A beautiful business
Twelve months ago Vivian, a 53-year-old British woman, decided she was going to have breast reduction surgery. And she decided she was going to have the procedure done in Poland. Her family felt uneasy about this. Vivian had booked her holiday-cum-surgery package through a Kraków and U.K.-based health tourism agency called Egosum Travel, which she had seen advertised in Marie Claire magazine. Vivian hadn't met the surgeon, Andrzej Bielecki, or visited his private clinic in Poznań. In fact, when Vivian boarded the plane for Poland, all she really knew was that she was getting a bargain - the price tag of the procedure, including her flights and two-weeks of post-operative care and accommodation was Ł2,600 ($3,760), almost half the going rate of a breast reduction in Britain. "The cost was the big factor," Vivian told the WBJ in a telephone interview from her home in rural Wales. "But my daughter was very dubious and to be honest I was worried too.
"The last thing my husband said to me, when he took me to the airport, was that if I didn't like what I saw at the Poznań clinic, I was to walk away." But Vivian liked what she saw. And now she is considering returning for more surgery; this time, the fat-removal procedure liposuction. "The clinic was immaculate and modern and the aftercare was brilliant," Vivian said. It was better than any National Health Service hospital in England." Poland's growing attraction as a destination for foreigners seeking cosmetic surgery is one of the more unusual business markets to develop here over the past 10 years. The big draw is cost. Monika Elliott, the Polish owner of Egosum Travel, estimates that even after including flights in and out of Poland, airport transfers, accommodation, meals and post-surgery medical care, the prices in Poland are still around 25-45% cheaper than in the U.K. "And just like in the U.S., cosmetic surgery is getting more and more popular in the U.K. and every year more and more people decide to undertake cosmetic procedures," said Elliott, who lived in the U.K. for a number of years. It was this growing popularity, and large price discrepancy, that prompted Elliott to start Egosum in July last year. Elliott approached Bielecki in Poznań (upon the recommendation of Elliott's mother who previously had visited the doctor for a breast enlargement, and who subsequently did Elliott's nose job) and won him as a business partner. Egosum Travel is now effectively an agent for Bielecki's services in the U.K. Elliott, who takes a 10-15% cut as her fee, conducts preliminary interviews with the patients, then chaperones them upon their arrival in Poland and acts as their translator at the clinic.
Shaping clients To launch her company, Elliott started advertising regularly in the U.K. edition of Marie Claire and several health magazines. "At the beginning I had a few calls from people curious to see how everything is organized in Poland and to ask about the hygiene and the surgeon and his qualifications," Elliott said. "Poland is not a very well-known destination and the image created in England is totally different. Everyone associates Poland with Russia." Last year, Egosum brought out 15 patients - mainly women - with the most popular types of procedures being breast augmentation, rhinoplasty and liposuction. Bielecki estimates the number of foreign patients coming to his surgery now account for 15% of his business. "This industry is big and it is growing," he said. Polish-born Alina Deeble opened the first Polish/British health tourism agency in 1994. Called Euromedica, Deeble cooperates with Wrocław surgeon Henryk Knakiewicz. Thanks to some good publicity in the U.K. for the first four years, Deeble was bringing groups of at least 12 to Poland each month, with seasonal peaks in late spring, summer and early autumn. She budgets up to Ł2,000 ($2,890) per month on advertising in Marie Claire and various other health publications and she considers herself the biggest and best in this growing market of Polish health tourism. "At the moment, I have four people here in Wrocław: One English, one Portuguese, one Asian and one Italian. It's fantastic," Deeble said. "And they all read my ad in Marie Claire."
Repeat business Sara Bains, Deeble's 37-year-old English patient, is here having minor liposuction on her stomach. She came last year to have her ears pinned back, and is now considering returning yet again, for a nose job. She's a good customer for Deeble, who takes a commission on each patient. However, Deeble believes that Poland's price advantage has diminished over time with Polish surgeons charging more these days, while in the U.K. increasing competition has seen cosmetic surgery prices drop. The most profitable procedure for Deeble is a face-lift, which costs around Ł4,500 ($6,505); compared to breast implants, which cost around Ł2,500 ($3,615), depending on the type of prosthesis used. There is also more competition for Deeble.
