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Thursday, December 08, 2005

Byline: Allison Adato Adrienne Bard in Mexico City; Cary Cardwell in Nuevo Laredo; Maureen Harrington in Los Angeles; Andrea Orr in San Francisco; Tracie Powell in Dallas; Charlotte Triggs; Jennifer Wulff in New York City

Lots of people come back from a Mexican vacation with a tan. Suzanne Jacobson hoped for something even more dramatic. Friends had boasted to her of going over the border for a little R&R, a few margaritas--and an inexpensive tummy tuck or face-lift. "A group would go for the weekend, go to the clubs, sleep in the clinic, and someone would have a procedure," she says. "Then they'd drive back in time for work."

Jacobson, 50, learned about a favored Nuevo Laredo clinic, about 140 miles from her home in San Antonio, and headed there in February 2002 for a tummy tuck. She did return transformed, but not in the way she'd planned. When she got home, she says, her stitches burst, leaving an oozing hole the size of a fist in her abdomen. Today she is still disfigured. "I have really bad scars," she says. But costly reconstruction is out of the question: "I can't afford more surgery."

A growing number of Americans are discovering that they can save thousands of dollars by going to Mexico for cosmetic procedures and weight-loss surgery. While many return home with outstanding results, the bargains may come at a steep price for others. For Americans familiar with U.S. health care oversight, checking surgeons' credentials and the quality of facilities in a foreign country can be difficult. And many patients who travel to Mexico for procedures receive little or no follow-up care, leaving them at risk.

"There are first-class clinics in Mexico where people can feel totally assured they are getting the best care," says Dr. Sergio Maltus, Mexico's director of federal health inspectors. But not necessarily "if you go to a clinic hidden on a backstreet." Such clinics, which can charge a fraction of the cost of similar procedures in the U.S., may not be licensed by Mexican authorities. "Our work is not easy," says Maltus. "Some of these places don't even have signs."

"Mexico is well regarded as a center," agrees Dr. Sebastian Padron, an emergency room doctor in neighboring Laredo, Texas. Problems for foreigners arise, he says, when people fail to verify their surgeon's credentials. (See box, p. 119.)

While neither country keeps count of Americans seeking surgery in Mexico, one indicator of the rising trend is the uptick in those heading home to U.S. doctors for repairs--or simply the follow-up care they've failed to receive at the border clinics, where so-called "weekend warrior" doctors drop in briefly from other parts of Mexico to operate on Americans. "If the patient has complications and goes back," says Dr. Khalid Soleja, a surgeon in Harlingen, Texas, near the border, "9 times out of 10 the doctor who operated on them isn't there."

Due to liability risks, Dr. Soleja no longer takes repair cases. But he recounts a list of horrifying complications he has seen from botched over-the-border surgeries: holes left in a woman's ears after a face-lift; nipples missing after breast reduction; a woman in her 30s who died from organ failure after a severe infection following liposuction. "She went into shock," he says, "most likely from too much surgery."

Travel agencies are even getting in on the act, arranging airfare, accommodations and a clinic. And a growing number of facilitators, who receive commissions to direct patients to clinics over the border, advertise in the U.S. on TV, billboards and the Internet. One of the most ubiquitous is San Antonio businessman David Hernandez, known as Dr. Dave. He's not a doctor--though several patients, including Suzanne Jacobson, say he has been decidedly vague on that point--but the Texas-based promoter of a Nuevo Laredo clinic catering almost exclusively to Americans. In April, federal health inspectors temporarily barred the clinic from performing surgery. (See box below.)

Jacobson's journey began with a visit to Hernandez's San Antonio office, where, she says, despite his lack of medical training he assessed her as a good candidate for surgery. She had lost 120 lbs. after a gastric bypass. "He told me I needed lipo and a tummy tuck," and said the surgeries would cost $2,800. She agreed and, with her ex-husband, drove to Nuevo Laredo for the procedure in February 2002.

"As soon as I walked through the door, I knew it wasn't right," says Jacobson, who met her surgeon, Dr. Jose Luis Villareal, who is certified by the Mexican Council of Plastic Surgery, only after she was on the gurney. She claims she saw blood from previous patients pooled on the floor. Yet she went ahead, she says, because "I was desperate to change my appearance." After the surgery, she stayed three days before heading home. Two weeks later, she says, her sutures gave out and she returned to Nuevo Laredo twice for repairs.

Hernandez disputes much of her account, including the alleged bloody floor. Jacobson, he says, didn't follow post-op protocol of walking bent over for a week, which is why her stitches split. After the second restitching, he told her that he would charge her for another procedure. At that point, says Hernandez, "the complaints started."

Victoria Bray, 36, also went to the Nuevo Laredo clinic for multiple procedures. Though she had a life-threatening scare during her trip home, the manicurist, who lives in a suburb of Ft. Worth, is very happy with the results of her liposuction, tummy tuck, breast augmentation and underarm skin removal, all of which cost her $9000, an extraordinary saving over the $40,000 quote she got at home. (Despite the lower prices, the clinics are a boon for Mexican doctors, who make far less than their American counterparts. At a public hospital, a surgeon earns only $1,800 a month, says Hernandez. "He can earn that much in a weekend at the clinic.")

Bray flew home with her husband, LaRay, just three days after her 5 1/2-hour operation. Bleeding and fevered, she became disoriented on the plane. The pilot radioed ahead and she was rushed by ambulance to an E.R. in Grapevine, Texas. "I was very unhappy when her care fell into my lap," says the surgeon on duty, Dr. Randall Wright. "I saw her as a huge liability risk." Bray, he says, "had lost a great deal of blood," due to having so many procedures at once. And traveling after three days was "ill-advised. She had ongoing needs."

