"I am going to have a tummy tuck, breast lift, and breast augmentation done at the same time with a board-certified doctor in Mexico. He says he can also do minor liposuction and inject the fat in the buttocks to give me a more smooth look. He says this is included on all tummy tuck patients if they wish to do so, but I am a little nervous. Is it possible to have the three procedures done, along with the lipo and Brazilian butt lift?"

- Housewife in San Diego

I am sorry to pick on you "Housewife in San Diego," but your question is very concerning to me. Frankly, I don't think you are being safe.

You're surgery is going to be far too long....

Dual-plane breast augmentations 1 1/2 hours

Wise-pattern (anchor) mastopexies 3-4 hours

Tummy tuck 3 hours

My math indicates that you're now up to about 8 hours. Frankly, that's already pushing it.

I try to avoid operating on a cosmetic patient for longer than 6 hours at a time. If she is young and very healthy, then maybe I'll do 8 hours. If I think that the case is going to last longer than 8 hours, I never do the operation in an out-patient surgery center. I do these ultra-long procedures in a real American hospital with all of the safety precautions. The patient stays overnight for close monitoring by an excellent nursing staff.

OK, but now you want to add Brazilian butt lifting. (Truthfully, I don't think BBL even works. It has never produced long-term success in my hands, and so I rarely offer this procedure at all anymore. But anyways...)

Liposuction 1/2 hour

Brazilian butt lifting 1 hour

So, now you've been in the operating room for at least 9 hours. 9 hours is way too long since I bet, Housewife in San Diego, that you will not be having your surgery in a fully accredited hospital.

Sorry. But this plan sounds unsafe.

Practicing in Ventura County, California, I take care of 5-10 patients annually, whose aesthetic surgeries were botched during Mexican plastic surgery adventures. To me, the thought of obtaining medical care—especially surgery—outside of the USA is ridiculous. Many plastic surgery procedures come with significant risks. For example, most honest American/European/Asian research studies of breast reductions report 30-40% rates of complications! For tummy tucks, 25-35%! Many of these complications do not manifest themselves for 2-3 weeks.

So, Housewife in San Diego, what are you going to do if you have a complication? Drive back to Mexico? Who is going to take care of your complication at 2 am?

Well, in my community, I do. So, yes, I am bitter. I do resent going to the emergency room in the middle of the night to take care of a patient who had bad surgery done by a foreign doctor who had no intention of looking after her.

And, frequently, my hands are tied because I do not know the details of the surgery. Is the patient supplied with information regarding antibiotic usage? Suture type? Implant size and manufacturer? The answer is always, “No.” Have the patients and I ever been able to obtain this information from the foreign surgeon? Almost never. Ultimately, my management of the patient's complications is necessarily suboptimal because I do not have the specifics.

I certainly admit that not every physician in the United States is outstanding. In fact, while there are approximately 60,000 American physicians performing cosmetic procedures, only 6,000 of us are certified by the American Board of Plastic Surgery. Certainly, we need to clean up our own backyard.

Likewise, I am more than happy to refer patients to any number of outstanding Mexican plastic surgeons. Many of the world's leaders in plastic surgery come from Mexico, particularly Mexico City.

But if you're going to get plastic surgery in Mexico, then do it right. Make sure that the surgeon is truly Board Certified. Which Board? The plastic surgery board or the general surgery board? Or just some Board that a group of doctors created to sound official? (That's done right here in the USA.)

Is the facility accredited?

What's the policy for complications? Who do you call in the middle of the night?

After you've found a Mexican plastic surgeon who gives you all of the "right" answers, then plan to stay in Mexico near his clinic while you recuperate. Make sure that you follow-up with the surgeon who did the actual surgery.

Because of the need for prolonged follow-up, even my Mexican colleagues who are fantastic surgeons are not right for my Californian patients. Follow-up is a crucial part of any surgery. Surgical care does not end when you leave the operating room! Patients need to be nursed through complications--some of which don't manifest for 4-8 weeks. Patients also need reassurance; they must have the opportunity to come to see me, any day of the week and any time of day, to make sure that their experiences are “normal.” Patients need continued compassion.

And a doctor can't do any of those old-fashioned duties across the border.

Moreover, a doctor needs to see his/her results. How can I make improvements in my technique if I don't get to see my results after complete healing? This might be the biggest flaw of the cross-border surgeons. They don't even know that they are continuing to make mistakes, because they never see their own complications.

Some things just shouldn't be “out-sourced.” Medical care is one of them.