Rogue Turkish cosmetic clinics are trying to cover up the dangers of cut-price operations abroad with an array of deceptions and hidden clauses – including threatening patients with £10,000 bills and legal action if they criticise the results of their operations online.
Thousands flock to Istanbul and Ankara every year to undergo cosmetic procedures at a fraction of the cost they would have to pay in the UK – lured by flashy adverts on social media platforms including Instagram and TikTok.
But as well as the risk of the procedure going wrong – at least 25 Britons have died following cosmetic surgery abroad since 2019 – hidden clauses in their contracts threaten nasty consequences for patients even if the procedure is a success.
Some providers threaten ‘legal action’ if patients who have experienced botched surgery share their ordeals on social media.
The clinics say they will pursue unhappy patients through the UK court system under libel laws, while also billing them the £10,000 ‘fine’. Even if ultimately unenforceable, the stress of legal threats is enough to silence many patients, say experts.
Demi Agoglia, 26, who died in January just days after going to Turkey for a Brazilian butt lift despite her family begging her not to go
Leah Cambridge, 29, also died after having the Brazilian butt lift procedure in Turkey
Shannon Bowe, 28 died after undergoing gastric band surgery in Turkey
And in small print buried in their terms and conditions many Turkish clinics also claim the right to use intimate ‘before and after’ photographs showing the results of their work. Many women have been shocked to see photos of their naked bodies on the internet after returning home.
Such terms and conditions are often handed to patients in Turkey just hours before the procedure is due to begin, and after they have paid.
The Mail has spoken to patients and the British surgeons left to pick up the pieces after surgical implements were left inside bodies, implants burst through skin or dangerous post operative infections arose.
At least 324 people have required corrective surgery on the NHS after returning home at a cost to the taxpayer of anywhere between £15,000 to more than £100,000 per op.
And while there are some reputable cosmetic surgeons in Turkey, experts insist it is impossible to identify them among the flood of Turkish government-subsidised advertising aimed at British customers.
Turkish doctors who would never be allowed to operate in the UK are also able to offer ‘consultations’ recommending procedures to be carried out in the UK. They do this at events held in British hotels that exploiting a loophole in this country’s medical regulations.
One medical tourism agency offering surgery in Turkey, which offers ‘all-inclusive care packages’ for procedures including boob jobs, bum lifts and ‘mommy makeovers’, also accuses British doctors of being ‘not so experienced’ when it comes to cosmetic surgery.
In leaflets given to patients explaining how their procedure will be handled, Medicci Aesthetics criticises NHS staff for treating anyone who confesses to having gone under the knife in Turkey as if they have the ‘plague’.
Also buried inside the 39-page document is a notice that the agency, which describes itself as a medical concierge company, reserves the ‘non-negotiable’ right to publish before and after photos of Britons who have had surgery for advertisement purposes, even if the patient is naked.
The Turkish government is providing subsidies worth thousands of pounds to clinics so that they can advertise to Brits online.
Campaigners said the Mail’s string of discoveries were further examples of the depths that some predatory overseas clinics were willing to plunge to by ‘silencing’ their former patients.
For years, British surgeons and the NHS have tried to steer Brits seeking surgery away from destinations such as Turkey, even if many clinics in foreign surgical hotspots are reputable.
Cheaper prices – breast enlargements are available for as little as £3,000 abroad, compared to up to £8,000 on Harley Street – can lure patients overseas, although experts warn of the potential dangers.
This extract of a Medicci Aesthetics patient booklet says British GPs are not experienced or knowledgeable when it comes to would care management of cosmetic surgery
Another section of the booklet promises dire legal consequences both in Turkey and the UK should a patient ‘expose’ Medicci Aesthetics to negative reviews
Surgical safety practices overseas are not always as stringent as they are in Britain. Most countries have lower training standards, while others don’t require medics to be insured.
In the UK, cosmetic surgeons offer at least a two-week cooling-off period to allow patients to reflect on their decision before actually going under the knife. This opportunity to opt out of surgery isn’t always given abroad.
Overseas operators, such as the clinics lining the streets of Istanbul and Ankara in Turkey, also have no enforced responsibility to fix things if complications occur, meaning the NHS – and by extension the taxpayer – can be left to pick up the pieces.
In many cases of the patients the Mail spoke to, they were ineligible for surgery in the UK due to their health or the extent of the cosmetic surgery they wanted, but were welcomed with open arms by Turkish operators.
Some of their procedures included so-called mega-liposuction or extreme Brazilian butt lifts (BBLs), neither of which are offered in Britain because of the associated dangers.
Latest UK data shows that, since 2018, at least 324 Britons have needed medical treatment – including corrective surgery – after going under the knife abroad.
