand their search due to a simple dearth of aesthetic doctors in their area, “some seem to believe that surgeons in South Florida are especially busy and experienced, and this instills confidence,” Dr. Rubinstein adds. “Certainly, there’s a lot of plastic surgery being done in South Florida, but probably no more than in other major cities, especially those in New York and California.”
Dr. Jon Kurkjian, a plastic surgeon in Fort Worth, Texas, finds that out-of-state plastic surgery patients tend to visit him “to achieve a specific type of result,” he says. “They’ve done their research, compared before and after photos [B&As] and concluded that the surgical results I’m achieving are consistent and aligned with their goals for natural results.” Texas, it’s worth noting, is another hot spot for plastic surgery, coming in fourth place in our study. “Some of the finest training institutions in our field are in Texas, so many of our local plastic surgeons are truly skilled,” says Dr. Kurkjian. Practically speaking, the Lone Star State’s central location is also a boon.
Wanderlust with plastic surgery comes with pros and cons. In the plus column, it gives you full freedom to choose your dream doctor, particularly one who specializes in your desired procedure. “In the age of Google and social media, people can now find a true expert,” says Dr. Rod Rohrich, a plastic surgeon in Dallas. “Because it’s no longer good enough to be a board-certified plastic surgeon, you have to go beyond that—you have to be a board-certified plastic surgeon who specializes in X.”
Nose job patients are particularly willing to travel for reputable surgeons and reliable results. “In my practice, rhinoplasty is the most commonly sought procedure from our out-of-town patients,” notes Dr. Kurkjian. “They’ve accurately identified that rhinoplasty is a unique procedure that requires true expertise to achieve well-balanced results that are proportionate to the face, and they realize that each rhinoplasty surgeon has their own style.”
The fast-growing Brazilian butt lift (BBL) is also worth the extra miles. “It’s a very specialized procedure, with inherent risks for complications and patient dissatisfaction,” cautions New York City plastic surgeon and BBL thought leader Dr. Matthew Schulman, who says that about 30% of his BBL patients come from out-of-state. “Surgeon judgment, experience and technical skill are key to a safe and acceptable result. Since there are only a handful of board-certified plastic surgeons who have long-term experience with this procedure, it makes sense to travel to these experts.”
For revision surgeries, seeing a plastic surgeon in another part of the country may simply be essential, since so few doctors specialize in these technically challenging corrections. “If you’re having a secondary rhinoplasty or you’ve already had two, three surgeries on your face or nose, [then] you need to see somebody who’s an expert in these areas,” says Dr. Rohrich, noting that 70% of his cases are revisions.
If you’re considering out-of-state plastic surgery, prepare for greater expenses and some major calendar choreography. Beyond basic travel arrangements, you’ll need to plan for post-operative care, a potentially lengthy stay and subsequent follow-up appointments. Here, let us guide you through it.
3 to 6 Months Before Surgery
Do your homework
And don’t even think about slacking: “Approach plastic surgery as you would a cardiac bypass—and treat it with the same respect,” advises Dr. Rubinstein. Remember: there are risks associated with every aesthetic procedure, even those that seem routine and Insta-friendly.
Since plastic surgery consults typically involve a fee—a hundred bucks or more, often applicable to your surgery, should you decide to book it—you’ll want to narrow your pool of doctors to avoid shelling out for countless meetings. Spend time on prospective surgeons’ websites; read unbiased reviews, like those on RealSelf; look for standardized B&As (meaning those taken from the same perspective, against the same background, in the same lighting); and try to get a feel for each doctor’s style and sensibilities.
“Eighty percent of my out-of-town patients say they found me through internet searches alone; the other 20% say [it was] a combination of general searches and Instagram,” says Dr. Kurkjian. “They always refer to our photos and online reviews as their primary reasons for traveling.”
Dr. Jacob Unger, a plastic surgeon in Nashville who specializes in revision breast surgery, says, “Surgeon selection should ultimately come down to who you trust and who you feel a connection with, because plastics is such a personal thing.” Granted, it can be tricky to ascertain trustworthiness from afar; but quite often, a doctor’s personality and professionalism will shine through in Instagram posts. Note their tone and topics of discussion: Are they aiming to educate and promote safety or merely shill services?
While social media shouldn’t be your sole source of research, it can be a valuable tool. Many of the country’s top plastic surgeons maintain their own social profiles, allowing patients a window into their world. “Practices like mine that showcase daily surgeries and results on social media give patients a glimpse into who we are and what is possible,” says Dr. Rubinstein. “And I think patients develop a higher level of trust in doctors who share on social media.”
Still, it pays to be wary when scrolling through B&As: “With Instagram, in particular, there’s a lot of marketing going on,” says Dr. Jason Roostaeian, a plastic surgeon in Los Angeles. “If you’re not seeing high-quality photos from every angle, then in my book, that’s a marketer and not a great plastic surgeon.” The most reliable “afters,” experts say, are those taken not immediately after surgery but months later, once the body has healed and swelling has subsided.
