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1 5 - 1 2 - 2 0 0 4 In medical quest for youth, cost-saving shortcuts can kill Unlicensed providers prey on those who can't afford legitimate services By John Lantigua Palm Beach Post Wednesday, December 15, 2004 Some Floridians stare into the mirror and dislike what they see. They conjure up a new image — usually younger and slimmer — and try to purchase that look through medicines or makeover surgery. But they can't always afford approved anti-aging drugs, or won't pay for certified plastic surgeons. So they try to find a bargain, and that's where their cosmetic nightmares begin. Especially over the past decade, hundreds of people in search of prolonged youth have fallen into the hands of hacks and ended up disfigured, maimed or dead. "People see others appear more youthful, what they consider miracle results, but those results cost money," says Dr. Jeffrey Kamlet, a Miami Beach internist. "They look for a shortcut and they end up in big trouble." Or as Dr. Fred Barr, head of the Palm Beach County Society of Plastic Surgeons, puts it: "They think they are getting extreme makeover and they get extreme disaster." Over Thanksgiving weekend, a Broward doctor with a revoked license apparently injected himself and three other people with a cut-rate imitation of the cosmetic drug Botox. All four are in critical condition, fighting for their lives. Although the cost of the drugs was apparently not a motivating factor in that case, the tragedy illuminates the problem of illicit cosmetic and anti-aging drugs and unlicensed individuals in Florida who profit from the search for eternal youth. The practitioners are often offering bargains. "It's like the ads you see, 'Laser eye surgery $299 with this coupon,' " says Dr. James Baker, a Winter Park plastic surgeon. "The last thing you want to do with your eyes is hunt for a coupon. It is the same thing with cosmetic surgery or anti-aging. There are no bargains if you want proper care." The case of Dr. Bach McComb, his girlfriend A.J. Hall, chiropractor Eric Kaplan and his wife Bonnie, of Palm Beach Gardens, is only the latest of the horror stories. Many of those terrible tales have involved substances such as silicone, which is used to fill out the face and other parts of the body. Physicians who use it emphasize that it must be employed in extremely measured amounts and with immense care.' "But we've had unlicensed people driving around the state offering patients liquid silicone shots in their homes and even in their cars," Baker says. "Liquid silicone can travel anywhere in the body and cause terrible problems. And sometimes what they are using is stuff they buy in the hardware store." Silicone shots prove fatal A case in point: Vera Lawrence, 52, of Miramar, died in March 2001 after receiving 36 silicone shots to her thighs and buttocks in the apartment of an acquaintance, reportedly costing $100. She was found still oozing the liquid from the shots and died that day of a lung embolism. The perpetrators, Donnie Hendrix and Mark Hawkins of Greenville, S.C., were not physicians. According to investigators, they had been purchasing supplies of industrial-strength silicone, which is normally used as a furniture sealant or as part of bathtub caulking. Hawkins was sentenced to 30 years in prison for third-degree murder; Hendrix received five years on lesser charges. "That kind of thing is still going on," says Dr. Leslie Baumann, director of cosmetic dermatology at the University of Miami. "We see doctors coming from outside the country, setting up in hotels and administering products that aren't legal here. It's dangerous." She says the latest fad is an import from Brazil: Aquamid, a filler similar to silicone that is untested and illegal in the United States. Another often-abused substance is steroids, which are used to build body mass and strength. Steroids have become a national issue because of scandals in Major League Baseball involving Jason Giambi, Barry Bonds and other stars. Many Floridians, especially bodybuilders, buy steroids illegally in gyms and use them without the advice of a physician. The drugs also are being found more and more among high school students, especially athletes. "And steroids can have awful side effects," Barr says. "Cataracts, diabetes, high blood pressure, sexual dysfunction, poor wound healing, hair growing in strange places and also buffalo hump." Buffalo hump is the massing of an unusual amount of flesh in one place on the body. "It can be a nightmare," he says, "and we have people out there taking massive amounts of them." Kamlet recalls the case of three young male bodybuilders who worked out at the gym of a Miami Beach hotel. They bought anabolic steroids from Mexico, which were originally meant to fatten up cattle. "The three men grew breasts and had to have cosmetic surgery to reduce the breasts," he says. Another drug being misused and abused in some circles is human growth hormone. "Everybody here is doing it," says Tommy Pooch, a prominent party promoter on South Beach. "You have to inject yourself in the stomach a few times a week, but that isn't stopping people." Pooch says he is not a user. HGH is produced by the human pituitary gland, but as a person ages the body produces less. It has been used to help children whose growth has been stunted and to help fight the wasting away of body mass in AIDS patients. Modern medicine now can clone the hormone and it has been used by some physicians as an anti-aging treatment. Patients say they feel and look younger, says Kamlet, who says he has used it with a limited number of his patients. "It's being bootlegged here, too," Pooch says, because legitimate HGH is so expensive. "With regular lab tests, it comes to about $2,000 per month," Kamlet says of the most-used legal HGH, marketed by the Swiss firm Serano. "People can't afford that so they are going to other sources. "Some people are buying it over the Internet from China, but most of the growth hormone out there right now is counterfeit. And who knows what you're getting?" Growth where it isn't wanted Doctors say the worst thing for a patient is to take too much HGH. That can lead to diabetes and a condition called acromegaly, which can cause enlargement of the hands, feet and head. The use of medicines from unknown sources and administered by untrained personnel also carries more general risks. "Let's just start with the danger of it being tainted by the AIDS virus or hepatitis," Barr says. As scary as using illicit drugs can be, linking up with the wrong plastic surgeon may be worse. Florida law, which allows physicians to perform all kinds of procedures in their offices, no matter their specialties, continues to be controversial. "Family practitioners who can't make money from HMOs are doing liposuction in-office to make money," Baker says. "You have pediatricians doing it, endocrinologists. Sometimes they end up perforating a liver, intestines or even a lung. ... They don't know what they're doing." Even in clinics that specialize in cosmetic procedures, catastrophe can strike. The case of Mona Alley, of Hollywood, is still before the courts. In 2000, Alley, then 50, entered the Florida Center for Cosmetic Surgery in Fort Lauderdale for a liposuction procedure. According to a lawsuit she filed, Alley's intestine was perforated during the procedure. This led to an infection that wasn't treated properly, which in turn caused circulation problems that resulted in Alley's legs being amputated above the knees. Some clinics have found it profitable to offer two procedures at once — liposuction and a tummy tuck. In February, after eight people died in the previous 18 months in Florida as a result of cosmetic surgeries, including the dual procedure, the Florida Board of Medicine temporarily banned the two-for-one offer. The board later lifted the ban but advised physicians to proceed with caution. Individuals not licensed as physicians in Florida also have entered the arena of plastic surgery. Perhaps the most famous case was that of Reinaldo Silvestre, allegedly a doctor in Cuba but unlicensed in this country, who performed plastic surgery on South Beach in the late 1990s. Investigators claim he used animal anesthetic on his patients and common household implements, such as spatulas, to insert implants. He gave one male patient, who was looking for chest enhancement, female breast implants. He also left a female patient with breasts drastically different in size. Known as the "Butcher of South Beach," he was a fugitive for five years but finally was captured this year in Belize after being featured on the TV show America's Most Wanted. [Link]

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