The vast majority had their op in Turkey, where clinics actively target them via adverts on social media. Some offer combined holiday packages promising both surgery and sunbathing. While others feature all-inclusive hotel stays, VIP airport transfers and more.
Overseas operators have no enforced responsibility to fix things if complications occur after surgery
And the problem is growing, with the number of botched operations experienced by Britons abroad rising by 94 per cent in three years.
Victims often need urgent NHS care to fix problems such as tissue infections. The total bill for corrective ops charged to the taxpayer since 2018 stands at nearly £5million.
Government data also shows that at least 25 Britons have died in Turkey either during or shortly after their surgery since 2019.
One patient told the Mail how upon returning to England after liposuction in Turkey the stitching on her thighs horrifically burst open leaving her two-inch deep wounds. NHS medics who treated her said she had been sown up too tight after the procedure with one surgeon saying he was ‘disgusted’ she had been sent home so early
This tally is likely to be an underestimate because it doesn’t include the most recent public cases, such as that of British mother Demi Agoglia. The 26-year-old, from Salford, died in January just days after going to Turkey for a Brazilian bum lift, known as a BBL, despite her family begging her not to have the surgery because of the dangers. Thousands of young women hoping for a Kim Kardashian-esque posterior have had the op.
Health tourism companies are able to offset up to 80 per cent of overseas advertisement and marketing fees.
A government guide highlighting the export investments available from the state, updated in January, states that companies are also entitled to support for consultancy fees, foreign rent and translation costs.
All health tourism firms in Turkey which have an ‘authorisation certificate’ from the government can claim ‘expenses for up to $400,000 annually for four years’, according to slides produced by the Ministry of Trade.
London-based NHS surgeon Mark Mikhail, who was the project lead for a British medical company when it was seeking to branch out to Turkey, said the ‘marketing noise’ from ‘unregulated companies’ can make it ‘impossible’ for patients to find a good surgeon.
He had hoped the project could make surgery in Turkey ‘supremely safe’ and wanted to ‘improve the whole industry’ but left after he disagreed with the direction it was taking.
After he quit in 2022, the project continued and the company, which he did not wish to name, established a clinic in Turkey.
While working there, he became aware that the Turkish Government was offsetting costs for firms to advertise abroad to lure customers and to subsidise their airplane tickets for patients.
According to documentation he saw in 2022, clinics can get up to 70 per cent of their advertising abroad covered by President Recep Tayyip Erdogan’s administration.
This includes ads on Google, Instagram, Facebook and YouTube worth up to £250,000 (9,104,805 TL) in the first few years of operation.
Multiple Turkish consultancy agencies also advertise how clients could get the same incentives with 60 per cent of their marketing fees paid for.
Clinics can also claim back substantial discounts on sending employees to exhibitions abroad as well as rent for overseas offices, all of which bring their costs down.
However, there are a few hoops clinics need to jump through to get this cash.
Another patient told the Mail how her nipple became necrotic in the UK after an all-inclusive combined surgery package deal in Turkey. The grandmother, who got a breast reduction and lift alongside a host of other procedures, was remotely reassured by her Turkish team that this was normal post-surgery reaction and discouraged her from seeking help from her GP. She would later need to have dead sections of the nipple cutaway by the NHS
To be eligible, clinics must prove that they are a health tourism company, that they have a website in multiple languages and they must also pass an inspection by the ministry of health.
Clinics are also required to pay an upfront licence fee of 102000TL (£2,804) and a yearly cost of 6000TL (£164), according to Dr Mikhail’s financial notes.
But he said these costs pale in comparison to the thousands of pounds they can get in subsidies.
‘This is why marketing is everywhere — it is a no risk expenditure to flood social media,’ said Dr Mikhail.
‘Turkey has totally changed its economy based on this. Their economy is massively struggling, but it really built this industry and a lot of that was how much the government was willing to put into it.’
Dr Mikhail said this money is partly responsible for the wave of adverts for Turkish surgery or dental work Brits see on public transport in the UK, floods of posts on Instagram and YouTube videos that encourage them to go abroad to get surgery.
The British Association of Aesthetic Plastic Surgeons found 324 cases of Britons needing medical treatment or corrective surgery after having gone under the knife overseas since 2018.
He added: ‘When you do have unregulated companies that can flood the advertising market, it’s impossible for the patient to filter through to find the people that are good.
‘There are some excellent clinicians over there, some have fantastic facilities and fantastic surgeons.
‘But it is impossible to filter through that because there is so much marketing noise.’
Dr Mikhail said warnings about the dangers of overseas cosmetic surgery, like those posted on the NHS website, were being drowned out by this promotional overload.
He said: ‘What are people going to do? Are they going to read the NHS website which does have guidance on it, or are they going to sit on Instagram and have these fantastic videos thrown at them from various different people with lots of enticing pictures? I’m probably going to do that.
