key: cord-0958641-gzrhoyyr authors: Bennett, Ruth; Sugden, Paul; Wokes, James title: Response to “Cosmetic tourism amidst the Covid-19 global pandemic”. date: 2021-11-18 journal: J Plast Reconstr Aesthet Surg DOI: 10.1016/j.bjps.2021.11.053 sha: 679aa035ed65dbbef8eb8c716c6635ced2eeda56 doc_id: 958641 cord_uid: gzrhoyyr nan Ruth Bennett 1 , Paul Sugden 1 , James Wokes 1. 1 Plastic Surgery Department, University Hospital of North Durham, North Road, Durham, DH1 5TW. Corresponding Author: Ruth Bennett: Ruth.bennett3@nhs.net In relation to the recently published letter by Long et al [1] , we have also observed a steady flow of patients presenting with post-operative complications following cosmetic surgery during the COVID-19 pandemic. 8 patients presented to our regional Plastic Surgery Department between September 2020 and February 2021. 5 had cosmetic surgery abroad and 3 in another area of England. This confirms that cosmetic tourism is creating an additional burden on an already saturated NHS throughout the UK, not just in Northern Ireland. Of particular concern is that two patients had previously required NHS treatment of cosmetic tourism complications. With one patient electing to undergo further surgery at the same unit in Turkey. During the time that our patients presented to hospital (September 2020-February 2021) the UK was still subject to COVID-19 restrictions with a large NHS COVID-19 burden. We note that 3 out of 8 (37.5%) patients declined recommended NHS treatment or did not attend follow up. 7 Travelling for cosmetic surgery is not a new phenomenon. A BAAPS survey in 2009 highlighted the extent to which the NHS manages complications of cosmetic tourism [2] . However, patients travelling abroad during the COVID-19 pandemic for aesthetic surgery is alarming. Despite our relatively small cohort, the lack of local cosmetic surgery availability seems to have driven patients abroad at a time when the NHS is under critical strain. This lack of individual responsibility needs to be highlighted, to protect the NHS. Surprisingly, we found 3/8 patients had travelled within England for their aesthetic procedures during the COVID-19 pandemic, despite guidance on avoiding non-essential travel. Local availability of aesthetic surgery varies geographically. It is our recommendation that, advertising campaigns and social media posts to entice patients to travel for surgery within the UK should be temporarily be banned when COVID-19 is prevalent. 8 The strain of COVID-19 on healthcare systems has varied locally and globally during the COVID-19 pandemic. A BAAPs press release on the 6 th January 2021 supported the resumption of aesthetic surgery where it can be safely provided without impacting on the National effort or NHS resources. A recent paper by Kaye et al lead to proposed guidelines from the leading aesthetic associations around the world, on how to safely reintroduce aesthetic surgery [3] with EASAPS emphasising the role of surgeons behaving ethically during the pandemic and COVID-19 consent [4] . The ISAPS page on cosmetic tourism recommends staying in the area where the surgery was performed for at least a week, depending on the procedurethough this may not be enough to avoid an NHS burden [5] . Additionally, the resumption of aesthetic surgery in the UK coincides with an anecdotal increase in the demand for certain cosmetic surgery procedures, the 'Zoom Boom', i.e. the demand for facial procedures driven by increased awareness of ones appearance on screen. Additionally, exercise restrictions are likely to increase demand for contouring procedures. As the national COVID-19 vaccination programme ramps up and restrictions ease we must ensure the NHS is able to cope with the backlog of postponed treatments. An increasing burden of patients with complications from cosmetic tourism needs to be avoided at all costs. We propose a national aesthetic complications database to audit trends and improve patient safety by feeding back to the provider any complications. England Turkey Greece Poland Cosmetic tourism amidst the Covid-19 global pandemic Sun Sea and Silicone: Cosmetic Surgery Tourism trends revealed at groundbreaking conference Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS-COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management EASAPS May 2020 Consensus on Resuming Aesthetic Surgery. 2020 Medical Travel Guide Plastic Surgery Tourists