Complications from Medical Tourism

Case Study: Managing Wound Complications After Lumbar Lipectomy and Abdominoplasty

Dr. James R. Benjamin, MD, ASPS & Joyce S. Benjamin, RN, PA-C Emeritus

Background

Body contouring surgeries such as abdominoplasty and lumbar lipectomy inherently involve extensive undermining. This surgical technique creates significant dead space, a setting in which fluid readily accumulates. Cavitating, draining wounds and wound edge dehiscence are recognized complications in these patients.

Negative Pressure Wound Therapy (NPWT), also known as VAC (vacuum-assisted closure), has become a mainstay in managing such complications—reducing wound volume, minimizing dressing frequency, and accelerating closure.

Case Presentation

Patient: P.H., 35-year-old, female, BMI 35
Surgical History: Cesarean section x2, abdominoplasty (2021), back liposuction (later 2021).

In January 2025, the patient traveled to Miami for a lumbar lipectomy. Despite preoperative counseling from a previous surgeon regarding the risks of early travel, she returned home five days post-op.

By postoperative day 10, she noted wound edge discoloration progressing to dehiscence with significant drainage. Initial management included wet-to-dry dressings, multiple daily changes, and referral to wound care. Three board-certified plastic surgeons separately evaluated her wound, and each concurred that NPWT would be optimal.

Insurance denied wound vac authorization due to the elective nature of the original cosmetic procedure. Her previous plastic surgeon secured a device independently. Following surgical debridement, NPWT was initiated.

Clinical Course

• Before NPWT: Wet-to-dry dressings required multiple daily changes, with little improvement.

• With NPWT: Dressing frequency decreased to every 72 hours. Progressive wound contraction and granulation were documented.

• Outcome: By March 25, 2025, wound depth improved from 1.5 cm to 3 mm, with lateral dimensions reduced by nearly half. The wound vac was discontinued, and the wound went on to heal fully by secondary intention by April 12, 2025.

Discussion

This case illustrates several important points:

1. Travel Restrictions Matter – Early postoperative travel likely contributed to impaired wound healing.

2. Consensus Among Specialists – Multiple board-certified plastic surgeons independently recommended NPWT, underscoring its value in managing post-contouring dehiscence.

3. NPWT Efficiency – Dressing burden dropped from several times daily to every three days, while wound healing accelerated.

4. Barriers of Medical Tourism – Financial and geographic strain complicated access to timely wound management.

5. Clinical Takeaway – When complications arise, NPWT remains one of the most effective modalities for salvaging surgical outcomes and supporting patients through recovery.

Conclusion

P.H.’s case highlights the dual realities plastic surgeons face: the growing trend of medical tourism in body contouring and the proven efficacy of NPWT in wound complication management. For surgeons, timely recognition and access to NPWT can dramatically alter the trajectory of healing—turning a challenging complication into a successful recovery.

Exploring Medical Tourism: Insights for Plastic Surgeons

James Benjamin, MD ABPS

As a plastic surgeon with 52 years of experience—47 of them in a board-certified practice—I’ve witnessed the growing trend of medical tourism for cosmetic surgery in the United States. If you’re reading this, you may well be a kindred spirit, perhaps a fellow plastic surgeon or someone intrigued by the complexities of wound care. My story, shaped by my role as Medical Director of The Wound VAC Company, a patient’s recent ordeal, and an article in the March/April 2025 issue of Essence magazine, underscores a critical issue: the perils of medical tourism and the need for better education within our communities.

The Essence piece highlighted the financial allure of cosmetic procedures abroad, a perspective echoed by Dr. Steven Williams, who urged diligence in choosing providers and facilities. While the savings can be tempting, the article didn’t fully address a harsh reality: surgical complications from these procedures often leave patients stranded. Most U.S. plastic surgeons, myself included, are reluctant to take on cases begun by others—a reluctance rooted in professional caution, not indifference. When complications arise, patients returning home often struggle to find care, a gap that can turn a cost-saving decision into a costly nightmare.

Take P.H., a former patient of mine. In April 2021, I performed her abdominoplasty without issue; her recovery was smooth. During follow-up, I advised that a lumbar lipectomy could enhance her results. Living in the DMV area, P.H. opted instead to travel to Miami for the procedure in February 2025, drawn by lower costs and without consulting me. The outcome was devastating: necrosis and dehiscence left her with a diamond-shaped wound on her lower back, measuring at least 2 cm per side and 2 cm deep. Her insurance, while robust, didn’t cover post-operative wound care for elective surgery. When she called me for help, her Miami surgeon suggested Negative Pressure Wound Therapy (NPWT)—a plan I agreed with after seeing photos—but getting her back to Miami wasn’t feasible.

Leveraging my position with The Wound VAC Company, I arranged NPWT supplies at no cost to P.H. A local plastic surgeon assessed the wound and applied the VAC, while a family member, a nurse familiar with NPWT, assisted with care. After at least nine dressing changes, P.H.’s wound began to heal. Remarkably, she later calculated that her total expenses—travel, surgery, and complications—matched what she would have paid to stay local. Her story is a stark reminder of medical tourism’s hidden risks.

Through this, I aim to caution patients and peers alike: the financial appeal of surgery abroad must be weighed against the potential for complications and the challenge of securing follow-up care. I also champion NPWT as a vital tool for managing such wounds—a solution I’ve seen work wonders. And, yes, I’ll admit a dual purpose: to introduce The Wound VAC Company as a resource for those in need. We in the profession must be as diligent in warning about medical tourism’s pitfalls as we are in promoting our expertise. P.H.’s journey is proof enough of that.