Journal of Medicine – When my co-worker, Teresa, recently told me that I always had a “stressed out” look on my face, her words burned a hole into my soul.  I had always thought of myself as young and good-looking, and her words unintentionally rocked my world and self-esteem. 

I knew that over the past several years, even when I was happy, I didn’t want to be in any group photos.

And thinking further back, I realized that as every year passed I had to go through a larger and larger pile of pictures to find ones that I liked. For some strange reason, good photos seemed harder to find. Yep, it was time for a facelift.

As a 53 year-old male, I knew that no one had emerged unscathed from the stresses of the current great recession.

When Suzanne, a dear friend of mine, got a facelift a few years ago, she was elated.  She looked really great. She confided to me that she felt more youthful and vibrant.


She told me that she was really happy with her results, and that most people, when they saw the “new Suzanne,” commented “You look very relaxed – have you just been on a vacation?“ Nobody asked, “Have you had a facelift?”  I knew that a plastic surgeon doing a facelift should be an artist, and that the hallmark of a good facelift was subtlety. The reversing of the aging process should be delicate and the face should not show a dramatic change. That to me was the “gold standard” to be achieved.

So I made the rounds for consultations in San Francisco. Every surgeon agreed I was ready for it.  I liked everything I heard from them except for one thing:  the price tag.


I got quotes ranging from $20,000 to $30,000. This looked to be an expensive proposition, and I just couldn’t afford to spend that kind of money for an elective procedure that would not be covered by insurance.


Undaunted, I started revisiting my research into “medical tourism,” a lower-cost alternative I had been looking into for approximately four years. I revisited my bookmarks.  Again, I read that doctors in other countries were charging 70-90% less then doctors charge here for the same medical procedures performed within the United States.


I discovered that the difference in the fees was mainly due to the lack of malpractice insurance required by foreign doctors, as opposed to the staggering malpractice insurance premiums paid by doctors in the United States.  No place on earth litigates like the United States.


Additionally, in the U.S. you’re paying for the doctor’s education and lifestyle.  You’re also paying for a whole assortment of other things, ranging from expensive anesthesiologists to highly marked-up hospital charges on everything from lab work to EKG’s.


I had also heard the other side of the argument, that “you got what you paid for” in other countries: under-educated doctors who offered lower prices because they just weren’t qualified or properly trained to perform the surgery.

I asked friends what they thought, and they all had heard horror stories about Americans traveling to other countries to undergo surgical procedures. They had all heard stories of people who went in for a breast reduction and came out of the operating room missing a leg. Some told me stories they heard of botched procedures.  Others told me stories of surgical complications that the surgeons were untrained to handle, and medical facilities lacking the necessary equipment to allow the physician to handle an unforeseen crisis.


I asked all of them if they knew any of these patients directly or witnessed anything first-hand.  Not one of them could validate any of these stories. I asked if any of them had ever visited a hospital in another country.  Again no one had, so basically, these all seemed like rumors to me.  Apparently, there was a lack of real information.


It seemed that horror stories like these have become part and parcel of the American medical culture and belief system. In other words, we Americans believe that the medical systems and surgical procedures in other countries are simply inferior to ours, and that having surgery in other countries is scary, dangerous and high-risk.


I read a statement by the American Medical Association (AMA) that set the guidelines for medical tourism. It included a “recommendation” that a medical tourist (patient) should only go to an “offshore” or foreign hospital that had been accredited by our own U.S.-controlled institutions, namely the “Joint Commission International,” a division of the main hospital certification board in the U.S., the “Joint Commission.”  This seemed to be just another opportunity for the American Medical Association to set and control the standards for U.S. citizens traveling for surgery to all other countries in the world.

I decided it was time to do it and find out for myself.

I spent several months doing research on the Internet.  I quickly found the medical tourist associations, the brokers, the hospitals and even the doctors.  But that wasn’t enough; I wanted to talk directly to an American who had gone through the experience.  I wanted to ask my own questions first hand about their procedure, their comfort level and the outcome. Who were the best surgeons?  And, above all, were they frightened?  Fear of surgery in a different country was by far the biggest obstacle for me.


I couldn’t find anyone to talk with.  Everyone “knew” someone that “knew” someone that did it. Even journal articles about “medical tourism” referenced other articles when it came to the patients describing their experience.


I read Deloitte’s 2009 study on medical tourism called “Medical Tourism: Update and Implications,” which estimated that there would be 1.6 million “out-bound” American medical tourists by 2012, so it seemed strange, that in a multi-billion dollar industry, I couldn’t reach one medical tourist.


I found myself determined to go and see for myself and report back the truth, be it good, bad or ugly. I researched a number of Internet sites dedicated to plastic surgery and found three plastic surgeons I immediately liked. All three were university affiliated, all were known as “artists” and all had good reviews from patients.