Feeding the market Since starting her business, Deeble estimates another four competitors have set up shop. Between them, Deeble says they bring 20 British patients to Poland each month. On top of this, she says the large Polish Diaspora in the U.K., Europe and America is fueling other "surgical holidays" here. According to the Hospitality Sales and Marketing Association International, the worldwide growth in health tourism is being fueled by a number of factors: aging baby boomers, the Western world's growing fascination with appearance and the inadequate and expensive health care systems in some countries.
Stiff upper lip However, the growing number of British patients coming to Poland has been met with caution at the British Association of Aesthetic Plastic Surgeons. "Our association has not itself made any official comment on this but there is certainly very grave concern in (Britain) about the standard of cosmetic surgery that people have got in Poland," said Michael Barratt, the association's spokesman. "As an association, we would not comment on this specifically. Our view is that people who have cosmetic surgery, who want to be safe, must go to really properly qualified cosmetic surgeons." Knakiewicz, the doctor from Wrocław, has a different opinion. "We charge the same prices for Poles and foreign patients," he said. "Therefore, Harley Street (London's top address for doctors and medical specialists) hates us and promotes dramatic accidents that happen here. Personally I think accidents happen all the time and everywhere. You cannot avoid them."
Medical hazards The accidents Knakiewicz referred to were shown in a documentary called "Face-lifts From Hell," that was broadcast Feb. 13 this year on the British TV channel ITV. The program featured a number of women, including two who had traveled to Poland for breast augmentation surgery, and got infections. The women had used the same U.K.-based agent, Europol Cosmetic Surgery, and the same Warsaw clinic, Sfera Klinika. Alicia Davies, the Polish-born woman who started Europol four years ago, said she believes the show distorted the truth and she is considering taking legal action. "The truth has been totally distorted and I provide a good service; the surgery is good; the accomodation is adequate and the clinic spotlessly clean, and the people who come here with me have a good time," said Davies, who has brought more than 100 women to Poland with Europol.
However, following the show, Jarosław Stańczyk, one of the plastic surgeons at Sfera, said he would not be working with Europol anymore and that he was unhappy with the care Europol was providing to women after their surgery. Europol's customers would spend a night at the Sfera clinic after surgery, then spend the following one to two weeks at Europol's Warsaw apartment. Stańczyk said that there was no cook for Europol's customers - who can often be quite debilitated in the days following surgery (although Davies did later employ a cook), that the apartment was too small for the number of women, and that some patients told him they didn't have access to a phone in case they needed to call the clinic urgently. Sfera cooperated with Europol for 18 months but it was only in January this year that Stańczyk visited the apartment after receiving some written complaints from Europol customers. "In retrospect, we (Sfera) should have made sure to take care of everything," said Stańczyk, a member of the Polish Association of Plastic and Reconstructive Surgery and Aesthetic Medicine.
A new Sfera clinic on the outskirts of Warsaw will be completed in a few months. It will include state-of-the-art surgery and on-site accommodation facilities so patients could spend the entire recovery time there, Stańczyk said. But bringing foreign patients to Poland for surgery has some inherent risks. Most patients spend one or two weeks recovering in Poland and then fly home, which makes it harder for post-operative follow-ups, Stańczyk said. Also, flying and carrying luggage to and from the airport can be risky for their wounds as the muscle and the skin stretches and the wound can open and be susceptible to infection. In the three years that Stańczyk has been operating at Sfera, he said that not one of his patients has gotten infected. The two English women were the first. Bad press The fallout from this TV show was immediate for companies like Euromedica and Egosum Travel. "I haven't had a phone call for a month," Euromedica's Deeble said. "The effect of this show is serious and it's been incredibly embarrassing. I've always tried to sell Poland from the best possible side." Egosum has seen a similar downturn in business. But both are hopeful that over time, their businesses will pick up again. In the future, Deeble also thinks that people running businesses like hers should face some form of regulation, although she is at a loss to say exactly what form that regulation should take.
