Patients who are not from Cape Town can stay at the Coach House. The Coach House is is a small historic cottage with a garden and pool. It is well situated in Cape Town, close to amenities with views of the mountain and is about three or four blocks from my rooms, about a ten minute gentle walk. My secretary, Anneli, stays upstairs and 2 units are available for patients. Anneli will look after you and provide a link to me. Each unit sleeps 2 and has its own kitchen and bathroom. The units are self-catering, but there is a good shop across the road and Anneli can provide stock beforehand as you require. There are good restaurants in the area and The Mount Nelson Hotel is almost next door. The Garden’s Centre, a major shopping centre in Cape Town, is 400 meters from the Coach House. The Company Gardens, museums, galleries, theatres and cinemas are close by.

For other accommodation in proximity to my rooms, such as backpackers and other hotels, please contact Anneli.

The primary issue to consider when planning your trip is safety. The secondary issues are those around your surgery; are you a candidate for surgery and what is the most appropriate procedure for you. To ensure that your surgery away from home is as safe as possible, I recommend that you adhere to the following advice:

• Avoid too much surgery. If you want an extreme makeover, have it at home. Ideally you should travel for only one or two procedures, not a shopping list of operations. I will guide you in this regard via email.
• Schedule enough time here to allow for recovery. Surgery is demanding on your body and you will need to rest afterwards. Do not plan on having too much of a holiday. Nevertheless, most medical tourists do get to see the sights in and around Cape Town, but I would not suggest that you travel too far afield.
• Go for a check up before you leave. This can be done by your family doctor who in addition to doing the usual medical check, should also check your haemoglobin levels (Hb) and your blood pressure (BP).
• Ensure that you are healthy when you travel. Get down to your ideal weight before you consider surgery. Eat healthily and have an exercise routine. Give up cigarettes if you are a smoker. Have a dental check-up prior to your departure. Bring a spare pair of spectacles.
• Ensure that required immunisations and vaccinations are up to date. If in doubt, check with your doctor or travel clinic at home before you leave. Cape Town is not a malaria area, although parts of the north of the country and other parts of Southern Africa are. If you are considering going to these areas, ensure that you have anti-malaria prophylaxis.
• If you are on routine medication, bring it with you in the original packaging.
• Take out travel health insurance.

If you are generally healthy and not overweight, then most cosmetic surgery procedures should be safe. As to the correct procedure for you, this can only ever be decided at the consultation although a lot can be achieved via email especially with appropriate photographs.

Before you leave home:

• Ensure that you are healthy. Go to your GP for a check up, including blood pressure and haemoglobin.
• Eat sensibly to achieve your ideal weight.
• Do moderate exercise, involve a personal trainer if possible.
• Live a healthy lifestyle.
• Avoid smoking, especially 2 weeks prior to and after surgery.
• Avoid aspirin-containing medication for 2 weeks prior to surgery. Aspirin can increase bleeding.
• Avoid the oral contraceptive pill and hormone replacement therapy for one month prior to surgery as this increases the risk of leg clots.
• Avoid any medication or substance, including vitamins (vit E) and homeopathic treatments, which can affect the clotting of your blood.
• Avoid arnica until about 2 days post-operatively.
• Bring sunglasses and a scarf for face surgery; loose fitting clothes for body surgery.

On the flight to Cape Town, it is recommended that you follow these precautions to prevent leg clots:

• Use graduated pressure stockings for your legs when you fly, such as TED stockings or flight socks, pre-op and post-op
• Drink plenty of water on your flight over. Avoid alcohol.
• Exercise on the airplane – follow the instructions in the in-flight magazine.

