Feb 24

I have mostly watched medical tourism from afar for several years, not participating in the so-called industry other than to continue to recommend my own dentists and to advise family, friends, acquaintances and strangers about how and when to access medical and dental care outside of the country.

I do know what I’m talking about — but I choose not to say much, very often. I have concerns about the Americanization of health care overseas, and also about general quality of care as more and more providers seek patients/clients/customers. A decade ago, when I first wrote about medical travel, I think it was actually easier for me to figure out an individualized approach if only because the doctors and dentists who were experienced were directly accessible. Now — that seems to be less prevalent.

I don’t know when or if I will update Beauty from Afar, the book, which is now eight years old, beyond the chapters on this site. It is available from online sellers for just a few dollars, at this point. I make nothing from it, which is fine. But I have moved on to other projects.

Back in the day — it was very exciting for me to be on NPR Talk of the Nation (Medical Tourism, and the Costs of Traveling for Care) and on ABC News (Money Matters, Special Report on Medical Tourism). If you’re interested in the topic — I think my book is still worth reading and those links are worth visiting. I’m leaving this site up — anywhere from 20-100 people a day still seem to want to take a look — but I’ll only be poking my head in episodically.

If you want to know what I’m up to, visit me at jeffschult.com … I am resolved to be there.


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Nov 12

I’m back where I started this week — Prisma Dental in Costa Rica. Good times.

I’ve wondered if I’ll ever get around to posting the rest of Beauty from Afar online — seems I’ve been stuck in Chapter 5 since the invention of tooth paste — but if anything will get me motivated again, it’s visiting with my dentists Josef and Telma, still up to their wrists daily with dental implants and crowns and smile restorations and such. They’re great people and I’d love them even if they weren’t my dentists.

Maybe I’ll add some photos and video later in the week.

If anyone asks, I’ve recently moved to Brookfield, Conn., and am commuting part-time to a job in New York City …


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Aug 16

Medical travel for major dental work, plastic surgery and other medical care continues to be in the news in the United States. On Friday evening, I was interviewed about the subject on the Your Time with Kim syndicated talk radio program.

You can listen to it here:

Kim Iverson — Jeff Schult interview on medical tourism

(Link fixed, Feb. 2015)

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Nov 15

Chapter 4 Page 6 | Other Cosmetic Procedures

Hair Implants

Hair implants involves the transplantation of thousands of tiny patches of hair-bearing scalp tissue to the balding areas of the head. Results vary from patient to patient and are by no means guaranteed. Though Costa Rica’s Dr. Cohen mentioned that he does not see as many hair transplant patients as he once did because transplantation has become less expensive in the United States, research indicates that there is still a substantial “overseas discount” of 25 percent to 50 percent. Hair transplant prices are generally based on the number of hair/skin grafts done. U.S. prices range upwards from about $3,000, depending on the extent of the work.

Ear Pinning (Otoplasty)

Prior to research, I’d had no idea that fixing protruding ears was a popular cosmetic procedure. Otoplasty is the general term for cosmetically enhancing the appearance of the ears. Roughly 25,000 U.S. residents underwent some sort of cosmetic surgery of the ear in 2004, according to ASPS statistics. Prices in the United States range from $2,500 to $4,000; prices abroad range from $800 to $1,500.

Weight Loss Surgery (Bariatric Surgery)

Bariatric surgery that is designed to cause significant weight loss is increasingly popular in the United States. The surgery alters the digestive process, either restricting the amount of food the stomach can hold or causing food not to be absorbed. There are several different procedures and techniques with more continuing to evolve. The intestinal bypass was the first and is still the most common in the United States.

There are eight recognized types of bariatric surgery including laproscopic bariatric surgery, bariatric bypass surgery, and vertical banded gastroplasty (VBG). Bariatric surgery is considered a drastic lifesaving solution for a major health problem. In this instance, it is covered by some medical insurance plans and prospective patients in the United States who have health insurance are generally well-advised to explore the option with their insurer. However, many patients do go abroad to afford the surgery. For those interested in bariatric surgery and wondering where to start, I recommend without qualification the Obesity Help website (www.obesity-help.com), an online support group that boasts more than 200,000 members.

