Top 5 Takeaways

  1. Increased Deaths Noted: The report highlights a significant increase in deaths of U.S. citizens from cosmetic surgery in the Dominican Republic, with average annual deaths rising from 4.1 (2009-2018) to 13.0 (2019-2022), peaking at 17 in 2020.
  2. Major Causes of Death: Fat or venous thromboembolism were the main causes of the 29 investigated deaths in 2019-2020. High proportions of the deceased had risk factors for embolism, including obesity and undergoing multiple procedures in one operation.
  3. Risk Factors and Preventive Measures: Many patients who died had risk factors for embolism. Improved surgical protocols and postoperative care, including prophylactic measures against venous thromboembolism, could mitigate these risks.
  4. Public Health Recommendations: The report suggests that individuals interested in cosmetic surgery should consult their healthcare providers about risks and that public health authorities should emphasize the importance of preoperative evaluations and the dangers of multiple simultaneous procedures.
  5. Investigation and Surveillance: The U.S. Embassy and the Dominican Republic Ministry of Health conducted an investigation due to the spike in deaths, emphasizing the need for better surgical practices and patient care.


This MMWR article discusses the notable increase in deaths among U.S. citizens undergoing cosmetic surgery in the Dominican Republic between 2009 and 2022. The report details the shift in the average annual number of deaths, with a significant rise observed in the latter part of the study period. It also outlines the main causes of death and associated risk factors, highlighting the importance of proper preoperative evaluation and the risks of undergoing multiple surgeries simultaneously.


The report defines a case as a death occurring in a U.S. citizen who received cosmetic surgery in the Dominican Republic and died within 3 weeks post-operation. It includes analysis of death records from the U.S. Embassy and medical and autopsy reports from the Dominican Ministry of Health for 2019-2020.


The discussion emphasizes the increased risk of perioperative death associated with specific patient and procedural risk factors, such as obesity and undergoing multiple cosmetic procedures. It calls for improved surgical protocols and postoperative care to mitigate these risks.


The MMWR article concludes with recommendations for individuals considering cosmetic surgery abroad to consult with healthcare professionals about their risks. It also suggests that public health authorities could help by supporting provider education on preoperative evaluation and the dangers of performing multiple cosmetic procedures in one operation.

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