Perils of plastic surgery

Some patients never return home from elective procedures

Fairfield Daily Republic ©

SUISUN CITY - On Thanksgiving Day 2005, 52-year-old Carole Schwartz kissed her family good-bye and headed to Brazil for plastic surgery.

Her intentions were to tighten the skin that sagged on her body after losing almost 200 pounds from a gastric bypass surgery two years earlier.

On Dec. 1, 2005, Schwartz died, 36 hours after her surgery in a Rio de Janeiro hospital and away from all her family members. The family was told Schwartz suffered for many hours after surgery. The image remains etched in their minds.

The Brazilian-issued death certificate states she died of pulmonary embolism (blood clot in the lung), mesenteric infarction (an obstruction of blood supply to the intestine) and abdominal liposuction.

"This is really hard. Before she left, she thought she researched everything as fully as she could," said her 22-year-old daughter, Jessica Link, who explained that Schwartz made her overseas plastic surgery plans through a Web site.

"It's like she left on vacation but she's never coming home," Link said.

Her remains came home, however, on Christmas Eve, one week after the family was told she would arrive. And Schwartz, a former school teacher in Fairfield and Vallejo, missed her own funeral - held on Dec. 17, 2005.
"She didn't need to go to Brazil but I couldn't stop her," said her husband of seven years, Jon Schwartz, quietly in his Suisun City home. "I just wanted her to be happy. I never dreamed anything like this would happen."

Online deals

Traveling oversees for plastic surgery is a growing phenomenon in the United States.

"Medical tourism," or all-inclusive vacation packages that include surgery, hotel and tours, is as accessible on the Internet as finding sugar in a candy store.

Schwartz, for example, made plans through a Web site that promises a "life, new and improved," where the headline reads, "Ready for your journey or looking for a quote?" situated slightly below a slim woman with a tight abdomen.

"It would have cost my mother $100,000 in the United States, yet in Brazil, it was $25,000 with travel and accommodations for a one-month stay," Link said, then added, "People think they're saving but they're not. The family is faced with dealing with a foreign government, red tape and other unknown costs."

Are these deals really worth the risk?

Buyer beware, said Dr. Ronald Iverson, spokesman for the American Society of Plastic Surgeons and chair of the ASPS Patient Safety Committee. When a person leaves the United States for plastic surgery with a cut-rate package, they're asking for problems.

"I'm taking care of a number of people who went to Venezuela or Mexico, had surgery and came back with horrendous problems," he said. "One woman probably spent five times as much to have me correct the work and it's still not as good as if she had it done right the first time."

According to the American Society of Plastic Surgeons, cosmetic surgery tourism is a price-driven phenomenon that has experienced growth over the past decade, with numerous companies on the Internet offering deals, some with "highly trained" and "credentialed" medical staff.

Since elective cosmetic surgery procedures aren't covered by insurance, "medical tourism" makes price the major selling point. An entire vacation and surgical package, for instance, costs less than an individual procedure in the United States.

On the Surgical Services International Inc. Web site, the average cost for a tummy tuck is $3,400. The national physician fee for the same procedure in the United States is $4,420, according to the ASPS.

For the estimated 51.3 million Americans who were uninsured for at least part of the year 2005, according to the Centers for Disease Control and Prevention, coupled with the rising costs of health care in the country, "medical tourism" might be an enticing option.

Although there are no official statistics on medical tourism, an estimated 150,000 foreigners sought care in India alone for 2004, based on, with a growing rate of about 15 percent annually. A proportion of those are U.S. citizens.

"It's like walking into a blind alley. You're literally taking a crap shoot," Iverson said of traveling overseas for cosmetic surgery. "There is no mechanism where you can check their credentials, the facilities' complication rates or problems. They don't have anyone who could take their license nor do they have an accredited organization. There's no way to check."

The Brazilian Society of Plastic Surgery in Brazil, which has 4,000 professionals accredited in Brazil, commented through e-mail that "adverse biological occurrences can take place. When they do occur, they are statistically examined carefully by officials. In the meantime, it is recommended that the surgeon is a specialist for the Brazilian Society of Plastic Surgery."

The Brazilian Society also mentioned that many of its patients originate from other countries, including the United States.

