Beauty on the Black Market

MIAMI

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Tony Cenicola/The New York Times

 

SEVERAL times a week, friends of a Miami clothing importer tip her off about illegal beauty treatments offered by unlicensed practitioners. Recently they have recommended a doctor from Peru who flies in to perform plastic surgery in a Miami apartment, a woman from Colombia who gives shots that melt fat off the hips, and an aesthetician who injects material that permanently bulks up the buttocks, she said.

"They call all the time to say that someone from Colombia, Venezuela or Peru is coming to Miami, and he can inject you or do surgery," said the woman, 41, who was not identified to avoid causing her further embarrassment about having tried one of these illicit procedures. Four years ago, the woman said, she and five friends went to a house in Coral Gables, Fla., a wealthy suburb, where a woman — she was introduced as the medical assistant to a renowned plastic surgeon in Colombia — injected their faces with a cosmetic filler to smooth their wrinkles and plump their lips.

"Afterwards my friends all looked fine, but my lips looked horribly swollen," the clothing importer said last Thursday in the office of Dr. David A. Rodriguez, a dermatologist in Coral Gables. She had come to Dr. Rodriguez in hopes of fixing several pea-sized protrusions in her lips.

"These beauty sessions they go to are like Tupperware parties," Dr. Rodriguez said. "But instead of getting a free casserole dish, the hostess gets free injections."

He added, "But there's no one for them to go back to when they end up with side effects."

In the last few years South Florida has become the nation's capital of black-market beauty treatments, in the view of many licensed doctors in the region who regularly see patients hoping to repair botched procedures. At parties like the one the clothing importer attended, or during private appointments in houses, hotel rooms, beauty salons and makeshift offices, people are getting everything from silicone shots to Botox, and in some cases plastic surgery, police and health department officials say.

The unlicensed practitioners, who include doctors trained in other countries, nurses, medical aides and even beauticians, attract patients with low fees, a willingness to use illegal permanent wrinkle fillers, a congenial atmosphere or the convenience of not needing to make an appointment weeks in advance.

"It's an epidemic," said Dr. Flor A. Mayoral, a dermatologist in Miami who sees two or three patients a day who have been deformed by illegal beauty procedures.

In 2001 the Miami-Dade Police Department responded by setting up an unlicensed practitioner unit, one of the few such task forces in the country dedicated to investigating medical fraud. The Florida Department of Health has an Unlicensed Activity Office, the only one of its kind, to investigate those who perform medical and cosmetic procedures without a license. Since its inception in 1998, this office has investigated more than 4,000 complaints and has led local police departments like Miami-Dade to arrest 485 unlicensed practitioners.

Miami's proximity to Central America and South America, along with a huge immigrant population and a party scene that caters to sculptured models and bodybuilders make it an ideal hothouse for bootleg procedures, said Spencer Marc Aronfeld, a lawyer in Coral Gables who is suing three unlicensed plastic surgeons on behalf of clients.

"Miami offers perfect-storm conditions for cosmetic crime," Mr. Aronfeld said. "It's a nexus of vanity, greed, corruption, warm weather, beautiful men and women walking around all the time wearing as little clothing as possible and unsophisticated immigrants trying to compete with them."

Miami's tightly knit immigrant groups inadvertently foster the underground providers, Dr. Mayoral and Dr. Rodriguez said. "It may be a cultural thing," Dr. Rodriguez said. "College-educated women who trust the recommendation of their friends and family go to unlicensed practitioners. If you are Colombian and your friends say this man is a doctor from Colombia, you may go to him."

In October 2004 Miami-Dade police arrested Daniel Acosta after he offered injections to a detective posing as a client. "He specialized in injecting lips and buttocks," said the 33-year-old detective, who was not identified because she works undercover.

After Mr. Acosta was arrested, police found needles, syringes, Botox and prescription drugs in the apartment in Kendall, Fla., where he worked.

In April 2005, Mr. Acosta pleaded guilty to practicing medicine without a license and was sentenced to probation.

Another unlicensed injector arrested in 2004 had a five-gallon bucket of industrial silicone, the kind used to seal furniture or lubricate car engines, that she injected in her clients' faces and bodies, detectives said. The woman also kept a tube of Krazy Glue in a night stand next to her syringes.

"Sometimes they use Krazy Glue to plug up the holes they have injected into," the undercover detective said. "But some of them tell us they mix Krazy Glue with saline and inject that. I don't think the public is aware of the consequences of being injected with unknown substances in unsanitary apartments."

The most frequent side effects from these beauty treatments are lumps and bumps and lopsided or grossly exaggerated facial features. More serious consequences, ranging from infection to death, have also occurred. Vera Lawrence, a 53-year-old secretary, died in 2001 after having silicone injected into her thighs and buttocks in an apartment in Miramar, Fla. One of the people who gave the injections, Mark Hawkins, is serving a 30-year prison term for his actions in the case. Most illicit beauty treatments in South Florida are offered by immigrant practitioners who live in the state, or foreign practitioners who fly in regularly to treat clients, police detectives say.

"We get a big influx of people who got their medical training elsewhere," said Sgt. Hector Llevat, a detective who oversees the Miami-Dade police's unlicensed practitioner unit. "When some foreign-trained doctors get frustrated trying to pass American medical exams, they decide to risk practicing without a license."

In addition to women looking for bargains, the clients for black-market treatments include transsexuals seeking to augment breasts and buttocks with large volumes of silicone, Sergeant Llevat said, procedures the medical establishment considers too dangerous. Also, doctors say some women who can afford legitimate doctors get a thrill from having illicit treatments.

