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 fianc 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.
Women seek out Hailparn for a variety of reasons: vanity, utility, emergency. But many begin their search for the same reason: frustration with their gynecologist.
Abba St. Germaine, 54, glances in the gilded mirror of her brightly painted home in Houston's Magnolia Grove neighborhood and sees her 35-year-old self. That's the image she wants frozen in time.
In the last 18 months St. Germaine has spent $70,000 on cosmetic and plastic surgeries. She has had her face lifted, her tummy tucked and her teeth capped. But when she called several local doctors to complain of stress urinary incontinence, their responses were uniform: It's normal, deal with it.
Brenda (not her real name) is a freelance graphic artist in Missouri City. After she birthed two nine-pound babies, intercourse became painful. Her gynecologist advised her to try Kegels. Brenda did the pelvic squeezing exercises for several months, but her condition didn't improve.
Jill (not her real name) runs a public relations firm in Houston. Since her labia had elongated after childbirth, she could no longer wear her favorite tight jeans. Her gynecologist's solution: Wear baggy jeans.
Unsatisfied with these responses, each of these Houston-area women keyed a phrase -- "urinary incontinence," "tighter vagina," "long labia" -- into an Internet search engine that eventually set them on the path to San Antonio.
All knew that the surgeries were risky. But they were persuaded by the testimonials posted on Hailparn's Web site from other women.
All got the combined vaginal tightening and labial reduction surgeries, and attest that the recovery was brutal. "My face-lift was a walk in the park compared to that," St. Germaine says. Jill is more graphic: "I looked down there and saw ground meat."
And yet all have recommended the surgeries to friends and relatives.
None, however, could confirm whether the vaginal tightening surgery improved their sex lives.
Jill wasn't having sex before the surgery.
Brenda says her vagina has already loosened up again, one year after the surgery. "My husband feels that for the amount of money he spent, it should stay just as tight as the first time," she says.
And St. Germaine says she hasn't had sex since the surgery was performed last summer. "Isn't that something? And here I paid all this money."
But the anticipation of having sex again for the first time reminds St. Germaine of her youth. And for her, that's the whole point of the surgeries.
"I had the exterior labia of a 50-year-old woman," St. Germaine says, beaming. "Now I have the labia of an 18-year-old girl."
Feminists and cultural critics question whether a standard of beauty even exists for female genitalia.
"The very idea of a quote-unquote normal-looking vagina is baffling to me," says Kirsten Gardner, assistant professor of gender studies at the University of Texas at San Antonio.
Many top plastic surgeons warn against the surgeries, since there is no scientific evidence to support claims that they improve women's sex lives. Worse, they say women risk painful scarring, numbness or oversensitivity.
Some critics invoke James C. Burt, the infamous Ohio-based gynecologist who was forced to surrender his medical license in 1989 for reshaping women's vaginas to enhance their sexual pleasure without their consent. Burt bragged in his 1975 self-published book Surgery of Love that his technique transformed women into "horny little house mice." His patients later suffered from incontinence, painful intercourse and vaginal infections.
Young, of the American Society of Plastic Surgeons, compares Matlock's vaginal rejuvenation campaign to early marketing of penile enhancement surgeries, which led to cases of male impotence and a slew of lawsuits.
"Greed's a big factor in it," Young says. "There's no advantage to having a laser. It's a great marketing gimmick."
Even if it's done successfully, he adds, a surgically tightened vagina offers a temporary fix. "Every woman started out with a tight one," he says. "Depending on the amount of traffic, it will get loose again."
By all accounts, Matlock's vaginal tightening technique is simple: Lase small incisions along the top and bottom of the vaginal canal, bring the muscle back together, remove excess tissue and stitch it in place.
The true value of being trained by Matlock lies in the right to use his trademarked promotional materials. One-third of Matlock's training session is spent lecturing on intellectual property rights and successful marketing techniques.
Hailparn spent $8,900 for his course. And she agreed to a two-year contract that required her to pay Matlock an additional $60,000 for support services and advice on how to handle specific cases. These expenses included neither future advertising costs nor the $36,000 ballpoint-pen-shaped laser.
