A world market, up 40% in four years
The 2024 survey of the International Society of Aesthetic Plastic Surgery (ISAPS) counts 37.9 million procedures performed by plastic surgeons worldwide — 17.4 million operations and 20.5 million non-surgical procedures (botulinum toxin 7.8 million, hyaluronic acid 6.3 million) — 42.5% more than in 2020. The United States comes first (6.1 million procedures), ahead of Brazil (3.1 million, first for operations with 2.3 million) and Japan. Eyelid surgery became in 2024 the most performed operation, ahead of liposuction, breast augmentation, scar revision and rhinoplasty; male demand is rising (gynaecomastia, eyelids, liposuction). The countries receiving the highest proportion of foreign patients are Tunisia, the Emirates, Colombia and Turkey. The UK counts about 30,000 operations a year by members of the British Association of Aesthetic Plastic Surgeons (BAAPS), the US about 1.6 million surgical procedures reported by the ASPS.
The most requested operations, and what can go wrong
- Breast augmentation (implants or fat grafting): capsular contracture (5 to 10% at ten years), rupture, displacement, loss of sensation, reoperation in one case in five within ten years; implants are not for life.
- Liposuction: irregularities, seroma, fat embolism, perforation; the risk rises with the volume removed (above 5 litres, overnight hospital stay required).
- Brazilian butt lift (BBL): fat injected into the buttocks; the deadliest cosmetic operation, with mortality estimated at 1 in 3,000 in 2017 (fat embolism when fat is injected into the muscle), brought down to about 1 in 15,000 since strictly subcutaneous injection under ultrasound; British surgeons suspended it from 2018 to 2022, Florida regulated it in 2019 and 2023.
- Rhinoplasty: unpredictable result in 10%, revision in 10 to 15% of cases; the flagship operation of Istanbul and Tehran.
- Abdominoplasty: the riskiest common operation for thrombosis and pulmonary embolism (0.3 to 1%), especially combined with liposuction.
- Eyelids, facelift: haematoma, asymmetry, an eye that no longer closes, facial-nerve injury (rare).
- Hair transplant: no threat to life, but catastrophic results when done by non-doctor technicians, which is the rule in part of Istanbul's clinics (a million transplants a year in Turkey).
- Injections (toxin, hyaluronic acid): skin necrosis and blindness by embolisation of a vessel (several hundred published cases of blindness worldwide), infections from counterfeit products; in England, toxin and fillers have been banned for under-18s since the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021, and a licensing scheme for injectors is being introduced; in the US, injectables may be given by nurses under medical direction, rules varying by state.
The scandals that changed the rules
- PIP (2010): the French manufacturer Poly Implant Prothèse filled its implants with industrial silicone; 47,000 women in the UK, 400,000 worldwide (Latin America especially); double rupture rate; the founder, Jean-Claude Mas, sentenced to four years in prison in 2013; the notified body TÜV Rheinland ordered to compensate; the NHS offered removal.
- Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): a rare cancer (about 1 in 3,000 to 30,000 implants) linked to textured implants; Allergan's Biocell implants were recalled worldwide in 2019 after France banned macro-textured implants; the FDA requires a boxed warning since 2021; monitoring is recommended, not preventive removal.
- The deaths of medical tourism: see below.
Medical tourism: the true price of a half-price quote
A breast augmentation costs £6,000 to £9,000 in the UK or $8,000 to $12,000 in the US, £2,500 to £3,500 in Turkey, flight and hotel included in the packages. The difference is explained by salaries, but also by what you do not see: no second consultation, compressed operating time (several operations in one session, the first factor of mortality), discharge the next day, no follow-up, and the impossibility of suing the practitioner from home. The facts: the UK Parliament recorded in March 2024 28 Britons dead in Turkey after elective procedures since 2019, and the Foreign Office is aware of 7 further deaths in 2025, plus hundreds of complications treated by the NHS on return (in 2022 BAAPS counted 324 patients returning with complications, including multi-resistant infections, at an average cost of £15,000 each). The US CDC investigated in 2023 the deaths of American women after BBLs in the Dominican Republic, and mycobacterial infections after liposuction in Mexico. The rules: never combine several operations in one session, stay at least ten days on site, refuse any operation not preceded by a consultation with the surgeon in person (not a "coordinator"), check their registration with the country's medical board, demand a written contract, and know that your insurance will cover neither complications nor repatriation. Destinations and their speciality: Turkey (Istanbul: hair, teeth, noses, BBL; the country claims 1.5 million foreign patients a year), Mexico (Tijuana, Cancún, Guadalajara for Americans; dental and bariatric surgery too), Dominican Republic (BBL, several US deaths), Colombia (Medellín, Cali, Bogotá), Brazil (the school of Ivo Pitanguy, very high level in Rio and São Paulo), South Korea (Gangnam in Seoul, faces and eyelids), Thailand (Bangkok, JCI-accredited international hospitals, popular with Australians), India (Delhi, Mumbai, Chennai), Poland, Czech Republic, Hungary, Lithuania (for Britons and Irish, breasts and teeth), Tunisia (for French speakers), Bali and Malaysia (Australians).
Checking a surgeon and a facility
- United Kingdom: check the GMC register for the specialist register in plastic surgery (gmc-uk.org); "cosmetic surgeon" is not a protected title and any doctor may operate; members of BAAPS and BAPRAS are plastic surgeons; the clinic must be registered with the Care Quality Commission (England), Healthcare Improvement Scotland, HIW (Wales) or RQIA (Northern Ireland); the Royal College of Surgeons recommends a two-week cooling-off period; ads must not target under-18s (CAP rules 2022). Not funded by the NHS.
- Ireland: Medical Council register, specialist division in plastic surgery; no dedicated regulation of cosmetic clinics yet — many Irish patients go to Turkey, Poland and Lithuania.
- United States: board certification by the American Board of Plastic Surgery (the "American Board of Cosmetic Surgery" is not recognised by the ABMS); members of the ASPS; office surgery must be in an accredited facility (AAAASF, AAAHC, Joint Commission); rules vary by state — Florida limits BBL to one patient per surgeon per day.
- Canada: Royal College certification in plastic surgery, provincial college register (CPSO in Ontario, CMQ in Quebec); Canadian Society of Plastic Surgeons; not covered by provincial plans.
- Australia and New Zealand: since July 2023 only doctors with AMC-accredited qualifications may call themselves "cosmetic surgeons"; look for FRACS in plastic surgery (ASPS, ASAPS), and AHPRA registration.
- India, South Africa, Nigeria, Kenya, Philippines: national medical councils; the Association of Plastic Surgeons of India, APRASSA (South Africa), the Philippine Association of Plastic Surgeons publish member lists; in Nigeria and Kenya, deaths in unlicensed "aesthetic clinics" led to prosecutions in 2022–2024.
- Everywhere: ISAPS publishes a directory of members verified in their country; a foreign surgeon found neither there nor in their national register should not operate.
The mind before the body
Body dysmorphic disorder (obsessive preoccupation with a minimal or imagined flaw) affects 2% of the population and 10 to 15% of cosmetic-surgery candidates, who gain nothing from it and chain operations; a good surgeon screens for it and declines to operate. Requests modelled on social-media filters ("Snapchat dysmorphia") and those following a break-up or a bereavement justify waiting. A successful operation changes a detail of the body; it does not change a relationship — the section Seduction and the page Seduction and beauty across cultures recall how much the canons vary. Finally, surgery that repairs (after cancer, an accident, a malformation, FGM — see Intimate surgery) follows other rules and is funded.