Dying for the Promise of Perfection

Lying in agony on an operating table, Lisa Espinosa, 43, was certain she was minutes away from death.

The promise of inexpensive cosmetic surgery lured her to the Dominican Republic in April 2004 where a physician in a makeshift operating room performed breast augmentation surgery, a tummy tuck, and liposuction, during which Espinosa contracted a virulent infection.  Instead of recovering, the feverish and seriously ill Espinosa, a clinical grant manager of infectious diseases at the Hospital of the University of Pennsylvania in Philadelphia, was told she would die if she didn’t get a blood transfusion.

The news sent waves of fear through her body. Unsure if the blood she would receive on the island would be free of life-threatening infections such as HIV, she initially refused the transfusion but later reconsidered. “I thought about being sent home in a box and what that would do to my mother and children. I gave my verbal consent and shortly afterward lost consciousness,” she says.

But sadly, the nightmare was only beginning. Years later, during surgery to repair the extensive damage to Espinosa’s breasts, her doctor discovered a litany of blunders: the removal of a healthy gland, severed nerves, multiple stitches embedded in the breast tissue, incorrect placement of her nipples, and the aftermath of an infection due to the use of unhygienic instruments, which caused significant buildup of scar tissue because the blood supply had been severed. “The inside of her breasts looked like the inside of a trash can,” recalls Dr. David Watts, the Vineland, New Jersey-based plastic surgeon who performed Espinosa’s reconstructive surgeries.

Espinosa would eventually undergo three painful reconstructive surgeries——the last one in March 2008——to repair the damage from the first faulty surgery. All told, it took her more than four years to fully recover from the ordeal. Unfortunately, her experience is not unique. Hers is among the innumerable cases of botched plastic surgery suffered by the hundreds of thousands who cross the U.S. border into countries such as Mexico, Panama, Thailand, Brazil, and Argentina looking for discounts. Doctors treating these patients have reported life-threatening infections resulting in amputation, massive body cavities, breast deformity and misalignment, damaged or severed nerves, scarring, and facial immobility. Unfortunately, African American and Latino women are increasingly afflicted.

THE PURSUIT OF PERFECTION

Long considered an indulgence confined to the wealthy and famous, cosmetic surgery has become an accessible and mainstream fascination. Its increased popularity has been spurred by a number of factors: greater affordability, innovative procedures, and most notably, the popularity of reality television shows such as Extreme Makeover, Dr. 90210, and I Want a Famous Face. According to the American Society of Plastic Surgeons, or ASPS, $10.3 billion was spent on 12.1 million cosmetic procedures in 2008.

While the majority of  patients are still white, cosmetic procedures among Caucasians dropped 2% in 2008. On the other hand, procedures among ethnic patients increased by 11% in 2008, with more than 3 million performed. ASPS reports that Hispanics experienced the largest increase, up 18%. African Americans made up 8% of total procedures, up 10% from 2007.

Historically, African Americans have rejected cosmetic reconstruction, seeing it as a way of conforming to white ideals of beauty; however, attitudes have shifted dramatically over the past decade. Cosmetic surgery is now viewed as more of a way to enhance beauty rather than an attempt to look Caucasian. ASPS’s 2008 statistics indicate that 907,141 cosmetic procedures were performed on black patients, with rhinoplasty (nose reshaping), liposuction, and breast reduction being the top three procedures requested.

Dr. Ferdinand Ofodile, clinical professor of surgery at Columbia University, board certified plastic surgeon, and expert in ethnic rhinoplasty, specifically black and Hispanic, explains. “Nowadays, plastic surgery is perceived as a way to streamline and enhance what you already have. The stigma surrounding nose reshaping has decreased, it’s now perceived as a means of creating greater harmony and balance in facial features, thereby increasing beauty while preserving ethnicity.”

A HARROWING EXPERIENCE

Espinosa was referred to the Dominican-based doctor from acquaintances whose surgeries he’d also performed, and she headed to the Caribbean for a surgery she felt was a steal. The package, which included surgery, travel, and five nights lodging, totaled $4,200. “I didn’t tell my family because they would have tried to talk me out of it,” she says. Before the surgeries, Espinosa asked the doctor several important questions, but was reluctant to ask more pertinent ones for fear of losing the sweetheart deal. Although he was not a certified plastic surgeon, he assured her that he’d performed these procedures successfully on many occasions.

Espinosa admits that she withheld information about her liver, medical history, and certain medications she was taking because of her fear of capsizing the deal. During a 25-minute consultation the day before her surgery, she and the doctor discussed her recovery time, bruising, and the need for follow-up care to remove her stitches. However, the focus of the conversation was on the initial $2,000 cash payment. Espinosa adds, “I was still trying to negotiate a price for breast implants; it became a flea market.”

The surgery was traumatic. “The operating room was dingy and old-fashioned. In the corner was a box similar to a trough for feeding horses. I thought of hospitals in the U.S., my instincts kicked in, and I became hysterical,” she recalls. To make matters worse, the doctor now disclosed that a previous patient’s death had been attributed to anesthesia complications. “I was terrified, but here I was naked and prepped for surgery in a foreign country. There was no turning back.” Espinosa was strapped upside down on a gurney, with a cloth placed over her head. Several minutes into the surgery she felt immense pressure from the tubes placed into her body, which quickly developed into full-blown pain. Panic mounting, she noticed the doctor removing surgical equipment from the trough-like box. “My physical agitation annoyed the doctor. He gave me another sedative and told me to be quiet so he could do what he needed to do.”

