Choeun Nuon traveled from her home in California to a Miami-area cosmetic surgery clinic to have a so-called Brazilian butt lift in February 2017. Instead of recovering after the procedure, the 32-year-old mother of two began slipping in and out of consciousness.
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She eventually passed out because of a severe drop in blood pressure.
When Nuon awoke and slowly found her bearings, she was in an emergency operating room at a nearby hospital, surrounded by medical staff. Medics learned that her surgeon had punctured her lumbar artery, causing her profuse internal bleeding.
"I was fighting for my life," Nuon said. "They told me that I was lucky to be alive."
South Florida has become a hub for the freewheeling industry in trendy cosmetic surgeries, drawing a boom in medical tourism. Costs for such procedures have come down — even as more routine surgeries covered by insurance and Medicaid have skyrocketed — in what observers such as Florida House Speaker Jose Oliva call a success of the free market.
However, complications and even deaths of several out-of-state women in recent years have spiked concerns over safety of the cosmetic procedures, prompting a bill before the Florida Legislature this year to impose stricter regulations.
Brazilian butt lifts, a fat transfer procedure in which doctors perform liposuction of the torso and then inject that fat into the buttocks, have been singled out as especially perilous. A task force led by the American Society of Plastic Surgeons found they have a mortality rate of 1 in 3,000, compared with a rate of about 50,000 for office-based cosmetic procedures in general.
The bill, which was approved by a House committee earlier this month and has support in both chambers, would require facilities and doctors to demonstrate financial responsibility to pay out claims when deemed at fault for serious injury. Current Florida law does not require cosmetic surgery clinics to have medical liability insurance.
The legislation, proposed by Miami-area Republicans Sen. Anitere Flores and Rep. Anthony Rodriguez, also would give the state Health Department authorization to suspend or place five-year bans on facility owners and physicians who fail to comply with the rule changes, preventing new clinics from being opened under another name.
"That's particularly important," Flores said. "What we found is that many of these clinics, someone will die at one of their clinics, and the next day they'll open back up and take new patients as if nothing happened."
The law change would also require surgery centers to be at least partly owned a medical doctor.
"We can give the Department of Health the tools to shut down the butcher shops," she said.
Often found in Miami-area shopping plazas, these businesses market their services via social media to women across the country with limited financial means who are seeking weight loss surgeries, breast augmentations, and Brazilian butt lifts. The doctors often are not certified by a plastic surgery board and provide such procedures at a fraction of the cost when compared with established, board-certified clinics.
Florida law permits any licensed medical doctor to perform cosmetic surgery without being a board-certified plastic surgeon. The bill would, however, require the state Board of Medicine to adopt new rules governing the standard of care for physicians practicing within the clinics, though it remains unclear how the board would enhance the protections.
Nuon had other cosmetic work done in the past and was aware of the risks. But she said she chose a doctor who claimed to be a board-certified plastic surgeon online, according to court documents. The surgeon, Dr. Anthony Hasan at Palmetto Lakes Surgical Center, it turned out, was not certified by the American Board of Plastic Surgery, nor did he have medical liability insurance.
Ryan M. Sanders, Hasan's attorney, declined comment on behalf of his client.
Still, Nuon has filed a lawsuit seeking damages for the punctured artery, as well as for emotional distress and loss of earnings.
"I feel violated, manipulated and betrayed," Nuon said.
Nuon's attorney, Andres Beregovich, who represents several clients across the U.S. who are suing Florida doctors and clinics, said Florida so far has been lax in policing plastic surgeons and the clinics they operate out of.
"Florida promotes and supports medical tourism," Beregovich said. "They need to have laws in place that will protect the consumer when something, God forbid, happens."
Rosemary Diaz of Orlando said she felt similarly angry after a botched implant replacement procedure left her breasts disfigured. She alleges that the doctor resized both of her areola even though she only asked for one to be resized. She suffered vomiting and bleeding after the surgery. In a follow-up procedure, Diaz said the doctor performed an unauthorized breast lift. She also is seeking damages from a clinic and surgeon who had no medical liability insurance.
"I felt 100 percent violated," the 37-year-old said. "It's like waking up to a part of your body that is not the same."
Nuon said her surgery left her disfigured and scarred and advises women to see beyond flashy social media campaigns and conduct deep investigations into a physician's background. Although she is dissatisfied with her appearance, she said she's unwilling to go under the knife again.
"My life is so much more important than trying to fix it," she said.