Dental Procedures and Appliances

My personal experience with going abroad for costmetic surgery is limited to dental work. It is ironic, perhaps, I did far less research prior to going to Costa Rica for full-mouth reconstruction than I now recommend that others do before making a decision. Readers interested in the extensive details of my own experience should visit my Web site Beauty from Afar (www.beautyfromafar.com).  Since having my work done in 2004, I have recommended at least dozens of patients to Drs. Cordero and Rubinstein at Prisma Dental in Costa Rica.  Invariably, however, I point out that there are other excellent dentists in Costa Rica and around the world, and I urge prospective dental patients to thoroughly explore their options at home and abroad before making a decision.

Dental insurance in the United States rarely covers the full cost of extensive cosmetic work. There is certainly little reason to go abroad for routine dental work. However, when the prospective out-of-pocket expense for wanted or needed dental work climbs into the thousands of dollars, going overseas can become the pragmatic option.

Generally, dental patients do not require extended convalescence abroad, or significant immediate after-care and support, as do medical surgery patients. Costs range widely based on various dental proceedures, but my general statement that patients can expect to save from 40 to 75 percent on medical services abroad holds true for dental work. Many cosmetic surgery patients abroad opt to get at least minor cosmetic dental work, such as teeth whitening, done on the same trip.



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Sep 28

Reading back over today’s segment:

Dear Dr. Rubinstein …

… made me remember just how nervous I was, originally — just how strange it felt — in 2004, to head off to Costa Rica to spend thousands of dollars to get my teeth fixed. Even though, as I briefly mentioned, I’m no stranger to travel or adventures. At 20, I’d run off to South Africa for a job, knowing only one person there, and I had an amazing time there. I’ve called it the best year of my life, out of many good ones …

But anyway, going to Costa Rica for dental work was also a life-changing experience for me, because,  besides getting my smile back, better than ever, I never would have gotten to write Beauty from Afar if I hadn’t gone. I still like the magazine piece I wrote about the trip better than how I handled it in the book but that’s because it was more concentrated, more detailed, more about … well, me.

In the book, Prisma Dental comes up a few times. I sort of deliberately broke up the experience. It comes here, in Chapter 1, just by way of telling readers how I came to be a medical traveler, a dental tourist. There is much more about Prisma and Drs. Rubinstein and Cordero later, in the chapter about Costa Rica.

I was in Costa Rica in June and met a gentleman from Cheshire, Conn., who had read my original article about getting my new smile back in 2004, and had finally, in 2009, decided to do what I had done. I asked him if he felt as though the article had been accurate, had prepared him for his own journal and dental work. He said that it absolutely had. So I felt good about that.

We’re up to page 32 of the book, by the way.

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Sep 28

Chapter 1 Page 6 | Dear Dr. Rubinstein …

When I contemplated traveling abroad for dental work, it took me a month of research on the Internet before I was finally ready to make a direct inquiry. A month — and that was just to feel confident about choosing a country from which I would select a dentist! I picked Costa Rica over Thailand because proximity to the United States played a big role in my thinking. “I don’t want to go too far if I don’t have to.” This, from someone who had thought nothing of taking off for Africa for a year, at age 20. (Which is a whole ‘nuther story.)

There was a wealth of information available on dentists and dentistry in Costa Rica at the time, more so than anyplace else (except for the United States, of course).  I wrote to the aforementioned Telma Rubinstein, D.D.S., of Prisma Dental in San Jose, Costa Rica, on February 16, 2004.  Prisma had a Web site.  I confess I chose them as first contact because they had a female dentist. I felt sure I would have a lot of questions,  and my instinct was that a woman would be more likely to be patient with me.

Dear Dr. Rubinstein,

I am writing to inquire about having cosmetic dental work done at your practice in Costa Rica.

My dentist here in Connecticut, two years ago, had taken a mold of my bite and recommended, as I recall, eight or 12 porcelain crowns. I must say I concur with his opinion. My teeth are quite worn and small, at 47 years of age. I also have a badly chipped front tooth. I could send you digital photographs, if you’d prefer to see that way.