Nearly three days later, Espinosa woke up in intensive care with excruciating pain and no immediate recollection of the surgery. “The nurses and my friends told me I needed a blood transfusion, my worst fear because I was recovering from hepatitis C and was now in good standing. I was terrified of a relapse of hepatitis C or contracting a blood-borne disease,” Espinosa says. She refused, until the doctor persuaded her to accept plasma to save her life. Days later, she was fitted into a full-bodied compression girdle that concealed multiple bruises and wheeled onto an airplane for a six-hour flight to Philadelphia. “I was given several pain pills and told to go to the emergency room only if I began to bleed excessively from my tummy, but that profuse bleeding from my breasts was normal.”

THE REAL PRICE OF BEAUTY

With greater accessibility and popularity come increased costs. According to ASPS, the average physician fees for popular procedures are $3,348 for breast enlargement, $4,197 for rhinoplasty, $5,167 for abdominoplasty (tummy tuck), and $2,881 for liposuction. Consequently, minority women with moderate incomes——particularly those eager for multiple procedures——sometimes opt for dangerous alternatives that cost 40% to 70% less than U.S. prices: offshore plastic surgery vacation packages.

According to ASPS, statistics are not available on the number of patients who have taken cosmetic surgery vacations. However, it is known that these patients usually mirror the U.S. demographic:  women age 35-50.

For Espinosa, the cost was much higher and not just paid in cash. In August

2007, three years after her initial surgery,  she visited Dr. Watts to rectify the extreme puckering in her breasts. “They’d become shriveled like prunes, my areolas were uneven, and there was a large indentation in the left breast,” she says. Hoping to get a breast implant to fill out the indentations, Espinosa was in for a shock. Watts recalls, “The architecture of her breasts was completely changed. The technique and design of this breast lift followed no known principles I was familiar with.” Complete reconstruction and removal of the scar tissue was necessary to facilitate the development of healthy blood supply requiring two additional surgeries over a period of several months. Watts says, “If this had happened in the U.S., the doctor would have had to explain himself before a medical board or lost his license and, at the most, faced criminal and negligence charges.”

WORTH THE RISK?

Despite the prevalence of botched overseas surgery, its popularity continues unabated due to low pricing and accessibility. Wendy Lewis, author of Plastic Makes Perfect: The Complete Cosmetic Beauty Guide and plastic surgery consultant with clients in the U.S., Europe, and South America, matches clients from various socioeconomic backgrounds with appropriate doctors. She insists there are a number of safe, domestic alternatives available to those with limited financial resources. “For example, visit doctors outside of large metropolitan cities or a board certified surgeon trained by a high profile surgeon and the cost is significantly lower,” explains Lewis.

But cheap surgery is only one component of why minority women are low- hanging fruit for offshore doctors. Fear of embarrassment and stigmatization combine to silence and disempower women. This creates the perfect storm, particularly deplorable within a segment of society most in need of vital information.

Many advertised packages offer surgery followed by beach trips, horseback riding, island hopping, and fun-filled adventures in the sun–an impossibility given the acute pain, discomfort, risk of infection, and need for healing time.
Because of the relative ease in which plastic surgery is portrayed on reality shows, many potential patients hold unrealistic expectations about achieving physical perfection in an abbreviated time period and are unaware of the complexity of the procedures.

Watts says, “The media has given the public pseudo- empowerment to make decisions about which they are neither informed nor educated. It’s a tremendous disservice, and doctors must draw the line and not allow themselves to be talked into procedures they know are unsafe.”

NO SHORTCUTS

Although rare, botched cosmetic surgery also happens on U.S. soil.  According to a 2004 ASPS study, serious complications occur in one in 298 cases and death occurs in one in 51,429 cases in the U.S.

Dr. Julius Few, director of The Few Institute for Aesthetic Surgery in Chicago and a frequent medical contributor on CNN and 20/20, lauds the expertise of many credentialed foreign doctors. Still he stresses that offshore plastic surgery is potentially dangerous. “The laws and regulations in these countries are much less stringent and there is no governing board or recourse for the patient if the surgery goes wrong.” Few adds, “Plastic surgery is major surgery. Having an extreme makeover abroad and then sitting on a plane for several hours poses life threatening consequences.”

Anticipating the magic of transformation, many patients, like Espinosa, ignore their instincts, opting instead for the assurance of friends or persuasive advertising. Dr. Anthony Griffin, a diplomate of the American Board of Plastic Surgery who was named one of “America’s Leading Doctors” by black enterprise and whose surgeries have been featured on ABC’s Extreme Makeover and CNN, says, “Frankly, some people don’t want to know. Despite the doctor’s advice, many will shop around until they hear what they’re looking for, which is rarely what’s advertised.”

Today, Espinosa has physically recovered from her surgery, but the memory of the trauma remains. She admits that the fear of being asked uncomfortable questions and being judged by health professionals impaired her judgment. To anyone considering offshore plastic surgery she cautions, “In hindsight, there are more viable, smarter options than leaving the country that, if I’d known, would have saved me a lot of pain and money. But if you’re dead set on going, don’t feel that you don’t have the right to speak up or ask certain questions because you’re getting a bargain. Always trust your instincts even over what the doctor is telling you. If it doesn’t feel right, it isn’t.”

As the economy continues its downward spiral, and with more consumers vying for bargains on products and services in an increasingly global economy, a greater number of foreign firms have made offshore plastic surgery their business. Griffin insists, “The U.S. has the highest medical standards in the world in terms of safety, expertise, and protocols. It’s unwise to leave this protection for countries without jurisdictions that oversee doctors. The truth is there is no free lunch and you can’t get a Mercedes for the price of a Saturn.”

This story originally appeared in the June 2009 issue of Black Enterprise magazine.