By The San Antonio Express-News
Special to MSNBC
updated 6/8/2005 6:48:42 PM ET 2005-06-08T22:48:42

The plastic surgeon had just peeled the skin down Lisa's forehead and face when a fly began buzzing over her bloody wounds.

Maybe it was the fly in the hot operating room — and the nurse chasing it with an unmarked bottle of red spray, that revealed the crudeness of the cosmetic surgery clinic. Or maybe it was Lisa's blood-soaked pillow and sheet the next morning, stained from the oozing wounds of multiple surgeries.

Lisa, 51, a twice-divorced mother of three, had looked up Centro de Ginecologia y Obstetricia in this border city after she was rejected for plastic surgery in San Antonio because of a heart condition.

Depressed and anxious
Premature wrinkling from sun damage had left her depressed and anxious. Without a total makeover — facelift, breast implants, tummy tuck and more — she thought men wouldn't give her a second look.

And without the means to pay $20,000 for the work on this side of the border, she followed the pitch from a marketer known as "Dr. Dave" and headed to a clinic across the Rio Grande.

"When I saw him on TV, I thought, 'There's my answer,'" Lisa said.

Beckoned by the promise of better bodies at a third of the cost in the United States, thousands of patients have crossed the Texas border for trips to plastic surgery clinics that have flourished to serve the growing craze for makeovers.

New clinics boast their services on billboards, newspaper ads and TV commercials. Some are full service and offer American-style standards, with inviting waiting areas and scrubbed surgical suites. Their doctors post medical licenses on the walls and register with Mexico's health ministry.

Many patients come back satisfied with their results. Like walking testimonials in U.S. border towns, they boast larger breasts and flatter stomachs costing less than a down payment on a new car.

"I tell everyone who wants to look better that they should have it done," says Miriam Martinez, a Univision anchorwoman in McAllen who underwent cosmetic surgery in Reynosa.

Darkside of a booming industry
But fancy clinics are the exception, and such testimonials of professional-looking results mask the downside of a booming business that has littered northern Mexico with backward operations run by physicians with questionable credentials.

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In more than two months of reporting on both sides of the border, the San Antonio Express-News found a largely unregulated system where patients can enter a dentist's office that also advertises plastic surgery and walk out with a nose job performed by an unlicensed doctor.

In interviews with doctors, patients, government regulators and families, the newspaper found patients left horribly scarred or fighting severe infections from botched surgeries. Because of poor record keeping, weak oversight and a system that discourages lawsuits, the number of injuries or deaths in Mexican clinics is unknown.

Yet U.S. doctors along the border are all too familiar with the problem. So many patients have required reconstruction that some Texas surgeons have begun to specialize in "secondary repair" to undo damage done in Mexico.

Some patients can't be saved. Plastic surgeons in Brownsville say they couldn't help two women who died from gangrene that developed from infections after their surgeries in Matamoros.

In one of the cases, the woman's skin peeled off when emergency room doctors lifted her from one bed to another.

"I have never seen a worse case of gangrene anywhere — not even in Mexico," said Dr. Rafael Arredondo, who was in the emergency room covering a shift when the woman's husband brought her in.

Costly complications
American doctors also fill in when their Mexican counterparts leave town. Because of the brisk business, surgeons from interior Mexican cities such as Guadalajara, Mexico City and Monterrey have opened satellite offices along the border. Some open only for a few days of surgery a month, forcing patients to search for alternatives when they try to return for follow-up care.

"Who does (the doctor) expect will fix his complications when he's gone?" said Dr. Khalid Soleja, a plastic surgeon with more than 30 years of experience in Brownsville.

Soleja doesn't keep track of how many times people have called him to repair a botched procedure, but he said that, through the years, "I've seen tons of people come in."

He remembers the day when a woman in her 50s showed up after undergoing a facelift, breast reduction, tummy tuck and liposuction in Monterrey.

"This woman came in with an infection on her head that left two holes in her ears, a missing nipple and lost skin on her abdomen," he said.

Soleja said it was costly to make her whole again, and he wondered why the woman risked her life for cheaper plastic surgery across the border.

Such problems didn't befall Lisa. But she wound up in a San Antonio emergency room with a complication not long after her surgeries.

Lisa cooperated extensively with the Express-News for this article by allowing a reporter to observe her surgery and granting hours of interviews. Late in the reporting process, however, she withdrew her support for the article, asking that she not be identified. The Express-News has decided to shield her identity by omitting her last name but believes her story is worth telling.

