What Australian and New Zealand Regulators Actually Say About Overseas Cosmetic Surgery

By Dr. Rushapol Sdawat, MD — Thai Board-certified Plastic and Reconstructive Surgeon, Medical Licence No. 17689
Last reviewed: 28 AUG 2026

You have already read the clinic pages, and probably the warnings too, and noticed that the two sets of documents do not appear to describe the same world. One is full of smiling people and package inclusions. The other uses words like disfigurement, evacuation and death. Neither reads as though it was written by someone who expected you to read the other.

I am a plastic surgeon in Bangkok. Almost every commercial incentive I have points towards not showing you the second set of documents. I am going to show them to you anyway, in their own words, because a decision made on half the evidence is not a decision — it is a purchase. Then I answer each one, conceding what is fair. Some of it is fair.

What Ahpra actually regulates, and what it cannot reach

Ahpra and the Medical Board of Australia introduced a cosmetic surgery reform package that took effect on 1 July 2023. The Medical Board's then-Chair, Dr Anne Tonkin, said it was intended "to stop patients being exploited and reduce the risk of harm." Ahpra's then-CEO Martin Fletcher said the aim was to "raise standards, improve consent about surgery and raise the bar in advertising."

For patients in Australia, the practical effects include:

• "From 1 July 2023, anyone considering cosmetic surgery must first get a referral from their GP."

• "There must be a cooling-off period (of at least seven days) after you give consent, before you book the surgery (or pay)."

• A requirement that the practitioner tells you "the risks and possible complications", the "total cost" including deposits, refunds and "payments for follow-up care", and "the complaints process and how to make a complaint".

• "All cosmetic surgery must be performed in a facility that is appropriate for the level of risk involved."

• An endorsement for cosmetic surgery, which Ahpra says "will help consumers know who is trained and qualified to perform cosmetic surgery safely."

Ahpra also warns, about its own register, that "searching the register may not be enough to tell you whether they are qualified and experienced in the specific procedure." That is unusually candid for a regulator describing its own tool.

Here is the part that matters to you. Ahpra registers and regulates practitioners in Australia. I am registered by the Medical Council of Thailand, not by Ahpra. If you are unhappy with my care, Ahpra has no power over me and no register on which to record a finding against me. That is not a criticism of Ahpra; it is what national regulation is. Any facilitator who implies otherwise, or who waves at "international standards" as though they were a regulator, is misleading you.

What the Australian Society of Plastic Surgeons says

The Australian Society of Plastic Surgeons (ASPS) is blunt. It calls cosmetic tourism "a price-driven practice where patients travel overseas to undergo cosmetic surgery procedures", and states:

"Cosmetic surgery is real surgery and like all forms of surgery carries inherent risks."

"Australia holds very high medical standards which are often not met in other countries."

"In the event of post-operative complications, follow-up care is essential."

"ASPS does not recommend combining surgery with having a holiday."

"ASPS strongly advises against overseas cosmetic surgery tourism."

I agree with four of those five without qualification, including the one about holidays: combining an operation with sightseeing is the most common reason I see wounds break down. The fifth is a position, not a finding.

What ASAPS asked the government for after the 60 Minutes programme

On 9 August 2026, Australia's 60 Minutes aired "Destination Disaster," about Australian women left disfigured after cosmetic surgery at a large Bangkok operator. Two days later the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) called for government action, naming the marketing practice it holds responsible: "heavily curated patient stories, before-and-after content and positive recovery experiences [that] can create an impression of safety that may not show complications, recovery difficulties or longer-term outcomes." That criticism is correct, and describes most of the industry I work in.

The statement did not ask for overseas surgery to be banned. It asked for "a review of the regulation of Australian businesses that advertise, facilitate or sell overseas cosmetic surgery to Australians, with a view to ensuring they are subject to equivalent cosmetic surgery-specific advertising safeguards", and "a Federal Government-funded national public education campaign on the risks of cosmetic surgery tourism."

I support both. An Australian company selling you an operation in Bangkok should face the same advertising rules as one selling you an operation in Sydney. There is no principled reason for the gap, and the gap is where the worst marketing lives.

