Sun, sea - and surgery
Cape Town for face-lifts, Brazil for firmer bottoms . . . On holiday
we're now checking into a clinic as well as a hotel.
It's cheaper than at home, but is it safe?
Sophie Campbell reports
'OH, I'd forgotten how beautiful it is! Even now, all these years later, it just breaks your heart." Sixty-nine-year-old Eliza Cotwell is gazing out of the car window at a city of world-class beauty. Above her, an expensive coating of houses and apartments peters out on the rocky flank of Table Mountain.
Perfect posteriors: more and more people are having cosmetic surgery on their holidays
On either side are hibiscus and magnolia, creamy stucco buildings and lawn sprinklers catching rainbows in the sun. Five minutes ahead are the deep leather armchairs, china coffee cups and warm receptionists' smiles of the Cape Town clinic in which she is about to have a five-and-a-half-hour operation.
The operation is to revamp her looks, restoring them to what they were around the year 1990. No, not revamp. Freshen. We are now in a world where blunt descriptives - cut, burn, break, bruise, twist, swell - are replaced by soothing bedside murmurs: lifting, smoothing, rotating, augmenting, shaping. We freshen rather than change, invigorate rather than improve. A whole new landscape of possibilities is opening up. Or, rather, blossoming.
Two highly skilled surgeons will make incisions behind her ears, peel the skin back, perform a delicate tautening of the tracery of muscles below, and take up the surface slack with almost invisible stitches. They will also evaporate the water from the cells around her mouth with a laser, removing the wrinkles that cause lipstick bleed and age a woman unnecessarily, leaving her with the equivalent of third-degree burns.
Eliza knows all this and is delighted. She lived in South Africa for 20 years and misses it. She has fond memories of a tummy tuck in Durban in the 1970s that left her with a stomach "as flat as a plank" and was, to her mind, one of the best things she ever did. She has researched the possibilities - and the dangers - diligently before coming.
When I called her in England to ask if I could report on her procedure (procedure is another one - nobody says operation), I was expecting a secretive neurotic. Instead I found a warm and funny woman ("There are risks, you know - I could end up looking like a gargoyle") who had lied prodigiously to her adult children, family and friends about where she was going. A shopping trip to Spain, I think she said. The only person who knew was her partner of many years, Richard. "It's partly for him, but mostly for me," she said, over dinner before the operation. "I'm really doing it for myself."
It has to be the most hedonistic illustration of the global economy. A steadily growing trickle of British women - and a few men - armed with a strong pound and in diligent pursuit of perfection, are shopping around the world for elective surgery. Face-lifts in Los Angeles. Bottoms in Brazil. In a year when we are expected as a nation to spend more than £200 million on cosmetic surgery, more and more people are choosing to combine it with a holiday. Which means that, assuming all goes well, not only do you come back looking and feeling great, but most people will never even realise you've had it done.
The phenomenon not only reflects the high cost of surgery at home but the perceived expertise of certain countries in certain areas. India is apparently tops for eye surgery. Poland, Denmark and Hungary are good for teeth. Thailand leads the way in the tweaking - or converting - of sexual organs. Los Angeles, being full of actors, is good at almost everything.
Prospective patients should beware, though: there are cowboys in every country who can wreak havoc with a scalpel. And one culture's idea of beauty may be another's idea of hell; Californian teeth, for example, look weird outside California, even on Californians, and Copacabana buttocks might look odd on Blackpool Beach.
South Africa is a particular centre of excellence because it not only has superb surgeons and clinics, a population largely fluent in English and a minor time change from the UK; it also has dozens of five-star hotels, game parks, winelands and beaches, and a spectacularly weak currency.
"First World infrastructure at Third World prices," as one surgeon observed drily, "the perfect package."
Several companies have spotted the niche; out in front is Surgeon & Safari, run by Lorraine Melvill, a Johannesburg resident, which has received extensive coverage in Britain. Eliza read about it in Woman's Own. Twenty-seven-year-old Carol (who, as Eliza's face is being freshened in Cape Town, is on the slab in Johannesburg having a couple of implants slipped beneath her breasts and a belt of fat removed from her stomach) saw it in the fashion magazine Glamour. Lorraine sends you a medical questionnaire, arranges your flights and hotel, liaises with the surgeons, picks you up at the airport and, perhaps most importantly, holds your hand throughout the whole thing.
