As reported by the New Haven Register, June 17, 2006.

New Book Explores Traveling Outside the U.S. for Procedures

By Abram Katz

You don't tend to notice Jeff Schult's teeth.

That's the whole point.

Schult had his mouth restored in Costa Rica in 2004 and subsequently wrote a book about an increasingly popular and equally weird phenomenon — medical tourism.

Medical tourism is essentially obtaining treatment at significant savings by using physicians and surgeons in exotic locales.

Dr. Rajiv Chandrawarkar, chief of plastic surgery at the University of Connecticut Health Center, said that there are excellent hospitals in Thailand, India and other countries in which medical tourism thrives.

"It's a very enticing thing. These are risky procedures unless you've done all your homework," he said.

One factor to consider is that overseas hospitals accept no responsibility for negligence, he said.

Yet roughly 100,000 Americans travel overseas every year for cosmetic surgery that would otherwise be unaffordable at home.

People with dental problems, surplus skin, too many wrinkles, droopy eyelids, saggy stomachs and other issues that domestic health insurance companies refuse to cover, are traveling all over the world to get the work done in Brazil, India, Thailand, Mexico, Costa Rica and other countries.

"Beauty From Afar — a medical tourist's guide to affordable and quality cosmetic care outside the U.S.," published by Stewart, Tabori and Chang, evolved from a magazine article Schult wrote about his Central American dental adventure.

Just how many are following in his footsteps is not clear, because the medical tourism trade seems to fall between regulatory cracks.

However, the International Society of Aesthetic Plastic Surgery recently placed "guidelines for plastic surgery travelers" on its Web site, and going under the scalpel in a country where you'd be reluctant to drink the water seems to be expanding.

Internet businesses that arrange medical package deals are proliferating, advertising overseas procedures for one-third to one-half the cost of similar care in the United States.

Since it's impossible to know who's behind the glossy Web pages, it is essential to know how to navigate the Internet, confirm information, double-check credentials and make sure you understand what you're getting into, skeptical physicians point out.

Others flatly counsel against travel to the Third World for inexpensive plastic and other kinds of surgery.

Schult said he hopes his book will help explain and clarify medical tourism and its ethical and cautionary boundaries.

Schult was in his mid-40s when the enamel on his upper teeth started to thin. Without the hard enamel, his teeth gradually deteriorated, he said.

He compensated with a quirky smile.

In 2001, he finally went to a dentist who recommended 12 crowns and additional repairs. At about $1,000 per crown, the work was "simply out of the question," Schult said.

"I was resigned to living with it. Then, early in 2004, I found out that medical services were being outsourced," he said.

The cost would be substantially less, but how did Schult know what awaited him in a foreign land?

He didn't, so the journalist and Web editor took to the Internet and started to explore.

Costa Rica seemed promising, but Schult wasn't comfortable with the idea of dental surgery outside of the United States.

"I was very leery. I had every preconceived notion," he said. Schult imagined dingy offices, old equipment and a paucity of expertise.

But there was a lot of information on the Internet, including descriptions of dental facilities and dentists in San Jose, the capital of Costa Rica.

He corresponded with Dr. Telma Rubinstein, a dentist whom he had read about. He obtained his X-rays from his somewhat sour U.S. dentist and sent them to Rubinstein.

Schult said he continued to troll the Web, looking for some of Rubinstein's other patients. He decided to go.

Rubinstein assured him that she performed superior work. His teeth had deteriorated since the X-rays were taken, she said, and told Schult that additional procedures were necessary.

Including the procedures, travel, lodging and other expenses, Schult would pay $8,000 to have his mouth restored. In the U.S., the reconstruction would have cost $18,000 to $30,000, he said.

"I decided to do it," he said. Rubinstein's office was as modern as any in the United States, and her work was impeccable, he said.

"It turned out great. I had the work checked out here, and the doctor said it was good work," he said.

Costa Rica provides dental care for hundreds of people in the United States, according to the International Society of Aesthetic Plastic Surgery.

Care is less expensive there because everything costs less, Schult said.

While patients give up the protections of the U.S. legal system, international doctors and dentists depend on Web and word of mouth, he said.

Bad outcomes are reported on the Internet, providing informal accountability, Schult said.

"They put themselves out there. Information gets out," he said.

"Beauty from Afar" includes chapters on how to conduct research on a potential care provider, the most common procedures performed, travel considerations and medical travelogues on Brazil, Costa Rica, Mexico and the Far East.

Dr. Ivo Pitanguy is the dean of plastic surgeons in Brazil, where many women who have lost large amounts of weight go to have excess skin taken in. Dr. Fabio Zamprogno takes these women and transforms them into "FrankenBarbies," a term coined by a grateful patient.

Getting rid of the extra skin with a minimum of scars and achieving a pleasing, natural shape is Zamprogno's forte.

Bariatric, or weight loss, surgery is popular in Mexico, Brazil and Thailand.

Schult said inclusion in his book is not an endorsement of certain doctors or hospitals, nor is lack of mention a negative judgment.

Schult recommends that medical tourists make sure that they can communicate effectively with prospective doctors. Examine the doctor's professional credentials and ask for referrals from previous patients.

"If you don't feel comfortable doing this research, there are companies that will arrange it all for you," he said.

"Ask questions. Find multiple sources. This is an option, but do your homework," Schult said. "Have there been horror stories abroad? Yes, but that happens in all countries."