San José, Costa Rica, since 1956

Nip-and-Tuck Tourism Options Expanding

She lies limp on the operating table, like Christ on the cross, arms spread open, feet together.

Her bare breasts and torso glisten with a red antiseptic spray beading on her flesh. A respirator pumps oxygen through her lungs, causing her chest to rise and fall to the beat of the techno music to which the doctors choose to work. Marker sketches work their way up her abdomen from her pubic hair like a blue grid.

They have just flipped over her body after sucking the fat out of her back with a footlong vibrating wand Dr. Cristian Rivera jabbed beneath her skin. Some of her orange yellow fat sits in a cup on a table next to her.

Rivera proceeds to carve a slab of skin and fat the size of a prize-winning bass from her stomach.He uses an electro-coagulating tool to cut and burn through the fat, causing small clouds of burning human to rise into the operating light. His assistants toss the slab into a plastic sack, making the sound of a textbook dropping into a shopping bag.

Just a couple of hours after they put her to sleep, they yank the unnamed Costa Rican patient’s skin down from her abdomen and sew shut the hole they have just cut into her. Just like that. A tummy tuck.

This is the future of tourism in Costa Rica, officials say. This, and breast implants, facelifts and liposuction.

Plastic surgery tourism will help rescue the industry’s sluggish growth rate by attracting foreigners such as Idaho resident Sally Shephard to Costa Rica’s operating tables and beaches, according to Costa Rican Association of Tourism Professionals (ACOPROT) vice-president Carlos Lizama. Two birds, one stone.

“It’s like a vacation,” says Shephard, as she lies in a hospital bed in the Iberoamérica University (UNIBE) clinic in the northern San José district of Tibás, a day after Rivera used a vibroliposuction wand to slurp four kilograms of fat from her stomach and back. “I want to go down to the beaches now.”

Patients such as Shephard can come to Costa Rica and pay a fraction of the cost they pay at U.S. hospitals, where prices are higher because of insurance and labor costs. Shephard spent $5,000 on her procedure.

Afterwards, she’ll go to one of the few hotels dedicated to exclusively caring for plastic surgery patients. Once she’s better, she’ll meet up with her husband and her niece (who is getting her mamas, or breasts, done), and go to the beach. She plans to spend a month in the country.

Exclusive Resorts

Up in the hills of San Antonio de Escazú, a western suburb of San José, Raúl Cossío has been building what will be the country’s biggest resort exclusively for plastic surgery patients. The 32-room hotel, which will have its own dentist on-site and nurses to tend to healing patients, is situated on 4.5 acres with a panoramic view of the city below.

Cossío’s Paradise Cosmetic Inn resort will also feature a butterfly farm and a spa offering patients lymphatic massages.

“We’ll have bingo, too. And we’ll make it interesting. If you win, you get a free shot of Botox,” he says, his smile stretching tight across his skull.

Cossío, a Cuban-American real estate lawyer whose face is wrinkle-free, spent $3 million with partners to front the cost of his dream.

“There are lots of hotels like this, but only in Brazil,” he says, looking out upon the half-constructed hotel, which is set to open this month.

After the United States, home to 5,000 registered cosmetic surgeons, Brazil, with about 4,000, comes in a close second as the biggest country for cosmetic surgery, according to the American Society of Aesthetic Plastic Surgery.

Costa Rica has about 40 surgeons, according to Rivera. But the market here is growing fast – at about 20% a year, according to Hernán Campos, a Chamber of Industries researcher who did a study on the plastic surgery market in Costa Rica. In 2006, nearly 6,000 patients were operated on here, he says.

Though Costa Rica’s growing market is relatively small compared to the two giants, the tiny country’s plastic surgery market is posed to bank off cheap costs for clients, a market with quality surgeons, and a country where plastic surgery can go hand in hand with sunny beaches.

In Costa Rica, breast implants, for example, can cost a third of what they cost in the United States (about $6,000).