Meeting 'Dr. Dave'
Lisa didn't know what to expect when she opted for surgery in Mexico. All she knew was that she wanted to look younger and more attractive, and didn't want to pay a fortune.

Fill 'er upStanding naked one day in the middle of her kitchen with her arms extended, after pointing out the wrinkled flaws on her body, she asked in a joking, yet serious, way, "Would you (have sex with) me?"

"No," a reporter answered.

"Neither will anyone else," she said.

A former heart patient who is anemic, Lisa was turned down as a candidate for surgery by a San Antonio physician.

Another local doctor agreed to take her in, but he said he would charge $20,000 for a facelift, neck lift, eye surgery and breast augmentation — more than she could afford.

Lisa thought it through when she turned on the TV and saw a man talking about affordable plastic surgery in Mexico.

David Hernandez, co-owner of Centro de Ginecologia y Obstetricia, looked friendly and knowledgeable. He told viewers his clinic offers plastic surgery not just for the wealthy, but for anyone who wants to look better.

His patients call him "Dr. Dave," but he's not a doctor on either side of the border, although he said he briefly attended medical school in Monterrey. Working from a small office on West Avenue, Hernandez places ads, handles calls from prospective patients and schedules surgeries at his clinic. One ad, touting "affordable cosmetic surgery," appears Sundays in the Star magazine insert in the Express-News.

'I'm not scared at all'
Lisa paid attention to Hernandez as he described high-quality surgery at extremely low prices. He has been sending American patients to his clinic in Nuevo Laredo for about 25 years, he said on the TV program.

Soon after, she met with him and liked what she heard.

Yes, he could smooth the wrinkled skin on her arms, neck and chest. He could make those lines on her face disappear. He could help smooth out those saggy legs and make them look sexy again.

And, yes, he could do it all for a lot less than what it would cost in San Antonio. He would charge only $8,000 for the procedures, including a hospital stay in Nuevo Laredo. Plus, he would throw in a few extras: a tummy tuck, a leg lift, a bladder lift and another procedure that Lisa didn't want publicized.

The Express-News later learned Hernandez lowered her costs to $3,500 when Lisa agreed to share her experiences with the newspaper.

In San Antonio, all of these operations would have cost nearly $30,000, according to average costs compiled by the American Society for Aesthetic Plastic Surgery, and they would have taken months to perform.

Lisa weighed her options and decided to go with Hernandez.

"My friends tell me, 'Are you crazy?'" she said. "I told them, 'I'm not scared at all.' And I'm not."

Hernandez makes her feel at ease, she said, "and think of all the money I'm saving."

From B-cups to D-cups
It was a hot and humid day last summer when Lisa rode in Hernandez's Chrysler along Interstate 35 to Nuevo Laredo.

Once they crossed the international bridge into Mexico, they meandered through crowded, potholed streets before turning into the full parking lot at the clinic.

"Wow, this is nice!" Lisa exclaimed as she entered the two-story, cinderblock building.

Hernandez showed Lisa to her spare room, whose walls were bare except for a small cross hanging above the bed. Ants were crawling around the sink in the small bathroom, where dusty, hot air blew in through an open window.

"I think a lot of people care about having a really pretty room," she said while looking around. "They are willing to pay the extra $25,000 to have that comfort. I felt that being able to stay a few more days (to recover from surgery) was better."

Key events in the quest for a bigger bust line.An hour before her surgery, Dr. Jose Luis Villarreal Arroyo, a plastic surgeon from Monterrey, walked in and wondered how a woman so young could look so old. It was the first time she met the man who was going to perform her surgery.

He studied her face, neck, upper arms and breasts. With a black marker, he dabbed a few dots on her face and neck, and drew lines on her arms and breasts.

He decided that she would need to go up another bra size. She had asked for a B-cup, but Hernandez talked her into a C-cup. Villarreal upgraded that to larger D-cup implants.

"Her skin is too stretched out," Villarreal said. "We need to go larger to fill in the space."

'He seemed like he was in charge'
It would be but one operation in a round of serious procedures. But the atmosphere in the room was anything but sedate. Banter gave the clinic more of a locker-room feel, rather than the usual sterile setting of a hospital.

"You're going to have some hooters," Hernandez said with a laugh as Villarreal sized up Lisa.

Lisa didn't mind. Her spirits were high as she praised both the surgeon and Hernandez for putting her at ease.

"He just seemed like he was in charge, and he seems like a human being," she said of the surgeon.