ASAPS's patient guidance is worth reading in full. It states that "the risks of having cosmetic surgery overseas can be serious, and in some cases, life-threatening"; that "overseas facilities often lack the strict safety standards, accreditation, and hygiene protocols required in Australia"; that "in some countries, surgeon titles aren't protected"; and that "in some countries, the surgeon you meet may not be the one who performs your operation." It estimates roughly 15,000 Australians travel overseas for cosmetic procedures each year, spending about $300 million, with revision needed in up to 7 per cent of cases, and advises that "in Australia and New Zealand, patients are advised not to fly for 6–8 weeks post-surgery" because of the risk of deep vein thrombosis and pulmonary embolism.

What Smartraveller tells you before you fly

The Australian Government's Smartraveller service does not soften anything:

"There are always risks with medical procedures. You could suffer from complications, or you could die."

"If you have complications they can't treat overseas, you may need medical evacuation back to Australia. This can cost hundreds of thousands of dollars."

"Basic travel insurance policies rarely cover medical tourism."

Its advice is to talk to your doctor in Australia and get a health check at least six weeks before you go. I would add only this: bring that doctor's letter and your medication list with you.

What the Better Health Channel says about Thailand specifically

Victoria's Better Health Channel names Thailand first among destinations, and puts the saving at "as much as 80 per cent off the cost of the same procedure at home." It lists the risks as "lower quality surgical skills and practices that can lead to infection or disfigurement", "antibiotic resistant bacteria that can cause complications after surgery and may not be treatable", and "lack of follow-up after the operation."

On money it says "Medicare Australia is unlikely to cover overseas medical treatment, and private health insurance may not cover it either", and notes Australia has reciprocal healthcare agreements with only "11 countries, and these are mostly for emergency treatment only." Thailand is not one of them.

Its sharpest sentence is about liability: "The person having the procedure carries all the risk."

What NZAPS tells New Zealanders about ACC

The New Zealand Association of Plastic Surgeons states that "long flights and changes in altitude and pressure can complicate recovery from surgery, increasing the risk of blood clots, deep vein thrombosis (DVT), and other complications", and that "once they return home after their operation, the patient is essentially on their own."

On accident compensation it says:

"ACC does not cover injuries sustained from surgery overseas. New Zealanders needing care will have their emergent needs (eg. infection, wounds opening up) met through the public hospital system, but there is no guarantee that any treatment beyond this will make it through the public hospital waiting list system."

Where these bodies are right, and I will not argue

They are right that cosmetic surgery is real surgery. Augmentation, abdominoplasty and rhinoplasty all carry haematoma (blood collecting under the wound), seroma (fluid collecting), infection, wound breakdown, necrosis (tissue death at the edges of long incisions), nerve injury with numbness or weakness that is sometimes permanent, venous thromboembolism, unpredictable scarring, asymmetry, and the outcome hardest to talk about — a result that is technically sound and that you are nonetheless disappointed by. Distance adds the flight, and the fact that if something goes wrong in week three you are 7,000 kilometres from the person who operated on you.

They are right that follow-up is the weak point of the model, that titles are not protected everywhere, that ghost surgery happens, and that curated marketing creates a false impression of safety.

And some people should simply have their surgery at home, whatever the price difference: anyone with a significant clotting history, anyone whose cardiac or respiratory reserve makes a long-haul flight a risk in itself, anyone with poorly controlled diabetes or a BMI that materially raises wound and anaesthetic risk, anyone travelling alone, anyone whose expectations do not match their anatomy, and anyone who cannot comfortably absorb the cost of a revision. If that is you and a clinic is still encouraging you to book, that tells you something about the clinic.

Where the wording is broader than the evidence

Conceding the fair criticisms does not oblige me to accept imprecise ones. Several widely repeated statements are true as general warnings but wrong as absolute rules.

