The vast majority operate safely, but deaths and disfigurements have prompted crackdowns. California lawmakers passed measures last month aimed at misleading advertising and procedures conducted in outpatient settings. New Jersey instituted less-stringent regulations. And new laws in Florida will require any doctor doing surgery in office to register with the state and report unsuccessful outcomes, just as hospitals must do.
"That's been one of the problems all over the country. People don't know what's happening out there because there are no reports on adverse incidents," says Tanya Williams, director of Florida's Board of Medicine.
Charging from $3,000 to $4,000 per surgery, Silvestre operated in an office at the less-trendy end of Lincoln Road Mall - the end with the cheap shoe stores rather than the chic galleries of a few blocks west. His business came by word-of-mouth. He had diplomas on the walls and a doctor's reassuring manner, alleged victims say.
In South Beach's nightclubs and gyms, where gorgeous bodies are on display, the Silvestre case has been endlessly dissected. Cosmetic surgery is both common and commonly discussed here. The local phone book has nearly nine pages of listings for plastic surgeons - three times the number for pediatricians.
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