There are accredited facilities that exist in other countries, Iverson said. And those are the ones who don't advertise or are listed with tourism companies.

"They have their facilities and they have their clients. They're not advertised in those types of programs," he said. "There are clinics in major cities throughout the world that are accredited with a quality staff. Those are the ones that stay away from advertisements."

Then why do it?

Jon Schwartz had not spoken of his wife since her death last year - until now.

"She was uncomfortable with her weight and how others perceived her," he said. "I didn't see that. I saw the person she was and I married."

A photo of his wife sits on the mantle of his home, which seemed to stare at him as he sat at the dinner table across the room.

His eyes, lowered for most of the conversation, still show the pain of his loss, still express a sense of bewilderment.

"She researched so much and she was determined," Schwartz said. He paused then laughed, perhaps thinking back to a moment that defines his wife. "I like that. She was thorough."

He recalled how she dropped from 260 pounds to 180, participated in many weight-loss groups, took prenatal vitamins to replenish a limited food intake and wired money to Brazil before she left.

"It's hard to talk about this now," he said.

As Carole Schwartz was making plans to go to Rio last year, Dee Dee Linderer, 57, was having a tummy tuck and breast reduction performed in Vacaville.

"It was the best thing I ever did that I went back for a liposuction," she said. Linderer mentioned she had two liter bottles of fat taken out.

Cosmetic plastic surgery trends are on the rise in the United States.

Last year, 10.2 million cosmetic surgery procedures were performed in the U.S., up 11 percent from 2004, according to the ASPS.

Liposuction, the removal of unwanted fat, was the top surgical cosmetic procedure in 2005 with 324,000 cases, followed by nose reshaping, breast augmentation, eyelid surgery and tummy tucks.

The out-of-pocket cost for Linderer was between $10,000 and $15,000, she said, which was worth the money.

"I have three grown boys and there was no getting that muscle back," Linderer said. "I spent years trying to lose weight, fluctuated up and down and my breasts were going south."

She went down six sizes, she said, and is encouraged to take care of herself.

"I feel so good about myself that I go to the fitness center almost every day," she said.

Linderer, once an overweight child without friends, said she is not addicted to cosmetic surgery, although she is scheduled to have a face lift in February 2007.

She vows, however, never to travel outside the U.S. for plastic surgery.

"What are you going to save? A total of $3,000 for putting your life into someone else's hand in another country?" she asked. "There is nothing I can get somewhere else that I couldn't get here."

The aftermath

Carole Schwartz' daughter, Misty Calderon, hasn't put closure to her mother's death.

She still thinks about picking up the phone to call her mother, but Calderon knows she won't answer.

And she cries, wrapped in thoughts of guilt and loss, quietly wiping the tears from her rosy cheeks.

"It's all a matter of being OK with who you are and how you look," she said. "You can still do something yourself without going to drastic measures."

Jon Schwartz, a man who seems to seldom express his pain, silently aches for the woman he still loves.

"I took her to the airport and I remember what we said before she left, but I won't repeat it," he said. His voice began to choke before continuing. "It replays in my mind all the time, which is quite lonely. She didn't have to go. That's all I have to say."

Cosmetic Plastic Surgery

10.2 million cosmetic surgery procedures performed in 2005, up 11 percent from 2004.
$9.4 billion spent on cosmetic surgery in 2005.
Between 1992 and 2005, there was an increase of 775 percent in cosmetic plastic surgery.

Ethnicity in cosmetic plastic surgery

921,000 procedures on Hispanics in 2005, up 67 percent from 2004.
769,000 procedures on African-Americans in 2005, up 67 percent from 2004.
437,000 procedures on Asian-Americans in 2005, up 58 percent from 2004.

Top Five Surgical Cosmetic Procedures in 2005
1. Liposuction (324,000)
2. Nose reshaping (298,000)
3. Breast augmentation (291,000)
4. Eyelid surgery (231,000)
5. Tummy tuck (135,000)

Gender Facts
9 million cosmetic surgery procedures performed on women, up 13 percent from 2004.
88 percent of all cosmetic surgery patients were women.
12 percent of all cosmetic surgery patients were men in 2005, up 44 percent from 2000 to 2005.