Circumferential or “360” abdominal procedures. Abdominoplasty. Liposuction. Breast uplift. Sometimes several procedures performed together.

And something has made me think.

It isn’t simply where somebody has had their surgery.

It is what happens afterwards.

Some people I see have had surgery in the UK and describe a pathway that continues well beyond the operating theatre: postoperative appointments, wound checks, specialist dressings when necessary, review of swelling or fluid collections, access to their surgical team and, in some clinics, postoperative lymphatic treatment.

Others have travelled abroad for surgery and returned home remarkably quickly.

Sometimes their aftercare appears to consist largely of photographs sent back to the overseas clinic and messages asking:

“Is this normal?”

I have now seen enough wound separation, considerable swelling and difficult postoperative recoveries to want to understand whether what I am observing clinically is reflected in the research.

So I went looking.

Not to prove that cosmetic surgery abroad is bad.

Not to suggest that surgery performed in the UK is automatically good.

And certainly not to frighten anyone considering cosmetic surgery.

I wanted to ask a much more useful question:

Does what happens after surgery influence what happens next?

And perhaps an even more important one:

When we give informed consent for surgery, should we also be giving informed consent for the recovery?

The answer is more complicated than a headline.

But there are some things I think anyone contemplating major cosmetic surgery should know.

First, we need to be careful with the statistics

There is now a substantial body of published literature describing complications following cosmetic surgery performed abroad.

A 2026 systematic review brought together 58 studies involving 1,249 patients who had developed complications following cosmetic surgery abroad.

Infection was the most frequently reported complication, followed by wound dehiscence, implant-related complications and systemic complications.

But there is a very important sentence hidden behind those statistics.

The researchers concluded that geographical comparisons remain observational and hypothesis-generating rather than epidemiological estimates.

In other words:

We can see patterns.

We cannot use these studies to calculate your individual risk simply according to the country where you have surgery.

Read the 2026 systematic review — Journal of Plastic, Reconstructive & Aesthetic Surgery

That distinction matters enormously.

Another major UK study published in 2026 examined 198 cases reported to the BAAPS Cosmetic Tourism Complications Database between September 2022 and September 2024.

Among this group:

37% experienced wound dehiscence

28% infection

24% seroma

20% tissue necrosis

Nearly half — 48% — required further operative management under general anaesthesia.

The researchers identified inadequate aftercare, poor pre-operative optimisation and premature air travel among recurring contributory factors.

Again, these are important findings.

But they do not mean:

“37% of people who have cosmetic surgery abroad suffer wound breakdown.”

The study began with people whose complications had been reported.

It did not take thousands of matched patients having identical procedures in the UK and abroad and follow all of them prospectively.

We don’t reliably know how many people travelled abroad, had comparable surgery and recovered without complication.

That missing number matters.

It is the denominator.

Without it, we cannot honestly tell someone:

“Your risk of wound breakdown abroad is X compared with Y in the UK.”

At present, the evidence simply doesn’t allow us to make that comparison reliably.

Fi Clinical Pearl

Evidence-informed practice isn’t simply quoting a statistic.

It is knowing what that statistic can — and cannot — tell us.

 

So what CAN the evidence tell us?

It can tell us that UK hospitals are repeatedly seeing certain complications in people returning following cosmetic surgery abroad.

And the same problems keep appearing.

Wound dehiscence. Infection. Seroma. Tissue necrosis. Implant-related complications. Systemic complications.

Some require dressings and monitoring.

Some require hospital admission.

Some require further surgery.

Some are potentially life-threatening.

That doesn’t prove that travelling abroad caused the complication.

Surgical complications can occur wherever surgery is performed.

Indeed, the NHS explicitly states that no surgery is risk-free and complications can happen after surgery in the UK or abroad.

But it raises another question.

What happens when the complication occurs after the patient and surgeon are no longer in the same country?

And this is where the conversation about aftercare becomes much more important.

Surgery is an event. Healing is a process.

We sometimes talk about surgery as though the operation itself is the treatment.

