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September 15, 2009

Plastic Surgery Nightmares

model holding surgical needle against leg

Photo Credit: Liz Von Hoene

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It's easy for charlatans to market themselves as the real deal. Attorney Aronfeld had a case in which a sham plastic surgeon put up a spiffy website and papered his office walls with bogus diplomas—even fooling the Spanish version of Good Morning America on the Telemundo network into featuring him. Aronfeld's client Victoria Arnaiz went in for liposuction and came out with crater-like indentations on her back and cottage-cheese-like lumps rippling across her abdomen. "It turned out the guy wasn't a doctor at all," says Aronfeld. "With Photoshop and a website, I could turn you into a plastic surgeon overnight. They've tweaked the game up so that it's no longer just back-alley kind of stuff. They rent an office—it looks legitimate with the marble floors; it smells nice, and they're wearing doctors' jackets."

Thirty-year-old Andrea Lee understood that her injector was not a doctor. "I'm still in a lot of pain," she says, knowing that she's lucky to be alive. In January, after an acquaintance used a 10-gauge needle to inject her 40 times in the buttocks with silicone (purchased over the Internet from a source in Atlanta), she was rushed by ambulance to Tampa's Town & Country Hospital, unable to walk—her liver, lungs, and kidneys shutting down, clogged with the gelatinous substance. "They didn't expect me to make it," she says today. "They told my mother to start making funeral arrangements." She spent seven days in the ICU and three weeks on dialysis after her kidneys failed; her heart, even after a month in the hospital, is still enlarged. Lee says that she just wanted to have a fuller, rounded rear, like Jennifer Lopez, and that among her friends, illegal hookups of silicone injections given by nondoctors are all the rage. Indeed, just this March, Donnie Hendrix was arrested in Flagler County, FL, for allegedly injecting people with syringes filled with industrial-grade silicone—the kind used for caulking bathtubs. (At press time, he had pleaded not guilty.) And it wasn't the first time: He had served five years in jail for killing a 53-year-old Miami woman who collapsed after he helped inject her with a half-gallon of silicone at a "pumping party" in 2001. "We have heard there's a whole underground network that administers the shots," says Major Harold Winsett of Florida's Hillsborough Country Sheriff's Office. Why do women subject themselves to such shady treatment? Because the contraband substance, used to augment breasts and butts and erase wrinkles, is cheap: Lee paid $500 for her bootleg procedure—as opposed to the $5800 that a legit plastic surgeon on the East Coast would charge for a gluteal augmentation.

Bargain prices are what drew at least three clients per week to 37-year-old Juan David Acosta, who was arrested in April for allegedly performing gluteal augmentation implant surgeries from his lakeside home in Miami. (He has pleaded not guilty.) At $800 a pop, he charged a tenth of what a legitimate doctor would. According to the Miami New Times, detectives found bloody gauze, used syringes, medical chemicals, and unidentified biomaterial (to create the fake buttocks) in his garbage. Sergeant Caballero, who cannot comment on the case as it's still pending, says that he spends most of his days trying to track down people like Acosta, as well as the increasing number of fly-by-night foreign practitioners who prey on women looking for cheaper procedures. "Those transient doctors are hard to catch," he says. "He flies in, is here for a week, and then flies back. We see it a lot." They set up shop in a hotel room, the back room of a beauty salon, or medi-spa—even, says Caballero, in a van.

Luiz Carlo Ribeiro used the basement of a condominium in Framingham, MA. For two years, Ribeiro, who was not a licensed doctor, and his wife blew into this large town next to the turnpike from Brazil on 30-day work visas to perform cheap nose jobs, breast enhancements, and fat suctions on a massage table. Word spread throughout the local Brazilian community: Call Celia, make an appointment, bring cash. And the women, who could not have afforded it otherwise, did.

Then one Sunday afternoon, Fabrioloa DePaula, just 24 years old, handed over $3000 for a liposuction procedure and reclined on his table. Ribeiro injected her with lidocaine, a topical anesthetic, and Rohypnol—otherwise known as roofies, the date-rape drug—and carved several incisions into her belly. Ten minutes later, she stopped breathing. With no medical equipment on hand to help her, Ribeiro and his wife threw DePaula in a car and took her to the emergency room at Metro West Medical Center, where she was pronounced dead. The cause? A pulmonary fat emboli—her own fat clogging her lungs—a complication that could have been easily caught by an anesthesiologist, had one been present.

Although Ribeiro and his wife went to jail in March 2008 and "Celia" has been deported, the assistant district attorney on the case, Lee Hettinger, says that in the course of his investigation, he heard of numerous other illegal, underground cosmetic-surgery operations going on in the area. "This was not an anomaly," he says. "There are a lot of them, working out of beauty shops and other places." To his knowledge, no one is investigating them.

Shirleen Sifford wanted to have a baby. When her doctor recommended that she lose weight before getting pregnant, she decided to get lipodissolve, a nonsurgical—and much cheaper—alternative to traditional liposuction in which a non-FDA-approved chemical cocktail is injected, "melting away" the fat. Information she cherry-picked from the Internet made it seem quick and easy, but what Sifford didn't understand was that the procedure was experimental: There is no standard ingredient list for the synthetic soup (some mixture of soybean extract, hormones, a cattle bile derivative, antibiotics), and where the fat goes (the lymphatic system? The bloodstream?) is anyone's guess.

