I Get Asked About Online Consultations Every Week. For Surgery, Here’s Why I Still Say No.

As someone who works with a growing number of international patients, I’m seeing more and more requests for online consultations. It seems so easy now with video calls, messaging apps, and high-speed internet. But I have to be honest: when it comes to surgical or other invasive procedures, online consultations are only a small supplement. They often do more harm than good. Here’s why.

The face on the screen is often not the real face

Most video consultations rely on cameras — and let’s be realistic, the webcams used in many clinics are not high-resolution medical imaging devices. Details get lost. But the bigger problem is the smartphone photos patients take of themselves. Modern phones use wide-angle lenses and automatic beauty enhancements that can create an image quite different from what the naked eye sees. Many people stare at these selfies until they start believing that’s exactly how they look, and they come to me saying, “I need to fix this part I see in my photos.” Yet when I examine them in person, those features are often barely noticeable or completely absent. Setting a surgical goal based on a phone photo you’ve mistaken for your real appearance is like operating on a distorted shadow — it’s fundamentally unsafe.

Time zones, fatigue, and the doctor who might not be there

I’m in Korea. My patients are scattered across time zones that are often completely opposite to mine. To find a slot that works for both sides, someone is always outside their normal biological rhythm — tired, puffy, and not in their best condition. When you’re exhausted, your face shows swelling more, your eyelids droop a little, and you look worse than you actually are. That’s not a good baseline for a surgical assessment. Also, let’s not gloss over how surgical schedules work. Most surgeons are in the operating room or doing in-person clinical work during daytime hours. Online consultations are frequently crammed into leftover gaps or handled by non-clinical staff. Patients often believe they’re talking to a doctor, when realistically they are speaking to a coordinator. That’s not what anyone signs up for.

A legal minefield that many patients don’t see

In a lot of countries, providing medical advice through any channel — including online — legally counts as practicing medicine. If I sit in Seoul and give clinical opinions to a patient in another country, I could be subject to that country’s medical licensing laws. This isn’t a small formality. Hospitals are increasingly careful, and many avoid having doctors engage directly in cross-border online consultations for good legal reason. The result is often a watered-down conversation that rarely reaches the depth of a real medical evaluation.

In life, “simple is better” is a beautiful rule that works most of the time. But when you’re about to let someone cut your skin, reshape tissue, or inject a substance into your body, simplicity should never come at the cost of safety. Meeting your doctor in person — seeing their face, letting them examine you physically under proper light, and building trust through real conversation — remains the safest path. That safe path, and that careful preparation, is what gives both the surgeon and the patient the best chance at a truly good outcome.

If you are considering traveling for a procedure, please don’t skip the step of a real, in-person consultation. Your body deserves more than a pixelated screen and a time-zone compromise.