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Cosmetic surgery performed abroad has increased in recent years and poses a growing burden on publicly funded healthcare systems in Europe. While procedures are elective, their complications frequently require urgent treatment after patients return home. Evidence describing the clinical patterns, microbiology, destination countries, and healthcare costs of these complications remains fragmented.

A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO. PubMed, Embase, Scopus, and the Cochrane Library were searched without language or time restrictions. Eligible studies included adult patients who underwent cosmetic procedures abroad and subsequently received treatment for complications within European healthcare systems. Data on procedure type, complications, microbiology, destination countries, and direct healthcare costs were extracted. Risk of bias was assessed using Joanna Briggs Institute tools, and certainty of evidence was evaluated using GRADE.

Thirty-six studies published between 2007 and 2025 were included, comprising 941 patients. Breast surgery, abdominoplasty, and liposuction were the most commonly reported procedures. Infection was the dominant complication, reported in 94% of studies, followed by wound dehiscence and implant-related complications. Polymicrobial infections were frequent, with Staphylococcus species most commonly identified. Turkey was the most frequently reported destination country. Twenty studies reported direct healthcare costs, with a combined total exceeding €5.4 million for 797 patients and a median cost per patient of €6,845. Highest costs were mostly derived from included infected implants, extensive soft tissue infection, repeat surgery, and prolonged admission.

Complications after cosmetic surgery performed abroad represent a consistent clinical and economic burden for European public healthcare systems. Management often occurs without access to operative details or shared responsibility from the original provider, shifting both clinical risk and financial cost to the public sector. These findings support the need for improved reporting, clearer postoperative responsibility, and informed patient counselling.

Cosmetic surgery tourism has increased substantially, with growing numbers of UK patients returning with complications requiring National Health Service (NHS) care. Limited regulation, remote preoperative assessment, and inadequate postoperative follow-up contribute to preventable morbidity. Using the first national database of its kind, this study analyses registry data to characterise complication patterns, severity, and health-system impact.

A retrospective observational study was performed using all cases reported to the British Association of Aesthetic Plastic Surgeons Cosmetic Tourism Complications Database between September 2022 and September 2024. Demographics, index procedures, destinations, complications, and outcomes were analysed descriptively. Complications were graded using a five-stage BAAPS classification reflecting resource utilisation. Free-text surgeon reports underwent thematic analysis.

A total of 198 patients were included (93% female, mean age 39 years). Turkey accounted for 76% of index procedures. Abdominoplasty was the most common operation (45%), followed by breast surgery (34%) and liposuction (20%); 38% underwent multiple procedures. Common complications were wound dehiscence (37%), infection (28%), seroma (24%), and tissue necrosis (20%). Using BAAPS grading, 20% were managed non-operatively, 28% required minor procedures, and 48% required operative intervention under general or regional anaesthesia; 4% required intensive care and one death occurred from pulmonary embolism. Nearly three-quarters of patients required procedural treatment. Thematic analysis identified inadequate aftercare (21%), poor preoperative optimisation (12%), technical concerns (7%), and premature return travel (5%) as recurrent factors. Based on estimated per-patient costs (£5,883–£9,328), the total NHS treatment burden for the cohort of studied patients was approximately £1.16–£1.85 million.

Cosmetic surgery tourism generates substantial morbidity and healthcare burden, predominantly following body contouring procedures. Nearly half of patients required major surgical intervention on return to the UK. Improved patient education, complication insurance, structured postoperative pathways, and international safety standards are required to reduce preventable harm and protect healthcare resources.

Medical tourism for aesthetic surgery is increasing due to lower costs, shorter wait times, and access to procedures unavailable locally. However, what begins as a vacation-like experience can become costly when patients return with complications. Infection is among the most common complication, frequently caused by resistant or uncommon microorganisms. This study aims to highlight the microbiological spectrum of such infections and the challenges involved in their treatment.

This retrospective study analyzed the microbiological spectrum of infections and their management in patients who underwent aesthetic surgery abroad treated at the Plastic Surgery Departments of Lugano (EOC) from 2020 to 2024 and Frauenfeld (STGAG) from 2016 to 2024.