The statement, as commonly readWhat the source actually supportsWhat I would do about it"ACC does not cover injuries from surgery overseas"NZAPS states this flatly. Jonathan Wheeler's 2020 analysis in the Australasian Journal of Plastic Surgery (3(2), doi:10.34239/ajops.v3n2.204) found ACC "will accept a treatment injury only if the surgery has been performed by an appropriately qualified doctor," and that ACC "may cover some patients who have complications as a result of surgery undertaken overseas." Of claims lodged 2014–19, 76 related to overseas procedures.Cover turns on the surgeon's qualifications, not geography. Ask ACC in writing before you book — not the clinic, and not me."Overseas facilities often lack the strict safety standards, accreditation, and hygiene protocols required in Australia"ASAPS's word is "often," not "always." Accreditation is a checkable fact for any named hospital.Ask for the accreditation certificate number, and verify it with the certifying body rather than the clinic."Revision is needed in up to 7% of cases"ASAPS gives this as an upper bound, not a point estimate.Budget for a revision you may not need."The surgeon you meet may not be the one who performs your operation"Correct, and a real practice in parts of the industry.Get the operating surgeon's name and licence number in writing before paying a deposit, and verify it yourself."Medicare does not cover overseas treatment"Correct — and Australia has no reciprocal agreement with Thailand.It does not follow that you are uninsurable at home. A GP consultation in Australia attracts its normal rebate whatever prompted it."Cosmetic tourism costs the Australian hospital system heavily"An audit at the Royal Brisbane and Women's Hospital found that of 331 breast implant removals, 8 (2.4%) involved overseas-inserted devices, costing that department above AU$110,000 — about 4 per cent of its explantation spending.The burden is real and worth naming, and smaller than "cosmetic tourism crisis" implies. Both can be true.

The one claim I contest directly is the implicit one: that "overseas" is itself the risk factor. It is not. The risk factors are an unqualified operator, an unaccredited facility, an unrealistic timeline, and a patient who was never properly assessed — all four available in Sydney, Auckland and Bangkok alike. Distance makes each harder to detect and much harder to fix, which is a serious argument for caution. It is an argument about diligence, not about latitude.

When to seek care

In a Bangkok hotel room, on a plane, or at home: chest pain, breathlessness, coughing blood, or a hot, swollen, painful calf means an emergency department immediately, by ambulance if you cannot walk. Do not contact your surgeon or clinic first. Pulmonary embolism is the complication most likely to kill you, and it does not announce itself politely.

Also emergency, same hour: bleeding soaking through dressings, a breast or abdomen swelling rapidly and becoming tight and painful (an expanding haematoma), fever above 38.5°C with shaking chills, spreading redness with dusky, blistered or numb skin, or sudden confusion or collapse.

Same-day review, not tomorrow: a wound edge going from pink to grey or black, discharge that has turned cloudy or foul-smelling, pain escalating rather than settling after day three, one-sided calf discomfort, or a temperature creeping up over 24 hours.

Back in Australia or New Zealand, go to a public hospital emergency department for anything in the first two groups. Do not fly, do not wait for a Bangkok appointment, and do not let embarrassment cost you time. Take your operation report and medication list, and send me the notes afterwards; I would rather be woken at 3am than read about it three weeks later.

What I would actually do in your position

I would read the ASPS and ASAPS pages in full rather than in the quotes I have selected. I would ask Ahpra's questions of any overseas surgeon exactly as Ahpra frames them for Australian ones — total cost, refund terms, who pays for follow-up, what the complaint process is — and refuse to proceed with anyone who answered vaguely. I would verify the surgeon's registration myself, and ask in writing who will operate, who will assist, and who reviews me on day one, day three and day seven. I would confirm what is covered with ACC or my insurer, in writing, before paying anything.

If, having done all that, you decide to have your surgery in Australia or New Zealand, you will have made a good decision and I will have helped you make it. That is an acceptable outcome for me. What is not acceptable is that you make it on the basis of a page that only ever shows you half the file.

Dr. Rushapol Sdawat (known to international patients as Dr. Dominic) is a Thai Board-certified plastic and reconstructive surgeon practising at Intrarat Hospital, Bangkok, Medical Licence No. 17689. He holds Thai Board certification in General Surgery (Phramongkutklao Hospital) and in Plastic and Reconstructive Surgery (Ramathibodi Hospital, Mahidol University), has been a member of ISAPS since 2008 and is an international member of the American Society of Plastic Surgeons. Dr. Rushapol holds Thai specialist certification; he is not registered with Ahpra and does not hold Australian or New Zealand specialist registration. His registration can be verified on the Medical Council of Thailand register at checkmd.tmc.or.th.

This article is provided for general information and education. It is not medical advice and cannot substitute for individual assessment by a qualified practitioner who knows your history. Surgery carries risk, including risk of serious complications and of outcomes that do not meet expectations. Results vary between patients.