One was in Buenos Aires, Argentina.  The second was in Rio de Janiero, a city also known as the plastic surgery capital of the world, and the third was in Guadalajara, Mexico. Buenos Aires seemed a great choice. Rio was also great.  Who wouldn’t want to go to Rio I chose to go to Mexico.


Why Mexico?

The flights to Rio and to Buenos Aires were 18-hour marathons, and Mexico was only a short 5-hour flight from home.  I knew that complications occur in about 25% of all surgeries, no matter where they happen, and were not necessarily the fault of the surgeon. And if they such a complication occurred, no other American doctor would want to treat me as a patient, as it would involve too much legal liability.  This meant that I couldn’t rely on local care back home.

So I decided a 5-hour flight back to Guadalajara made the most sense, as it was closer and probably faster than most hospital waiting rooms.


I selected a plastic surgeon named Dr. Lazaro Cardenas Camarena in Guadalajara. Dr. Cardenas was university-affiliated and his education, experience and qualifications were all first-rate. Best of all, the web reviews all called him an “artist.”

I booked the surgery to take place the week before Thanksgiving. I was scheduled to arrive Thursday night.  On Friday, I’d meet with Dr. Cardenas for a pre-surgical consultation, get blood work and have an EKG.  On Saturday I’d have the surgery and spend one night in the clinic.  Then I’d go to my hotel for a week, where I would have the services of a full-time private nurse, arranged by Dr. Cardenas. I’d receive multiple light and ultrasound therapy sessions during the week to reduce the bruising and swelling. The stitches would be removed, I would pass my final examination by Dr. Cardenas, and leave the following Monday.


I arrived uneventfully in Guadalajara on Thursday night. The people were much friendlier than I expected.  It wasn’t a resort town like Cancun, Ixtapa, or Puerto Vallarta, where the real culture of Mexico is hard to find. In the non-resort city of Guadalajara, I felt comfortable and safe. The people were friendly, intelligent and kind.  Many were bilingual and interested in talking with me. This was the Mexico I dreamed of visiting while I was growing up.


Friday was consultation day. I went to a lovely hospital clinic called the “Hospital Clinica Angeles Chapalita,” near my hotel.  First I was sent into a room where my blood was drawn, and then came the consultation.


I met with Dr. Cardenas and his wife, who was also a plastic surgeon specializing in ear, nose and throat (ENT).  Dr. Cardenas and his wife spoke perfect English. The doctor had a very relaxed, powerful presence and was extremely charming. He listened to my concerns, showed me where the incisions would be made and how they would be hidden. The consultation went perfectly.  He was exactly the professional surgeon that I wanted to see. I felt very comfortable.


After the consultation, I took a cab to a shopping mall.  While I was wandering around, I met a young doctor named Cynthia, who asked me how I liked Guadalajara.  I told her I was there for plastic surgery. We had a fun conversation and I asked her if she’d be my personal physician for a week.  With a laugh and a wink, I told her that I would gladly pay her for her time (I was only half joking).  Cynthia told me she’d think about it and would call me back and let me know if she was available.


I went back for the EKG and was told in precise and excellent English, that my heart was perfect with no enlargements to indicate any diseases and no blockages. My heart was at the perfect angle and it was beating in a regular rhythm. The cost: $80.


I walked back to the hotel, watched a movie on Netflix and fell asleep. The following morning I strolled over to the clinic and met with Dr. Cardenas, his three-person surgical team and his anesthesiologist. They were all cheerful and friendly.  I counted to 20 and woke up four hours later.

When I awoke, Dr. Cardenas was there. He told me that the surgery had gone perfectly and explained some things to me that I was too groggy to remember.  I was rolled to a private room in the clinic for observation.


By 11:00p.m., I was still wide-awake and felt no pain or fear.  I was getting bored and restless, so I started walking around the clinic with my drainage bag and IV bottle to get some fresh air.  I stopped by the bathroom and pulled out my iPhone and took some pictures and had a good laugh at the way I looked.


A nurse came in about three times to tell me to stop walking around the halls and lie still.  I said sure but really wasn’t tired.

My Personal M.D.

Cynthia called about midnight and said that she could take care of me for the week.  I thought, “Getting my own personal physician is hard to beat”.  She could take care of me and reassure me between appointments with Dr. Cardenas. I wouldn’t have to worry about anything.  A nurse would have been fine.  But a doctor could diagnose problems and respond to emergencies quicker and communicate on an equal level with the surgeon.


Cynthia came to my room at 8:00a.m. on Sunday morning and we started chatting where we had left off at the shopping mall.  Dr. Cardenas and his surgical team came in an hour later and warmly greeted me.  He told that everything went perfectly.  They examined me again and told me that I was doing great.


Dr. Cardenas had arranged for some nurses to take me back to the hotel. I asked if Cynthia could take care of me. He agreed and gave her the instructions, medications, and my treatment schedule and exchanged their contact information.


I felt very well taken care of, safe and secure.  The transition between the medical team and Cynthia, my personal M.D., was perfect.  I couldn’t imagine getting this kind of treatment in any U.S. hospital.


