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As early as 1987, many authors have associated the terminology ‘cosmetic surgery tourism’ under the umbrella of medical, health and wellbeing tourism. Since then, it has been known as ‘aesthetic tourism’, ‘plastic surgery tourism’, ‘surgery tourism’ and ‘surgery abroad’ by Marck, et al (2010), Melendez & Kaveh (2011) and Campbell (2019). However, authors such as Griffiths & Mullock (2017), Pereia et., al (2018) and Bell et al., (2011) only describes this as ‘an emerging trend’ or ‘fast growing phenomenon’ without distinctively defining the terminology. This lacks in identifying specifically what cosmetic surgery tourism is. Despite this, Ackerman (2010) attempts to analyse the term as “a form of medicalized leisure, situated in elite private spaces and yet inextricably linked to a beleaguered national medical program”. This therefore, persuades this individual project to create a simpler terminology to clearly identify the meaning behind this emerging niche. Drawing primarily on a small number of existing studies mainly focused on medical tourism like Griffiths & Mullock (2018) attempt as “the movement of patients from one location to another to undertake aesthetic procedures, is a significant and growing area of medical tourism”. Additionally, the current growth, this individual project produced its own definition of cosmetic surgery tourism.
UNWTO (1995) defined tourism as “activities of people travelling and staying in places outside their usual environment for not more than one consecutive year for leisure, business, wellness and other purposes”. This is important to highlight to feature the tourism-ness of this phenomenon as it is also a tourism experience although medical purposes are not mentioned. Despite this, Connell (2006) defined medical tourism under the category of wellness as the most appropriate linkage to this industry. He defined medical tourism as people travelling often to overseas countries to obtain medical, dental and surgical care while simultaneously being holiday makers in a more conventional sense. Subsequently, develops holiday packages created by destinations with an interest in medical tourism. Drawing only on the tourism and medical tourism aspect adds value to the coined definition of cosmetic surgery tourism being the main elements to this type of tourism. However, will not entirely/ specifically define this niche. Therefore, to further analyze this definition, this form of surgery focuses on plastic and cosmetic surgery procedures. The definition the plastic surgery aspect has been identified in a 2017 report by Griffiths and Mullock as simply undertaken for altering physical appearance of a person. Furthermore, noted undergoing cosmetic surgery is connected to the alleviation of psychological anxiety related to the physical body and greater happiness which then improves self-image and appearance. Additionally, as ‘entirely elective’ work for enhancement of appearance purposes. Therefore, combining each element will evidently create the terminology of cosmetic surgery tourism today. The fact that surgery is undertaken on holiday and that holidays are narrativized as part of the ongoing tourist experience, it has been argued to produce a different framing when tourism is combined with cosmetic surgery tourism.
Cosmetic surgery tourism is the hybrid child of/conceptually connects tourism and cosmetic surgery whereas tourists travel outside of their developed residential areas overseas, sometimes to developing countries to undergo cosmetic surgery. This is often linked to a luxurious holiday where patients can commence in tourism activities after operations. Therefore, forms the concept of cosmetic surgery holidays where it carries traditional tourism activities such as lying on the beach, drinking alcohol, relaxing poolside and sight-seeing following surgery. Packages offer surgeries with recuperation in a beautiful location/ resort and traditional tourist activities. Cosmetic surgery requires spaces where transformation can occur. Therefore, their spaces are the holiday or luxurious treatment resort.
Jones (2011) studied this theory and linked it to the makeover culture. The niche is forever ongoing and results in no ‘complete’ self as a result of fragmentary enhancements and additions that will forever alter the body. Almost 20 years ago, Davis stated that recipients of this niche talked about this surgery as a way to become ‘whole’ or normal. Subsequently, develops the most intimate form of tourism as tourists’ bodies are the main concern and ‘touched’ by the experience forever. Therefore, cosmetic surgery is believed to be distinctive in its own way from the sole connection to surgical practices due to the nature and a result of the motives.
