CDC’s Division of Healthcare Quality Promotion (DHQP) (National Center for Emerging and Zoonotic Infectious Diseases) supports health departments investigating reports of patient harm resulting from breaches in healthcare infection prevention and control (IPC) through consultation. We defined consultation as a verbal or written request to CDC from health departments for investigation and technical assistance. We reviewed DHQP consultation records for the period of January 1, 2014–December 31, 2024, using specific search terms (Appendix) to identify investigations in which US residents traveled for cosmetic procedures. We included consultations in which US residents traveled (i.e., within or outside the United States) for cosmetic procedures that involved an adverse outcome. We excluded consultations involving US residents who traveled for nonmedical purposes; received incidental, noncosmetic medical care; or underwent reconstructive or bariatric surgery.

We abstracted information regarding the number of patients, country or state where the procedure occurred, type of procedure performed, reporting jurisdiction(s), infection type, pathogen(s), healthcare setting, postsurgical interventions, treatment of complications, clinical outcomes, and findings from IPC assessments where available. Two authors (K.M. and A.R.) reviewed included consultations and 10% of excluded consultations for agreement and jointly abstracted the above variables to ensure consistency.

Of 2,162 total consultations, 34 consultations involved patients who traveled for medical care. Of those, 21 consultations involved ≈145 patients who traveled for cosmetic procedures and were included. US residents traveled to international (n = 17) and domestic destinations (n = 4) and underwent liposuction (n = 12), abdominoplasty (n = 9), and other cosmetic procedures (Table 1). Sixteen consultations included >1 cosmetic procedure. The number of patients per consultation ranged from 1 to 38 patients, although 12 consultations involved only 1 patient. Seven (range 2–20) consultations involved patients from multiple states who underwent cosmetic procedures in international (n = 5) and domestic locations (n = 2) and were associated with the same provider, procedure location, or type of procedure during a specific time (Table 2).

Postsurgical infections were described in 20 consultations, of which 12 identified suspected or confirmed nontuberculous mycobacteria (NTM). Suspected NTMs were defined as growth on acid-fast bacillus culture without mycobacterial species identification. Surgery centers or surgery clinics (n = 14) were the most frequently reported healthcare setting. Four consultations reported patient deaths (7). IPC findings available from 1 domestic and 1 international consultation highlighted gaps in environmental cleaning practices, use of personal protective equipment, hand hygiene, and reprocessing of surgical equipment.

We identified adverse outcomes among US residents who traveled outside their state of residence for cosmetic procedures within the United States or abroad. This analysis highlights potential for lapses in infection control to contribute to transmission both internationally and domestically and the challenges of detecting and investigating outbreaks in which patients travel. Our findings reinforce the importance of risk mitigation strategies, including effective communication of potential risks to patients, to prevent serious complications of medical procedures or surgeries. CDC provides guidance and information for healthcare personnel and patients who are considering medical tourism abroad (3,8). US residents might also benefit from those risk mitigation strategies when choosing a domestic destination for cosmetic procedures.

Identifying adverse outcomes among persons who travel for cosmetic procedures is challenging and relies on clinical vigilance and reporting to public health authorities. Approximately one third of consultations reported large outbreak investigations involving multiple patients and states, which often requires extensive case-finding methods and information networks to connect information about geographically dispersed patients (2,7,9). One CDC Data (https://www.cdc.gov/data-modernization/php/one-cdc-data-platform/index.html) is a unified data platform that enables communication among public health professionals. Improved surveillance, continued partnership among clinicians and public health agencies, and strong patient engagement can encourage early identification of adverse outcomes and inform targeted prevention efforts for those settings (10,11). CDC is working with partners to explore opportunities to improve surveillance of adverse outcomes linked to medical tourism.

More than half of consultations were attributed to NTM, accounting for all domestic consultations and most international consultations. The invasive nature of cosmetic procedures and potential exposure to nonsterile ice and water, which have been associated with NTM outbreaks in healthcare settings, might contribute to the large proportion of travel-related cosmetic consultations involving NTMs (1,10,12). Clinicians might be more likely to report difficult-to-treat and rare infections such as NTM than other infection types. Although NTMs are not nationally notifiable, public health experts recommend investigating even a single case of healthcare-associated extrapulmonary NTM (13). Observing IPC practices and evaluating clinical use of nonsterile water or ice before, during, and after cosmetic procedures is a high-yield action for those investigations.

Regulation for facilities where cosmetic procedures are performed can vary, creating challenges to ascertain IPC standards and ensure patient safety. US state regulations can differ by locality, and not all facilities are federally regulated by the Centers for Medicare and Medicaid Services, potentially contributing to varying IPC and water management practices. The existence of international IPC regulations can be unclear, given the complexities of different regulatory frameworks by country. As a result, IPC standards in other countries might be unknown or uncertain. When adverse outcomes related to medical tourism have been identified in the United States, CDC has connected with country public health authorities, such as ministries of health, to alert international partners and help address IPC concerns, decreasing future risk to patients (7,9). Persistent IPC gaps contribute to a higher risk for infection, and addressing those gaps should be prioritized to ensure safety of cosmetic procedures.

The first limitation of our review is that we used a convenience sample from health departments that requested CDC consultation, and findings do not represent all travel-related healthcare outbreaks. Full investigation details, including specific IPC issues potentially contributing to transmission, were not systematically provided to CDC and, therefore, might be missing or incomplete in CDC records. Outbreaks were likely underdetected and underreported because facilities might not track patient outcomes and reporting standards vary by jurisdiction. Last, we did not include consultations involving cosmetic procedures occurring within a patient’s state of residence, which could pose similar infectious risks.

Outbreaks among persons who travel for cosmetic procedures, regardless of destination, might be difficult to detect and can lead to complex investigations associated with special challenges. Patients should consider the potential risks when traveling for cosmetic procedures. Clinicians should consider risk for infection, particularly NTM, among this population, and have a low threshold for notifying health departments. In addition to notifying the state or local health department, CDC requests notification of complications related to medical tourism by emailing medicaltourism@cdc.gov.