Medical tourism needs to understand that there are trends in cosmetic surgery that it must keep up with to compete. And new trends are often how domestic cosmetic surgery businesses fight off the potential of medical tourism. The latest two are Vampire facials and Cinderella surgery. Cosmetic surgery specialist lawyer Amy Milner of Penningtons Manches explains the Vampire facial – the latest blood curdling anti-ageing beauty treatment that is rapidly gaining popularity. Since Kim Kardashian underwent the procedure on her reality television programme in 2013, there has been an 800% increase in demand. “The Vampire facial is a treatment where a doctor uses a patient’s own blood to give the skin a more youthful appearance. The procedure itself is said to stimulate collagen and elastin as well as to enhance skin colour, texture and make fine lines and wrinkles look less noticeable. The surgeon who carries out the procedure will make small puncture wounds on the face and will apply the patient’s own blood. This is not a procedure for the faint hearted, as the puncture wounds on the face are clearly visible following the procedure. However, the results can be noticed immediately with the full results becoming apparent within a matter of weeks. The procedure can be quite painful, particularly when the surgeon is making the puncture wounds and a patient may experience some bruising. The cost of one treatment is around £538.The procedure is considered a safe and effective way to lift up the skin and smooth out wrinkles if properly done by a trained surgeon.” Amy Milner goes on to explain that as a new procedure, it is not yet known whether there might be longer term side effects, “ The common side effects are: •Mild irritation and itching (depending on the sensitivity of skin. •Mild swelling or oedema. •Bruising caused by the reaction of skin to the injection." Sarah Gubbins of Penningtons Manches has studied the latest offering of Cinderella surgery, named after one of the favourite fairy tale princesses. In the USA it is better known as a foot facelift. As the name suggests, this procedure is for women seeking to change the size and/or shape of their feet so that they can fit into, or look better in, designer shoes. To achieve this, some women ask for the removal of bunions while others want their toes to be shortened and straightened so they look better in peep-toe shoes. Increasing the arch in someone’s foot in an attempt to make high heels more comfortable is also a popular request. Some women have even opted to have fat inserted into the soles of their feet so they can walk more comfortably in high heels. As well as allowing women to wear designer heels, Cinderella surgery can help to repair the damage caused by wearing high-heeled shoes. When you wear high heels, your foot slides forward in your shoe, redistributing your weight and creating unnatural pressure points and misalignment. Over time, problems can develop, particularly if you wear shoes with narrow, pointed toes.” Some of the problems that can arise from wearing high heels include: •Hammer toe – a deformity where a toe curls at the middle joint. High heels cause this because they force the toe against the front of the shoe, causing unnatural bending. •Corns and calluses – thick hard layers of skin that develop as a result of friction. •Bunions and bunionettes - bony bumps that form on the joint at the base of your big toe (bunions) or on the joint of your little toe (bunionettes). Tight-fitting high-heeled shoes do not necessarily cause bunions but can exacerbate an existing problem. •Stress fractures - tiny cracks in the bone caused from the pressure that high heels place on your forefoot. •Toenail problems – constant pressure can cause in-growing toenails and nail fungus. •Joint pain in ball of the foot (metatarsalgia) - high heels put more weight on the ball of your foot that causes increased pressure, and therefore pain, in your forefoot. Sarah Gubbins highlights the problems, “Shortening the toe may include shaving off the bone and, because toes help to support people’s weight and balance the body, cosmetic surgery can affect people’s balance and redistribute their weight. This can lead to complications later in life, such as the development of serious arthritic pain. Surgeons have also warned of months of swelling after foot surgery. Any shaping of the bones will be subject to swelling and bruising but the feet are even more susceptible. After foot surgery, patients must stay off their feet for several days but many do not have the patience to do this, putting weight on their feet before they have properly healed and injuring themselves. Many people end up with long term issues with their feet even after surgery – with no fault on the part of the surgeon.” And she warns of an even scarier trend; “As people start having all kinds of procedures for purely cosmetic reasons, their judgment of what is reasonable can become distorted and the pursuit of beauty can go too far. It was recently reported that one patient asked her surgeon to amputate her little toes. Thankfully he refused but this highlights concerns that some people will stop at nothing to achieve their cosmetic goals. It is unclear whether this particular patient had ever considered that removing her little toes was likely to significantly affect her ability to balance. Before rushing out for Cinderella surgery in the hope that your perfect feet will help you catch your very own Prince Charming, it is important to consider the realities of this type of surgery.” The UK and the USA are the leaders in these new trends but they can be very tricky operations so there is cause for concern if poorly qualified surgeons in other countries begin offering cut-price surgery; the long-tern consequences of getting treatment wrong are horrific.