‘Even for us it was difficult when we were going to Turkey to find good surgeons, it was supremely difficult.
‘Everyone is saying they are the best surgeon there.’
Marc Pacifico, president of The British Association of Aesthetic Plastic Surgeons (BAAPS), a charity composed of surgeons aiming to advance excellence, education and safety in plastic surgery, said he was ‘shocked’ to discover adverts were being heavily subsidised by the Turkish government ‘because of how they trivialize the risks of surgery’.
‘Impressive glossy advertising will pull the wool over many people’s eyes, rather than being able to really understand what’s important,’ he said.
‘It still seems that many companies portray surgery as risk free, as almost as if people can pick a result out of a catalogue and packaging it up as if it’s some glamourous experience bolted into a summer holiday. Nothing could be further from the truth.’
And British advertising regulators are largely powerless to stop the flood of ads that no UK-based business would be allowed to run.
UK cosmetic surgery clinics are forbidden from advertising surgery using terms such as ‘mommy makeovers’ or phrases that could exploit body insecurities. Operators also face the prospect of fines and even imprisonment should they try to rush people through deciding to have procedures through ‘limited time’ discounts.
The Advertising Standards Authority (ASA) watchdog recently issued a wave of warnings against Turkish clinics inappropriately promoting life-changing surgery to Britons.
TikTok influencer and rapper Millie B was rapped by the ASA in January over videos she made of her getting cosmetic surgery abroad, in partnership with Erdem Clinic in Istanbul.
The regulator claimed the ads, which featured a testimonial from Millie herself about getting a breast augmentation, ‘trivialised the decision to undergo cosmetic surgery’ and ‘were directed at those aged under 18’.
Now the ASA has vowed to take further action on the overseas surgery sector, recently issuing an industry-wide notice that adverts attempting to lure Britons to go under the knife abroad need to follow UK advertising standards or be taken down.
Some of these companies are also looking to silence former patients looking to warn others of the potential dangers with legal threats using British courts.
Some threaten customers who criticise the business, or any of its surgeons, online with a fine of up to £10,000 in threats hidden inside the expansive T&Cs patients accept when sign up for a procedure.
Medicci Aesthetics is one of those medical tourism companies which promises consequences for negative reviews.
‘Patients upon signing of our contracts agree not expose Medicci Aesthetics to negative reviews or comments publicly or anonymously for any reason concerning their surgery or experience resulting in damage to brand reputation, without providing the opportunity of resolution of any complaints via mediatory routes,’ a patient booklet obtained by the Mail reads.
It continues: ‘Any defamatory false comments will also result in legal action in both your home country and Turkey.’
The booklet also states that Britons who sign up for surgery de-facto consent to images of their bodies being shared on the company’s social media profiles.
‘We hold full rights to the sharing of the before and after photos for use of advertisement of our work,’ it reads.
While it seeks to reassure patients that they will take the ‘utmost care’ in ensuring their genitals and identifying tattoos will be ‘anonymised’ in these photos, it believes it has the right to share these images online.
Melissa Kerr, 31, of Gorleston, Norfolk, died after having a BBL in Turkey
‘We believe that you have chosen our work based on viewing the photos of other patients and it is only right that other patients are offered the same chance to be informed of our work in the same manner,’ it reads.
The booklet adds that taking and sharing of such images is ‘non-negotiable’ and objection could result in either cancellation of the procedure or an additional charge.
Medicci Aesthetics, which promises a ‘seamless treatment journey’ on its website, also criticises British GPs and warns patients who suffer post-surgery complications of potential risks of seeking help from your family doctor.
‘Often we find general practitioners in the UK are not so experienced or knowledgeable when it comes to wound care management of cosmetic and plastic surgery patients,’ it reads.
‘God forbid you mention you have been to Turkey, then they treat you as if you have the plague and decide to send you to the NHS A&E Department where you will wait for hours and most likely be told you need to take the implant out.’
While the company goes on to recommend visiting a GP if needed, they add you should also contact themselves about any post-surgical issues.
The agency is not alone in threatening financial consequences for voicing any concerns or criticisms of their treatment.
Other tourism companies offering Britons procedures in Turkey, Casas Care and Hermes Clinic, also threaten their customers with £10,000 fines if they ‘bad name’ their services.
While £10,000 penalties are on the upper scale of the threat agencies post, fines feature regularly across many agencies’ terms and conditions.
For example, Clinic International, another Turkey-based medical tourism agency, warns those who criticise its services openly can face a penalty of £5,000.
Lisa Webb, Which? consumer law expert, said: ‘It’s outrageous for patients to be threatened with financial penalties for posting negative reviews, particularly in instances where they’ve had a terrible experience with a company and are trying to put out a genuine warning to other people about it.