It isn’t quite that simple.

The operation begins another biological process:

HEALING

Following an abdominoplasty, body lift, liposuction or breast surgery, the body has experienced substantial tissue disruption.

There is inflammation. Fluid movement changes. Blood vessels have been disrupted. Lymphatic vessels may have been disrupted. Tissue planes may have been separated and repositioned. There may be large incisions under mechanical tension. The tissues now have to repair and remodel.

That takes time.

Perhaps cosmetic surgery should therefore be thought of as:

ASSESSMENT → SURGERY → EARLY RECOVERY → WOUND HEALING → SWELLING MANAGEMENT → MOVEMENT → SCAR REMODELLING → RECOVERY

rather than:

SURGERY → HOME → DONE.

The difference may not simply be the operation

Imagine two people undergoing substantial abdominal surgery.

The first has surgery. Within days they are reviewed. Their wound is examined. Their swelling is assessed. They have access to their surgical team. A small area of the wound doesn’t look quite right. Someone sees it. It is assessed. Dressings may be changed. A possible fluid collection can be investigated. Their compression can be reviewed. They can be brought back sooner if necessary.

Now imagine somebody whose surgeon is hundreds or thousands of miles away.

They may still have excellent telephone or video support. Some overseas providers undoubtedly provide very good follow-up. But once that person has returned home, the pathway is inevitably different. If part of the wound starts separating, perhaps they take a photograph. If their abdomen suddenly looks more swollen, perhaps they send another photograph.

If something doesn’t feel right, perhaps they send a message:

“Is this normal?”

Remote communication can be extremely useful.

But sometimes someone needs to physically examine the person. A photograph cannot palpate an abdomen. It cannot feel temperature. It cannot assess tissue texture. It cannot properly determine whether swelling is diffuse or localised. It cannot perform an ultrasound if a seroma is suspected. And it cannot replace an appropriate clinical examination when something isn’t behaving as expected.

Aftercare is part of treatment

This isn’t simply my opinion.

The NHS specifically describes aftercare as an important part of treatment when advising people considering cosmetic surgery abroad.

It recommends establishing before surgery:

• what happens if complications occur
• where follow-up appointments will take place
• what happens if further surgery is required
• how easily the patient could return to the surgical destination
• and how much additional treatment might cost.

The NHS also points out that after surgery in the UK the surgeon has responsibility for follow-up treatment if complications develop, whereas an overseas clinic may not provide follow-up to the same standard or have a healthcare professional available in the UK.

Read the NHS guidance on cosmetic surgery abroad

BAAPS gives similarly detailed guidance.

Its cosmetic tourism recommendations state that patients should know how to contact their surgeon and clinic after surgery, should have at least one postoperative review with the operating surgeon before returning home, and should have follow-up arranged after returning.

Their guidance recommends early follow-up at approximately one to two weeks, followed by further assessment between six weeks and six months.

Read the BAAPS cosmetic tourism guidance

That’s worth thinking about.

The aftercare plan should exist before the operation happens.

Not after something has gone wrong.

The wound that starts to open

This is probably one of the differences that has made me think most in clinic.

A small area of a wound starts looking unhappy.

Perhaps the edges aren’t approximating properly.

Perhaps there is increasing redness.

Perhaps there is discharge.

Perhaps the tissue begins separating.

The clinical question isn’t simply:

“Which dressing shall we put on it?”

The important question is:

Why is this wound not behaving as expected?

Does it require wound care?

Is there infection?

Is there excessive tension?

Is there a problem with tissue perfusion?

Is there necrosis?

Is there an underlying collection?

Does the surgeon need to see it?

Does it need urgent medical assessment?

That requires clinical reasoning.

And sometimes the most valuable piece of aftercare is recognising:

This needs referring back.

A 360° tummy isn’t simply a scar around the middle

This is another part of the conversation I think prospective patients need to understand. The visible scar is only the part you can see. Underneath, tissues have been surgically altered. Blood and lymphatic vessels may have been disrupted. Inflammation is part of normal healing. Fluid movement changes. Tissue planes have to heal. Scar tissue begins developing and then continues remodelling for months. Swelling after significant abdominal surgery therefore isn’t particularly surprising.