As Cynthia drove me to the pharmacy to get the medications, I asked her if she wanted her own hotel room.  She replied, “No I have to be in the same room with you to take care of you.”  I thanked her for it.  I forgot I was the patient, I felt that good.


Sunday was the first day after the surgery.  I called it Day #2.  My next meeting with Dr. Cardenas was scheduled for Wednesday. I had no idea why I felt so good but Cynthia and I both laughed about it.  She said it must have been either the anesthesia or my adrenalin that kept me going, but she really couldn’t explain why I was so active and experienced no down time or pain.

Back at the hotel room, Cynthia looked at my lab tests and said, “You’re like a 15-year old,” which I thought was a perfect justification to get her to take me to Starbucks. I had to wear a baseball cap and sunglasses to cover my bruises and to make sure that I didn’t frighten anyone. When she wanted me to walk in the shade, I noticed her care and attention.

We didn’t go back to the hotel room until about 5:00p.m. And I felt just fine.


Although I probably shouldn’t have, I looked in the mirror. I got a bit freaked out and I asked her, “Is this normal?” She replied, “Yes, it’s great, everything is okay.” I must have asked her that same question two dozen times – or at least every time I got a glimpse of my face in the mirror.  Each time, she would patiently examine my face and answer the same way, “Everything is OK, just perfect.”  She reassured me enough so I could let it go, and then I felt just great.

With the fear gone, I was enjoying her company and wasn’t worrying at all.  We talked and laughed like kids the entire day.


On Monday, Day #3, we went to a shopping mall and saw a movie in English with Spanish subtitles.  Cynthia was picking movies she knew I’d like.  I began to understand the term “medical tourist.”


On Wednesday, Day #5, I met with Dr. Cardenas and his surgical team at the modern “NeoPlatic & Hospital Puerta de Hierro” in Andares, a wealthy area of Guadalajara. They examined my stitches, swelling and bruising and gave me a thumbs up. Cynthia asked Dr. Cardenas some questions in Spanish.  While listening to both of them discuss my case, I felt secure and in excellent hands.  All was just perfect.


Cynthia made a comment that Dr. Cardenas was better than the plastic surgeon she had interned for. I asked why she said that.  She said she didn’t use the same criteria I did, and told me it was because Dr. Cardenas’ surgical team consisted of some residents who called him a “master” and “brilliant.”  As an intern, she never was told to say that.  So the words were genuine and if his team felt that way, then he definitely was.


Next up in my recovery would be a series of three light and sound rehabilitation treatments to bring down the swelling and help heal the bruising.  Then the stitches on my eyes would be removed.


The light treatment lasted 30 minutes and felt soothing. It was followed by an ultrasound treatment.  Both treatments took place in Andares; in a suite I called the “Spa”, which was located inside the hospital.

After my treatments were completed, Cynthia and I left and went to visit the gorgeous Andares mall.  I believe this mall is nicer than any mall in San Francisco, with the same high-end stores as in Union Square.  After that, we went to another movie and dinner.


On Thursday, Day #6, the stitches from my eyes were removed, and it went perfectly.  At 4:30p.m., I went back to the Spa for more light and sound therapy.


After that, on Days #7 and 8, Cynthia and I indulged in some sightseeing, movies, more malls and more dinners.


On Sunday, Day #9, one week after the facelift, I went for my final examination by Dr. Cardenas, who gave me instructions for removing my stitches and strengthening my eyes by massaging them.  It was simple and very easy.

That evening Cynthia introduced me to her family and we went for an hour-long drive to a lake outside of Guadalajara.  It was lovely.


On Monday morning, Day #10, Cynthia drove me to the airport for my 6:00a.m. return flight. I felt like I knew her all my life. We said a fond farewell at the airport, and soon I was home again. I felt great and I worked from home for about a week before returning to the office.


Cynthia emailed me about a dozen times, and always asked, “How’s your face?” and told me “Everyone says hello.”

Dr. Cardenas contacted me twice to follow up, and when I contacted him to ask a few questions he replied immediately each time.


About a month later, I went into the bank to make a deposit.  The teller asked me, “Have you been on vacation?  You look very relaxed.”  A close friend also told me that I looked 10 years younger.


I smiled, and thought to myself, the “gold standard” had been achieved.

I visited my personal physician back in the Bay Area, and without telling him where I had the facelift done, he told me that the surgeon “knew what he was doing.”


I haven’t told Dr. Cardenas this yet but I don’t think he’ll be surprised.  I had a great experience and would highly recommend Dr. Cardenas.


The bottom line:  would I recommend this to anyone?  Absolutely.  Would I do it again? Yes – in about ten years.

The testimonial noted above was published in the Journal of Medicine which is published by the National College of Physicians.  The author is R.F. Cramer and he may be reached at the following e-mail address:

a u t h o r 0 2   at

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