Britons travelling abroad to Turkey for cosmetic surgery may be unaware of risky procedures being upsold to them at the last minute, a coroner has warned following the death of a mother-of-three. The warning was made at the inquest into the death of Hayley Dowell, who was offered a discounted Brazilian butt-lift (BBL) and given five minutes before going into surgery to decide whether to do it and pay.

Ms Dowell died at BHT clinic Istanbul Tema Hospital on October 3 2023 of complications from liposuction fat removal surgery, according to pathology evidence. An inquest at Winchester Crown Court heard on Thursday from her husband, Neil Dowell, that she had originally booked to get a tummy tuck and liposuction.

But the 38-year-old, who lived in Eastleigh, Hampshire, was offered the third procedure as an add-on in her first meeting with her surgeon just before the operation at a 1,000 discount. Area coroner Nicholas Walker raised concerns that such practices as offering the risky procedure could lead to future deaths.

Although on evidence Hayley did not die from BBL, this was offered to her and can be offered to others, he said. Im satisfied upselling in such circumstances and lack of time to reflect on consequences will create a risk of future deaths. Hayley was marked up and ready to go to theatre when presented with a choice and given a card machine to complete that transaction.

Mr Dowell described that he was with his wife the first time she met the surgeon, who advised to use the fat from the liposuction and place it in her bottom as it was a little flat. Mr Dowell said Ms Dowell was quite happy with that but they did not know it was for an additional cost.

As soon as he left the room, a young lady came in with a card machine, we had a five-minute window to decide to have the procedure or pay for it or not, he said. I dont recall seeing a consent form at all. It was just in the moment it was so quick. We had to make a quick decision, it was a mad rush.

The coroner added that the BBL operation was offered as an afterthought with minutes to go before surgery and, in his judgment, the pages-long consent form could not have been done properly in the timeframe set out by Mr Dowell. Mr Walker added that such upselling would not happen in the UK as a patient would have to have a 14-day cooling off period, as heard in evidence by expert witness, consultant plastic surgeon Elaine Sassoon.

Moreover the operation itself would have been discussed likely well in advance of the operation by the surgeon who was going to conduct the operation, he said. Giving evidence at the inquest, Mr Dowell said his wife decided to get a tummy tuck and liposuction done abroad because of the cost, and that it was a kind of trend having heard stories and friends who had done it too.

I didnt trust surgery abroad, thought it should be in the UK, he said, where Ms Dowell previously had breast implant surgery. I tried to persuade her not to but she was very persistent, shed done her research.

She found medical broker Qunomedical on the internet, who organised the hotel, clinic and surgeon for about 7,000 euros while the couple arranged for their own flights. Mr Dowell had also booked to get his teeth done while they were away together.

They arrived in Turkey the evening before the operation and were taken to the clinic to have blood tests and sign paperwork, which included a list of risk factors. Ms Dowell was not given a copy of the signed documents to take back to the hotel room with her before the procedure the next day, Mr Dowell said.

The inquest heard that Mr Dowell was initially advised, after four hours of surgery, that everything was OK but, as it got towards midnight, he was told by the surgeon that his wife was very unwell, had suffered two cardiac arrests and you should say your goodbyes.

The coroner said he made no findings about the surgery or the competence of the surgeon, and that further questions from the family may be answered in litigation currently ongoing in Turkey. The clinic was an interested person in the inquest but did not give evidence.

Ms Dowell was described as a fun-loving girl who adored her children and was training to be a dental nurse. Her family told the inquest: Shes a big loss, she had everything to live for, especially her children, shes greatly missed.

The coroner will write to the Health Secretary and General Medical Council in a prevention of future deaths report including to raise concerns over a lack of database on evidence on the extent of this problem. He added: I cannot be involved in what happens in any other country but I have to look at this with the focus of this country and how those in this country are informed so that their eyes are open when they (get) on a plane.

Asking Ms Sassoon of her view of being offered additional treatment at a discount price around 15 minutes before surgery, the expert witness said: My professional view is, oh dear, this is a conveyer belt, there is no sense as the patient being viewed a patient, a human being, as a doctor should view the patient.

Its become just a transaction and you just think, because he had no contact with Hayley before, he had no idea of who she was.

In her evidence she added that cosmetic tourism is not going to disappear and it contributes billions to the Turkish economy. You have political aspects to it, you also have people want to do it. Its not going away and more people do it, she said.

We cant stop it but what we need to do is set baseline things that will make it safer.