‘Terms and conditions that attempt to silence consumers in this way may well be in breach of UK consumer rights law, potentially making them unenforceable anyway.
‘Review hosting platforms must take action against any business they find indulging in this type of behaviour. Failure to deal swiftly with these bad actors would result in the platforms knowingly hosting misleading reviews.’
Dawn Knight, who has campaigned tirelessly against poor practice cosmetic surgery since she herself suffered a botched eyelift in the UK in 2012, said the threats silence botched patients from warning others honestly and openly about their experience.
She added that this, in turn, leaves many Britons with the false impression they were undergoing a risky procedure with an operator with a perfect track record.
‘It absolutely skews it,’ Ms Knight told the Mail. ‘We’ve known for years that surgeons and directors leave their own five-star reviews.
‘By them skewing the numbers in their favour it leaves patients absolutely baffled in retrospect when they look back.’
While Ms Knight knew overseas clinics had sent threats to pursue this kind of legal threat, she was unaware of any following through with actual court action.
However, she added that for many victims dealing with a poor surgical outcome, alongside the associated impacts to both their physical and mental health, a threat of a massive fine was likely to be enough to get many to retract a negative review.
‘It’s a predatory practice,’ Ms Knight said.
She also condemned the appalling practice of harvesting patients’ surgery photos for promotional purposes.
Ms Knight said she knew of women who had unknowingly signed up to such agreements, having not taken the time to read the extensive agreements, only to then see photos of their naked bodies online at a later date.
She added that it was standard practice in some Turkish clinics to only hand over the terms and conditions for signing when a patient is hours, sometimes minutes, away from going under the knife.
‘In our experience it’s when they’re already in Turkey when they’ve already paid for the procedures,’ she said.
Abimbola Ajoke Bamgbose, 38, died after liposuction in Turkey
Carol Keenan, 54, died after having a BBL and tummy tuck in Turkey
Diarra Brown, 28, died after having liposuction in Turkey
Ms Knight urged people thinking of going for surgery overseas to read the terms and conditions posted online ‘forensically’.
If they spot anything like the examples that the Mail has highlighted, she advised them to ‘stay far away’ from that operator. ‘These are massive, massive, red flags,’ she said.
A Medicci Aesthetics spokesman defended the notice about legal action to patients, also revealing they had successfully taken two ex-clients to court for ‘defamation’.
‘Unfortunately, we have seen comments in groups which are not true and defamatory,’ they said.
‘We are always open to patients sharing their experience but we have seen they share is not always true. Sometimes patients actually do it on purpose and later go on to blackmail us and ask for money to remove their comments.
‘We have however successfully taken legal action over two clients in the past for defamation and received settlement and will not hesitate to do so if false information is shared about us.’
The spokesman added that the line in the leaflet seen by the Mail about the ‘non-negotiable’ right to share surgery photos on social media is from an older version, and has been removed in the past few months, and the company was ‘careful’ not to share unconsented photos.
However, the line rubbishing British GPs remains, and the company defended its inclusion.
‘I have chosen to include this in our booklet as it is unfortunately true and I have a long list of evidence recorded as proof,’ the spokesperson said.
‘I think it is safe to say a plastic surgery clinic and its doctor see a more variety of different complications and wound issues relating specifically to cosmetic surgery than a GP who has an overall knowledge in general medicine.
‘We have often seen patients being scared or pushed into removing their implants when it is unnecessary and no other opinion by any other doctor even the operating surgeon itself is considered solely because the surgeon is in turkey. Even though that same surgeon has extensive experience and training in the USA and other countries.’
The Medicci Aesthetics spokesman added that they accept that there ‘many terrible clinics in Turkey with unethical practice’ but said ‘we are not one of them’.
Alarm has also been raised over social media ads promoting medical consultations in Britain by Turkish practitioners.
Turkish surgeons are running ‘free consultations’ for life-changing cosmetic and weight loss ops out of British hotels, campaigners told Mail+.
One such event – promising to ‘help you on your journey to a happier you’ – was held in Manchester in November out of a £200-a-night hotel.
The procedure list for the event included ‘mommy makeovers’, liposuction, nose jobs, tummy tucks and gastric bypass as well options for dental veneers, also known as ‘Turkey Teeth’.
BAAPS said it was alarmed about the event.
Doctors working in the UK need to be registered with the medical regulator the General Medical Council (GMC), which holds those working in Britain to strict ethical and professional standards.
However, as long as foreign medics running these roadshows don’t diagnose a condition or prescribe drugs, they aren’t breaking any rules.
None of the surgeons listed as attending the two-day event were on the GMC’s register.
Campaigners have previously raised the alarm about foreign surgeons using a ‘crazy loophole’ to tour Britain and recommend women get major surgery abroad — despite themselves not being allowed to carry out ops in the UK.