Afterwards, there is the tourism. Stellenbosch wine estates? No problem. The Blue Train? Fine. She regularly sends people to a game lodge in the Waterberg Mountains, three hours' drive from Johannesburg, arranges township and garden tours, opera visits to Spier - Cape Town's Glyndebourne - and, of course, shopping. With nearly 16 rand to the pound, lots and lots of shopping.
For both Eliza and Carol the cost of return flights, 10 nights in the country's best hotels, pre- and post-operative consultations, surgery, after-care and most food was the same as the cost of surgery and one night in a clinic at home. They paid £6,500 and £5,500 respectively, not counting any excursions and purchases.
There is now half an hour to go before the operation and Eliza's blood pressure is high. The surgeons come in for a final chat, all tans and smiles. Lionel Jedeikin cups her face in his hands, moving it this way and that. Shane Barker sets to work with a purple felt pen ("Shane?" said one Capetonian I met during my stay, "he's wonderful! And such a good seamstress").
The anaesthetist appears - "I scared the pants off them," Eliza had told me with relish, "because I had a cardiac arrest under a general once" - and the room seems filled with tannned men in their 40s, just back from their long summer breaks. My blood pressure would have been pretty high too.
What bothers me, strolling later among the glittering blues and whites of Cape Town's Waterfront development and watching the Robben Island catamaran plough back and forth across Table Bay, is why these women feel they need surgery. Eliza is a slim, well-turned out woman with a tip-tilted nose and a blonde pageboy haircut who already looks far younger than her age. What has happened to us that the external has come to matter so much? (Then on my open-topped bus tour they point out the biggest hospital in South Africa, which deals with the other local medical boom, Aids, and I realise that it is indeed a mad, mad world.)
"You have to be realistic," says Lionel, looking tired after the operation. He is talking about plastic surgery and patient expectations, often a tricky combination. "It depends on your age, how much sun you've had, your genetic history, whether you smoke. Do your ears stick out? Have you got a receding chin?"
In other words, there is only so much they can do. And it is possible that you could fill in your questionnaire, talk to your surgeon, fly to Africa and find that you are unsuitable for surgery. He also reserves the right to ground you. "I had one guy who had an eye-lift and went shark diving 10 days later. But if I want you to stay in your hotel room and rest, you have to accept that."
Your hotel room, then, is important. Eliza, who unexpectedly needs another minor op and spends two nights instead of one in the clinic (at extra cost), eventually returns to a huge, airy room overlooking the pool at the five-star Mount Nelson. She opens the door wearing a cotton-wool beard and moustache, like Father Christmas. The face-lift is invisible; perfect. The lasered area is blazing red and painful. On the table is the copy of Kathy Lette's Nip 'n' Tuck that I gave her as a present. She has plenty of time for reading and watching television: she's not going anywhere. "It's awful," she says. "People stare at you when you walk around."
On the day I fly up to Johannesburg to meet Carol, Eliza decides to move into a small, family-run guesthouse, also on the company's books. She is lonely and too self-conscious to stroll in the hotel's 18th-century gardens or to tuck into cakes and scones at its renowned daily English tea.
Judy, Surgeon & Safari's Cape Town "nanny", squares it with the hotel, arranges the move, negotiates the price for the extra op at the clinic and generally takes the worry away. Eliza cannot speak of her too highly.
Up in Johannesburg, meanwhile, Carol has also needed pastoral support. Her new breasts are swollen and seem terrifyingly huge, her stomach is bruised and does not feel much flatter, and she has to wear a corpse-coloured surgical corset, which is a blow to the self-esteem.
Lorraine has arranged a reassuring chat on the phone with her surgeon, Rick van der Poel. Alwyn, the guest relations manager at the five-star Westcliff, generally considered to be the city's best hotel, has spent an hour or two cheering her up. By the time I meet her, she looks great.
"The thing is, I'm a size 14 anyway, but I was completely flat-chested. I've been wanting to have it done for years, really," she says, "but it's quite a major change to deal with, it's quite a shock."