Further precautions to be taken after you arrive in Cape Town:

• Go for a good walk soon after arrival to improve the circulation in your legs. Walk as much as you can.
• Wash well the night before surgery and the morning of surgery. If possible use an antiseptic soap such as Betadine and shower rather than bath.
• At the pre-op consultation ensure that all your questions are answered and that you are confident that you understand your procedure, the risks, possible complications and the likely post-op course. The better prepared you are, the easier it will be. If you are unsure about anything, ask me.
• On the day of surgery you must wear no makeup or jewelery. Wear loose-fitting, comfortable clothing and bring a scarf and sunglasses if you are having facial surgery.

Guidelines for after your surgery:

• Allow yourself time to recover. Do not plan too busy a schedule. Although pain and discomfort are likely to last only a couple of days, plan on resting rather than a busy holiday schedule.
• Follow the post-op instructions diligently.
• Do not expect to see the result immediately. Your body takes time to heal and to recover. Swelling and bruising take on average 2-3 weeks to settle.
• Allow for the routine post-op consultations. I will see you a number of times after surgery and before you leave for home.
• Follow the same precautions for your flight home as you did on your flight to Cape Town.
• Once you are back at home, keep in touch and keep me informed of your progress via e-mail.

Complications, if they occur, can be problematic for any patient and even more so if you are a traveller away from home, or if you have already returned home. Although rare, complications can occur, even the healthiest patient who has the best surgeon can get complications! Fortunately most complications are minor and are resolved without the need for further surgery. In addition, most complications are likely to occur soon after surgery, hence the recommended duration of stay. Complications which occur once you are back home will have to be dealt with by a doctor or plastic surgeon in your home country. I can keep in touch and give advice, but obviously cannot treat a problem from some distance away. I do have plastic surgery colleagues, mainly in the UK, who will be available to see problems on a fee-for-service basis. In addition, being a member of ISAPS, I can refer you to any other ISAPS member who will see you. To avoid complications I try to operate with an awareness of the potential for problems and my surgical philosophy is one of conservatism. On the whole, plastic surgery is safer than many other types of surgery because procedures are relatively minor and superficial and surgery is being performed on a fit, healthy individual. Safety is my primary concern. I do not take on unsuitable or high risk cases. Having plastic surgery in another country should really be restricted to the routine case rather than the extraordinary. Careful patient selection is important so that the great majority of patients can undergo uneventful surgery and return home healthy and happy.

Deep Vein Thrombosis (DVT) is the formation of a blood clot in the deep veins of the legs. The blood clot can break off and travel in the blood stream to the lungs as a pulmonary embolism (PE). Pulmonary embolism can cause problems with breathing, blood flow in the lungs and can even be fatal. Prior to undergoing surgery, it is appropriate to have some understanding of DVT, its causes and risk factors, and what you can do to minimise the chance of its occurrence. The risk factors for DVT are:

1. Long haul flights
2. Surgery: major surgery, abdominal surgery
3. Previous DVT or PE
4. Patient age (increase risk with increased age)
5. Obesity
6. Disease (diabetes mellitus, cardiac disease, respiratory disease, polycythemia)
7. Medication: oral contraceptive pill
8. Pregnancy
9. Cancer

Preventative measures:

1. Avoid risk factors such as the oral contraceptive pill, etc. If you are on the pill, I recommend stopping it one month prior to surgery. Don’t forget to take other contraceptive measures!
2. Stop smoking: Not only does smoking increase the risk of DVT, but it also increases the risk of other complications.
3. Graduated compression stockings such as TED stockings can be obtained prior to your departure from home, used on the aeroplane coming over, and during and after surgery. This is well worth doing and I would urge all patients traveling from abroad for surgery to do this.
4. Exercise routinely post op and on the flights here and home. Every hour on the hour: knee bends, ankle movements, wiggle toes. Walk around. Follow the guidelines in the in-flight magazine.
5. Avoid sleeping pills and alcohol on the flight.
6. Drink plenty of fluids, water in particular.
7. All patients will receive treatment in theatre with graduated pressure calf/foot pumps.
8. High risk patients should avoid traveling for surgery. The use of Clexane injections prior to flying and before and after surgery are useful.