But:

Not all postoperative swelling is lymphatic swelling.

A postoperative abdomen could involve expected inflammatory oedema.

Or a seroma.

Or haematoma.

Or infection.

Or a vascular complication.

Or lymphatic dysfunction.

Or several things at once.

And those situations do not all require the same treatment.

So:

“I’m swollen — I need lymphatic drainage”

is not enough information to determine what somebody needs.

First we need to understand why they are swollen.

Seroma is a recognised complication of abdominoplasty

Seroma — a collection of fluid within a tissue space — is one of the best-recognised complications following abdominoplasty.

A large systematic review and meta-analysis involving 27,834 patients estimated an overall seroma prevalence of approximately 10.9% after abdominoplasty.

This isn’t an “abroad” complication.

It is a surgical complication.

And that distinction is important.

Good aftercare doesn’t guarantee that complications will never happen.

What it can provide is a pathway for identifying and managing them when they do.

And the lymphatic map really can change

This is probably one of my favourite pieces of research in this whole subject because it demonstrates beautifully why postoperative treatment requires reasoning rather than a memorised routine.

Researchers studied 20 women undergoing abdominoplasty using lymphoscintigraphy.

They mapped superficial abdominal lymphatic drainage before surgery and then again at one month and six months afterwards.

Before surgery:

100% demonstrated drainage towards the inguinal lymph nodes.

After surgery:

only 15% demonstrated the same pathway.

In 65%, drainage was instead observed towards the axillary lymph node chain.

A further 10% demonstrated both axillary and inguinal drainage, while another 10% had an indeterminate pattern.

Importantly, there was no significant change between the one-month and six-month postoperative findings.

Read the lymphoscintigraphy study — Plastic and Reconstructive Surgery

Just think about that for a moment.

The operation hasn’t simply created a scar.

The map underneath may have changed.

For me, as a lymphoedema and manual lymphatic drainage practitioner, that matters.

It is precisely why postoperative treatment should not simply be somebody following the same drainage sequence on everybody.

We need to understand:

the surgery

the scar

the swelling

the tissues

the stage of healing

the lymphatic pathways

and most importantly,

the person.

So does everybody need MLD after cosmetic surgery?

No.

And this is where I want to be particularly careful.

Manual lymphatic drainage has become almost synonymous with cosmetic postoperative care on social media.

You can easily come away with the impression that:

Liposuction = ten lymphatic massages.

The research doesn’t justify such a simple prescription.

There is some encouraging evidence.

A prospective clinical study involving 18 women following liposuction or lipoabdominoplasty reported reductions in pain, oedema and tissue fibrosis following 12 treatment sessions.

But those treatments combined manual lymphatic drainage AND therapeutic ultrasound.

There was no untreated control group allowing us to isolate the effect of MLD.

Therefore, it would be inappropriate to use that study to claim:

“MLD has been proven to prevent fibrosis following cosmetic surgery.”

It hasn’t.

Another small prospective comparative study involving 20 women examined postoperative oedema after abdominoplasty with core liposuction, comparing women who did and did not receive three weeks of MLD.

The findings suggested MLD may promote faster resolution of oedema.

But again:

20 women is a small study.

It is interesting evidence.

It isn’t definitive evidence.

That distinction is informed consent too.

MLD may be a useful component of postoperative management for selected people.

But it shouldn’t become a blanket prescription.

My question isn’t:

“How many MLD sessions should everybody have?”

It is:

“What does this person need today?”

Sometimes that may include MLD.

Sometimes movement.

Sometimes breathing.

Sometimes positioning.

Sometimes reviewing compression.

Sometimes leaving healing tissue alone.

And sometimes the most important thing I can do is say:

“I don’t think I should be treating this. Your surgical team needs to see it.”

That is aftercare too.

And compression isn’t quite as simple as we might think either

This is another area where postoperative packages can become formulaic.