Regulations Warsaw plastic surgeon Andrzej Sankowski also thinks there should be more regulation in the industry. At one point he was cooperating with a woman who had a health tourism agency in Britain but he stopped after she failed to have prospective patients undergo pre-surgery tests prior to leaving the U.K. "She said no, it's not possible; these tests are too expensive," Sankowski said. "But it's much more expensive if the patient flies to Warsaw and I do the tests and then have to say no, it's not possible to do the surgery. "If a patient has heart disease or hypertension, it can be dangerous for these patients to have surgery and my anesthetist will say no, that is not possible. The patient could die during surgery." At his busy clinic, Sankowski's bookshelves are lined with photo albums showcasing his 20-year career as a cosmetic surgeon. They are filled with before-and-after photos of his patients, and also photos of patients who come to him seeking help to repair the botched work of other cosmetic surgeons in Poland. The photos show asymmetrical breast augmentations, breasts that are misshapen because of the incorrect insertion of implants, and noses chiseled by heavy-handed surgeons.
According to Sankowski, problems like these occur because of a lack of industry control. "But it's a problem worldwide," Sankowski added. "There are some plastic surgeons who have no specialization that do horrible things. It's not easy to find good plastic surgeons." Sankowski is a member of both the Polish Association of Plastic and Reconstructive Surgery and Aesthetic Medicine and the European Society of Plastic Surgery. He gets most of his new patients through word-of-mouth referrals. These days he estimates that 50% of his clients are foreigners from America, Germany, Britain, France and Italy, and that figure keeps growing. Sankowski, who also works at Warsaw's School of Medicine, said another industry issue is that more and more young Polish doctors are showing interest in specializing in plastic surgery. "And this is a big problem because plenty of young doctors think that, 'Oh, plastic surgery is a very good way for me to earn money,' " he said. "They don't realize it's not easy. That it's very difficult and it's necessary to have many years of practice and it's necessary to go to international courses and visit other clinics around the world." And he pointed out, these courses, and the surgical equipment required, cost a lot of money for Polish doctors "who have a fee 10 times less" than their United States' counterparts.
First, do no harm The quality of Poland's doctors and surgeons is a subject close to the heart of Adam Sandauer, the head of Poland's Patient's Society, Primum Non Nocere. Established in 1998, the title is a Latin phrase borrowed from the doctors' Hippocratic oath, and means "not to harm." The organization provides advice to thousands of people each year who claim to have been injured by their medical provider. "And many cases are connected with cosmetic surgery," said Sandauer, who is a doctor of physics, not a medical doctor. Sandauer recalls one case of a woman who had surgery on her eyelids where too much skin was removed and she couldn't close her eyes, plus other cases involving infection from liposuction. He has also received a small number of calls from dissatisfied foreign patients who had surgery in Poland. Sandauer said the biggest obstacle for patients seeking recourse is the lack of public scrutiny in the industry. The various medical chambers that hear malpractice cases are made up of judges who are doctors and cases that do proceed to legal courts rely on the evidence of experts who are also doctors from these medical chambers.
Business augmentation Despite these qualms, the cosmetic surgery business in Poland keeps growing. "I don't know what it was but last year it was like an epidemic," Sankowski said. "There were plenty of patients who wanted to have breast augmentation." Sankowski is hoping to soon move to bigger premises and employ two more surgeons. He is seeing more Polish women coming to his surgery each year, likewise the number of men - who want everything from nose jobs, to facelifts and breast implants to make their chests look bigger. Sankowski's clients are getting younger, while he also sees more husbands and wives who come to have surgery together. In Wrocław, Knakiewicz is also looking to invest in another clinic. He said that foreign patients, including British patients recruited by Euromedica, account for 30% of his business. It's especially busy in December when "Germans of Polish origin who have family in Silesia try to kill two birds with one stone and have Christmas holidays and cosmetic surgery in Poland." Knakiewicz said this growth, combined with the growing number of Poles having cosmetic surgery, has seen the number of Polish plastic surgeons swell by 25% in the past decade, to reach 100 - the majority of whom work in private practice. "The future looks bright for only some of Poland's plastic surgeons," Knakiewicz said. "Just like in every other business, only the best will survive. The weaker ones will be out of the market."
You look marvelous
In 2000, the cosmetics company Avon conducted its Global Women's Survey, polling 30,000 women in 33 countries. The results found that: " 75% of Eastern/Central European women would never have cosmetic surgery.
" Central American women are the most likely to consider cosmetic surgery (44%).
" The most popular beauty wish for Eastern/Central European women is the elimination of cellulite.
" 85% of women in Eastern/Central Europe think that how they look is an important part of defining who they are.
" Regionally, Eastern/Central European women are the most satisfied with the way they look, with only 14% indicating they are never satisfied with the way they look.