The clinic's owner, Dr. Luis Trevino-Cisneros, says that his facility has not had any complaints, does not discharge anyone if they are at risk, and patients are free to return if complications arise.

Bray, who is planning to have lower-body-lift surgery in Brazil, doesn't link the bargain prices to her complications. "What happened to me in Mexico could have easily happened here," she says. Dr. Wright isn't sure he agrees. "What she received is certainly not the typical standard of care here," he said. "Yes, it could happen in the U.S., but it's certainly less likely to happen."

Even going well beyond the border, to more southerly cities like Monterrey, doesn't always ensure a good result, unless prospective patients carefully research doctors, their facilities and surgical materials. Marlena Perkins, a Fremont, Calif., bus driver, was quoted $25,000 in the U.S. for a lap-band procedure, which aids weight loss by constricting the stomach and limiting the amount of food a person can eat. A doctor at a hospital in Monterrey, whom she had found online, said she could get one for $10,850. "That was my whole savings," she says. In September 2003 Perkins, now 28, was on a plane with her father.

She met her doctor, Rodolfo Sanchez, not long before the surgery. "He had a good bedside manner," says Perkins. After the procedure, which she believed went well, they hugged and took photos together. At home she began a diet of liquids and restricted foods prescribed by Dr. Sanchez. She took with her a list of local doctors who could offer follow-up care.

In the first month she lost 25 lbs. But then she started to feel very hungry, and saw a doctor to have the band tightened. Perkins reports that tests showed no band around her stomach at all. "I started crying," she says. "I spent all that money and it didn't do anything." Dr. Sanchez declines to comment on specific cases, but notes that "all surgeons make mistakes. Those things can and will happen even in the U.S."

Rather than return to Sanchez, in July of last year Perkins underwent lap-band surgery in San Francisco, at a cost of $14,000. During that operation, her surgeon, Dr. Paul Cirangle, found the Mexican lap-band below her stomach. "It was not an [FDA-approved] lap-band," he says. "And it had been put on improperly. It wasn't dangerous, but it obviously wasn't working." He put a new one in, and Perkins has since lost about 40 lbs. With a sigh she says, "I should have just had it done here in the first place."

By Allison Adato. Adrienne Bard in Mexico City, Cary Cardwell in Nuevo Laredo, Maureen Harrington in Los Angeles, Andrea Orr in San Francisco, Tracie Powell in Dallas and Charlotte Triggs and Jennifer Wulff in New York City

[BOX:]

FINDING A FOREIGN DOCTOR

You can get safe procedures outside the U.S., says Wendy Lewis, author of America's Cosmetic Doctors and Dentists, if you do some legwork:

(1) Use a doctor recognized by the International Society of Aesthetic Plastic Surgery (www.isaps.org). For Mexico, www.cirugiaplastica.org.mx lists board-certified plastic surgeons. Check that the clinic has an up-to-date license.

(2) Ask: Are there registered nurses? Do the staff speak English? If the procedure is to be done in a doctor's office, is there a nearby hospital, and what is done in the event of an emergency? What follow-up care is offered?

(3) The American Society of Plastic Surgeons says a reputable doctor will begin by taking a full medical history to determine if you're a good candidate for surgery.

(4) Be willing to walk away, says Lewis, if you don't have a good feeling about the facility.

[BOX:]

OPERATING UNDER THE RADAR

Two of the subjects interviewed for this story encountered problems after surgery at the same clinic, Centro de Ginecologia y Obstetricia in Nuevo Laredo, where Texas-based marketer David Hernandez had been steering American patients. So PEOPLE called the Mexican agency that licenses hospitals to inquire about the facility. Shortly after that call, the agency ordered an inspection of the clinic--owned by Mexican doctor Dr. Luis Trevino-Cisneros--which was unlicensed and therefore had never been monitored. While Centro's doctors are board-certified specialists, inspectors found several problems with the facility itself: inadequate barriers between surgical and nonsurgical areas, improperly calibrated anesthesia equipment, no backup power generator and expired vaccines. On April 22 authorities shut down the clinic's operating room. The closing came as a shock to Trevino-Cisneros, who says, "I've not had any problems, lawsuits, complaints. No clinic complies with all the articles in the Mexican health laws--there are too many demands." A few weeks later, Hernandez claimed the clinic's O.R. was back in business, after a May 4 visit by the local Tamaulipas state health department. "We made changes," he says. "We're allowed to operate." No, say federal authorities, which have yet to lift their sanctions. Mexico's director of federal health inspectors Dr. Sergio Maltus insists, "As long as they do not correct the problems, they cannot operate, you can be sure of it." But on June 6 a caller to Hernandez's San Antonio 800 number requesting a breast augmentation received an appointment for later this month.

[BOX:]

NO FOUNTAIN OF YOUTH

Four years ago Martha Ponce de Leon, 49, went to a doctor in Tijuana for injections to fill out her thinning lips and paid $100. (It could cost up to $1,000 in L.A., where she lives.) Pleased with the results, she returned when she needed re-plumping 18 months ago--but not to the same doctor. "Now I have a monkey lip," says Ponce de Leon, a marketing exec. She is seeing Beverly Hills plastic surgeon Dr. Paul Nassif about repairs. Would she go back to Tijuana for a procedure? "No. It is not worth it to save money."

COPYRIGHT 2005 Time, Inc.