San José, Costa Rica, since 1956

Cut to Care: Plastic Surgery Popular Here

WITHIN the two years after she underwent a surgery that reduced the size of her stomach, Mary Wigginton, a 48-year-old U.S. citizen and registered nurse, had lost 125 pounds, but her skin had not caught up with the weight loss.It sagged from her stomach in what she called an “apron of fat;” the folds that were once taught over her 305-pound body drooped when the flesh shrunk beneath it.Her disfigured body tormented her psychologically, though she had the support of others who had suffered problems like hers in a virtual support group through It was through that group, e-mail correspondence, online research and prayer, she said, that she began to give plastic surgery more than a skeptical glance. But the cost was prohibitive.“As I did research it looked like an impossible dream – thousands of dollars, the fear of putting yourself in someone’s hands,” she said.She spoke with a surgeon in Kentucky who quoted her tummy tuck at $12,000. Her insurance company had covered gastric bypass surgery, but it balked at the idea of shelling out for any surgery that fell under the “plastic” category. BESIDES the cost of the operation, she would need to pay for someone to care for her during her recovery and she did not want to impose on her family.Through the suggestions of her virtual friends in solidarity online, she sold her Lincoln Navigator, flew to Costa Rica and consulted Dr. Rashi Rosenstock at the Rosenstock-Lieberman Center for Plastic Surgery in San José. He is a plastic surgeon with the American Association of Plastic and Reconstructive Surgeons.UNDER his knife, Wigginton lost eight to ten pounds of flesh in the tummy tuck, had her breasts lifted, enlarged with cohesive gel implants, her neck waddle tightened and the wrinkles smoothed across the lower part of her face.“I had these little old woman breasts that were going south and I wanted a lift, maybe an augmentation. I didn’t want to look like a table dancer, just better,” she said. “Dr. Rashi is intuitive, makes good eye-contact – that’s extremely important – listens to the patients and you can tell he really cares,” she said, adding, “He’s an artist, really.”After the operation she stayed for 12 days at Chetica Ranch, a specialized surgery recovery retreat on the fringe of San José at the foot of Braulio Carrillo National Park (see story below).“You take the skill of the doctor here and the aftercare of Chetica and I don’t know if you could find anything better,” she said.ACCORDING to Rosenstock, the demand for plastic surgery in the country has increased 15 times during the last 10 years, a phenomenon he attributes to the loss of the stigma that was associated with the surgery.Now, he said, his patients are both young and old, people in business, stay at- home parents who go for nose-jobs, face-lifts, eyelid surgeries, breast enlargements, liposuction, hair and fat transplants and a host of other procedures. They are motivated, Rosenstock said, by a desire for a better self-esteem and an increased quality of life.HE estimated that 60%-70% of his patients are foreigners, the majority from the United States, about 10% from Canada and 10% from other countries, and he operates on more women than men. People between18 and 40 generally request nose-jobs, breast enlargements and liposuction, and those over 40 look for face-lifts, eyelid surgeries, hair transplants and tummy tucks.“The most important thing is that people feel very comfortable,” he said.Wigginton believes her operation triggered a rejuvenation of her spirit. She spent her time in recovery in the hills outside of San José meditating on the possibilities, listening for divine inspiration about the direction her life should take now that she has a new body.Dr. Arnoldo Fournier is a plastic surgeon with the Santa Rita Hospital in San José, whose foreign patients also make up a substantial part of those he sees. He is a corresponding member of the American Society of Plastic and Reconstructive Surgeons and International Society of Plastic Surgery, and makes quarterly visits to the United States to attend training conferences.In spite of the prices of airfare and a hotel stay, he said, operations in Costa Rica cost from a quarter to half that of the same procedures in the United States. Most patients, he said, stay for about 10 days after the procedures to recover in hotels or one of several recuperation homes.PLASTIC surgery has changed over the years. Fournier said the 1970s saw more superficial skin stretching and results that looked artificial and that dissipated quickly. Now, surgeons move muscles, bones and cartilage to contour the body.“The trend now is to obtain results that make a person look more balanced and relaxed instead of looking as if they had plastic surgery,” he said.Fournier warns that, though some people think they will recover quickly, these and most surgeries do not fully heal for up to a year or 18 months.He said he is in love with his job. In spite of such grisly sounding operations, Fournier said he is so satisfied with surgery, the continual education process, the challenges it poses and the repertoire with patients, sometimes even 10 years after their visits, it fulfills every goal of his and is something he would do even in his free time and in lieu of any hobby.For more info, contact Rosenstock at the Rosenstock-Lieberman Center for Plastic Surgery at 223-9933, and on the web at, or Fournier at the Santa Rita Hospital 223-7214 and online at is a rough explanation of popular procedures. Both doctors provide material on pre- and post-operation requirements and recommendations, as well as in-depth looks at the operations themselves.The tummy tuckThis is considered a major surgery. The patient is anesthetized locally for the three-to four-hour operation. The doctor cuts the skin from hipbone to hipbone in an arc that passes along the pubic area.The skin is lifted from the abdomen above the ribcage under the breasts. The doctor then cuts out the fat and excess skin, and tightens the loose underlying tissue and stitches the muscles. Excess skin and fat are trimmed away to fit the new dimensions of the abdomen. Two drains are inserted into the area for a week to drain the local anesthesia and other fluids.LiposuctionOne of the more commonly requested operations is the suction of body fat through a tube. A thin tube (attached to a machine that produces a vacuum) is inserted into the body through tiny incisions, often tucked into strategic places such as the belly-button to avoid obvious scars. The doctor then rummages around the inside of the body sucking out fat in a controlled method that sculpts the body. Three months after the surgery the walls of the canals shrink together and the skin contracts with them.Eyelid surgeryWrinkles in the eyelids and puffy bags beneath them are caused by excessive skin and bags of fat that have retained water and bulged. As in liposuction, the fat cells removed from these areas will never grow again. Fournier recommends post-operation patients apply ice, wear dark sunglasses and use eye drops to avoid inflammation, eye damage and bruising.Nose surgeryNot only cosmetic, it can be applied to improve breathing problems for those with allergies or obstruction in the nasal passages. They only require a general anesthetic, according to Fournier, and up to 14 days of recovery time in a nose cast. The operation has incisions inside the nostrils, nasal bone filing, cartilage cutting to diminish the size of the tip or the crook or grafting to lift the nose’s profile.

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