Why So Many Women Travel to Miami and Die on the Operating Table

When the Miami-Dade Medical Examiner’s office released a report earlier this year that revealed 40-year-old Kizzy London’s cause of death was a fat embolism, it was of no surprise to those who had been following her fatal plastic surgery case and other cases like it. 

In December, London traveled from Baton Rouge, Louisiana, to Miami for a Brazilian Butt Lift procedure. But just as in the case of 25-year-old Ranika Hall from Missouri, 29-year-old Heather Meadows from West Virginia, 32-year-old Maria Christian from Ecuador, and 51-year-old Maribel Cardona from Naples, FL, what may have seemed like a simple plastic surgery procedure would ultimately end in her untimely death.

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London, and the countless other women before her who tragically died on the plastic surgery table or who have been permanently disfigured by botched surgery, was in search of a low-cost fix. At Jolie Plastic Surgery Center in Miami, where her procedure was performed, the BBL surgery specials advertise for thousands less and sometimes even more than half off the average cost for this type of procedure. 

But what London may not have known before she boarded the airplane for sunny South Florida, was that Jolie Plastic Surgery was once named Eres Plastic Surgery, and not long before that, Encore, and before that, Vanity. Owned and operated by the same person, over the course of a few years, the strip-mall clinic continued to change its name following several plastic surgery-related deaths and numerous investigations by the Florida Attorney General’s Office.

Miami plastic surgeon Daniel Careaga, MD says a fat embolism is a rare and severe complication that can happen when injecting fat into the buttocks, but it’s becoming an increasingly occurring trend due to the number of unqualified doctors who are deceiving patients by advertising as plastic surgeons. “During a Brazilian Butt Lift, if the surgeon is not aware of how deep the tip of their instrument is, they can accidentally inject the fat too deep and into a vein, which then allows the fat to travel to the heart and lungs,” he says. “It’s important to emphasize that in South Florida, most of the deaths that have occurred are at the hands of doctors who are not plastic surgeons. Anyone can call themselves a ‘cosmetic surgeon;’ there is no training requirement or board exam needed for you to call yourself that.”

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The Legal Loophole That Allows for Under-qualified Physicians 

Miami general physician Arnaldo Valls, MD, the doctor who performed London’s surgery, studied medicine in Havana, Cuba, and has no record of plastic surgery training to his name. “This doctor is not even board eligible to be certified in any plastic surgery specialty,” says Miami plastic surgeon Adam Rubinstein, MD. “According to the Florida Board of Medicine website, his sole qualification in surgery is a two-month rotation in pediatric surgery. It’s hardly adequate training to be operating on people.”

Based on the latest reviews on sites like RealSelf and Yelp, where many patients chronicle their out-of-state plastic surgery journeys, Dr. Valls is still practicing BBL, tummy tucks and breast augmentations at Jolie. In the state of Florida, any doctor with a valid medical license can legally perform any surgery on any patient who provides consent. “This isn’t just in Florida; this is consistent nationwide,” says Robert Aicher, Esq., the legal counsel for the American Society for Aesthetic Plastic Surgery. “Unlike other jurisdictions like Canada, which actually has plastic surgery separately identified, in the U.S., every medical certificate says physician and surgeon. Technically even psychiatrists are MDs, although they wouldn’t be able to get privileges of course, they’d still be within their legal right to do it. I hate to say buyer beware, but the real expression should be buyer be educated.”

The case of Dr. Valls’s lack of qualifications is not isolated, even within his own practice. Another physician operating alongside him at Jolie, dermatologist Anthony Hasan, MD, is the doctor responsible for Maribel Cardona’s fatal BBL procedure. Although Dr. Hasan was once board-certified (his certification is now inactive) by the American Board of Dermatology, this certification does not guarantee he is qualified to perform tummy tucks, breast augmentations or Brazilian Butt Lifts. “There’s a reason there is plastic surgery training and board-certification,” says Dr. Rubinstein. “You wouldn’t call a plumber to fix an electrical problem and you wouldn’t call an electrician to fix your toilet. If you wouldn’t call a plumber to take a look at your electrical problem, why are you going to a family practitioner or an internist to perform your surgery?”