Unlike Eliza, Carol can go out. But she is used to schlepping around with a backpack, so being islanded in luxury in a city with a scary reputation for crime is disorientating.
For most people, however, the Westcliff is the ultimate place to convalesce after cosmetic surgery. Built Mediterranean style, on a hill overlooking the forested city zoo, it is laid out in a way that ensures you can be driven with absolute discretion to your room.
Post-operative spa treatments can be done privately. The room service menu features comfort food. And the staff are used to guests suddenly appearing in headscarves and dark glasses.
Johannesburg is a world away from Cape Town: seaside brightness replaced by warm greens and red earth and a surprisingly high altitude - more than 6,000ft above sea level. Carol and I went to the casino one evening and spent a day in Soweto, buying mangoes in the market and seeing some of the great landmarks of recent South African history.
"If you drove into an estate at home with a busload of tourists," she told the tour leader, "well, I hate to think what would happen."
As tourists, neither of us found the atmosphere threatening; electric fences ran discreetly along the top of bright walls and most guard dogs slavered at the front and wagged at the back.
Carol went shopping in the hip suburb of Melville, got some new clothes and began to feel better about things. I, meanwhile, was interviewing surgeons. Clinic after pristine clinic, flowered suburb after flowered suburb; eye surgeons, orthopaedic surgeons, dental surgeons.
Before-and-after pictures of bloodhound wrinkles ironed away, jowls tweaked, cheekbones redefined. Diagrams of eyeballs and colour guides for teeth
(like paint cards with incisors along the edge). A dental surgeon told me my fillings were hiding decay. Someone else suggested botox for my frown lines. I left feeling so wrinkled, so drab, so European.
On my last day, Carol set off for Sun City. I went to Kingfisher Lodge, in the Waterberg range, where many of Lorraine's clients hole up, going on game drives and watching hippos in the lake. "The last lady looked fantastic," said Michelle, the owner. "She'd had a tummy tuck and, um . . . ?" "Eyelids," supplied Steve, the ranger, who tailors drives - or walks, if customers don't want to bounce around in a Land Cruiser - to individual needs.
"We always ask how was the op," said Michelle. "They're usually really relaxed."
We went out for a game drive, but it was midday and the animals were snoring in the rocks and scrub of the sandstone escarpment. "We do have the Big Five here," said Steve, pointing out lesser fry - swallowtail butterflies, ostriches, springbok, impala, zebra - "which is why a lot of people come - we're not that far from the city."
It seemed a different planet to me. The bush Big Five are leopard, lion, buffalo, rhino and elephant. The city Big Five are face-lift, eye-lift, breast-augmentation, rhinoplasty (nose job) and abdominoplasty (tummy tuck). Nature versus nurture. Animals versus humans. The two worlds were almost impossible to reconcile.
One thing made sense, though. Where else are you going to go for a rhinoplasty but Africa?
Sophie Campbell flew with South African Airways (0870 747 1111, www.flysaa.com). Return flights London-Johannesburg start from £588, plus taxes from £47.70.
From Johannesburg, the safari at Kingfisher Lodge, including two nights' full board, return private transport, games drives and local beverages, cost £620; the Soweto township tour is £38. From Cape Town, the Wineland tour costs £78, the Table Mountain cable car is £10. Further details from the South African tourism information/ brochure line 0870 155 0044.
Eliza: 12 days at the Mount Nelson in Cape Town, £1,866; face-lift and eyelids, £3,415; peri oral laser, £500. Return flights and tourist activities, £719. Total - £6,500.
Carol: 10 days at the Westcliff in Johannesburg £1,466; breast augmentation £1,700; liposuction £1,771. Return flights and tourist activities, £563. Total - £5,500.
Surgeon & Safari (0027 11 463 3154, www.surgeon-and-safari.co.za) will package together the different elements of your cosmetic surgery and holiday, but you pay the surgeons direct. The sample costs above include the services of surgeon, anaesthetist, private clinic, 24-hour nursing, theatre charges and medication, all consultations and administration fees and hotel. They do not include extra surgery needed if something goes wrong. (A serious complication could involve a return visit or further surgery in the UK.)
Surgeon & Safari surgeons fly regularly to London for consultations, which cost £50.
Report filed: 09/03/2002