When Debbie Monroe returned from her five-week vacation to Peru, Argentina and Brazil, everyone thought she looked great. Six years later, even her closest friends don’t know she had a facelift, an eyelid lift and an aggressive micro abrasion skin treatment during her South American excursion.

“‘You look so great,’ they’ll say. I can tell they’re trying to put their finger on what changed,” Monroe says. “They’re thinking, ‘did she look that young before?’”

Monroe isn’t alone. Many Valley residents are landing back at Sky Harbor sitting on new bums, sporting new noses, bosoms or teeth. Others come home weighing less altogether. The procedures, veiled in the appearance of a lengthy international trip, leave many of their closest acquaintances none the wiser. Did Sally’s stomach used to…? I don’t remember…. It has been awhile….

Not all cosmetic vacations have secrecy as their impetus. Many of those traveling to faraway lands for cosmetic procedures are driven by the reduced prices. Monroe’s new mug, for instance, set her back $4,485 in Brazil, including medical fees and three nights in a hospital. Surgeons in the United States had quoted a price tag of $17,000 for the same face, without hospital costs.

One nip and tuck regular from Phoenix has undergone four cosmetic surgeries and says she prefers reputable international surgeons to average U.S. skin dressers. Mary Wagner had three cosmetic operations in Arizona before she headed south for her first facelift in Mexico.

Wagner says her Mexican surgeon fixed scar tissue left in her eyelids by an American surgeon while also giving her a facelift, all for less than one-third of the quoted price in Arizona. Now Wagner’s sister, cousin and sister-in law have all visited the same Rocky Point surgeon, with no complications or infections.

On the other side of the operating table and across the border, U.S. cosmetic surgeons say Valley residents hoping to save a few thousand dollars could end up paying with their health, or worse their lives.

“Nearly one-half of surgeons have seen patients traveling abroad to undergo cosmetic surgery and then coming into their practices with complications or re-dos,” reports the American Association of Facial Plastic Reconstructive Surgeons in a 2005 summary.

Two Valley cosmetic surgeons said they have fixed patients who came home with complications from international procedures. One of the surgeons, Dr. Deborah Bash of the Mayo Clinic, added that varying methods and instruments banned in the U.S. make repairs increasingly difficult for international sculpting gone wrong.

The U.S. State Department also reports two Americans died following cosmetic surgeries in Brazil last year, stating a number of U.S. citizens experienced severe complications after surgeries in the Dominican Republic.

While no one agency tracks the number of Americans flying abroad on cosmetic journeys, international surgeons from Mexico to South Africa all report significant increases in the number of U.S. patients.

Discount Souvenirs

For Debbie Monroe, 56 at the time of her Brazilian facelift, it all started with an international exchange student. Monroe is 19 years older than her husband and began to notice the age gap in her sagging face.

“I thought we were going to be housing this poor boy from Brazil. Instead, he’s telling me how behind the times we are, that his mother and 14-year-old sister have both had cosmetic operations,” Monroe says.

“In Brazil it’s like going to the dentist,” Monroe says. She visited a U.S. cosmetic surgeon for a free quote. The basic facelift, without eyelids or micro abrasion resurfacing, started at $12,000.

When the exchange student’s family visited for Christmas, Monroe couldn’t help but notice how beautiful the mother and daughter were. That’s when the boy’s mother said the same facelift would cost less than $6,000 in Brazil.

In 2000, Monroe refinanced her ranch to buy a handful of rental properties. She took out an extra $12,000, the price of the basic facelift in the States and decided she would spend the extra $6,000 visiting South America prior to her scheduled facelift in Brazil. A trip to Machu Piccu and the Amazon helped persuade her husband to sign off on the cosmetic odyssey.

“I read up on it and learned that Rio De Janeiro is the cosmetic surgery capitol of the world,” Monroe says. “The village we were in was just outside of Rio,” Monroe adds.

The U.S. State Department acknowledges Brazil’s slice of the growing cosmetic surgery market and its world-class facilities, while issuing U.S. citizens a warning that “boutique” surgeons far from hospitals may not be qualified to deal with unexpected medical emergencies.

Slim At Your Own Risk

Sitting at a beach house in Rocky Point, veteran cosmetic surgeon Dr. Cesar Saucedo speaks through a translator to say his standards of sterility and antibiotics are on par with those in the U.S. Casually dressed Saucedo's dark eyes look sincere behind his glasses, his silver dark hair neatly combed.

Saucedo says he has seen a steady increase in U.S. patients during his 30 years as a cosmetic surgeon in Mexico. Now Americans account for about 40 percent of his business, roughly 200 operations each year. They come from Arizona and beyond leaving with their desired new backsides, breasts, noses or lips.