“You’ve got to remember—a lot of this is art,” adds Dr. Roostaeian. “Make sure your art and your surgeon’s art are in line and that you’ve seen an honest representation of their work before you invest.”
Another crucial criterion: “You want someone who is extremely accessible,” Dr. Unger says. “I FaceTime patients on my cell phone. I take calls 24 hours a day, seven days a week, unless I’m on an airplane, in which case I have my nurse manage calls and texts until I land. Find someone who’s really committed to plastic surgery—and to you, the patient—beyond the hours of nine to five.”
Schedule a video consultation
For out-of-state plastic surgery, face-to-face consults are typically done via FaceTime or Skype, no less than one to two months before your target surgery date. “You absolutely should be speaking to the operating doctor directly before you even think about scheduling a procedure,” says Dr. Rubinstein.
Prior to arranging a chat, a nurse from the surgeon’s office will request some background on you and what you’re looking for: What bothers you about the feature in question? Would this be a revision surgery? Have you had any previous plastic surgery procedures? They may also ask for a complete medical history, records from past surgeries and photos of you (typically one forward-facing, plus right and left profile views). Deliver as much detailed intel as possible.
Next, a representative from the surgeon’s office will reach out to schedule your e-consultation, which should last between 15 and 30 minutes. This is your chance to get to know the surgeon and “make sure you click,” says Dr. Rohrich. “I don’t operate on people I don’t like—and of course, I want patients to like me, because surgery, especially complicated procedures, can be a long haul.” Ask all your questions and express any concerns—and your surgeon will do the same: during the consult, “I’m wanting to see that you’re very clear and realistic about what you want and what I can deliver,” Dr. Rohrich adds.
Be sure to go over the potential risks and complications of your surgery, and find out where your operation will take place—an accredited OR or outpatient facility—and who will be administering the anesthesia (accept only a board-certified anesthesiologist).
Once you’ve committed, your doctor’s office will help you set a date and send you the necessary pre-op paperwork, including consent forms, to fill out and return prior to the big day.
Book travel and make a post-op plan
Beyond the obvious getting-there arrangements—planes, trains, or automobiles?—you’ll need to find clean, comfortable lodging in the vicinity of your surgeon’s office or OR. Different surgeons provide different resources to out-of-towners, but most will offer up a list of recommended hotels (at varying price points) and options for post-op nursing care. Some practices, like Dr. Rohrich’s at the Dallas Plastic Surgery Institute, actually maintain their own private hotel—staffed around the clock by plastic surgery nurses—offering care for the first night or two after surgery.
If you can’t afford to go that route or would rather not hire a nurse, your surgeon will require that a relative or friend accompany you for the surgery and stay with you for at least the first night of recovery.
When calculating travel time, factor in an additional two to three days prior to your surgery date, for a pre-op exam (more on that ahead), and at least one week after surgery. Your surgeon will be able to give you a more precise timeline for planning purposes. Generally speaking though, count on sticking around for seven or eight days following primary rhinoplasties, blepharoplasties and liposuction; this is when docs want to see you back to assess healing and remove nonabsorbable sutures. Breast augmentation recovery tends to be quicker, so you may be able to head home within a few days of surgery.
For more complex operations or those resulting in both sutures and surgical drains—think: various revision surgeries, facelifts, BBLs, mommy makeovers, breast reductions, tummy tucks—commit to staying 10 to 14 days after the procedure, abiding by your surgeon’s specific terms.
Related: 3 Women Get Real About Their Mommy Makeover Experience
Some doctors admittedly have a no-tolerance policy for those unwilling to put in the post-op time. “I don’t operate on people who want to fly right home,” says Dr. Rohrich. “I need to see them in person [the following week] to make sure their early post-op recovery is on track.” Others are more willing to cater to patients who can’t take the extra time, and they will enlist a colleague—a fellow board-certified plastic surgeon who practices near the patient’s hometown—to remove stitches, splints and drains. “We’ve all gotten those calls, and we’re all happy to help each other out,” says Dr. Rubinstein. Still, all the surgeons we spoke to say they much prefer to handle post-op care themselves.
1 Month Before Surgery
Go for pre-op testing and hit the pharmacy
Plastic surgeons generally require you to knock out the requisite labs, EKGs and chest X-rays a week or two before your operation. The lab/imaging technicians will send your results directly to your doctor via email or fax (your surgeon’s office will provide you with requisition forms and instructions).
“Full medical clearance is required for all patients having surgery—and that doesn’t change because they’re flying into town,” says Dr. Rubinstein. Taking tests two weeks out grants a little wiggle room “should there be a blip on the radar, like an irregular result, that we need to check out before surgery.”
