Santo Domingo, Dominican Republic – The recent investigation into the deaths of 93 U.S. citizens who underwent cosmetic surgery in the Dominican Republic between 2009 and 2022 has raised significant concerns. The majority of the deceased were young to middle-aged women, and findings show that the primary cause of death among 90% of cases was embolic phenomena. These fatalities were often linked to personal or procedural risk factors, such as BMI ≥25 kg/m², being above the age of 40, undergoing procedures on the trunk of the body, or having multiple procedures during the same operation.
One common risk factor identified in the report was fat embolism, particularly in cases where patients underwent liposuction and gluteal fat transfer. To mitigate the risk of fat embolism, recommendations have been made to avoid injecting fat into the deep muscular layers of the buttocks during procedures to reduce potential complications. Additionally, preoperative assessments to identify patient risk for venous thromboembolism are now being considered a standard of care, using validated risk-assessment models like the Caprini score to guide preventive measures.
The limitations of the report include the lack of accurate statistics on the total number of U.S. citizens receiving cosmetic surgery in the Dominican Republic annually, which hinders the ability to calculate the precise risk for perioperative death. Furthermore, the report may underestimate the actual number of deaths related to cosmetic surgery, as it only includes cases reported to the U.S. Embassy. It is important to note that perioperative deaths are rare complications, and the report does not address other adverse events like postsurgical infections that can lead to significant morbidity.
In response to these findings, the Dominican Republic Ministry of Health has issued safety and quality recommendations for cosmetic surgeons, focusing on training requirements, patient evaluations before surgery, and limitations on the number of procedures per operation. The U.S. State Department has updated its advisory on medical tourism and elective surgery, providing guidance for U.S. citizens considering cosmetic surgery abroad. Recommendations include obtaining international travel insurance to cover potential medical evacuation back to the United States and consulting with healthcare professionals about post-surgery risks and preventive measures.
As investigations continue and measures are implemented to improve safety standards in cosmetic surgery practices, it is crucial for individuals to be well-informed and take necessary precautions when considering elective procedures abroad. Consultation with healthcare providers and travel medicine specialists, along with proper planning to reduce the risk of complications, are essential steps for ensuring a safe and successful cosmetic surgery experience.