Surgery → compression garment → lymphatic massage.

But research gives us another reason to remain curious.

A 2023 randomised study involved 32 women following abdominoplasty.

Sixteen wore compression garments.

Sixteen did not.

Interestingly, all 32 received ten sessions of MLD, beginning seven days after surgery.

Researchers assessed oedema using circumference measurements and bioimpedance and assessed seroma by ultrasound.

The result?

The women not wearing compression garments demonstrated less subcutaneous oedema later in recovery than those wearing them.

Read the compression study — Aesthetic Surgery Journal

Does that mean:

“Don’t wear compression after abdominoplasty”?

No.

It was a small study.

Different operations, surgeons, garments and individual risk profiles matter.

But it does demonstrate something I think is incredibly important:

Common practice and proven practice are not always the same thing.

Compression is an intervention.

So it deserves reasoning too.

What garment?

What pressure?

How does it fit?

Is it folding or rolling?

What is happening underneath it?

What does the surgeon recommend?

What happens to swelling?

What happens to movement?

What happens when we reassess?

Treatment should have a reason.

Flying home is part of the surgical plan

This is another consideration that can disappear when surgery is packaged alongside flights and accommodation.

You aren’t simply booking surgery abroad.

You are also booking a journey home after major surgery.

That can involve:

airport transfers

walking through terminals

sitting for prolonged periods

reduced mobility

luggage

dehydration

and air travel while the body is still recovering.

Major surgery itself can increase venous thromboembolism risk.

Prolonged immobility and air travel add further considerations.

The NHS currently advises that people should generally not fly for five to seven days following procedures such as breast surgery or liposuction, and seven to ten days following tummy tuck or facial cosmetic surgery, while also advising discussion with the surgeon about individual circumstances.

The 2026 BAAPS national complications study also identified premature air travel among recurring contributory factors in the cases analysed.

So perhaps the question shouldn’t simply be:

“What day can I fly home?”

It should be:

“Why is that considered safe for me following the particular combination of procedures I am having?”

What about the long-term scar?

This is where there is an important gap in the evidence.

I went looking for good studies comparing long-term scar outcomes in matched patients undergoing comparable cosmetic surgery in the UK and abroad.

We don’t currently have good evidence that allows us to say overseas cosmetic surgery produces worse long-term scars.

That is worth stating clearly.

But we do know that wound healing matters to scar formation.

A wound that heals primarily and uneventfully has had a different biological journey from one complicated by:

dehiscence

infection

tissue necrosis

persistent inflammation

or prolonged open-wound healing.

Scar maturation then continues for many months.

During that time we can see changes in:

colour

sensation

sensitivity

mobility

tissue stiffness

adherence

and sometimes the person’s willingness or ability to move normally around the area.

This is why, when I assess a scar, I’m not simply looking at the line.

I want the story.

What operation was performed?

How did the wound heal?

Was there infection?

Did any area reopen?

Was there a seroma?

How long did healing take?

Where is the restriction?

What happens when the person moves?

Because the scar I see today is partly the history of the healing that came before it.

And what about how people actually FEEL about their surgery?

This deserves much more attention.

Because successful cosmetic surgery isn’t simply a technically good scar.

The person chose surgery because they hoped something would be different afterwards.

And for many people, it is.

A 2025 systematic review and meta-analysis involving 27 studies and 4,823 patients found body-image satisfaction generally increased following aesthetic surgery and then plateaued over time.

At 12 months, reported satisfaction was high overall, with breast procedures among those showing particularly high satisfaction.

So we shouldn’t create a narrative that cosmetic surgery usually leaves people unhappy.

The evidence doesn’t support that either.

But another 2025 systematic review looked more broadly at psychosocial outcomes.

It found some evidence of short-term improvements in areas including body-area-specific satisfaction, self-esteem and physical and sexual wellbeing.

However, evidence concerning mental health, overall body image, quality of life and social functioning remained limited or inconclusive, and surprisingly few studies followed people beyond six months.