Cosmetic surgery reinforces and heightens physiological concern with body image and culturally prescribed standards of beauty. This performs under the intersection of tremendously complex and significant social trends related to gender, personal, media, celebrity, finance, psyche, ethics, culture, body along with communication and medical technologies. Substantially performed to achieve the ‘ideal’ body as part of the makeover culture written earlier mentioned. This contributes to the youth culture which is seek by the mostly by the baby boomer generation and people of specific background who upholds cultural standards. Cosmetic surgery is one of the few medical procedures linked to fashion as well as to health and it has become a status symbol in some cultures. Authors such as Jones (2011) wrote that there is an evident linkage in cosmetic surgery tourism and a shopping overseas tour where the element of impulse buying is encouraged in both. Now they are more likely to see cosmetic surgery as a product or a purchase, and to narrate it as part of a grooming or fashion regime rather than a pathway to the true self.
The holiday carries a weight of expectation: that it will be out-of-the-ordinary, and in some way either restorative or transformative (or both). Connell (2006) noted that tourism is part of relaxation, increase wellbeing, pleasure and health. Further, stated that the purpose of holidays is dive into something out of the ordinary and go back home refreshed. With this said we can see how elements can link cosmetic surgery tourism as a literalization of the idea. Souvenirs collected from these tourists includes a new nose or smaller waist as opposed trinkets or a tan. This proves to others that you have been on holiday. John Connell (2006) ponder ‘It is a truism that tourism is supposed to be about relaxation, pleasure and an increase in wellbeing and even health. Tourists need not necessarily be hedonists, but they expect a beneficial outcome.’ This is one starting point: going on holiday is supposed to be restorative. Holidaying is about going away, doing something different, and coming back refreshed. In this sense, we can see cosmetic surgery tourism as the literalization of this idea, scaling it up from the more familiar suntan or weight loss (or gain) that marks on the body the fact of having been on holiday. Eryn Casanova (2007) argues that we want people to notice we’ve been on holiday, so cosmetic surgery tourism builds on those other bodily markers of tourism such as the tan. But, she adds, the idea of the holiday as a restorative time-space might also be utilized by tourists to invoke this idea more subtly, allowing for people to undergo ‘secret’ surgery. Cosmetic surgery is itself framed as a ‘treat’ or ‘reward’, something well-earned and that will also repay its investment by bringing into being a ‘new you’. However, for people that desire the idea of travelling without anyone’s knowledge and returning after the makeover is completed can venture ‘secret’ surgery holiday. Nevertheless, at least for some consumers, the association of the holiday with restoration and wellbeing can usefully be combined with the transformation enacted by surgery, suggesting that one fruitful way to theorize the tourism-ness of cosmetic surgery tourism might be to track the ways in which these ideas are mobilized both by producers and consumers, in tourist promotional materials and in the narratives of tourists themselves. Wearing et al. (2010) noted ‘tourist consumption involves … some form of reworking of the self’ whether in terms of reshaping the body or in terms of identity work and narrating the self, including the tourist self. As well as embodied traces, such as a suntan, other material traces are used by tourists to remember and signify their experiences the holiday memento, photographs and videos, even the act of sending a postcard home. As a result, the surgical experience might be remembered or ‘mementoized’.
Travel has always had a deliberate link to human activity tracking back thousands of years. However, the idea of travel for leisure, educational or health purposes developed during the eighteenth century ‘Age of Enlightenment’ with the development of the ‘Grand Tour’ in Europe. Drawing from that research, health purposes has had a long association with travel and tourism from the development of spa resorts in Roman times to seaside or mountain sanatoriums popular with Victorians. This is directly linked to the theory that some of the earliest forms of tourism were directly aimed at increased health and wellbeing. This was evident in the numerous spas in Europe which generated the effective emergence of local tourism, during the 18th century where ‘taking the waters’ became common. Additionally, health tourism ‘laid the foundations for the development of much of the modern tourism industry in Europe’.
During these times, this trend was once for the wealthy, sufficiently vulnerable, desperate and/or narcissistic indulged in cosmetic surgeries. Cosmetic surgery recipients were once seen as patients due to desired they acquired to undergo procedures were often secretive and ashamed. Today cosmetic surgery tourism is known as a burgeoning industry as more consumers are seeking it now than ever. This fast-growing market is taken into consideration based on significant variation of motivations by different types of tourists. Doctors in low-income countries provided these services and products which attracted develop countries tourists to this emerging trend. Societal attitudes towards this niche have as evolved gradually from public to private sectors which then eliminates the need of prior consultation from clinical gatekeepers or formal referral from family doctors. However, this ultimately impacts the management of surgical tourism by the creation of a gap in the care network. This phenomenon has gradually become affordable and a part of grooming and mainstream beauty with links to aesthetic and cultural imperative. This was due to cosmetic surgery as ‘normalized perfection’ which resulted in underclass people to utilize this service. Currently this has developed to a consumable item as recipients are no longer ‘patients’ but viewed as ‘clients’ whose surgeries occur in a new global conglomeration of media, technological and aesthetic conditions.
