KNIFE’S EDGE

Dominican Republic 2019 | HEALTH | FOCUS

Thousands of travelers visit the Dominican Republic for low-cost cosmetic and medical treatment, but the sector requires strict regulation to protect patients and build a reputation for safety as well as affordability.

Over the least two decades, the Dominican Republic has become a destination for people across the world seeking cosmetic surgery and other medical services at competitive prices. Medical tourism, especially cosmetic surgery, offers the economy great reward but comes with risk for clients and clinics if regulators fail to maintain strict oversight of the sector.
Standard medical treatment is available, including heart surgery and orthopedic surgery, but cosmetic surgery promises to be a more lucrative sector, as happy customers are likely to be more vocal, online and offline, about their experiences than someone who is satisfied with their new knee.

The Dominican Republic's cosmetic surgery clinics can offer prices far lower than those found in the US. While a facelift in the US can cost upward of USD14,000, a Dominican provider will charge just USD4,000 for the same service. But the cosmetic clinic is not the only one who benefits. Hotels, restaurants, tour guides, and street merchants can expect to reap more benefits.
Even if medical tourists don't stick around for the sunsets, the sums they pay do. And the specific nature of cosmetic surgery can attract repeat visits, with clients at clinics returning for more work, especially if they are happy with the initial results. Keeping them happy with their experience draws even more money to the country.

The Dominican Republic's economy already relies heavily on tourism as a source of foreign capital, and it has seen a boom in hotel building in recent years. But medical tourism as a national product represents a significant step up the value chain. The Dominican Republic's status as a medical tourism destination is only as good as its reputation. A failure by one provider can tarnish the reputation of the entire sector.

No amount of regulation can completely eliminate risks of medical procedures, but government oversight of the sector can reduce the chance of harm to patients and the Dominican Republic's brand. Patients who have bad experiences in plastic surgery become walking, talking reasons for others to avoid the island. Some even take to YouTube or social media to describe their experiences, both positive and negative. Even if they are isolated cases, negative stories can give others considering the Dominican Republic's clinics a reason to rethink.

Unlike medical treatments where a patient who is sick gets better, the results of cosmetic surgery are a matter of the patient's opinion and their friends' evaluation of how they look afterwards. Trying to ensure every patient is satisfied with the results of cosmetic surgery is impossible for regulators. Thus, their focus needs to be on the delivery of safe treatment and consequences for surgeons whose patients fall ill, or even die, after botched cosmetic procedures.

In 2014, a New York City woman travelled to the Dominican Republic for a tummy tuck, or abdominoplasty, and died during the procedure, according to an Associated Press report at the time. The US Centers for Disease Control and Prevention issued a warning against travelling to the country for cosmetic surgery procedures.

"Some of these patients end up going through one or more surgeries and various travels through the medical system," Dr. Douglas Esposito, a CDC official, told the AP at the time. "They take a long time typically to get better."
The CDC issued another report in 2017 after dozens of American women came back from a single Santo Domingo clinic, Centro Internacional de Cirugía Plástica Avanzada (The International Center for Advanced Plastic Surgery), with severe, painful infections that required further treatment.

Low prices and quick availability for appointments mean the Dominican Republic will remain a destination for patients seeking plastic surgery, but the medical tourism market is highly competitive. If regulators in Santo Domingo cannot ensure the safety of patients, then patients might start to look to other countries for cosmetic procedures, despite the country's geographic and aesthetic advantages. For the benefit of all involved and the long-term health of the sector, doctors should demand tougher regulations from the Dominican government.