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The wealthy young Kuwaiti woman appeared in Dr. Troy Hailparn's San Antonio office and collapsed in tears.
Before she left to study abroad, her family had arranged for her marriage. She and her fiancé were about to return home to wed. But they were in serious danger. They had engaged in premarital sex, violating conservative Islamic religious and cultural traditions.
"Doctor, you must understand, I can be killed," the woman pleaded.
The couple shelled out $5,000 for a 30-minute operation to reconnect the membrane that once covered the opening to the woman's vagina, making her appear to be a virgin again.
Hailparn, a bone-thin 46-year-old with a thick New Jersey accent, never imagined she'd be paying down her mortgage by reattaching hymens.
Some women request the surgery for a sentimental reason: to let their husbands deflower them anew. Others were sexually assaulted, and come seeking empowerment. And then there are those like the Kuwaiti woman, or the Saudi Arabian woman who arrived in Hailparn's office with a similar story a few months earlier.
"I only hope that my work held up, because their lives are at stake," Hailparn says. "That kind of pressure makes me uncomfortable."
Hailparn bills herself as the lone female, board-certified obstetrician gynecologist in the country who has received specialized laser training in cosmetic gynecology, an increasingly fashionable area of plastic surgery.
In addition to hymenoplasties, Hailparn also tightens vaginas ($8,000), trims labia ($7,000) and liposuctions pubic mounds ($4,000).
She markets these procedures as ways for women to aesthetically enhance their genitalia and to improve sexual gratification. She offers several credit options. Combine surgeries, Hailparn pitches, and receive half off the second procedure.
The surgeries are controversial. Religious leaders say they promote deception. Feminists liken them to genital mutilation. And several prominent plastic surgeons dismiss them as clinically unproven and risky.
Such arguments haven't dented Hailparn's practice. The surgeries are so popular she has junked her previous practice and now performs them exclusively. She reports making more money last year than several years combined as a traditional OB-GYN.
Women travel from all over to visit Hailparn. Recently an Eskimo from a tiny Alaskan fishing village e-mailed her office requesting a consultation.
But the vast majority of Hailparn's patients hail from Texas, and Houston women are increasingly traveling Interstate 10 west to the Alamo City to have their genitals sculpted.
Vulvar and vaginal nips and tucks represent the fastest-growing segment of plastic surgery, according to Dr. V. Leroy Young, who chairs the Emerging Trends Task Force of the American Society of Plastic Surgeons.
The techniques have been practiced for more than half a century to repair childbirth-related injuries. But a decade ago a handful of West Coast surgeons for the first time promoted the procedures to improve sexual function and to prettify women's genital organs.
Doctors who perform the surgeries say their patients frequently carry pictures of nubile porn stars and Penthouse centerfolds.
In 2000, the platinum-blond porn star known as Houston had her labia-reduction surgery filmed and distributed to subscribers over the Internet. The excised flesh was auctioned off for $4,500.
The trim, clean-shaven look represents the ideal for female genitalia, these doctors say.
Hailparn contends there is an array of styles. Some prefer baldness, while others fancy a more tapered look. She views herself as an artist. "You have to have an eye for this," she says.
Hailparn's patients have ranged in age from 14 to 74. Some came to her complaining of discomfort: Their labial lips were too long, and chafed when they wore tight-fitting clothes. Others were bothered by their appearance: The pigmentation was too dark, making them self-conscious.
Insensitive comments proved devastating. "Having sex with you," one woman was told, "is like throwing a pebble into the Grand Canyon." Another woman was mortified when her young son saw tissue hanging down and asked: "Mommy, do you have a penis?"
Hailparn insists the surgeries improve her patients' quality of life. They've certainly improved hers.
A few years ago Hailparn's OB-GYN practice was tanking thanks to the soaring costs of medical malpractice insurance. Premiums in Texas were rising annually by as much as 60 percent. "I had colleagues giving up OB-GYN and going into real estate," she says.
To supplement her income, Hailparn took a course in laser hair and vein removal. But that didn't pan out.
In April 2003 she flew to Beverly Hills to train under Dr. David Matlock, who claims he pioneered the use of a laser for female genitalia surgeries.
Hailparn delivered her last baby in October, and has since renamed her practice. Complete and Compassionate OB/GYN Care is now the Laser Vaginal Rejuvenation Institute of San Antonio.
Since she began offering the surgeries in July 2003, Hailparn's once-harried schedule of 30 examinations a day has dwindled to a leisurely 30 patients per week. Meanwhile, her profits have multiplied. She's no longer beholden to insurance companies. Last year, she reports, she collected a career-high $1.5 million.
And Hailparn has enjoyed a minor celebrity profile. Dr. Drew, a sex-advice program on Discovery Health Channel, featured her in a three-part series that attracted dozens of new patients. Last month Hailparn began running commercials during Dr. 90210, a show about plastic surgeries on E! cable network, in the Houston, Austin and Phoenix markets.