Sifford found a local medi-spa called AltMed of the Triad in Greensboro, NC, to perform the procedure. She had no reason to doubt its legitimacy: The website looked top-notch and had a doctor's name attached to it, and Lauretta Cheek, the owner, seemed not only professional, but like a friend. "I didn't check her credentials, I didn't investigate her. I just researched the procedure itself," says Sifford today. "I saw her certificates on the wall, and her business card had some initials following her name. It seemed like a safe environment." The day after her third session in which Cheek used dull needles for the 100 injections of a double dose of chemicals—Sifford couldn't stop crying. Unable to walk or catch her breath, she was rushed to the emergency room. She had a near-fatal blood infection.

This February, Sifford was awarded a $500,000 settlement—by default: Cheek never showed up in court. At the time, she was already facing 20 felony counts for prescription fraud, and a charge for practicing medicine without a license. Cheek—a nurse's assistant—wasn't just performing lipodissolve. In December 2008, she injected three women with what she claimed was SilSkin, a silicone oil not FDA-approved for cosmetic use, to enhance their buttocks. Within 24 hours, all three were in the hospital, two on dialysis with acute kidney failure. To this day, no one knows what she injected into their bodies.

"Nurses and beauticians and electrologists are doing these procedures now," says Dr. Mathew Avram, the director of the Massachusetts General Hospital Laser and Cosmetic Center in Boston. "It's a huge problem that is going to worsen." Many of these non-docs, like Cheek, find legal employ in medi-spas, the fastest-growing segment of the $11 billion spa industry, which doubled its revenues between 2006 and 2007 and hauled in $1 billion in profits last year. Though these hybrid retail operations have caused injuries and deaths, they lack any national standards and oversight organizations.

Most state boards dictate that anything affecting the structure or function of the skin qualifies as a medical procedure, and must be performed or supervised by a doctor. But states vary vastly on what "supervision" means. New Jersey, for instance, mandates that only medical doctors can operate laser devices (enforcement is another issue), while Massachusetts does not have any laws stipulating supervision of laser devices. That's where ghost medical directors come in. Dermatologist Dr. Jeffrey Dover, the director of SkinCare Physicians in Chestnut Hill, MA, has received letters from strangers asking him to lend his name to a medi-spa. "They say, 'We'll pay you a monthly retainer, and you don't ever have to come here,'" he says. Dover has refused three such offers, but knows of colleagues who have essentially rented out their licenses for extra annual income estimated to be in the $80,000 range.

Sacramento, CA, lawyer Charles Barrett has a client who received second-degree burns inside her vagina—the resulting scars may prevent her from having kids—from Brazilian-style bikini-line laser hair removal done at a franchise laser-spa by a nurse. The spa's medical director, an EMT, says Barrett, was affiliated with more than 70 medi-spas nationwide. "He was never on the premises and basically just rented out his license," Barrett says. "He never even provided training."

In a 2008 survey by the American Academy of Facial and Plastic Reconstructive Surgery, more than 75 percent of its doctors said that they were aware of a medi-spa with a medical director who was not on-site performing, or even overseeing, medical procedures. Detective Craig Cotten, of the Guilford County Sheriff's office, says that Cheek used the name of a local family doctor to write prescriptions. At one point, she paid that doctor to be at her medi-spa a few hours a week and in return, posted the doctor's name on her website and in her office, luring in women like Sifford, whose waist is now covered with knotty, painful keloids and whose dream of starting a family is on hold.

"We are seeing more patients trying to save money at a medi-spa who then have to come to us anyway," says Dr. Robert Weiss, president of the American Society for Dermatologic Surgery, pointing out that the cost of fixing a botched procedure—which insurance will not cover—far exceeds paying a legitimate doctor's fee. "You have businessmen running them, hiring people to administer treatments who would normally be checking out your groceries. It's our philosophy that only M.D.s should be doing the injections and lasers. Botox, the most toxic chemical ounce for ounce, should only be in qualified hands," Weiss says.

It was while Massachusetts Senator Joan Menard was getting her own Botox and dermal filler fix from Dover that she first learned of the exponentially increasing incidents of women cramming his waiting room after having been burned and disfigured at medi-spas. "There were no regulations," Menard says. "None." So she formed the Massachusetts Medical Spa Task Force to look into the problem. It found that there was no way to discern what sort of training—if any—non-medical practitioners had. Menard's goal is to ensure a trained and licensed professional does every procedure. After the task force met for three years, Menard sponsored Senate Bill 836, based on its recommendations to set up a broad statutory licensing scheme and requirements for medi-spas that she'd hoped would eventually serve as a model for the rest of the country. But at the hearing before the Public Health Committee in July, she was met with stiff opposition—from businesspeople and, in particular, cosmetologists—who feared the negative financial impact it could have on their lucrative industry. Now Menard is busy retooling a draft that will, perhaps, make everyone happy—but also may not protect consumers as well. Indeed, Dover, who served on the task force, testified at the hearing that the bill in its current form is too lenient, allowing nurses and aestheticians to perform unsupervised procedures. "There are still a lot of concerns; it's a lot of learning," Menard says, vowing to continue a fight that could last several more years.

Rigorous legislation can't come soon enough. Also last July, Debra O'Gara-Schultz, a nurse and owner of Superior Laser Aesthetics in Superior, CO, was arrested for allegedly forging a doctor's name to purchase and inject Botox and Restylane. (At press time, she had not yet entered a plea.) And Dover just examined a patient who revealed she was having Botox done in her home by a nurse who was charging one-fifth of his fee.

Meanwhile, women like Deyanira Polledo and Lissette Pita will continue to pay a steep price. How many more will be injured or killed when unbound vanity collides with unscrupulous practitioners who will do just about anything to make a buck?


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