What Australian and New Zealand Regulators Actually Say About Overseas Cosmetic Surgery

By Dr. Rushapol Sdawat, MD — Thai Board-certified Plastic and Reconstructive Surgeon, Medical Licence No. 17689
Last reviewed: [SET DATE ON PUBLISH]

You have already read the clinic pages, and probably the warnings too, and noticed that the two sets of documents do not appear to describe the same world. One is full of smiling people and package inclusions. The other uses words like disfigurement, evacuation and death. Neither reads as though it was written by someone who expected you to read the other.

I am a plastic surgeon in Bangkok. Almost every commercial incentive I have points towards not showing you the second set of documents. I am going to show them to you anyway, in their own words, because a decision made on half the evidence is not a decision — it is a purchase. Then I answer each one, conceding what is fair. Some of it is fair.

What Ahpra actually regulates, and what it cannot reach

Ahpra and the Medical Board of Australia introduced a cosmetic surgery reform package that took effect on 1 July 2023. The Medical Board's then-Chair, Dr Anne Tonkin, said it was intended "to stop patients being exploited and reduce the risk of harm." Ahpra's then-CEO Martin Fletcher said the aim was to "raise standards, improve consent about surgery and raise the bar in advertising."

For patients in Australia, the practical effects include:

• "From 1 July 2023, anyone considering cosmetic surgery must first get a referral from their GP."
• "There must be a cooling-off period (of at least seven days) after you give consent, before you book the surgery (or pay)."
• A requirement that the practitioner tells you "the risks and possible complications", the "total cost" including deposits, refunds and "payments for follow-up care", and "the complaints process and how to make a complaint".
• "All cosmetic surgery must be performed in a facility that is appropriate for the level of risk involved."
• An endorsement for cosmetic surgery, which Ahpra says "will help consumers know who is trained and qualified to perform cosmetic surgery safely."

Ahpra also warns, about its own register, that "searching the register may not be enough to tell you whether they are qualified and experienced in the specific procedure." That is unusually candid for a regulator describing its own tool.

Here is the part that matters to you. Ahpra registers and regulates practitioners in Australia. I am registered by the Medical Council of Thailand, not by Ahpra. If you are unhappy with my care, Ahpra has no power over me and no register on which to record a finding against me. That is not a criticism of Ahpra; it is what national regulation is. Any facilitator who implies otherwise, or who waves at "international standards" as though they were a regulator, is misleading you.

What the Australian Society of Plastic Surgeons says

The Australian Society of Plastic Surgeons (ASPS) is blunt. It calls cosmetic tourism "a price-driven practice where patients travel overseas to undergo cosmetic surgery procedures", and states:

"Cosmetic surgery is real surgery and like all forms of surgery carries inherent risks."

"Australia holds very high medical standards which are often not met in other countries."

"In the event of post-operative complications, follow-up care is essential."

"ASPS does not recommend combining surgery with having a holiday."

"ASPS strongly advises against overseas cosmetic surgery tourism."

I agree with four of those five without qualification, including the one about holidays: combining an operation with sightseeing is the most common reason I see wounds break down. The fifth is a position, not a finding.

What ASAPS asked the government for after the 60 Minutes programme

On 9 August 2026, Australia's 60 Minutes aired "Destination Disaster," about Australian women left disfigured after cosmetic surgery at a large Bangkok operator. Two days later the Australasian Society of Aesthetic Plastic Surgeons (ASAPS) called for government action, naming the marketing practice it holds responsible: "heavily curated patient stories, before-and-after content and positive recovery experiences [that] can create an impression of safety that may not show complications, recovery difficulties or longer-term outcomes." That criticism is correct, and describes most of the industry I work in.

The statement did not ask for overseas surgery to be banned. It asked for "a review of the regulation of Australian businesses that advertise, facilitate or sell overseas cosmetic surgery to Australians, with a view to ensuring they are subject to equivalent cosmetic surgery-specific advertising safeguards", and "a Federal Government-funded national public education campaign on the risks of cosmetic surgery tourism."

I support both. An Australian company selling you an operation in Bangkok should face the same advertising rules as one selling you an operation in Sydney. There is no principled reason for the gap, and the gap is where the worst marketing lives.