A search by the Express-News found Villarreal is board certified in Mexico, and his credentials are posted on a Web site promoting the clinic. But no accreditation for the clinic could be found through a check of government records.

Hernandez disputed that and last week faxed what he said was proof of the accreditation to the newspaper. But the document was dated in 1994 and was for a different clinic that Hernandez previously said had closed, Clinica San Antonio. In Mexico, health accreditations must be renewed every year.

Hernandez said Friday he didn't realize his clinic needed to be reaccredited annually.

Mexican health officials advise patients to deal only with clinics accredited by the Ministry of Health. At the same time, they note, only about 130 of the 3,000 private hospitals in Mexico have earned that distinction.

"My guess is that a few of them, if any, are accredited (along the border)," said Dr. Enrique Roelas, the deputy health minister for Mexico's public health service.

Lost in translation
Official imprimaturs are one thing. Once in a clinic, patients put their trust in the doctors and nurses. Lisa discovered that can be difficult when they speak different languages.

Before surgery, a nurse began to prep Lisa by shaving her pubic hair.

"Why are you shaving me?" she asked the nurse as a reporter translated.

The nurse said she was instructed to prepare her for liposuction.

"No, no liposuction, no liposuction," Lisa said emphatically.

"Ay, perdon," the nurse apologized.

Lisa confronted Hernandez about the incident as she was walking to the operating room.

It was a miscommunication, he said, between him and the nurse. He meant for the nurse to go to the room next to Lisa's.

Pretending to pick her shaved hair off the floor and placing it over his lip, he joked, "Oh, I just wanted to use it (pubic hair) as a mustache. I'm sorry, honey."

Lisa didn't laugh.

'Goodnight, sweetheart'
Hernandez stood by Lisa's side and held her hand as a doctor placed her under general anesthesia.

He promised her that a cardiologist would be in the room during surgery in case something went wrong, and he said he would come back later to check on her.

"And it's not because the press is here," he said. "We do this for all of our patients."

Lisa looked into his eyes and felt safe.

"Goodnight, sweetheart," Hernandez said. "See you when you're chesty."

Eight surgeries
The operating room was stuffy, the climate regulated by a ceiling unit that provided little cool air.

Lisa lay sedated on the operating table, her arms extended like a crucifix. Villarreal cut through her scalp, from ear to ear, and then peeled it over her face like an orange. It was the first step before he tightened the underlying muscles with sutures and pulled the skin up for her facelift.

A fly buzzed around Lisa's exposed, bloody face.

The surgeon and surgical nurse tried to swish it away, then instructed another nurse to kill it. She walked around the room with a bottle containing a reddish liquid and looked for the fly. She never found it.

A lone fly in an operating room may seem trivial, but it has the potential of spreading disease if it lands on open flesh, medical experts note. It also can be a red flag to unsanitary conditions.

"Even if that fly hasn't landed on her, what else is not sterile?" said Joe Johnston, a trauma surgeon at University Hospital in San Antonio.

In a five-hour span, Lisa would get a facelift, breast implants, an arm lift and cosmetic eye surgery.

Lisa was Villarreal's third operation of the day. He had performed a tubal ligation reversal on one patient and liposuction on another before it was Lisa's turn.

Calling for help
Back in her room, Lisa woke up in the middle of the night, turned around to inspect her bed and noticed the blood. Her sheets were sticky and wet and she desperately wanted them changed.

Buying beautyThe dressing wrapped around her head was soaked in blood. She felt helpless and frustrated as she tried calling the nurse for help. The room wasn't equipped with a call-nurse button. For the first time, she began to question the quality of her care.

She didn't find out until the next day that no cardiologist was present during her surgeries.

"What do you mean the cardiologist wasn't there?" she asked a reporter. "He'd (Hernandez) better have a good explanation for this."

Hernandez later told her that the cardiologist was nearby and, if he was needed, he could be there in 10 minutes.

She seemed satisfied with the answer. When Hernandez was in the room, Lisa was sweet and pleasant. She often called him affectionate names such as "honey" or "sweetheart." And he reciprocated.

When he wasn't around, she expressed concern and frustration.

"If I was to say anything negative, and I don't want to say anything negative, but the whole communication thing is horrible," she said.

Scars measuring 8 feet
Lisa returned home a couple days later and the incisions began to heal. Two weeks later, she was back to complete the makeover, getting a tummy tuck, leg lift, bladder lift and a fourth procedure.

Eight procedures in two weeks. More than 10 hours of surgery. A body lined with nine rippling scars measuring about 8 feet. Lisa was on her way to becoming the woman she wanted to see in the mirror.