My dental insurance at the time would not cover any of the considerable fee, however. I now find myself without dental insurance at all, but I recently heard that practices such as yours could do a fine job on the work I require at a significant savings. What can you tell me beyond what I have read on the Internet? How would we proceed?

Thank you for your time,

Jeff Schult

I never had to write to another dentist in Costa Rica or elsewhere. During the next 6 weeks, I peppered Telma, as she asked me to call her, with more than 20 e-mails filled with questions about her credentials and experience,  my teeth, prices, travel and accommodations, and Costa Rica in general, and she patiently answered every one.

Still, I didn’t really make up my mind until after I asked her if she had any problems with my writing a magazine article about my experience.  She had no qualms at all, and I took that as a sign of her complete confidence in her ability. I realized that I already knew more about Telma Rubinstein than I had ever bothered finding out about any doctor or dentist who had treated me in the United States.  Later, I felt kind of bad about having been so difficult.  “I put you through the wringer,”  I told her when we finally met. She laughed. I had been easy, she said, compared to many of her other prospective patients from the United States: “Some of them, Jeff, they ask me so many questions that I feel I have been stripped naked!” Since then, I have heard similar stories from doctors, dentists, and surgeons around the world who treat patients from the United States.

As I’ve already stated,  I believe that the United States has the highest quality of medical care in the world, the most and the best medical facilities, the highest level of technology, and the most stringent regulations and standards. Does that mean that all doctors and dentists and surgeons in the United States are better than all of their peers abroad, or even that most of them are?  I do not think even the most xenophobic member of the American Medical Association (AMA) would dare make such an assertion in intelligent company.  Even the most vociferous critics of medical tourism acknowledge that there are many fine doctors, surgeons, and dentists around the world working in facilities that are as modern as anything in the United States.

But the official party line of the medical establishment in the United States is:  Traveling abroad for surgery is generally far more risky than having surgery in the United States. Bad things are far more likely to happen. You shouldn’t do it.

The recent history of medical tourism in the United States suggests that more and more prospective patients for elective surgery, particularly candidates for cosmetic and plastic surgery, are rejecting the medical establishment’s No. 1 considered wisdom in this matter.  By far, the No. 1 reason they are doing so is cost. Aesthetic and cosmetic surgeries are elective services, paid for out-of-pocket by patients. Wealthy patients are not so price-sensitive, but procedures are no longer for just the well-to-do.

The demand for aesthetic and plastic surgery has skyrocketed in the United States and around the world.  U.S. surgeons performed three times more face-lifts in 2004 than in 1992;  nearly eight times as many people had liposuction. (5) A whole new business in so-called minimally invasive procedures (like Botox and injectible fillers) was born in the space of a few years. In 2004, U.S. cosmetic plastic surgeons performed more than 9.2 million separate procedures.  The most visible sign of the broad acceptance of aesthetic and cosmetic surgery in mainstream society was the emergence of several popular (and controversial) reality television shows such as Dr. 90210, The Swan, and Extreme Makeover. The Swan and Extreme Makeover were short-lived, but that they made it to television at all was a sure sign that plastic surgery is no longer seen as just for the affluent.  Americans of more modest means also want to look good — but price matters.

(5) American Society of Plastic Surgeons Statistics. at www.plasticsurgery.org.



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Sep 23

When it come to writing about places to which I have traveled, I have almost always chosen to write about the people I encounter and what it is like to be *me* when I travel. This is perhaps remarkably egocentric, yet I don’t see an honest way out of it. People can have wildly different experiences from a trip that is supposed to be more or less the same for anyone. I imagine that most people have very similar trips to DisneyWorld, for example. Yet my first visit there was on a belated honeymoon, nearly a quarter of a century ago; and my strongest recollection of the trip is a fabulously nonsensical fight I had with my then-wife over a game of miniature golf. This is not Disney’s fault; for all that they try to homogenize the American Vacation Experience, not everyone leaves with the intended memories.