Several months ago Matlock licensed all his intellectual property to a company based in Sonoma, California. Today he offers a turnkey operation in which doctors pay $49,500 for a three-day training session that includes the laser -- which costs Matlock just $16,000 -- and the right to use and advertise his trademarked procedures.
Matlock is open about his efforts to monopolize the market by trademarking his techniques and promoting them through ubiquitous ads and media appearances.
In his quest to create a one-stop shop for women's sexual needs, he's now awaiting approval from the Food and Drug Administration for his patented G-Spot Amplification, or G-shot, an $1,800 collagen injection that temporarily enlarges the nerve-rich pleasure area and makes it easier to locate.
Matlock is raking in millions by franchising his techniques. He has already trained nearly 100 board-certified gynecologists, urologists and plastic surgeons in 20 countries. Fourteen are American, including two in Texas: Hailparn in San Antonio and Dr. Jose Fernandez in Pharr, located near McAllen just north of the Mexican border.
Training doctors at a rate of 12 per month, Matlock says he is on pace to have 300 surgeons employing his techniques by the end of the year. He plans to establish training institutes in Asia, Europe and Latin America.
Hailparn has performed the surgeries on 335 patients. Two-thirds of the women were from Texas, three dozen from Houston. Even some California women pick San Antonio over Los Angeles because they'd rather be treated by a female.
"Matlock's like the king," Hailparn says, "and I'm the queen."
Hailparn empathizes with the women she treats.
"I don't like my labia," she admits. "They're not painful, but they're discolored. And they're longer than I'd like them to be."
It doesn't inspire confidence that Hailparn has not had any of the surgeries performed on herself. Why not go to Matlock, whom she calls her mentor?
"That's a bad subject," she says. "There are things that transpired between he and I that are private and I can't talk about them, okay?"
Hailparn broke her two-year contract with Matlock. As a result, she is no longer listed on his Web site as being certified in his techniques.
Early on, Matlock had planned to train 40 doctors to cover 50 states. Each doctor would be assigned a large region, to avoid competition. Hailparn wanted exclusive rights not only to San Antonio but also to Austin and Houston. When Matlock refused, Hailparn stopped cutting him monthly checks.
Matlock is not averse to litigation. He has sent cease-and-desist letters to at least two New York doctors who tried to piggyback off his success by advertising their own versions of vaginal rejuvenation surgeries.
And yet Hailparn still promotes Matlock's trademarked surgeries and uses his Web site template, which features a photograph of them posing together in scrubs.
Will she be sued?
"I don't know," Hailparn says. "If a lawyer comes after me I'll know, okay?"
Many prominent plastic surgeons condemn Matlock for trademarking and franchising medicine while publishing no scientific data in peer-reviewed journals.
"There are no secrets in medicine; this is not the Middle Ages," thunders Dr. Rod Rohrich, chairman of the plastic surgery department at the University of Texas Southwestern Medical Center at Dallas. "We share advances with our peers. It's part of our Hippocratic oath."
Young compares Matlock's Laser Vaginal Rejuvenation Institute franchise to McDonald's. But it's more like Kentucky Fried Chicken, since Matlock claims to have the secret recipe for enhancing female orgasms.
Matlock claims he wrote two papers that support his surgeries. But, he says, his attorney dissuaded him from publishing them, in order to protect his intellectual property rights.
"They have a corner on the market right now," Hailparn explains, "and they don't want to give that corner up."
Hailparn believes the surgeries eventually will become mainstream. Until then, she plans to cash in. "I'm not going to give away the technique," she says.
Matlock and Hailparn dismiss their critics similarly.
Says Hailparn: "I've undergone a lifestyle change. They're jealous."
Says Matlock: "They're not making the kind of money I'm making, and they never will." He pauses for several seconds and adds: "Christ had naysayers."
Hailparn has defended the surgeries in realms beyond the media. Last summer a colleague filed an anonymous complaint against her with the Texas Medical Board in Austin. She went before a five-member panel to defend the assertion that her surgeries enhanced sexual gratification, as advertised on dozens of billboards between Austin and San Antonio.
"It was very stressful," she says. "I could have been cited for being unethical."
