Eat, Play, Cut

Written by Amy Saunders Category: Lifestyle Issue: July 2015
Group Free

Seeking a bigger bust or tauter skin, cosmetic surgery patients from around the world come to Scottsdale – and make a sun-soaked vacation out of it.

During her trip to Scottsdale last September, Kathleen Kitts spent her days ordering lunch poolside as she lounged under a shaded cabana at the DoubleTree Resort by Hilton. Along with a friend, she shopped, dined and saw movies in Old Town and treated herself to manicures and massages.

At one point, she called her husband to report back on her trip, the purpose of which was more “business” than pleasure. “I’m actually having fun,” she told him.

Two weeks later, she returned to Denver with a face that looked two decades younger than it did when she left home.

Before her trip to Arizona, Kitts, 63, habitually avoided mirrors, not wanting to see her hooded eyes and sagging neck –  a face that no longer seemed hers. She wanted to get a face and brow lift, but not in Denver, a city she deemed too “sporty and natural” for expert cosmetic surgery.

To consult with a top surgeon, she was willing to travel anywhere. She considered New York and California, where friends had undergone plastic surgery, but after extensive research, she settled on Scottsdale. “I knew it was a big hub for plastic surgery,” she says, “and it’s a great place to come and recuperate.”

In recent years, as both cosmetic surgery and medical tourism have become increasingly common, plastic surgeons in the Scottsdale area have witnessed more patients like Kitts. From as near as California and as far as China, these recreation-minded recuperators fly in for a nose job, or a breast enhancement, or a butt-lift, and stay for a vacation – recovering at resorts and shopping in sunglasses and protective hats.

Out-of-town patients have changed the nature of the business for some surgeons, who offer concierge services and alter office logistics as they market specifically to visitors. Kitts’ surgeon, Dr. Daniel Shapiro, says out-of-towners make up 30 percent of his practice, a percentage he expects will continue to grow. “The days of feeling like you have to go to Los Angeles – it’s not like that anymore,” Shapiro says.

Ziegenhagen holding her Allergan silicone implantLike Getting Your Hair Done
Thanks to reality TV shows like Extreme Makeover and Dr. 90120 (or any episode of Keeping Up With the Kardashians), Americans are no longer shy about discussing cosmetic surgery – or pursuing it. More than 1.7 million cosmetic surgeries were performed last year, an 82 percent increase since the American Society for Aesthetic Plastic Surgery (ASAPS) began keeping track in 1997.

Scottsdale and other Western regional hubs account for 30 percent of cosmetic surgeries nationwide, more than any other part of the United States, according to the American Society of Plastic Surgeons (which doesn’t publish statistics at the state level).

Other, larger cities have more total plastic surgeons, but Scottsdale has a notably high density of those who specialize in aesthetic surgeries. The ASAPS directory counts 36 members in Scottsdale and Paradise Valley. By comparison, Houston – a city 10 times more populous than Scottsdale – has 33 members.

Visitors to Scottsdale can interview multiple surgeons within a 15-minute radius of their resort.

“It’s sort of one-stop shopping in a way,” says Dr. Patti Flint, who says out-of-town patients make up at least a third of her practice based in Scottsdale and Mesa. “In their home state, they may have to drive four to six hours to see two or three surgeons.”

And some Scottsdale surgeons can boast that they have more experience than those in other cities. Dr. John Corey says he does three times more work than the average board-certified surgeon who specializes in cosmetic surgery, which gives him a more extensive body of work – and more before-and-after photos that patients can evaluate when choosing a doctor. The high volume and level of competition gives Scottsdale a national reputation for cosmetic surgery, Corey says. He sees the local industry’s image as a compromise between the attributes of other surgery hotspots: more natural than Los Angeles (“the old Pam Anderson, way overdone,” Corey says), more hip than New York (“more facelift-y, more Joan Rivers-y”) and more classic than Miami (“they’re doing butt implants.”)

To many non-Arizona patients, cosmetic surgery almost seems like a routine procedure in Scottsdale, another reason to leave home. Having observed plenty of plastic while attending college in Arizona, Andrea Ziegenhagen didn’t even consider looking for surgeons in her current home of Minneapolis. “Living in Minnesota, I only know one or two people who have had plastic surgery,” says Ziegenhagen, 26, who saw Corey for breast augmentation in April. “(Arizona) seemed like a better place to start.”

