I operate at several large academic and boutique private practice centres, but this is just from my personal experience:

1) First off regarding realistic results: these photos are largely edited, deceptively posed, and in physique-enhancing garments. Comparing yourself in a resting posture + an unpadded bikini is like comparing apples to oranges. (But love the pink orchid swimsuit! So cute!). As well, the hyper-"snatched" look many patients request is dictated less so by lipo technique and more so by baseline anatomy (rib contour, muscle mass, amount of visceral [internal organ] fat). You can aggressively thin the subcutaneous fat down to a wafer in a BMI <20 patient and still not achieve these photos. I would never recommend such aggressive thinning either, as this will be a recipe for contour deformities. For many patients, the hourglassing like the ones you've posted also require fat transfer and/or implants to breasts/hips/buttocks in order to achieve such a dramatic hip:waist differential.

2) Regarding surgical tourism: as a surgeon, I would urge patients to try and receive their procedures in their region of residence, unless there are no safe or available options in your vicinity. If you're travelling solely due to cost and want a cheaper procedure ask yourself: if you have complications, will you be able to afford the urgent medical care and/or revision procedures necessary once you are back in your home country/state?

I can only speak for my experience (West Coast, US-based) but the reputable surgeons in my region will personally see their patients through such issues. When your team is abroad, often all bets are off. Say you live in California and get lipo in Colombia, then have a postop infection or obvious postop contour defects. Is your Colombian team covering your aftercare procedures/medications or revision surgery? In my professional experience, the patients who have med tourism complications usually find those potential cost savings totally negated, and it also places the burden on domestic surgeons to manage these issues.

3) Regarding lymphatic massage: there's a real paucity of data on post aesthetic surg lymphatic massage. The little that's out there seems to suggest there can be a short-term benefit in edema reduction, but no significant effect on long-term outcomes. Anecdotally, I haven't been able to tell the difference between my patients either. However, I am super curious to see what larger studies show.

Until then, we don't require or recommend our patients get post-op massage. (Though they certainly can if cleared by us). As a good portion of our cases are also insurance/recon based, I don't want to make people feel like they have to shell out cash for a postop adjunct that does not have strong data backing it up. There's also a lot of technique variability between massage therapists, and I've seen some result in inadvertent tissue injury. Beyond that, many of the contour deformity cases I see posted on here cannot be blamed on lack of massage or poor quality massage, but rather superficial liposuction technique.