The British Association of Plastic, Reconstructive and Aesthetic Plastic Surgeons (BAPRAS) have on their website a page on Cosmetic Surgery Abroad. They include a check list for patients seeking cosmetic surgery abroad which I will deal with lower down. One needs to bear in mind that these plastic surgeons, because of the high cost of plastic surgery in the UK, have lost a significant market share. There is certainly an element of turf protection and fear mongering in what they write. Also their experience of medical tourism is from a skewed perspective: they only see medical tourists when there is a problem. They don’t see the many satisfied patients: there is no reason. Medical tourism is here to stay and patients now have the choice of a global market. Excellent and affordable surgery can be found outside the UK. It can be performed safely, professionally and with a level of care at least as good as at home. Medical tourists make up about one third of my practice and I have been treating these patients since becoming a specialist in 1997. Nevertheless some of their issues require consideration. 1. Complications Complications are rare. Complications may be early or late. The recommended duration of stay for medical tourists will allow early complications to be managed. Following your return home, you can maintain email contact with me. Patients frequently simply require reassurance and while email is not as good as a live consultation, because of the visual nature of plastic surgery, email is often sufficient. Serious later problems are exceedingly uncommon, but if a consultation is required then I have colleagues around the world who will see patients for me. I have seen patients on this basis for other surgeons from the UK, USA, Sweden and elsewhere. But remember, complications after you return home are very rare. 2. Special risks of travelling for cosmetic surgery abroad: DVT Ambulatory surgery lowers the risk of DVT 3. How do I know that the surgeon is properly trained? I am. See about me. 4. How do I know if the clinic is clean and safe? My clinic, Tranquillity Clinic, is regularly inspected, certified and licensed by the Department of Health. Private health care establishments in South Africa are obliged to conform to world class standards.  We have to regularly check the quality of the air in the theatre and it easily surpasses the requirements. An ambulatory facility such as mine carries a much lower incidence of noscomial (hospital acquired) infection. There are superbugs in hospital, not in my facility.

5. Why is surgery sometimes cheaper abroad than in the UK?

Surgery in the UK is expensive because it is “heavily regulated” and “surgeons in the UK must have extensive malpractice indemnity”. It is the same in South Africa and I pay a special premium to the Medical Protection Society (based in London) to cover me for the treatment of medical tourists. At our congresses we sometimes receive UK speakers who during their presentations have shown slides of themselves in front of their Ferraris, aeroplanes, yachts, etc. My pricing does not allow me to afford those. 6. Is cosmetic surgery always better value abroad? I have treated hundreds of patients from the UK (and elsewhere). The main reason they come is that their surgery is of better value. I have seen many of these patients again when they want another procedure.

7. How well can cosmetic surgery be combined with a holiday?

It depends what you want from a holiday. Following surgery you will need rest and recovery. Sometimes recuperation and resting away from home can relieve the pressure of dealing with your normal life’s demands. If your idea of a holiday is to lie around reading books, then recuperation can satisfy that. After surgery check ups will need to be done. Towards the end of your stay you will be able to see some sights and have a gentle holiday, but do not plan on being too active. I recommend having your surgery at the beginning of your stay to allow you to have the maximum amount of time close to me in Cape Town. If you want a separate holiday, do this beforehand.

8. Will my trip be covered by my normal holiday insurance?

You will need to check with them. You should declare your reason for travel.