In England, where Suzi Couszins lives, plastic surgery tends to have a negative reputation – something seen only on surgery-gone-wrong TV shows, she says. The 22-year-old, of Ipswich near England’s eastern coast, decided to get breast implants in the Phoenix area, where her sister lives and had done the same. “I don’t think there’s one person in Scottsdale who’s not had it done,” her sister half-jokingly reassured her.

“It wasn’t like a big, ‘Oh, my God, she’s getting surgery’ – it was the norm,” says Couszins, who saw Scottsdale surgeon Dr. Sean Lille in January. “It was so casual. It was like I was going to go get my hair done.”

PHM0715MT04The Customer’s Always Right
Like other surgeons who cater to out-of-town patients, Shapiro runs a practice that’s part medical office, part concierge service. Along with scheduling appointments and explaining pre-operative instructions, his office employees book hotel accommodations for visiting patients and recommend restaurants according to their tastes. Shapiro has even served as a booker for tennis matches.

“These people are used to that, and they want to be taken care of,” he says. “We’re surgeons, we’re psychiatrists and we’re sort of in retail. The customer’s always right. We’re trying to make people happy, and it’s not just the surgery.”

Customer service and marketing are especially important for surgeons who are looking to lure out-of-town patients to Scottsdale – and in doing so, compete not only against local practices but also those across the country.

Most practices have web pages dedicated to out-of-town patients that double as tourism sites, offering discounted hotel rates and ideas for shopping, dining and activities for a presumably female patient and her family. “Fly in for cosmetic surgery!” Corey’s website suggests. In a section called “What will my husband do?” men are advised to hit spring training games, the Bob Bondurant School of High Performance Driving and the Scottsdale Gun Club (“He can even rent a machine gun here!”)

Marketing efforts also extend to plastic-surgery websites like RealSelf.com, which includes resources like reviews of surgeons and before-and-after photos of their patients. By answering questions in patient forums, surgeons can rise to a coveted place at the top of search results. Shapiro is listed fourth in Phoenix after having answered 1,713 questions, including this one from a woman in San Francisco: “I want a butt like Nicki Minaj. Should I gain weight before my BBL (Brazilian Butt Lift)?” (Shapiro’s answer was no.)

As they would for any other spending decision, patients increasingly rely on online crowdsourcing when choosing a surgeon. “In a lot of ways, that’s like your word-of-mouth,” Shapiro says.

The efforts to attract and accommodate out-of-town patients have changed medicine-as-usual operations for some surgeons. For patients unable to make a pre-surgery visit to Arizona, doctor-patient rapport is built over phone calls and emails, and selfies sent online take the place of consultations. Despite the psychologically delicate nature of surgery, Ziegenhagen and Couszins didn’t meet their doctors until the day before they went under the knife.

To simplify logistics for out-of-towners, Corey’s employees can drop off prescriptions at the pharmacy and chauffeur patients to and from hotels. If necessary, Corey will schedule appointments on weekends and make hotel calls to check on recovering patients.

“In a purely elective cosmetic practice, you have to cater to them as much as possible,” he says.

PHM 800x800 FPOWhy They Come
Some out-of-towners return home after surgery in Scottsdale with a tan and a certain joie de vivre.
Whether they want to avoid obligations at work and home or just the glare of nosy neighbors, “There are a lot of people who just don’t want to have [surgery] done where they live,” Shapiro says. “They come back and no one’s the wiser. People think they look well-rested.”

Kelly Norling of Fort Lauderdale, Fla. is in that camp. The 32-year-old had coveted breast implants since she was a teenager, but she knew she’d have to leave home. Aside from disliking what she sees as the South Florida surgery aesthetic (“I’m not interested in looking like a blowup Barbie doll”), she needed to recover away from her three young children.

With her best friend, a Scottsdale naturopathic doctor, serving as her post-op caregiver, Norling had a full “mommy makeover” – breast augmentation, a mini tummy tuck and liposuction – with Corey in January. During her two-week escape to Scottsdale, Norling hit multiple malls, explored the city’s organic food scene and took advantage of another organic product: medicinal marijuana, legal in Arizona but not in Florida. “It was the best two weeks of my life I’ve had in a while,” she says. “I needed to go away. I couldn’t do it here and still maintain being a mom.”

