Carlos Chaves, Mall Surgeon

Sure, an unlicensed doctor was performing liposuction at a hair salon. Stranger still: Clients kept showing up.

Remarkably, Diaz then scheduled her next surgery, and paid $2,000 for it.

This time, though, Chaves and Vazquez said they couldn't proceed that day because of Diaz's high blood pressure. The next day she returned to the office and demanded her money back. She didn't get it, and furious, she filed a report with the Florida Agency for Health Care Administration.

It seems worth noting that though Diaz may have harbored qualms about the abilities of Chaves and the Vazquezes, she continued to submit herself to their care. It wasn't their medical practices that finally prompted her to complain; it was a consumer issue, the clinic's failure to refund her money. Diaz may have believed that the house on Coral Way was a legitimate medical facility, but her mind-set was that of the mall, where you can return an item and get your money back, no questions asked.

"The doctor": Even in his mug shot, Carlos Chaves looked the part.
Houston Police Department
"The doctor": Even in his mug shot, Carlos Chaves looked the part.

Two other dissatisfied patients also filed complaints against Chaves and the Vazquezes: one man was unhappy with Chaves's surgery to remove a cyst from his forehead, and his girlfriend suffered swollen lips after Mayra Vazquez gave her collagen injections. The three complaints led to a health-department investigation, and eventually, the case was turned over to the cops.

At 7 a.m. on May 26, 1998, Miami-Dade police officer F. Carollo knocked on the door of Chaves's middle-class house in northwest Miami. Chaves answered, confirmed that he was Dr. Chaves, the cosmetic surgeon, and was promptly arrested. At the police station he stated that he'd performed numerous surgeries without a Florida medical license, and was sorry for the crimes.

He was charged with the unlawful practice of medicine, as well as petty and grand theft for accepting fees for services he couldn't legally render. Released on bail, he wasn't supposed to leave the state of Florida. And he certainly wasn't supposed to continue his surgical career in a Houston hair salon.

Beatriz Diaz says that her cosmetic-surgery ordeal has left her emotionally fragile, that she has been using Xanax and Zoloft to control the resulting panic attacks. She says Mayra Vazquez's collagen injections left her lips swollen unattractively for months before wearing off, and the aftermath of the liposculpture was worse: Not only did Diaz suffer infections, she was left with eight "holes," pits where the needle had removed fat. She says she has spent $10,000 to have another plastic surgeon repair the damage.

Diaz's lawyer, Jared Gelles, believes that she has a good civil case for battery: Because Chaves and Vazquez falsely led her to believe they were licensed doctors, she didn't truly give her consent for surgery. But Gelles worries that even if Diaz prevailed in court, she might never collect any money. She hasn't yet filed a lawsuit.

As ugly as Diaz's story is, though, it's probably best to think of Chaves in the context of other cosmetic surgeons. Even legitimate doctors often have dissatisfied patients -- that's why they carry malpractice insurance -- and cosmetic surgery inspires more dissatisfaction than most other medical procedures.

According to the American Medical Association, plastic surgeons attract a disproportionate number of malpractice claims. All sorts of unpleasant things can, and do, go wrong: Implants leak or slip or even protrude through skin; the tissue around them hardens; and all too often, liposuction can kill. There's no central registry of deaths due to liposuction, but a California State Senate study put the death rate at one in 5,000, shockingly high for a surgery that's not medically necessary. Another estimate, delivered at the Global Summit on Aesthetic Surgery, put the number of liposuction deaths in 1997 somewhere between 67 and 100.

No statistics seem to exist on the number of botched cosmetic-surgery procedures, but in a recent Newsweek article, New York's Dr. Gerald Pitman, one of the nation's most respected liposuctionists, estimated that as many as one in ten cosmetic surgeries has to be redone.

Last year a Fort Lauderdale Sun-Sentinel investigation found that since 1986 at least 34 Floridians had died after undergoing cosmetic procedures in a doctor's office. Surgeries in a doctor's office are riskier than those performed in a hospital. The offices may not be set up with crash carts for emergencies, or they may not be adequately staffed. But the most important difference is this: Hospitals screen the doctors they allow to operate, and oust surgeons whose practices they consider risky. In a doctor's own office, no such scrutiny applies.

This spring Florida stiffened the state laws that govern such surgeries; among other restrictions, the state limited doctor's-office liposuction to nine pounds of fat, a limit critics say is almost twice as high as it should be.

In California, state legislator Liz Figueroa has crusaded to reform the state's cosmetic-surgery practices. Last month the governor vetoed one of her bills that would have allowed consumers to check doctors' records on the Internet, but signed into law measures that, like Florida, place limits on cosmetic surgeries performed in doctors' offices. At the same time, California passed laws on cosmetic-surgery ads. Surgeons can no longer claim to be "board certified" without specifying which board has approved them; nor can they use misleading before-and-after photos and scientific claims that can't be substantiated.

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