Americans seeking plastic surgery flock to Costa Rica

Tim Johnson
Knight Ridder/Tribune News Service

December 29, 1995

SAN JOSE, Costa Rica _ Big sunglasses covered Joan Zook's face as she went sightseeing here, but they didn't quite block the telltale bruises that identified her as one of a flood of foreigners coming to Costa Rica for cut-rate plastic surgery.

``It's a little embarrassing to go out. You look like your husband beat you up,'' said Zook.

But it was worth the irritation, the California woman said: ``I have to go back to the job market, and I'm 58 years old. I don't want to look 68.''

In any given week, some 20 Americans visit Costa Rica for face lifts, tummy tucks, breast jobs and fat reduction. Drawn by low prices, a respected medical system and friendly attention, patients have generated a word-of-mouth buzz that is drawing crowds from South Florida, especially among Cuban-American and Jewish women, and from the San Francisco Bay area.

Arthur Marks, a retired salesman from Pembroke Pines, Fla., said he and his wife Ada grew curious when a friend disappeared for a few weeks.

``We asked where she was. They said, `She went to get her eyes fixed,''' he recounted. ``When she finally came out of hiding, she looked fantastic!''

After learning that she had the cosmetic surgery in Costa Rica, the Markses decided to travel abroad for face lifts themselves.

``The main reason is the price,'' said Marks. ``It would have cost $16,000 for the both of us in the States. We paid five.''

Marks is happy with the result _ ``I look like a man 50 years old when I'm 72'' _ while his wife is ``half and half'' about her own surgery.

``She wanted to come out looking like Marilyn Monroe,'' said Marks. Still, ``We have recommended it to others already. And a lot of them have gone.''

At least 28 plastic surgeons practice in San Jose, and a half dozen of them operate mainly on Americans, doing as many as 300 operations a year.

Several have offices in the Miami area, with assistants who book flights, arrange lodging and schedule surgery, as well as provide references for those skeptical about undergoing surgery in a Third World country.

``They almost always have someone who coordinates things and brings people from over there,'' said Dr. Carlos Centeno, a Costa Rican plastic surgeon.

The clinics offer slick English-language brochures and provide packages that include airfare, lodging, sightseeing tours and surgery. One surgeon, Dr. Arnold Fournier, has his own home page on the World Wide Web to advertise his services.

Cosmetic surgery generally isn't covered by health insurance. So, for decades, Americans have headed abroad for cheap surgery, going to Mexico, Brazil, Costa Rica and the Dominican Republic. Today, the capital of Costa Rica and Mexican cities such as Hermosillo, Nogales and Tijuana are dotted with plastic surgery clinics.

More than a decade ago, the first Americans to head to Costa Rica for surgery were Hispanics, mainly Cuban Americans from South Florida. ``The Latinos were familiar with Latino surroundings and weren't suspicious,'' said Dr. Ronald Pino King, who runs a plastic surgery clinic geared to foreigners. ``If you tell an American, `Go get an operation in Costa Rica,' he has no idea what he's getting into. He thinks he'll be operated on in a hut in the jungle.''

In fact, Costa Rica is renowned for its medical system, which has conducted heart, kidney and liver transplants.

Business took off here once the lists of happy plastic surgery patients grew to include spouses of U.S. doctors, inspiring confidence in others.

``Just from Miami, I think I've had about 100,'' said apartment owner Mary Helen Phillips, who rents units to patients for eight to 10 days of recovery after surgery.

Patients usually come in pairs, or groups. Sometimes sisters come together, or mother and daughter, or husband and wife.

``The wife gets operated on, and the husband sightsees, plays golf, tennis or goes fishing,'' Pino said.

Some people like to combine the surgery with a Costa Rican vacation, contributing to the boom here, said Dr. Miguel Alfaro, a Costa Rican doctor who specialized in plastic surgery at the University of Colorado.

But Phillips noted that ``most come because they are alone and they are looking to win someone over. ... Both the women and the men are looking for someone younger.''

Some Americans also come to Costa Rica because they find surgeons here more willing than their American counterparts to take on the face, the breasts and fat reduction of the stomach or hips at the same time.

The tradeoff, though, is that combining the operations entails more risk. That's one of the red flags that U.S. plastic surgeons raise in talking about surgery abroad.

``As you pile more and more procedures together, your possibility of complications goes up,'' said Dr. Roxanne Guy, chairman of the public education committee of the American Society of Plastic and Reconstructive Surgeons, based in Arlington Heights, Ill.

Those looking into going abroad should ask many questions, she said.

``What if you get into trouble, where are you going to go? If you got really sick, who's there to respond? Is there an ambulance service? ... Or are you just going to die there?''

She adds more questions: Can you talk to anyone else who's had surgery there? What is the surgical center like?

``If they have flies in the operating room, it's probably not the place you want to be,'' said Guy, who practices plastic surgery in Melbourne, Fla.

Surgeons in Costa Rica bristle at any suggestion that their surgery may be subpar, saying their popularity is proof of their excellence.

``Good plastic surgery is being done here, or people wouldn't come,'' Pino said. ``People return home satisfied.''

Added Alfaro: ``They come because of the price, but the majority also come because they saw another patient and they liked the results.''

Olga Lujan, a Coral Gables, Fla., dentist who is married to a physician, said she went to Costa Rica two years ago for a face lift, breast work and fat reduction, observing the conditions there closely.

``The hygiene was very good,'' said Lujan. ``They are very modern there. The hospital was clean. I am very happy with what they did. ... I came home to Miami after 15 days, looking perfect. I'm the oldest of five, and now I look like the youngest.''

The U.S. Embassy in Costa Rica said it has not received complaints from anyone who was unhappy with the results of plastic surgery.

Many foreigners who have gone to Costa Rica for plastic surgery say they were impressed by advances that make face lifts less obvious.

``For so many years, that's what turned me off: The skin looked so tight that it would pop,'' said Georgia Frink, 68, a resident of Montserrat in the Caribbean. She arrived in Costa Rica for surgery two months ago after finding a surgeon who ``doesn't make your face look like it's going to crack open.''

She initially planned to go to the United States for surgery, but ``I've heard a few horror stories there, as well.''

An obvious concern about going abroad for surgery is that if an operation is botched, the patient has little legal recourse.

Another drawback: Follow-up visits become nearly impossible once the patient leaves Costa Rica.

``It is the major concern,'' said Fournier. ``It is a very big limitation _ follow-up.''

That's important because there may be post-surgical bleeding, for instance, or a permanent eyelash liner may droop, or scarring may become visible. Or patients simply need to be reassured after a few months that bruising and swelling will diminish.

``The healing process isn't a process that's done in two weeks. Wound healing is a continuum that usually can take a year,'' said Guy, the Melbourne, Fla., surgeon.

Said Pino, one of the Costa Rican doctors: ``In the worst of cases, what can happen? Costa Rica is two and a half hours from Miami and the ticket costs $350, so they can come back. We do adjustments at no charge.''

Copyright 1995 Knight-Ridder/Tribune News Service

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