Other patients come to Scottsdale for more practical reasons. Some travel from states like Alaska, where plastic surgeons are few and far between. Others are motivated by cost: Compared with some countries or larger cities, Scottsdale surgery prices are downright cheap. For Couszins, breast augmentation here costs about $5,000 – half what it does in London, where she would have had to finance her surgery. “In the U.S., I could afford to just pay outright, which is kind of mad,” she says. “It made me worry – oh, my God, is it too cheap? The more I looked, it seemed to be the standard price over in the U.S.”

The same was true for Cassandra Schultz, who saw Dr. John Ward in 2012. Breast augmentation in Scottsdale – plus a five-day resort vacation with her boyfriend – cost less than the surgery alone at home in Calgary, Alberta, where waiting lists were longer and surgeons had less experience. Schultz, whose results are frequently on display in bodybuilding competitions, has since referred her two sisters and more than 10 other Canadian patients to Ward. Motivated by the strength of the Canadian dollar, Ward dedicated a webpage to patients from our northern neighbor, mentioning his Canadian parents and childhood summers spent fishing in Ontario.

Other patients, though, are willing to travel anywhere to see a top surgeon, regardless of the price. Tara, a 36-year-old business consultant from Chicago who asked that her last name not be used, visited six surgeons as she considered breast augmentation: two in Chicago, one in Miami and three in Scottsdale, where a friend lives. She ultimately chose Flint for her surgery in February, largely because of photos showing the surgeon’s natural-looking results.

“I wanted the best,” she says, “not necessarily the best in my area.”

Drawbacks and Dangers
Reality shows that skip from the operating room to the big reveal miss a major component of every plastic surgery: the recovery time.

Dr. Anne Taylor, chair of the public education committee for the American Society of Plastic Surgeons, worries that patients traveling for surgery may not fully understand what they’re getting into. It’s a trip – not necessarily a vacation. “There’s a period of time where you need to rest and let your body heal,” she says. “You really don’t feel very good. You feel kind of slow, and there’s pain involved. You’re not really able to do vacation-related activities.”

That was the case for Couszins: On a side trip to Las Vegas more than a week after her breast augmentation, she was in bed most nights by 10 p.m., too tired and in too much pain to party.

Couszins stayed in Phoenix for nearly a month post-surgery before heading home to England. Lille, her surgeon, recommends that patients remain in the area for at least one or two weeks after a major surgery like breast augmentation in the event that infections or other issues arise. But, like other surgeons, he’s seen insistent patients travel home after only a day or two of rest. “That’s against medical advice,” Lille says. “They may tend to oversimplify the procedure and dismiss some of the risks.”

The ASPS is raising awareness of medical travel risks as patients are increasingly leaving home – and crossing oceans – for cosmetic surgery, an elective procedure not covered by insurance. In countries like Malaysia, India and Thailand, the cost of a cosmetic surgery can be half the American price. Reliable statistics aren’t available, but Patients Beyond Borders, a website and book series about medical tourism, estimates that 1.2 million Americans traveled outside the U.S. for medical care in 2014.

The society warns that surgeries abroad may involve unaccredited physicians and facilities as well as procedures and devices that aren’t considered safe in the U.S. Follow-up care might be limited – and, in the event that something goes wrong, legal recourse may be even more limited.

And post-surgery travel itself is a risk, increasing the chances of developing blood clots, swelling and infections.

Experts say patients should also be aware of risks close to home: Under Arizona law, additional training isn’t required for a physician who wants to broaden his or her scope of practice to include cosmetic surgery. A doctor who performs cosmetic surgery can say he’s board-certified, but that doesn’t mean he’s board-certified in plastic surgery. One cautionary tale is that of Peter Normann, a former physician in Anthem who is serving 25 years in prison for his role in the deaths of three patients in 2006 and 2007. The internist was performing liposuction, for which he had undergone six days of training. Two patients died from an overdose of anesthesia; the third died when her fat was accidentally injected into her vein.

Normann’s example, though extreme, underscores the importance of researching surgeons and checking for proper certification. Taylor recommends patients start the search in their own backyard rather than take on the additional risks of travel.

“There are competent, board-certified plastic surgeons throughout the country,” she says. “Patients are better-served staying closer to home.”

The Benefits of R&R
If Ziegenhagen had undergone breast augmentation at home in Minneapolis, post-surgery activities might have involved leaving the couch to do dishes.