Jolie Plastic Surgery center is just one of the many clinics that advertise their doctors as cosmetic surgeons, or even more deceptively as plastic surgeons. Their Instagram page boasts almost 10,000 followers with daily posts that advertise unbelievable deals on BBL surgeries that include six nights in a recovery house and rides to and from the airport. For potential patients who perform a quick Internet search,  Real Self shows doctors like Valls and Hasan listed as “Miami Physician” instead of “Miami Plastic Surgeon,” as the site cannot verify their plastic surgery credentials. This slight change of language, however, is misleading to consumers who may not be aware of the disparity in wording.

But even so, as RealSelf user LIONESS92, who flew from Texas to Miami for her BBL, stated in a review of the clinic seven months ago, the word-of-mouth credentials from the clinic and the doctor can sometimes be enough for those seeking a low-cost procedure. Because the intake process for the clinic's out of town patients involves just sending paperwork ahead of time and being given the choice of a few doctors to perform the surgery, most patients don't see their doctors in person until they arrive for their procedure. After inquiring into Dr. Valls’s credentials upon her arrival in Miami, LIONESS92 was still confident in her choice of surgeon despite discovering that he and another doctor merely had medical licenses, but no plastic surgery training.

“I asked how long he has been performing BBL's (10 years was his answer), why did he close his own practice (he claims it was too much maintaining his own practice), and what are my chances of anything going wrong (I did not get a clear answer, but he assured me I will be fine). Now, I am aware of the reputation that the company has which are numerous deaths involving different procedures and other surgeons working there doing unethical practice. However, I made my decision to choose Dr. Valls or Dr. Johnathan Fisher because neither surgeons have any reported deaths and both have licenses. Dr. Valls studied in Cuba and graduated in 1975. Dr. Fisher study at Harvard for physiology and attended another accredited medical school that I cannot remember. Either way I feel I have done extensive research on either doctors and I am confident with the decision I have made despite all the negative things that are out in the media.” —  Real Self Member LIONESS92

Preventing Future BBL Deaths

Dr. Careaga is all-too familiar with these tragedies as he himself has even dealt with the string of what he calls Miami “chop-shops” firsthand. “The worst experience I have ever had was four years ago when a patient came to me for a consultation for a Brazilian Butt Lift despite having paid for the surgery already at a local chop-shop,” he says. “They would not refund her money, so she had no choice but to go through with her surgery there and subsequently died on their operating table. It was a tragic but preventable death.”

The truth is, plastic surgery-related tragedies don’t only happen in Miami. Both Dr. Careaga and Dr. Rubinstein agree that patient education is vital to preventing more casualties that stem from the Wild Wild West mentality of low-cost surgery. “You want to put yourself in the best circumstances for the best results,” says Dr. Rubinstein. “At any time, the most qualified, most experienced surgeon can have a complication. These things can happen and at times its uncontrollable, but when you look at a trend across a certain type of center, you have to ask yourself why these things are happening.”

If you are considering plastic surgery and have been referred to a surgeon by a friend, social media or an internet search, educating yourself and following these steps are imperative. “Look them up in their state health department website. Here, you can confirm if they are licensed physicians and whether or not they've had any disciplinary actions against them,” advises Dr. Careaga. “Visit checkyoursurgeon.com to determine if they are board-certified in plastic surgery,” adds Dr. Rubinstein, “and make sure the facility where your surgery is taking place is certified by an accrediting body of surgical facilities like the Joint Commission and the American Association for Accreditation of Ambulatory Surgery Facilities."

Kizzy London’s case serves as a cautionary tale for the mothers, wives and daughters who continue to fly to Florida for the promise of a “look for less.” Despite the Florida Attorney General’s investigation into the clinic, Jolie remains open, and its RealSelf page shows that the news of London’s death and the many reviews that reveal unsatisfactory BBL results has not stopped others from forging ahead with their surgeries. Without a governing body regulating whether a doctor is qualified to perform certain surgical procedures, the onus is entirely on the patient to do the research themselves. It’s now more important than ever to arm yourself with the proper information before making a decision based solely on price. “Being frugal about a vacation, a car or your clothes is a good thing, but this is not the case for plastic surgery,” says Dr. Careaga.

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