Psst, You Wanna Plastic Surgeon?

By John Borrell/Tijuana

The magazine rack in the waiting room of Dr. Carolina Goldstein's dental surgery on Agua Caliente Boulevard in Tijuana is stuffed with copies of Good Housekeeping and other U.S. publications. THANK YOU FOR NOT SMOKING says a notice in English. Nearby, stacked pamphlets, also in English, extol the virtues of resin-bonded ceramic fillings. Soft music from a San Diego radio station fills the room. It could easily be an American dentist's office. Indeed, in some ways that is exactly what it is. Like many other dentists, doctors, opticians and pharmacists in Tijuana, Goldstein relies on Americans, several coming from as far away as San Francisco, for a growing part of her business.

Goldstein is one of thousands of Mexicans in towns and cities along the 2,000-mile U.S. border engaged in the lucrative and rapidly expanding business of providing health care for Americans. In Tijuana alone (pop. 1.3 million), there are 18 plastic surgeons and a range of other specialists among some 2,000 registered doctors and 1,700 dentists. Their listings take up 44 pages in the city telephone directory. From a simple dental filling to major reconstructive plastic surgery to a cataract operation, almost every health need imaginable is available just across the border. A major part of the appeal: prices that are about one-third to one-half of those charged in the U.S. "Americans are looking for bargains, and we are offering them," says Tijuana Optician Francisco Fandino Montero, whose clientele is about 80% American.

The rapid growth of legitimate Mexican health services has helped change the image of many border towns once better known for services of a seedier sort. Tijuana and Ciudad Juarez, for example, came of age serving liquor to thirsty gringos during Prohibition. More recently, they have catered to amorous misadventures of Americans, offering prostitution, easy abortions and quick divorces. "Standards are a lot higher than they were ten years ago," says Ana Maria Ley Estrella, president of the Tijuana Dental Association.

Yet some questionable practices linger, thanks to the comparative laxity of Mexican drug-regulatory laws and the predatory ways of get-rich-quick doctors. Until recently, thousands of Americans crossed the border for the sole purpose of buying Redotex, a potent Mexican-made diet prescription not licensed for sale in the U.S.; some pill-dispensing physicians became millionaires almost overnight. "They would send young boys out to tout for patients," recalls a Mexican physician in Nuevo Laredo. "Some doctors would see as many as 100 patients on a weekend. They would call them in five at a time and sometimes dispense the pills themselves." The Mexican government has since taken steps to end abuses in the selling of weight-loss medication.

Even so, many prescription drugs are more readily available in Mexico than in the U.S., and American health officials are concerned about the growing popularity of self-medication with drugs purchased south of the border. "Anyone who buys drugs without a prescription is taking a terrific risk," says Dr. Laurance Nickey, director of the El Paso City County Health District. Thousands of American cancer patients still flock to Mexican clinics each year for treatment with Laetrile, whose alleged curative powers have been discredited by U.S. health authorities.

One of the fastest-selling pharmaceuticals in border towns now is Ribavirin, a drug developed in the U.S. to treat AIDS but not approved by the Food and Drug Administration. Despite official doubts about Ribavirin's efficacy, thousands of Americans are crossing the border to buy it; smuggling rings have been formed to transport large quantities to the U.S. for resale. "I have had people come in saying they will buy all I can get," says a pharmacist in Ciudad Juarez.

As the number of middle-income Americans looking southward for doctoring grows, so does the demand for sophisticated services. Mexican plastic surgeons are now in big demand. Reason: a face-lift or tummy tuck south of the Rio Grande costs about 40% of what it does in the U.S. "An operation that typically costs $5,000 in the U.S. can be had for about $2,000 here," says Dr. Jorge Lopez y Garcia, a plastic surgeon from Mexico City. Lopez, a graduate of the Institute of Reconstructive Plastic Surgery at New York University Medical Center, flies to Nuevo Laredo twice a month to attend to his growing practice. Most of his patients are women from Texas seeking restorative surgery.

Many Americans are surprised by the range and quality of Mexican health care. "I was very dubious at first about coming here for dental work," recalls Mark Hamilton, a San Diego telecommunications consultant who came to Goldstein in Tijuana in 1983 for root-canal treatment. "But now I am convinced that not only is it cheaper, but also I am getting superior dentistry. They care more down here." He recalls once Goldstein even picked him up at the San Ysidro border crossing in her own car and dropped him off again after the appointment. Says he: "Now you can't beat that for service, can you?"