"Wealthy women are going to injection parties," said Dr. Daniel Kane, a plastic surgeon in Miami who treats complications from these procedures. "They tell each other: 'So-and-so is having a guy over to inject stuff. She looks gorgeous.' And then they go. They're proud of it, until they have a problem."

The three most prevalent unlicensed medical activities here are plastic surgery, injections to the face and body, and dentistry, said Bob Mundy, the investigation manager for the Health Department's Unlicensed Activity Office for South Florida.

Practicing medicine without a license in Florida is a felony punishable by up to five years in prison. Helping unlicensed practitioners is also a felony. Because of this, detectives say, illicit beauty practitioners use word-of-mouth marketing through networks of hairdressers, manicurists, aestheticians and personal trainers.

"You have to be very careful about who you refer, but it's still easy to get a referral," said a 45-year-old hairstylist who works in a Coral Gables salon that caters to affluent clients. The stylist's name was not used to avoid associating him with providers of illicit treatments. "Instead of walking up to a stranger and asking, 'Who did your hair?,' you ask 'Who did your lips?' " he said. "Usually, someone will give you a phone number."

Dr. Mayoral sees serious side effects from black market beauty treatments. She photographs the most egregious cases and categorizes them by appearance. She classified one woman whose face looked hollow after she had illicit injections as a "cadaver." The terms "chipmunks" and "blowfish" cover women who have been injected with so much material that their faces are severely bloated. "Parrots" are patients whose injections by amateurs cause their lips to resemble snouts.

"Some say they were injected with shark cartilage or with sheep collagen," Dr. Mayoral said. "But most of them have no idea what they've got in their faces, which makes them hard to treat."

Repairs can be expensive. When patients come in with lopsided faces or lumpy lips, Dr. Mayoral injects fillers like Restylane. This works, but a treatment lasts no more than six months and can cost $600.

Patients offer different explanations as to why they get beauty treatments from amateurs. "Greed over getting a cheap deal made me do it, combined with my anxiety to be pretty," admitted Wilma Sepulveda, 51, an administrator at a real estate development company who is now one of Dr. Mayoral's patients.

Five years ago Ms. Sepulveda said she paid $2,000 for a series of 10 injections from María Collado, a cosmetologist who had an office in Hialeah. Ms. Sepulveda said she believed the woman was a dermatologist who was licensed in the Dominican Republic.

After the injections Ms. Sepulveda's face became swollen and her lips developed irregular lumps, she said. Ms. Sepulveda's sister, Thelma Vásquez, who had her buttocks injected by the same practitioner, developed lesions and pus-filled sores.

(Police arrested Ms. Collado in 2003 for unlicensed medical activity unrelated to the case of Ms. Sepulveda, who did not file a criminal complaint. The charges against Ms. Collado were dropped in March 2005 after she completed an education program for first-time nonviolent offenders. Reached in the Dominican Republic, where she performs surgery, Ms. Collado denied ever practicing medicine in Florida.)

"I thought just because she does not have credentials here does not mean she is not a doctor," Ms. Sepulveda said. "But I learned my lesson." She then mentioned a cautionary phrase in Spanish. "Lo barato sale caro," she said. "Something that looks cheap can end up costing you dearly." While people like Ms. Sepulveda willingly visit unlicensed practitioners, other would-be patients in Miami believe they are seeing licensed doctors.

In 2004 "De Mañanita," a Miami-based talk show on the Telemundo network, broadcast a series on cosmetic treatments featuring Luis Ayala, whom one talk show hostess referred to as "our own trusted plastic surgeon."

Watching the segments, Victoria Arnaiz, a manicurist in Hialeah Gardens, was impressed by Mr. Ayala's professionalism. She had always wanted to have liposuction. So when the show flashed the name of Mr. Ayala's clinic, the Advanced Center for Cosmetic Surgery, she asked her husband to copy the phone number.

Ms. Arnaiz then went to the clinic in Weston, an upscale suburb of Fort Lauderdale. There she met Mr. Ayala and Gregorio Nosovsky, a man wearing green surgical scrubs whom she believed to be another plastic surgeon.

They promised her that surgery would give her a body like Barbie's, she said. "You say to yourself, 'These are the doctors I have been looking for,' " Ms. Arnaiz said. Two weeks later both men were in the operating room before she received anesthesia for her liposuction, she said. After the post-operative corset was removed, Ms. Arnaiz discovered craterlike indentations on her back and cottage-cheese-like lumps in her abdomen, which a licensed plastic surgeon told her would cost $18,000 to $20,000 to fix. She cannot afford either fee.

Last April Mr. Nosovsky was arrested for the unlicensed practice of medicine after another patient complained. After Mr. Nosovsky's arrest, 35 women who had procedures at the clinic, including Ms. Arnaiz, contacted the police. Mr. Nosovsky's criminal case is pending in state court. His lawyer, J. David Bogenschutz, said Mr. Nosovsky is licensed in Mexico and "may have explained operations and recuperations to people, but he never operated on a single patient while he was in the state of Florida."

Ms. Arnaiz has sued Mr. Nosovsky and Mr. Ayala, who has not been charged in a criminal complaint, for personal injury. Their civil lawyer, Louis Giovachino, declined to comment because of the lawsuit.

Professional medical societies advise would-be patients to check the Web sites of state medical boards to verify that the doctors they consult are licensed.

In addition patients seeking cosmetic procedures are advised to contact medical boards to see that doctors are board certified in dermatology or plastic surgery.

"People are so anxious to have beauty procedures that they spend less time investigating the practitioner than they would spend researching a new car or a piece of jewelry," said Dr. Michael D. Storch, a plastic surgeon in Miami. "A recommendation from a friend, a neighbor or a hairdresser is not more important than a state license."