The board took no action against her. "There have been no substantiated complaints made against the doctor," confirms Jane McFarland, special projects manager for the Texas Medical Board.
But the hearing shook Hailparn, and led her to alter the ads. "Now I downplay the sex," she says. The original slogan, "Feel sexy again," has become "Feel confident again." And "Imagine how much better sex can be" has been changed to "Imagine how much better life can be."
These days Hailparn tries to distance herself from the controversies that surround Matlock, while continuing to capitalize on his name. Unlike Matlock's, she says, her practice focuses on treating women with physical discomfort. And unlike Matlock's, she says, her ads are tasteful.
Hailparn claims she no longer uses Matlock's ads. But a stack of his brochures, featuring a bikini-clad woman arching her back as if in mid-orgasm, is displayed in her front office. She also says she doesn't like the media-coined term "designer vaginas." But a blown-up, laminated version of a magazine article with that headline hangs prominently in her waiting room.
Hymen reconstruction is the most controversial of all the surgeries offered by Matlock's growing army of doctors. All market the surgery on their Web sites, though many are unwilling to speak about it.
"We don't want to be targets," frets Dr. Robert Jason, who trained under Matlock in 2004 and has offices in Manhattan and Great Neck, New York.
Matlock and his associates claim their willingness to perform hymenoplasties demonstrates a commitment to women's rights. "I don't have to do this," one doctor says. "I'm jeopardizing my life to help these women."
Some conservative Muslim, Asian and Latin American cultures demonize the loss of virginity before marriage. A small number of these societies tolerate the killing of women who do not bleed on their wedding night in the name of family honor. The act is usually performed by the woman's father, brother, uncle or cousin.
Honor killings are prevalent in poor, rural Islamic communities, though isolated cases have occurred throughout Europe and even in America, according to Taina Bien-Aime, executive director of the international human rights group Equality Now.
Many such killings go unpunished and unreported. One recent study found that two dozen honor killings occur in Jordan every year, according to The Media Line, a news organization that focuses on the Middle East.
Dr. Robert Stubbs, a board-certified plastic surgeon based in Toronto, doesn't advertise hymenoplasties, though he has performed them for women in dire circumstances.
A 19-year-old, first-generation Afghan-Canadian came to him covered in bruises. She said she'd been date-raped. Stubbs advised her to get counseling. But her parents were strict, conservative Muslims, and she was terrified. Her rapist had threatened to tell her parents it was consensual in order to prevent her from calling the police.
Another American doctor, speaking on condition of anonymity, says he reconstructed the hymen of a 28-year-old Iranian woman four times. On each occasion, the same man accompanied her and paid for the surgery. The couple was having premarital sex, the doctor explains, but the woman "wanted to be ready" when her parents picked her mate. "That's expensive sex," the doctor muses.
All plastic and cosmetic surgeries are forbidden by conservative Islamic societies, says Sami Hizaji, headmaster of the Al-Hadi School for Accelerated Learning in Houston.
"God created human beings in a perfect form, whether they think so or not," Hizaji says. "Harming oneself to beautify oneself is not acceptable."
Zoubir Bouchikhi, an imam for the Islamic Society of Greater Houston, says that women who undergo hymenoplasties are committing a grave sin. "It's a deception," he says.
The moral dilemmas posed by female genitalia surgeries pass over Hailparn's head. Since the procedures are elective, she says, they cannot be compared to female genital mutilation. Hailparn has treated victims of female circumcision, a custom that remains legal in many African and Middle Eastern countries.
Several years ago she delivered the baby of an African woman whose clitoris had been removed by tribal members. The woman had been held down against her will. No anesthesia was used.
Hailparn repaired the woman's torn urethra and removed scar tissue. But she couldn't undo what had been done to her, since clitoral tissue cannot be put back.
The Kuwaiti woman Hailparn treated said she would have to hang a sheet outside her bedroom to show the blood on her wedding night.
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Hailparn advised her to prick her arm with a safety pin and fake it.
Better to reconstruct a woman's hymen than to see her stoned to death, Hailparn figures.
Reflecting on her newfound fortune, Hailparn sometimes pricks her own arm.
"How can these tiny pieces of tissue have so much control over women's lives?"