Anyway —  I tried to make Beauty from Afar as much a book about compelling personal stories as it is a general guide to traveling overseas for cosmetic surgery, dentistry and medical care. So Chapter 1 starts out at a breakfast table at Las Cumbres Inn in Costa Rica, with patients sharing experiences, before I head in to Prisma Dental for a long second day with my mouth open.

Chapter 1 | Medical Tourism: Here, There and Everywhere

We’re up to Page 23 of the actual book, out of 220.

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Sep 23

Chapter 1 Page 1  | Medical Tourism: Here, There and Everywhere

More than 100,000 United States residents leave the country for
cosmetic procedures every year. Where do they go? Wherever they like …

It is April, 2004, and I am having breakfast with a few new friends at Las Cumbres Inn outside San Jose, Costa Rica. Sandy, perhaps 45, a Californian, is nearly recovered from her nips and tucks, and is contemplating having her teeth bleached. “Might as well do it while I’m here,” she mutters, knowing she’ll be heading home in a few days.

Vicki, also forty-something, and a self-described vagabond, wears dark glasses to cover the swelling from the work done on her still-healing eyes. She is a U.S. citizen who has lived frugally but comfortably in a Costa Rican village for most of the past 11 years. She is thinking she is going to need to get a job again, soon.

Nina looks like she had been in a car wreck. She has had a face-lift, a neck lift, a “medium chemical peel,” and perhaps some other “work” that does not fix in my memory. She shows me the estimate she had gotten from a cosmetic surgeon in New York City for the major procedures she wanted. It came to $22,420: $18,000 for the face and neck lift, $2,100 for an operating room fee, $1,320 for post-operative nursing care, and $1,000 for anesthesia. Her entire bill in Costa Rica will come to $5,700, she says. On this morning, she wonders if she will ever again look anything like she had looked before, let alone better or younger. We assure her that she will, and later, we are proven right.

Me? I tell Sandy about my dentists, Josef Cordero, D.D.S., and Telma Rubinstein, D.D.S., childhood sweethearts who went to college and dental school together, got married, and have spent more than 20 years building an international practice. Sandy decides to go with me in the van that day to see if they can squeeze her in for a teeth bleaching.

They can. We all feel pretty smart, in the way people do who have a shared secret.




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Jun 25

I’m Jeff Schult. I wrote Beauty from Afar: A Medical Tourist’s Guide to Affordable and Quality Cosmetic Care Outside the U.S. in 2005 and 2006; it was published by Stewart, Tabori & Chang, an imprint of Abrams Books, New York, N.Y., in July 2006. BFA, as I came to call it for short, was the first book about medical travel and tourism published in the United States. I became known as something of an expert on the subject of medical travel and made a small career out of that. The book sold thousands of copies.

Unfortunately, it did not sell the tens of thousands of copies that might have earned it a second printing and, in July 2009, the rights to the book reverted to me. I have no regrets. I did a good job on the book and therefore, most likely, will get to write another one — and I am working on that.

In the meantime, however — what to do with BFA? You can still buy the book itself online, new or used … but it will become increasingly unavailable as time goes on. The logical thing to do is to make it available as an e-book, and that I will do.

For now (Jan. 2013) about the first third of the book is online here. Eventually, the full text of Beauty from Afar will become available, paragraph by paragraph, chapter by chapter, on this web site. This way, I can comment on it myself and update where necessary. Though I think the book holds up well over time, inevitably I will have more to say.

Here is what I had to say when the book was first published:

Since I wrote the book, I have consulted for various medical travel companies both in the U.S. and abroad; I was editor of a medical travel newsletter;  and I have conceived, executed and written web sites and blogs for medical travel companies and web sites. I am webmaster and editor of the Prisma Dental blog for my Costa Rican dentists, and their site has become the most trafficked site of any dental practitioner in the world, according to Alexa rankings.

I am available for work. I’m less expensive than you might think, but I’m not cheap.

I expect that this book site will, in time, become one of the most popular sites about medical tourism on the web. I am open to advertising and partnership ideas. You can contact me at:

jss at beautyfromafar dot com.

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