Operations of humanitarian plastic surgeons in developing countries are becoming increasingly difficult. Local health authorities require temporary surgical permits, customs offices try to clear surgical material and look at expiration dates of medicines, and pandemics complicate planning of INTERPLAST missions. It therefore seems increasingly necessary to go as single teacher, training engaged local surgeons and assisting operations. The alternative is inviting local surgeons to Western hospitals and introducing them to the basic skills of plastic surgery and empathy with the poor. However, the lack of recognition of medical degrees from all developing countries remains a problem for their training in Europe.Level of evidence: Level V, risk/prognostic.