But first she would endure weeks of discomfort that she would dull with painkillers, and she would enclose her body in compression underwear to keep everything in place while she healed.

And she would soon realize the oozing wounds foretold something much worse, and more dangerous.

He hears about them when they come back in pain, or disfigured.

Dr. Tolbert Wilkinson, a San Antonio plastic surgeon, has seen dozens of women return from the border with implants that either are broken or slipping to the side.

He's seen infections and large scars. Abdominal tucks and liposuction that just don't look smooth.

"Ugly scars are coming from the border," Wilkinson said as he flipped through an album with pictures of disfigured victims that he's treated. "And tummy tucks are sometimes so awful you just don't want to throw your hands on them."

Post-surgery repairs
Wilkinson is one of the few Texas surgeons who take in women who need help when things go wrong in Mexico. Many won't accept these referrals because the liability is too great.

Lisa made an appointment with Wilkinson to get a second opinion on her scars, but she didn't keep it.

In the United States, patients can turn to a justice system that entitles them to financial compensation for medical malpractice when things go wrong.

Recourse is available in Mexico, but American patients can face language and cultural barriers in a legal system that discourages lawsuits.

Dr. Jorge Sanchez Gonzalez, director of the national medical arbitration board in Mexico City, said anyone - Mexican citizens and foreigners — can seek the board's assistance to force a physician to fix a botched procedure.

The patient must document the surgery and must show that it was done by a certified doctor.

Since many surgeons aren't certified, and patients typically have nothing in writing from their doctor, arbitration is impractical for most American patients.

The arbitration board has existed for about nine years. To date, no American has filed a complaint against a Mexican plastic surgeon, Sanchez said.

Incisions not healing correctly
Wilkinson and other surgeons on both sides of the border recognize the growing risks posed by shoddy clinics. He said a group of doctors from Monterrey recently asked him, "Can you in Texas help us clean up the border plastic surgery?"

Spreading word about unaccredited clinics is one solution, he said, but there is no coordinated effort by the Texas Health Department, the Texas Medical Association or the American Society for Aesthetic Plastic Surgery.

After two rounds of surgery, Lisa was edgy and frustrated. Unsure if she was healing correctly, she suffered post-surgical depression and aimed her growing anger at Hernandez's clinic.

Should she threaten to sue if her procedures were botched? Should she tell others to avoid the clinic?

Her tummy tuck, bearing an incision encircling her midsection, was leaking fluids badly, so much that the dressing couldn't contain the blood. The back of her jeans was stained and moist.

Treating the wound
She went back to Hernandez, who decided to send her back to his clinic to be checked. If it's an infection, he told her, she needs stronger antibiotics right away. Or she might need more surgery to close the wound.

Lisa dreaded another trip to Nuevo Laredo, but Hernandez insisted it was important.

The visit went poorly. Lisa screamed when a nurse couldn't find a vein to draw blood. She complained that the needles were too large and not modern and thin like the ones in the United States.

"I do not know how people get down here without friends or reporters and get through it," she said. "If my life weren't at risk here, I would be begging you, 'Please, please, please let's go home now. Screw them.'"

She spent the night at the clinic while lab work was done on her blood. She was sent on her way the next morning with a prescription for more antibiotics, including one that required injection.

She returned to San Antonio and, in near hysteria, went with a reporter to an emergency room to seek treatment.

Cursing Hernandez on the way home from Nuevo Laredo, she vowed never to go back again.

"If I survive this, that's it for me," she said, her eyes still watery from the eye surgery four weeks prior.

She drove to the Veterans Administration hospital in the Medical Center and waited for about two hours in the emergency room before a physician was ready to see her.

The red, puffy lines on her legs and abdomen looked like they were healing just fine, the doctor said. But the leaky patch on her lower back was a problem.

Wrong prescription
He said the antibiotics prescribed in Mexico were wrong for her.

"This antibiotic needs to be injected, not into your skin, but into an IV," he said when he read the Mexican prescription.

He prescribed an oral antibiotic instead and sent her home.

Weeks later, Lisa told the newspaper the wound healed and the scare was over. She said she would return to Hernandez's clinic for cosmetic surgery on her neck, upper chest and lower arms.

Lisa broke off contact with the newspaper last year. But when reached last week, she said she was pleased with her results.

"For the record, I am so happy," she said Friday. "I have never been happier in my life. I would go back to them a million times."

She would not provide further details.

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