Read the 2025 psychosocial outcomes systematic review

So:

Looking better

feeling better about the operated area

and

improved overall psychological wellbeing

are related concepts.

But they aren’t necessarily the same outcome.

What happens when the surgery is complicated?

A particularly relevant UK study published in 2026 explored the experiences of people who had required emergency care after cosmetic surgery abroad.

This study is important — but again, we must interpret it properly.

These weren’t all cosmetic surgery patients.

They were people who had experienced complications.

The researchers found significant effects on patient satisfaction, regret and willingness to undergo further surgery.

That doesn’t mean people who have surgery abroad generally regret it.

It means:

When cosmetic surgery becomes complicated, the consequences can extend well beyond the wound.

There can be anxiety.

Uncertainty.

Additional costs.

More appointments.

Time away from work.

More procedures.

Changes to the expected cosmetic result.

And sometimes months of recovery that the person never anticipated when they looked at the original before-and-after photographs.

That belongs in a conversation about informed consent too.

 

Perhaps we have been asking the wrong question

When cosmetic surgery abroad is discussed, the debate can quickly become:

UK versus abroad

I don’t think that is the most useful question.

There are excellent surgeons in many countries.

There are complications following surgery in the UK.

There are people who travel abroad, receive excellent treatment and recover beautifully.

And there are people who undergo UK surgery and experience complications.

A passport doesn’t tell you whether somebody is a good surgeon.

And a high price doesn’t guarantee uncomplicated healing.

Perhaps the more useful comparison is:

SURGERY WITH A ROBUST POSTOPERATIVE PATHWAY

versus

SURGERY WITHOUT ONE.

Because the operation is only one part of the journey.

Informed consent shouldn’t stop at the operating theatre door

When people research cosmetic surgery they understandably investigate:

Who is the surgeon?

What are their qualifications?

How much does it cost?

What will the result look like?

What are the reviews like?

Where will I stay?

When can I fly home?

I think we need to add another set of questions.

BEFORE YOU BOOK: RESEARCH THE RECOVERY

Ask the surgeon or clinic:

Who is responsible for my care after the operation?

When will the operating surgeon personally examine me again?

How many postoperative reviews are included?

How long will I remain near the surgical clinic before travelling home?

What happens if part of my wound opens?

Who assesses possible infection?

What happens if I develop a seroma or significant swelling?

Who can arrange imaging or aspiration if necessary?

What symptoms require urgent medical attention?

When is it considered safe for me to fly following my specific operation or combination of operations?

Who looks after me once I return home?

Is there a clinician in my home country who can physically assess me?

If I need further surgery, where will it happen?

Who pays for it?

What does the clinic’s insurance cover?

Does my own insurance cover complications of elective surgery abroad?

What is the plan for compression — and why?

Is MLD recommended? If so, why is it appropriate for my surgery?

Who will provide it and what are their qualifications?

What happens if my recovery takes longer than expected?

And perhaps the simplest question of all:

“If something doesn’t look or feel right when I’m back home, who is actually going to examine me?”

Not simply look at a photograph.

Examine me.

Fi Clinical Pearl

DON’T JUST RESEARCH THE SURGEON.

RESEARCH THE RECOVERY.

Before major cosmetic surgery, we understandably research:

THE SURGEON

THE CLINIC

THE PRICE

THE REVIEWS

THE BEFORE & AFTER PHOTOGRAPHS

THE RESULT

But there is another word that deserves just as much attention:

AFTERCARE

Because a technically successful operation still has to heal.

And good aftercare doesn’t mean throwing every available treatment at a postoperative body.

It means having appropriately qualified people who can recognise:

what is expected

what needs monitoring

what may benefit from treatment

and, importantly,

what isn’t normal and needs referring back.

The operation may take a few hours.

Healing takes considerably longer.

That deserves to be part of the decision before the first incision is ever made.

One final thought

This isn’t an article telling you not to have cosmetic surgery.

It isn’t an article telling you not to travel abroad for surgery.