Connell (2006) questioned the ‘tourism-ness’ aspect of cosmetic surgery tourism. Therefore, persuades this individual project to attempt to bring clarity to this. Combining wellbeing, in this case cosmetic surgery with holiday and restoration theorizes a view of the tourism-ness of cosmetic surgery tourism. As retelling stories is part of ‘tourism-ness’ likewise cosmetic surgery narrated by tourists. Evidently, will identify then develop types of tourists in this niche in terminologies that clearly defines them. Kanittinsuttitong (2015) formed the concept of medical tourism by two main theories tourism and medical services. The author defined one group, medical focused tourists as tourists who mainly emphasize on medical treatment and other factor related to medical services while less focus on tourism aspect. In contrast, the second group tourism focused tourists who mainly focus on tourism factors and less focus on medical or healthcare services. Provided that, cosmetic surgery tourism can be recognized with similar forms/groups due to evidence that shows relation to medical tourism.
Cosmetic surgery focused tourist and tourism focused tourists have yet been identified by researchers in previous research. Therefore, this individual project defines both drawing on many authors’ perceptions. Cosmetic surgery focused tourist may seek the services of the very best cosmetic surgeons in the world or seeks more extreme or even risky procedures that they may be unable to get in their country. Therefore, their association of the holiday with the surgery may not be their primary motivation. Whereas tourist focused tourists seek cosmetic surgery treatment based on tourism factors such as the holiday, destination, amenities and services. Seeks packages offer surgery plus recuperation in a beautiful resort location or specialized retreat, while also offering more familiar tourist experiences for patients and accompanying family members or fellow travellers, such as sight- seeing or even safaris. As a result, their primary focus relies more on the holiday/ tourism aspect.
The question of what motivates both tourists to travel to these destinations in Southeast Asia is not a simple one to answer. The difficulty lies in current case studies where researchers did not distinctively develop assumptions of both types of tourists, making it generalized. Subsequently, the motives of behaviours they have observed. There is an element of subjectivity identified in motivations. However, it is simple to identify which motives co-relates/ exists with each or a both. This then forms the core of this project, motivation and forms the basis of this literature review.
Motivation is a complex area of research which comprises explaining human behaviour and attempting to understand it. In relation to tourism, Gnoth (1997) explains travel motivation as “a response to felt needs and acquired values within temporal, spatial and social and economic parameters”. The emergence of this trend has been highlighted by many authors over two decades and facilitated motives for both types of tourists to select this niche.
The UK’s annual International Passenger survey shows that approximately 100,000 UK citizens go abroad each year for medical treatment, which is projected to rise about 20% per year. The Treatment Abroad found that cosmetic procedures account for 60–70% of all medical tourism, 42% excluding dental and obesity. Growth has been facilitated by a number of underlying factors which allowed this developing niche to continue rapidly evolving (Connell, 2006). Cosmetic surgery tourism really came to prominence by the emergence of new companies in developing countries, although not health specialists, however brokers between international patients and hospital networks. Additionally, the rise of the internet and new technologies which promote marketing strategies associated with tourism that attracts people from developed countries to countries that developing or low-income. This is a result of high cost treatment performed in these developed countries along with long waiting lists. Subsequently, air travel fare for these treatments are relatively affordable with favourable exchange rates. This attracts the ageing of the affluent post-war and baby-boom generation. Thus, developed new demands for example, cosmetic dental surgery is not covered by insurance in countries like the UK, hence dental tourism has become particularly common.
Patients undergo these procedures purely for aesthetic reasons. Over the past few decades, according to Griffiths & Mullock (2018) societal attitudes to cosmetic surgery have evolved quite dramatically. This has become a lifestyle choice for people gradually increasing in numbers. Provided that, these multiple impacts play a significant role which produce these services acquired by these travellers including stakeholders directly or indirectly linked to tourism. To continue the success of the niche in tourism it is recommended to implement national and local tourism policies. Patients are lured by low prices and high quality cosmetic surgery procedures. Referrals quicker, less consultation and paper work developed from a novelty to a significant tourist attraction.
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