Scheduling surgery in Scottsdale, instead, allowed Ziegenhagen and her boyfriend to take a cross-country road trip, stopping in Colorado Springs and Sedona and at the Grand Canyon. Less than 72 hours after surgery, she had toured Jerome and even hiked to the top of a mountain in Prescott, where she was staying with her sister.

“The weather’s so nice; it made me want to move around,” she says. “It helped me feel better.”

In turn, plastic-surgery trips can bring benefits to the Valley: Although the impact of plastic surgery on tourism hasn’t been formally studied, surgeons say they’ve seen patients return for vacations and additional procedures – and, in a few cases, even to buy a second home here. Flint says, “They go back looking better, which says something to their friends about the positive nature of coming to the Valley. It’s a win-win for the surgeons, for the patients, for the community.”

Kitts, for one, left Scottsdale last fall with a new favorite destination in addition to a rejuvenated look. She brought her husband back for the winter, inspired by the weather, shopping and dining she experienced during her surgery trip. Instead of taking their usual vacation to California, the Denver couple rented a condo in Scottsdale for six weeks.

“I had time there with nothing to do, to really explore and see what the area had to offer. I totally loved it,” Kitts says. “I can see us coming back every winter.”

POST-OPportunities
In recovery mode following your facelift, tummy tuck or boob job?  Recuperate in style with this Valley recreation guide.
Breast augmentation
Your cups overfloweth. Time to get some new bras and blouses. Combine your recovery with some retail therapy at Biltmore Fashion Park (shopbiltmore.com), home to outposts of Macy’s, Saks Fifth Avenue, Ralph Lauren, Vera Bradley, Escada and more; or Scottsdale Fashion Square (fashionsquare.com), where you’ll find Barneys New York, Nordstrom, Kate Spade, Burberry, Prada and more. Boutique shoppers will love the vintage stores along Seventh Avenue in the Melrose District of central Phoenix, like Zinnias at Melrose, Rust and Roses, and Melrose Vintage (m7streetfair.com).

Tummy tuck
To guard against overexertion (docs recommend 2 to 4 weeks of minimal physical activity during recovery from a tummy tuck), take a private tour. My Arizona Guide (myarizonaguide.com) gives city tours of Scottsdale and Phoenix (and farther-flung locales Tombstone and Tucson), along with leading private excursions to Sedona and the Grand Canyon. Or let Pink Adventure Tours (pinkadventuretoursscottsdale.com) do all the driving (or flying) on a Sonoran desert adventure or Grand Canyon helicopter tour. If you’re looking more to enjoy the great indoors, Ultimate Art Tours (ultimatearttours.com) conducts forays to Metro Phoenix art galleries, museums and architecturally notable sites like Taliesen West and Arcosanti.

Facelift
Given the swelling, drainage, bruising and bandages involved in facelift recovery, indoor activities that engage the body while keeping one’s face from the sun (and social situations) are ideal. Why not indulge from the neck down with a private body wrap, massage, mani or pedi? Some Valley resorts will bring spa services right to your room, including the Four Seasons Resort Scottsdale at Troon North ($295-$450 for 50-110 minute massage, fourseasons.com/scottsdale/spa); Sanctuary on Camelback ($75 additional charge per in-room service, sanctuaryoncamelback.com); and Arizona Grand Resort ($250-$280, arizonagrandresort.com). Wanna go full-pamper? Omni Scottsdale at Montelucia offers exclusive afterhours access to its Joya Spa with a package that includes a couples massage, stargazing and dinner on the terrace (packages start at $750, omnihotels.com/hotels/scottsdale-montelucia/spa).

Rhinoplasty
Getting a prettier proboscis means staying out of the ornery old sun, but that doesn’t have to mean a quarantine. Enjoy entertainment under cover of darkness (and in air-conditioning) at one of Arizona’s alternative or art house cinemas. FilmBar (thefilmbarphx.com) shows a cornucopia of cult classics and indie flicks (and pours beer and wine) in Downtown Phoenix, while the IMAX theatre (imax.com) at Arizona Mills mall in Tempe puts the action in your face with 3D screenings. For a cinematic soiree that doesn’t feel like a Bond villain’s dungeon, iPic Theater at Scottsdale Quarter (ipictheaters.com) offers plush lounge chairs, artisanal cocktails and food to go (and to take into the theater) from adjacent eatery Tanzy.