In general, plastic surgery in the United States is safe. However, once the patient decides to leave the borders, the predictability of the result may be more varied. Doctors are screened in the United States for board certification and licensure is given to plastic surgeons with the American Board of Plastic Surgery, after they have met strict residency and fellowship training programs. When patient's venture off to other countries, for cosmetic surgical procedures, the standard of care is difficult to "standardize." We do not know whether the doctors are board certified plastic surgeons, and is their board certification equivalent to that of the American Board of Plastic Surgery. Having plastic surgery procedure should not be like rolling the dice or spinning the wheel-of-fortune. More than ever, the consumer must do his or her homework in ensuring, through due diligence, that the cosmetic surgery will be performed by a board certified plastic surgeon, that the physician putting the patient to sleep is a diplomat of the American Board of Anesthesia, and that the ambulatory facility is certified. For example, Medicare and/or state licensure. Once again, having plastic surgery is nothing like buying an expensive purse or shoes. If the results go wrong, and the patient has a poor outcome, it may be impossible to repair her or him back to a normal appearance. Therefore, it is very risky to consider cosmetic surgery procedures upon crossing the borders. Another problem may deal with postoperative recovery, as well as continued management of the patient. Obviously, if a surgery is performed in a foreign land, there may be no followup care whatsoever with that surgeon, which could lead to increased complications, as well as poor final outcomes.