Also, Rivera says Costa Rican surgeons have more than a decade’s head start when it comes to silicone breast implants, which were virtually banned in the United States for 14 years and only recently regained U.S. Federal Drug Administration approval.

Cosmetic Vacations

Cossío, 56, doesn’t look 56. He came to Costa Rica five years ago to get a face-lift. The trim, tennis-playing Miamian has hair implants, “and I won’t say what else I’ve had done,” he laughs.

He says that while healing after the facelift he explored San José with fresh bruises from the surgery.

“I didn’t care if anybody saw me,” he says. “I didn’t know anybody.”

Anonymity: another market advantage Costa Rica has for foreigners.

When Cossío arrived, he stayed in a small guesthouse with ho-hum food and service.  That’s when the idea hit him. Plastic surgeon friends of his confirmed his hunch.

“We have a problem: there aren’t enough quality lodgings to meet the increasing demand (for foreign plastic surgery patients),” Rivera says.

He’s been marketing his “cosmetic vacations” product to try to get a piece of the U.S.’s $12.4 billion cosmetic surgery industry. Specifically, he targets married couples nearing retirement, from the United States and Canada.

Lizama calls Paradise Cosmetic Inn “a very interesting initiative that tells us this could grow much more.”

He says health and medical tourism, which will attract people coming to Costa Rica for the health benefits of its climate and the affordability of its medical treatments, will be a big market in 2007. The average plastic surgery patient stays for up to two weeks and spends between $8,000 and $12,000 (about five times the country’s percapita income).

“I’m glad you see the value in this market,” Tourism Minister Carlos Benavides told Cossío at a recent event at the Casa Presidencial.

“It’s health tourism. It reinforces the quality of this destination and gives it a better image. And it always brings them back for a second visit,” Benavides later told The Tico Times.

Vanity Fair?

Back at the UNIBE clinic, Shephard sips a glass of water and munches on saltine crackers.

This is the first time the 54-year-old grandmother has been in a hospital. About a year ago, a friend came to get liposuction here, and returned home happy. So Shephard decided it was her turn. She was willing to take the risk of not being able to sue a Costa Rican doctor should something go wrong.

“Fat. I just wanted to get rid of it,” she says. She saved thousands on operation costs here, which she will put toward her subsequent beach vacation, she says.

Rivera says that nowadays everyone knows someone who has had plastic surgery.

Shephard says she has three friends who have hit the cutting board, and her niece is next. “I think we are vain, but that’s how society is,” she says.

Rivera, 34, says about a third of his clients are foreigners – virtually all North Americans.

There is a “growing wave” of foreigners coming to Costa Rica for plastic surgery, a market that is ready to explode, he says.

“The boom hasn’t arrived yet,” says the doctor who nonchalantly carries on conversations with a cellular phone earpiece while operating.

He says low prices aren’t the only thing Costa Rica has going for it. The country also has quality doctors, who offer cutting-edge procedures such as the most recent form of liposuction, known as “vibrolipo.”

Rivera specializes in the latest liposuction technology, which takes out more fat in a fraction of the time, is less obtrusive than traditional liposuction, and means faster recuperation for patients.

Most of his clients come for aesthetic operations, with breast implants and vibroliposuction the most popular. About 20% come for reconstructive surgery, or because their doctors sent them to get liposuction because of obesity problems. Another 20% are patients who lost weight and want skin removed.

Rivera says that though many patients come back for different surgeries (about a third of his patients return), he doesn’t believe there is such a thing as addiction to plastic surgery.

“They’re just losing their fear of plastic surgery,” he says.

Rivera says his team of 10 employees takes before and after photos of each patient. Many look like completely different people. Some have had to get new ID cards.

“It is very meaningful when you see their facial expressions afterwards; they’re smiling … it helps people improve their selfimage, makes them more socially productive,” he says.

Unfortunately, he says, most people can’t afford the procedures.


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