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Peruvians Bilked by Plastic Surgery

February 13, 1998

LIMA, Peru (AP) _ A dingy stairway in downtown Lima leads to a cramped waiting room, and to a makeshift operating room where a doctor sells dreams of beauty to Peru’s largely Indian poor.

Despite the risk of infection, disfigurement and even death, Maria Espichan nervously awaits her turn to undergo surgery, hoping it will straighten her curved nose, alter her Indian profile and change her luck.

``I know my life is going to improve when I look better,″ the 22-year-old Espichan says, squeezed together on a rickety couch with three other patients like her _ dark skinned, poor and nervous.

``A lot of my friends have had plastic surgery and now have boyfriends and jobs,″ Espichan says. Some have had problems, she concedes, ``but I’m willing to take the chance.″

Lured by the promise of a prettier face and a brighter future, poor Peruvians are flocking to clinics in rundown neighborhoods, where doctors with as little as a week’s training in plastic surgery offer everything from nose surgery to breast implants at bargain-basement prices.

With signs advertising plastic surgery and liposuction for as little as $50, business is booming. So, too, are instances of medical calamity.

``Every day we see death, deformation and infection from botched operations by unqualified doctors,″ says Dr. Carlos Navarro, president of Peru’s Plastic Surgeons Association.

Once a luxury for Peru’s rich, plastic surgery in the past five years has become a beacon of a better life for its poor, who believe, not unreasonably, that a more ``European″ appearance is their avenue to a good job or marriage.

More than 80 percent of Peruvians are either Indian or mestizo and suffer discrimination at the hands a light-skinned, wealthy elite. Job offers in newspapers demand a ``good presence,″ which sociologists say is code for a non-Indian appearance.

With demand high, the number of unqualified plastic surgeons has grown to between 200 and 300, in addition to the 80 who are certified, Navarro says.

On busy Avenida Alfonso Ugarte in crime-filled downtown Lima, a row of surgeons’ offices stand amid swarms of street vendors and beggars. Red and white signs offer everything from pregnancy tests to plastic surgery _ all cheap. The smell of spicy fried meat from street stands wafts over patients.

The doctors working here lower costs by skipping basic safety measures, including blood and diabetes tests, electrocardiograms and other standard pre-operative procedures, said Dr. Cesar Morillas, Peru’s most prestigious plastic surgeon.

``The patient is operated on quickly in a small room behind the doctor’s office in unhygienic conditions. He leaves immediately afterwards to catch the next bus home, often with a rag held to his face,″ Morillas said.

The abuses of cosmetic surgery in Peru can be traced, Navarro says, to weak government regulation that allows surgeons to perform plastic surgery without training. It has become a favorite second job for surgeons working in public hospitals, who are paid as little as $300 a month.

Often, however, doctors touting themselves as plastic surgeons receive only a one-week training course. Malpractice suits are nonexistent.

Women like Patricia Lira have little recourse when things go wrong. Lira, 33, a low-paid secretary at a Lima paper factory, wanted a nose resembling those she saw on women pictured in foreign magazines, but she had little money.

So she went to a surgeon offering a nose job for $300. In the United States, by comparison, nose surgery costs $2,000 to $20,000.

Four operations later, her nose is too small for her face and one nostril is visibly larger than the other. After the first surgery her nose was flat ``like a boxer’s″ and after the third her nose collapsed, with loose skin dangling in front.

``When I first saw what the doctor had done to my face, I threw myself on my bed and cried. I thought my life was over,″ says Lira, who lives in the working-class district of Surquillo.

Despite those precedents, Lira wants a fifth operation.

In the Lima shantytown of Comas, Dr. Victor Aguero defends his uncertified colleagues, saying they provide a needed medical service to the poor.

Aguero has a lucrative practice performing nose surgery, liposuction and facelifts for the poor. He has a degree in plastic surgery. but says most of his colleagues do not. He charges $200 for a nose job.

Cardboard hovels and roadside auto repair shops surround his clinic, and clouds of dust fill the waiting room.

``Most of my patients want the surgery for concrete reasons that are more than vanity. They want a job or to repair damage from an accident,″ he said.

``What is lacking is regulation to weed out the bad doctors.″

Peru’s poor, including peasants in rough sandals, fill his waiting room.

``They find the money to get the surgery, somehow,″ Aguero says.

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