Your doctor will order any prescriptions you may need (pain meds, sedatives, ointments, and the like) prior to surgery so you can pick them up at your usual pharmacy before traveling. While you’re there, grab whatever oral supplements your doctor recommends, to prep your body for surgery and aid in healing. Surgeons commonly suggest taking bromelain, a pineapple-derived enzyme, and the homeopathic herb Arnica montana for several days before and after surgery, to minimize bruising and swelling, but this isn’t standard protocol. More universally, docs will demand you steer clear of blood thinners (like alcohol, NSAIDS, fish oil, vitamin E, and ginkgo biloba) for at least two weeks before.
1 to 3 Days Before Surgery
Attend your pre-op visit
The pre-op visit allows your doctor the chance to examine you in person for the first time before your scheduled surgery. “I’d never operate on someone unless I’ve seen them at least one day—in many instances, a few days—prior to surgery,” Dr. Rubinstein says.
The one- to three-day window holds for most plastic procedures, even the high-risk BBL. “We need to make sure you are, indeed, a good candidate, and that the plan we developed virtually is still appropriate,” explains Dr. Schulman.
In rare situations—typically, complicated revision cases—a doctor might ask you to fly in a week or more ahead of time, for additional consults, exams and measurements. “There are some patients I can’t diagnose properly until I see them in person,” explains Dr. Anthony Youn, a plastic surgeon in Detroit. From there, he can devise a concrete surgical plan.
The Day of Surgery
Get excited: it’s go time!
Wear loose, comfy clothes—elastic-waist pants, a button-down if you’re having facial surgery—and follow your surgeon’s instructions to a tee. Be sure someone is available to take you back to your hotel after you’re discharged. Your surgeon and his staff will brief your caretaker on how to keep you comfortable and tend to your incision sites.
After Surgery
Your return trip—and beyond
Truth time: in even the best-case scenarios, air travel following surgery “is not going to be the most comfortable flight of your life,” Dr. Roostaeian concedes, but it is safe to fly—and doing so will not affect the outcome of your procedure.
If you’re going a great distance, Dr. Rubinstein suggests bringing a wedge pillow onboard to keep your head elevated. Rhinoplasty patients will want to stash a moisturizing nasal spray in their carry-on, to combat in-flight dryness (which can lead to nosebleeds). “These patients also seem to swell more when they fly, maybe from the drop in cabin pressure, so I’ll sometimes have them tape off their nose for the flight, to minimize swelling,” says Dr. Roostaeian.
If you’ve had a BBL, “you’ll need to minimize pressure on the grafted areas, like buttock and hips, for six weeks, to help improve overall fat survival,” says Dr. Schulman, who recommends getting a pressure-reducing buttock pillow that fits in an airplane seat. Get up and move as much as possible when traveling, he adds: “In a car, this means frequent stops to walk and stretch; on a plane, fly business or first class, if possible, or book an aisle or extra-legroom seat so you can move about more easily.” Overall, he says he hasn’t found long flights to negatively affect BBL results.
Related: The Future of Opioid Use in Plastic Surgery Recovery
“And assuming patients are healthy and have no preexisting risk for blood clots, the risk of a clot from flying is highly unlikely,” Dr. Schulman notes. “All of our patients are prescreened for clotting disorders, and we encourage frequent walking after surgery, to keep the blood flowing properly.” He also supplies patients with a note to present at the airport, requesting assistance through security for faster boarding.
Once back in your own zip code, most follow-ups can be done virtually, assuming you’re not experiencing complications and you’re happy with your results. Surgeons typically want to touch base at six weeks, six months and one year post-op. Ideally, they say, at least one of those check-ins will be in person.
Should complications arise at any point during your recovery, your first call should be to your surgeon. “If you need to be seen right away, go to a university-affiliated hospital where they have plastic surgery coverage,” says Dr. Youn. The surgeon who operated on you should then connect with the plastic surgeon on call, to give them background details pertinent to treatment.
According to our experts, it’s rare for problems to arise weeks after surgery—especially with facial procedures. “Urgent medical complications are usually pretty immediate,” Dr. Roostaeian notes, with anything that would qualify as a true emergency occurring within the first week. Which is precisely why doctors insist on you lying low locally during that stretch.
The Bottom Line
Should I stay or should I go now?
Casting a nationwide net when searching for a plastic surgeon can yield big rewards—namely, unlimited access to the country’s leading specialists. But it’s certainly not the only way to go. In fact, our survey found that RealSelf members from Michigan, Texas and Arizona prefer to stay local: searches for aesthetic doctors in those states were significantly more likely to come from in-state residents. A whopping 70% of the total searches for aesthetic providers in Michigan came from local residents.
“You really want to make sure that you can’t find the same caliber of care in your area before going elsewhere,” says Dr. Youn, because there’s something to be said for the home-field advantage: “It’s far more convenient and less stressful to visit your doctor when they’re only a short drive away. And if you have any kind of complication, believe me, you’re going to want them close by.”
Finally, before making any decisions, check your motivations for traveling, especially if you find yourself honing in on areas known for blowout pricing. “Sometimes when you think you’ve found a bargain,” notes Dr. Rubinstein, “you wind up getting more than you bargained for.”