63 patients presented through outpatient clinics (52%) or emergency departments (48%), having undergone 83 aesthetic procedures in 15 countries. Of these patients, 59% were hospitalized—54% treated surgically. 41% were treated as outpatients—9% treated surgically. 46% of patients were foreign nationals, with 52% operated in their country of origin. The most frequent destinations were Turkey (27%), Czech Republic (16%), Germany (11%) and others (46%). The most common procedures were breast augmentation (36%), abdominoplasty (20%) and others (44%). In total, 54 surgeries were required to treat infections caused by Staph. aureus (28%), coagulase-negative Staph. (26%), Enterobacter cloacae (11%) and others (35%). Polymicrobial infections were found in 51% of cases, 2 involved Mycobacterium. Only 22% of bacteria were antibiotic-sensitive; 61% multidrug-resistant, 17% extensively drug-resistant. The antibiotics used were co-amoxicillin (54%), clindamycin (22%), cefuroxime (19%) and others (5%). Overall, 44% of patients received multiple antibiotics, the average treatment duration was 20 days. Intravenous antibiotics were used in 63% of cases; 37% received oral therapy.

Infections following aesthetic surgery abroad represent a major clinical challenge, often involving resistant pathogens and requiring intensive treatment. The high rates of multidrug resistance, surgical interventions and prolonged antibiotic use underscore the significant burden on both patients and healthcare systems. These findings emphasize the need for pre-travel counseling, increased public awareness, and the establishment of global surgical safety standards.

Breast implant infections caused by Salmonella species are rare and are typically associated with hematogenous spread following gastrointestinal infection. We report a case of Salmonella enteritidis infection involving long-standing PIP breast implants in the setting of newly diagnosed HIV-1 infection and recent gastrointestinal illness.

A 61-year-old female patient initially presented with acute diarrhea and was hospitalized for colitis of unclear etiology. Shortly thereafter, HIV-1 infection (CDC stage A2) was diagnosed, with a viral load of 11,749 copies/mL and a CD4 nadir of 451 cells/µL. Resistance testing revealed no clinically relevant mutations, and antiretroviral therapy with Biktarvy was initiated. Within two weeks, the patient developed progressive right breast pain followed by spontaneous fistulation with purulent discharge. Ultrasound demonstrated a fluid collection adjacent to a long-standing breast implant. Initial drainage yielded approximately 250 mL of pus. Due to extensive abscess formation with implant rupture, surgical intervention including implant removal, capsulectomy, and radical debridement was performed. Empiric intravenous co-amoxicillin was initiated.

Microbiological cultures from the abscess and capsule grew Salmonella enteritidis. Histopathology revealed purulent and necrotizing inflammation without evidence of malignancy. Blood cultures remained negative, arguing against endovascular involvement. Given the temporal association with the preceding diarrheal illness, hematogenous seeding was considered the most likely source. Antibiotic therapy was subsequently de-escalated to ceftriaxone. Further surgical management included contralateral implant removal and total capsulectomy. Following clinical improvement, the patient was transitioned to oral Bactrim and discharged for outpatient follow-up.

This case illustrates a rare hematogenous breast implant infection caused by Salmonella enteritidis following gastrointestinal illness in a patient with newly diagnosed HIV-1 infection without advanced immunosuppression. Clinicians should consider uncommon pathogens in implant-associated infections, particularly in the context of recent systemic infection. Prompt surgical management combined with targeted antimicrobial therapy is essential for a favorable outcome.

Aesthetic medicine has become an integral part of modern lifestyle, with global procedure volumes rising by nearly 40% over the past four years. In several countries, non-physicians are legally allowed to perform non-surgical aesthetic treatments, reflecting a diversification of providers. In Austria, the legal framework is thoroughly regulated. Aesthetic procedures without medical indication may only be carried out by licensed physicians, and authorization is tied to specialty-specific competence. Despite this regulation, systematic data on providers of aesthetic services in Austria are lacking.

A systematic internet-based analysis was performed on all websites of office-based physicians in Austria regardless of their specialization, including both private and insurance-based practitioners listed by the Austrian Medical Chamber at this time. 19 388 office-based physicians could be included. The study was designed as a descriptive observational analysis.

Among office-based physicians in Austria, 7.1% (n=1 436) list aesthetic services on their websites. 62.5% (n=12 566) show no reference to aesthetic procedures, while 30.4% (n=6 116) cannot be evaluated due to the absence of a personal website. Within the group of physicians offering aesthetic services, the most represented specialties are General Practicioners (n=243; 16.9%), Ophthalmologists (n=203; 14.1%), Dermatologists (n=387; 26.9%) and Plastic Surgeons (n=230; 16%). Non-surgical aesthetic treatments are mostly listed by Dermatologists (32.7%), followed by General Practicioners (20.3%). In contrast, Plastic Surgeons rank first when it comes to aesthetic surgeries.

Our study shows that 84 % of all medical website-based offers of aesthetic procedures are provided by specialists other than Plastic Surgeons. This highlights the broad interdisciplinary involvement in aesthetic medicine.