Many U.S. surgeons claim these traveling patients may be gambling with their lives. Phoenix surgeon Dr. Martin Johnson has been practicing cosmetic surgery for 25 years. “The issues you have to consider are the qualifications of the person you’re going to,” Johnson says. “Some were trained in the States, so you may be getting an okay deal. Even in the U.S. complications happen. If they happen here, we’re here to help. If they’re across the border, it’s pretty difficult to hold the doctor accountable. You have to ask yourself then, what have I really saved?”

In Mexico, Dr. Saucedo points to his list of happy and beautiful clients as one of his credentials. “There is a myth of malpractice in Mexico,” Saucedo says. “Villages may have problems because of state healthcare, but private healthcare is a free market, and the doctors here have to be very careful and competent because of competition.”

Saucedo says his anesthesiologists administer the same antibiotics before, during and after a procedure as they do in the U.S. “Infection comes from the environment. I work on the coast because the best hospitals are here and guarantee the best facilities for my patients.”

One of Dr. Saucedo’s former physician’s assistants, now a general physician in Sonora, Mexico, says American plastic surgeons are upset that so many patients are finding better deals south of the border.

“U.S. doctors talk down Mexican doctors because the Mexican surgeons are killing their market,” Dr. Alvero Avurto says.

Not so says Mayo Clinic surgeon Dr. Deborah Bash. “You don’t ever want to put down or criticize the medical care in another country. Some of it is excellent,” Bash says. “The problem is you just can’t check the credentials.”

Dr. Bash also expresses concern over whether the foreign doctors are equipped to deal with an emergency if one should arise. “The problem is that they have those complications and they’re 10,000 miles away,” she says. Bash sees complications mostly from Mexico, but has also treated Valley patients who brought home infections from Thailand and South America.

Bash is especially concerned about skin fillers and implants that aren't approved in the U.S. “I’ve seen one patient who had a product injected into his face to fill out his cheeks. It later became infected. I can’t find information about it, even on the Internet,” Bash says. “I had to treat the infection and cut out the skin on his face. For most insurance companies, complications from a cosmetic surgery are not a covered expense.”

Pesos and Sense

Like Monroe, who knew a Brazilian family that had used her same cosmetic surgeon, Valley resident and mother of five Mary Wagner became acquainted with previous patients of Dr. Saucedo’s before driving down to Mexico with her daughter for surgery.

Wagner was no stranger to cosmetic surgery when she looked up Dr. Saucedo. She had paid U.S. prices for her liposuction, tummy tuck and eyelid lift in Arizona. While in Mexico, Wagner priced out a facelift, and her jaw dropped.

“The cost was incredibly low. My facelift was $3,000. That included the hospital, medication, everything. In the U.S. it would have been at least $20,000,” Wagner says. “I just thought I would take a gamble on this Dr. Saucado. He seemed like he knew what he was talking about.”

Wagners’s daughter drove her to Caborca, Mexico, and spent the night with her after the operation. “They provided a couch in my private room. She stayed with me all night. The service during the night was incredibly good. The nurses were very attentive, there within seconds,” Wagner says.

According to Wagner, the facelift was successful. “Six years later, my skin’s starting to sag a little bit more, so I’m thinking of having it done again,” she said.

Cosmetic Safari

While the chance to save thousands drives patients like Wagner to international destinations, the desire for privacy pushes others to pay even more for surgery abroad. Monroe says money was one reason she traveled all the way to Brazil for surgery, adding she was also sold on the privacy of the faraway locale.

Valley surgical technician Linda Hardy, 36, agrees. Sitting at a Valley Starbucks near the hospital where she works, Hardy says she will be having a tummy tuck and breast reduction surgery in South Africa next year.

South African surgeons, known for their Britton qualifications and experience, don’t cost much less than U.S. surgeons, but past patients from South Africa say they still saved thousands on the pre- and post-surgery hospital costs, even after airfare.

Hardy started researching international cosmetic surgery options about a year ago. She had a great respect for South African medical standards and training, having worked with numerous anesthesiologists from South Africa.

“Their training is as good, if not better,” Hardy says. “Here the doctors seem more into it for the money. There they seem to be into the health aspects and personal outcome.”

Hardy plans to pay a set fee of about $20,000 for her surgeries, which will include aftercare at a bed and breakfast and conclude with an African safari.

Hardy and Monroe both say researching the credentials of their surgeons, including previous patients, was a must before seriously considering international surgery.

For Monroe, it’s been almost six years since her facelift in Brazil. The doctor predicted her stretched skin would stay tight for about 10 years, and Monroe figures his estimate was about right. She’s starting to see some of the sagging that first took her to the Brazilian surgeon. Now she says the question isn’t if she’ll be back to Brazil for another lift, but when.

Names of cosmetic surgery patients have been changed at their request.