ASAPS's patient guidance is worth reading in full. It states that "the risks of having cosmetic surgery overseas can be serious, and in some cases, life-threatening"; that "overseas facilities often lack the strict safety standards, accreditation, and hygiene protocols required in Australia"; that "in some countries, surgeon titles aren't protected"; and that "in some countries, the surgeon you meet may not be the one who performs your operation." It estimates roughly 15,000 Australians travel overseas for cosmetic procedures each year, spending about $300 million, with revision needed in up to 7 per cent of cases, and advises that "in Australia and New Zealand, patients are advised not to fly for 6–8 weeks post-surgery" because of the risk of deep vein thrombosis and pulmonary embolism.

What Smartraveller tells you before you fly

The Australian Government's Smartraveller service does not soften anything:

"There are always risks with medical procedures. You could suffer from complications, or you could die."

"If you have complications they can't treat overseas, you may need medical evacuation back to Australia. This can cost hundreds of thousands of dollars."

"Basic travel insurance policies rarely cover medical tourism."

Its advice is to talk to your doctor in Australia and get a health check at least six weeks before you go. I would add only this: bring that doctor's letter and your medication list with you.

What the Better Health Channel says about Thailand specifically

Victoria's Better Health Channel names Thailand first among destinations, and puts the saving at "as much as 80 per cent off the cost of the same procedure at home." It lists the risks as "lower quality surgical skills and practices that can lead to infection or disfigurement", "antibiotic resistant bacteria that can cause complications after surgery and may not be treatable", and "lack of follow-up after the operation."

On money it says "Medicare Australia is unlikely to cover overseas medical treatment, and private health insurance may not cover it either", and notes Australia has reciprocal healthcare agreements with only "11 countries, and these are mostly for emergency treatment only." Thailand is not one of them.

Its sharpest sentence is about liability: "The person having the procedure carries all the risk."

What NZAPS tells New Zealanders about ACC

The New Zealand Association of Plastic Surgeons states that "long flights and changes in altitude and pressure can complicate recovery from surgery, increasing the risk of blood clots, deep vein thrombosis (DVT), and other complications", and that "once they return home after their operation, the patient is essentially on their own."

On accident compensation it says:

"ACC does not cover injuries sustained from surgery overseas. New Zealanders needing care will have their emergent needs (eg. infection, wounds opening up) met through the public hospital system, but there is no guarantee that any treatment beyond this will make it through the public hospital waiting list system."

Where these bodies are right, and I will not argue

They are right that cosmetic surgery is real surgery. Augmentation, abdominoplasty and rhinoplasty all carry haematoma (blood collecting under the wound), seroma (fluid collecting), infection, wound breakdown, necrosis (tissue death at the edges of long incisions), nerve injury with numbness or weakness that is sometimes permanent, venous thromboembolism, unpredictable scarring, asymmetry, and the outcome hardest to talk about — a result that is technically sound and that you are nonetheless disappointed by. Distance adds the flight, and the fact that if something goes wrong in week three you are 7,000 kilometres from the person who operated on you.

They are right that follow-up is the weak point of the model, that titles are not protected everywhere, that ghost surgery happens, and that curated marketing creates a false impression of safety.

And some people should simply have their surgery at home, whatever the price difference: anyone with a significant clotting history, anyone whose cardiac or respiratory reserve makes a long-haul flight a risk in itself, anyone with poorly controlled diabetes or a BMI that materially raises wound and anaesthetic risk, anyone travelling alone, anyone whose expectations do not match their anatomy, and anyone who cannot comfortably absorb the cost of a revision. If that is you and a clinic is still encouraging you to book, that tells you something about the clinic.

Where the wording is broader than the evidence

Conceding the fair criticisms does not oblige me to accept imprecise ones. Several widely repeated statements are true as general warnings but wrong as absolute rules.