9. Can I change my mind if I do not like the look of the place when I get to the clinic?

It is natural to second guess your decision on arrival. The aim of my site is to allow you to get an idea of my clinic and my practice – explore my site. I have never had complaints about the look of my clinic, on the contrary I usually receive compliments. Undergoing cosmetic surgery is an emotional process. Prior to surgery its not uncommon for patients to get ‘nerves’. You may feel anxious and this can translate into any of a number of reasons for not wanting to go through with it: unsure now, after months of planning, that it is right for you, fear of pain, lack of support, etc. Once you have seriously considered that a procedure is what you want, once you have committed to surgery, paid your fee and you are set on it, then you should not cancel for the wrong reasons. As mentioned on my site, much planning for medical tourists is done via email. But the final decision is only ever made at consultation when we meet face to face. This gives me the right to cancel should you not be suitable (basically this would be because you will not have given all the information about yourself and surgery would be unsafe or unwise). I have a busy practice with operating lists booked well in advance. I do therefore require that you pay for surgery beforehand to book your operating time. Sometimes patients want to see other plastic surgeons here in Cape Town before they make up their mind. While that may be fair enough, I cannot then guarantee that I will have operating time to fit you into my schedule. Because I have my own facility, I sometimes can find the time, but this is often not possible.

10. If something goes wrong, can I go to the NHS for it to be sorted out?

I am don’t have experience of this so perhaps the best is to quote the BAPRAS site: “The NHS will always look after you in the event of a life threatening emergency, such as bleeding or blood poisoning, however NHS Trusts and commissioners will usually refuse treatment for less serious complications or bad outcomes following cosmetic surgery in the UK or abroad.” That seems fair enough to me.

Cosmetic surgery abroad checklist

About your surgeon and your treatment •  What is the surgeons experience in cosmetic surgery? I have been in private practice since 1998, performing cosmetic surgery. •  How many years has he or she been practising? As above. •  How many procedures of the kind you are interested in have they undertaken? I do a small range of procedures and those that I do, I do well. I am an experienced plastic surgeon. Of the more common procedures (breast, lipo, face, tummy tucks) I have done hundreds. Of the less common procedures, if I have not done a considerable number I will not do the surgery. •  Are they properly qualified and to what professional organisations do they belong to? Yes. See about me. •  Can you have at least one consultation with the person who will actually be caring out the procedure, in the UK, before you commit to surgery? No. I do not consult in the UK. I prefer to do things via email. •  Does your prospective surgeon speak English well enough to communicate issues related to your surgery? Yes, it is my first language. About the clinic •  What are the clinics credentials? I operate in my own fully accredited and licensed ambulatory facility, Tranquillity Clinic. •  Ask if you can speak to patients they’ve treated before. If you require this, we will do our best to put in touch. •  Ask to view before and after photographs of other patients’ surgeries. Yes, at consultation. For confidentiality reasons I do not like to send photographs of my patients out to other people. •  What facilities do they have and what back up do they have if something goes wrong? I have admitting rights to major hospitals in the area. I am well known in the medical community in Cape Town and I know other specialists in other disciplines who can help out if required. •  Is there always a doctor in the clinic and is there a high dependency or intensive care unit? Yes, I will be in the clinic for your recovery. I usually consult in my clinic in the afternoons after surgery. My clinic has full resuscitation facilities. If high care or intensive care is required, this can be arranged. About the procedure •  What complications or risks are there associated with the surgery you wish to have? Discussed on my site under each procedure and on the complications page. There will be further discussion at consultation. •  What are the complication rates for this procedure? These can be supplied on request. It depends on the procedure. •  Who is part of the surgical team? See my staff. After surgery •  Once you have had your surgery what are the arrangements for follow-up care with the surgeon? See your recovery. •  Who will sort out any complications that may arise once you have returned to the UK? Would you have to pay to return to the clinic for further advice or treatment? Your first contact should be with me. If you need referral to a plastic surgeon there then I will arrange that. The treatment of complications is not covered in the surgical fee, so yes, complication treatment would be for your account. Regulation and insurance •  Is there a body that regulates the clinic or practice to ensure that it meets minimum standards of care and treatment? The clinic is regulated by the provincial Department of Health. I am regulated by the Health Professions Council of South Africa and the Association of Plastic and Reconstructive Surgeons of South Africa. •  Will you be covered by travel insurance for such a trip which includes an operation? You need to check that with your travel insurance. •  What medical insurance arrangements are there if an error occurs? I am covered by the Medical Protection Society.