And it isn’t suggesting that UK surgery cannot result in complications.

It is about something much less dramatic and, I think, much more useful:

INFORMED CONSENT

When you consent to surgery, you aren’t only consenting to the operation.

You are accepting a period of healing.

You are accepting that complications are possible even in skilled hands.

And you need to understand what will happen if your recovery doesn’t follow the expected pathway.

So before you choose the surgeon, clinic, flights or hotel, find out who will be looking after the healing.

Because:

YOUR SURGERY DOESN’T END WHEN THE STITCHES GO IN.

 

Research & further reading

Goodarzi MR et al. (2026). Beauty Abroad, Burden at Home: Complications and NHS Impact of Cosmetic Tourism — Insights From the BAAPS National Database. Aesthetic Surgery Journal. National retrospective analysis of 198 reported complications; particularly useful for understanding wound dehiscence, infection, seroma, necrosis, further surgery and contributory factors including aftercare and premature travel.
Read the paper on PubMed

Complications and health costs of cosmetic tourism: A systematic review (2026). Journal of Plastic, Reconstructive & Aesthetic Surgery. Fifty-eight studies involving 1,249 patients. Particularly important because the authors explicitly caution against interpreting regional findings as true comparative complication rates.
Read the open-access systematic review

NHS. Cosmetic surgery abroad. Patient guidance covering risks, consultations, aftercare, insurance, complications and flying following surgery.
Read the NHS patient guidance

British Association of Aesthetic Plastic Surgeons. Cosmetic Tourism Guidelines. Includes recommendations for postoperative review, contact with the operating surgeon, early follow-up and access to emergency treatment following return home.
Read the BAAPS guidelines

Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplasty (2022). Plastic and Reconstructive Surgery. Lymphoscintigraphy study of 20 women demonstrating substantial alteration in superficial abdominal lymphatic drainage after abdominoplasty.
Read the lymphatic drainage study on PubMed

Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty postoperative care. Small prospective study of 18 women reporting reductions in pain, oedema and fibrosis following combined treatment. Important limitation: MLD cannot be separated from the ultrasound intervention.
Read the study on PubMed

Maningas T et al. Manual Lymphatic Drainage in Postoperative Abdominoplasty With Core Liposuction Patients.Small prospective comparative study involving 20 women suggesting MLD may accelerate resolution of postoperative oedema. Useful preliminary evidence, but not sufficient to establish a universal postoperative protocol.
Read the MLD study

de Moraes BZF et al. (2023). Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty?Aesthetic Surgery Journal. Randomised study of 32 women; all received postoperative MLD. The non-compression group demonstrated less subcutaneous oedema later in recovery, illustrating why apparently established postoperative practices still deserve critical evaluation.
Read the compression study on PubMed

Garbett K et al. (2025). The psychosocial outcomes following cosmetic surgery are largely unknown: A systematic review. Seventeen controlled prospective studies; some short-term improvements were identified, while evidence for broader mental health, quality of life and long-term psychosocial outcomes remains limited.
Read the systematic review on PubMed

Friedman O & Tal D. (2025). Temporal satisfaction patterns in body image after aesthetic surgery: A systematic review and meta-analysis. Twenty-seven studies involving 4,823 patients; useful counterbalance showing that many patients report increasing body-image satisfaction following aesthetic surgery.
Read the meta-analysis on PubMed

Outbound cosmetic tourism from the United Kingdom: Patient experiences following a decade of complication management at a tertiary plastic surgery unit (2026). Explores satisfaction, regret and subsequent decision-making among UK patients who experienced complications following surgery abroad. The crucial limitation is that these findings apply to a complication cohort and should not be generalised to everybody undergoing surgery overseas.
Read the patient-experience study on PubMed

This article is for education and informed decision-making and does not replace individual medical advice. Anyone with increasing redness, heat, discharge, wound separation, fever, rapidly increasing swelling, significant new pain, breathlessness, chest pain or other concerns following surgery should seek appropriate medical assessment rather than relying on massage or other postoperative treatment.

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