The statement, as commonly read	What the source actually supports	What I would do about it
"ACC does not cover injuries from surgery overseas"	NZAPS states this flatly. Jonathan Wheeler's 2020 analysis in the Australasian Journal of Plastic Surgery (3(2), doi:10.34239/ajops.v3n2.204) found ACC "will accept a treatment injury only if the surgery has been performed by an appropriately qualified doctor," and that ACC "may cover some patients who have complications as a result of surgery undertaken overseas." Of claims lodged 2014–19, 76 related to overseas procedures.	Cover turns on the surgeon's qualifications, not geography. Ask ACC in writing before you book — not the clinic, and not me.
"Overseas facilities often lack the strict safety standards, accreditation, and hygiene protocols required in Australia"	ASAPS's word is "often," not "always." Accreditation is a checkable fact for any named hospital.	Ask for the accreditation certificate number, and verify it with the certifying body rather than the clinic.
"Revision is needed in up to 7% of cases"	ASAPS gives this as an upper bound, not a point estimate.	Budget for a revision you may not need.
"The surgeon you meet may not be the one who performs your operation"	Correct, and a real practice in parts of the industry.	Get the operating surgeon's name and licence number in writing before paying a deposit, and verify it yourself.
"Medicare does not cover overseas treatment"	Correct — and Australia has no reciprocal agreement with Thailand.	It does not follow that you are uninsurable at home. A GP consultation in Australia attracts its normal rebate whatever prompted it.
"Cosmetic tourism costs the Australian hospital system heavily"	An audit at the Royal Brisbane and Women's Hospital found that of 331 breast implant removals, 8 (2.4%) involved overseas-inserted devices, costing that department above AU$110,000 — about 4 per cent of its explantation spending.	The burden is real and worth naming, and smaller than "cosmetic tourism crisis" implies. Both can be true.

The one claim I contest directly is the implicit one: that "overseas" is itself the risk factor. It is not. The risk factors are an unqualified operator, an unaccredited facility, an unrealistic timeline, and a patient who was never properly assessed — all four available in Sydney, Auckland and Bangkok alike. Distance makes each harder to detect and much harder to fix, which is a serious argument for caution. It is an argument about diligence, not about latitude.

When to seek care

In a Bangkok hotel room, on a plane, or at home: chest pain, breathlessness, coughing blood, or a hot, swollen, painful calf means an emergency department immediately, by ambulance if you cannot walk. Do not contact your surgeon or clinic first. Pulmonary embolism is the complication most likely to kill you, and it does not announce itself politely.

Also emergency, same hour: bleeding soaking through dressings, a breast or abdomen swelling rapidly and becoming tight and painful (an expanding haematoma), fever above 38.5°C with shaking chills, spreading redness with dusky, blistered or numb skin, or sudden confusion or collapse.

Same-day review, not tomorrow: a wound edge going from pink to grey or black, discharge that has turned cloudy or foul-smelling, pain escalating rather than settling after day three, one-sided calf discomfort, or a temperature creeping up over 24 hours.

Back in Australia or New Zealand, go to a public hospital emergency department for anything in the first two groups. Do not fly, do not wait for a Bangkok appointment, and do not let embarrassment cost you time. Take your operation report and medication list, and send me the notes afterwards; I would rather be woken at 3am than read about it three weeks later.

What I would actually do in your position

I would read the ASPS and ASAPS pages in full rather than in the quotes I have selected. I would ask Ahpra's questions of any overseas surgeon exactly as Ahpra frames them for Australian ones — total cost, refund terms, who pays for follow-up, what the complaint process is — and refuse to proceed with anyone who answered vaguely. I would verify the surgeon's registration myself, and ask in writing who will operate, who will assist, and who reviews me on day one, day three and day seven. I would confirm what is covered with ACC or my insurer, in writing, before paying anything.

If, having done all that, you decide to have your surgery in Australia or New Zealand, you will have made a good decision and I will have helped you make it. That is an acceptable outcome for me. What is not acceptable is that you make it on the basis of a page that only ever shows you half the file.

---

Dr. Rushapol Sdawat (known to international patients as Dr. Dominic) is a Thai Board-certified plastic and reconstructive surgeon practising at Intrarat Hospital, Bangkok, Medical Licence No. 17689. He holds Thai Board certification in General Surgery (Phramongkutklao Hospital) and in Plastic and Reconstructive Surgery (Ramathibodi Hospital, Mahidol University), has been a member of ISAPS since 2008 and is an international member of the American Society of Plastic Surgeons. Dr. Rushapol holds Thai specialist certification; he is not registered with Ahpra and does not hold Australian or New Zealand specialist registration. His registration can be verified on the Medical Council of Thailand register at checkmd.tmc.or.th.

This article is provided for general information and education. It is not medical advice and cannot substitute for individual assessment by a qualified practitioner who knows your history. Surgery carries risk, including risk of serious complications and of outcomes that do not meet expectations. Results vary between patients.