This report originally aired on June 24, 2005.
She had sweated and struggled for years, but Tammy Vredenburg couldn't seem to win the battle of the bulge. Having given birth to six children, including triplets, she said her body had been through the wringer.
"I had a C-section when I was 17, and it was done vertically. So, I have what looks like a double loaf of bread on the front of my stomach," she told "20/20's" Deborah Roberts.
Her husband, a Coast Guard officer, said he loved her as she was, but it was not enough for Vredenburg, 38. "I think that he'll love me just the way that I am even more when I love myself more," she said.
Lori Brown and her sister Linda Firth, from Nashville, Tenn., weren't happy with their bodies either.
Like lots of women their ages, Brown and Firth, who were 40 and 48 years old when "20/20" met them, wrestled with self-image and weight.
By adulthood, Brown's weight had ballooned to nearly 300 pounds. Four years before we met her, she had gastric bypass surgery, which was covered by her insurance. She dropped an astounding 119 pounds, but she still had lots of excess skin. So, she began looking into cosmetic surgery.
Dauntingly High Prices at Home
After Brown heard a quote of $35,000 from a Tennessee plastic surgeon, the procedure was out of the question. She was an office assistant — she couldn't afford it.
Firth, a dog groomer, was also saddled with stomach flab since she had given birth 30 years earlier.
Though the two sisters had never met Vredenburg, and they lived hundreds of miles apart, the women wound up on the same Internet site — as they surfed the Web to find affordable cosmetic surgery prices.
What they found online opened up a whole new world of possibilities.
They all learned that Costa Rica — the land of volcanoes, beaches, rain forests — was also the land of low-priced cosmetic surgery. The country is now one of the hottest spots for average Americans looking for an extreme makeover.
Just a quick plane ride away from many American cities, Costa Rica offers what America cannot: inexpensive medical care and affordable recovery resorts. That was all the three women needed to see.
"It's so much cheaper there, I'm going to get some lipo done. And before you know it, well, I think I'll get a breast augmentation. What the heck. I'm there anyways," Firth said.
And because Firth had brought her sister, the doctor had offered a discount.
Brown said she planned to have a thigh lift, a tummy tuck, an arm lift and a breast lift with implants — all for $7,000. That's about a quarter of what that laundry list of procedures would cost in the United States.
The women checked the references of the surgeons who were performing the procedures — Luis Da Cruz and Federico Macaya — and felt confident about the doctors' credentials.
Still, even the best credentials can't guarantee perfect results. News reports describe horror stories abroad and in the United States. "20/20" has reported a case of one American woman who died from cosmetic surgery.
But danger was the last thing on the minds of the three women, and they were soon off to sunny Costa Rica to fulfill their beauty dreams.
Many people worry that if cosmetic surgery is so much cheaper in Costa Rica, that it has to be substandard, but Da Cruz, who worked on the two sisters, assures his patients they'll receive quality care.
"I always say it's not that here is cheap. It's that outside in some places it's too expensive," he said.
Less-Than-Perfect Results for One Patient
"20/20" checked in with Vredenburg, Brown and Firth months after their surgeries.
They all felt and looked great, but for Vredenburg it was rough road to recovery after surgery. A painful infection set in soon after she got home to Savannah, Ga. "It was considered you know life threatening at that point and I was beside myself. It was kind of like, 'What have I done to myself?'" she said.
Though it seemed like such a quick plane ride when she was healthy, Costa Rica and her doctor now felt like a world away. She turned to a local emergency room.
"I felt I was treated pretty badly because I immediately told them that I had had surgery out of the country. And it was, 'Oh, so that's what you did? Well that's why you're in trouble,'" she told Roberts.
In fact, it turned out that Vredenburg had a history of infections after surgery, even at home. After a dose of antibiotics she began healing.
But there were other problems. Her laundry list of body work — a tummy tuck, liposuction, a breast lift with implants and eyelid surgery — didn't exactly give her that Barbie doll look she wanted.
"The left breast kind of is saggy, points down, is kind of misshapen, and it's kind of got a bump on this side," she said. She found some comfort though in her tummy tuck. Her unattractive C-section scar is now gone. Still, Vredenburg hasn't healed as well as she'd hoped.
"20/20" took Vredenburg to Paul Lorenc, a top plastic surgeon in New York, to have her results evaluated. He was not impressed with her results. "Almost each one of the procedures would benefit from secondary surgery. That's unusual," Lorenc said.
But overall, Vredenburg felt her bargain cosmetic surgery had been worth it. She said she was considering having secondary surgery, and considering going back to her Costa Rican surgeon, who had offered to fix everything free of charge.
Lorenc advised her to wait before making a decision. He said it took a full year for scars to settle. But, Vredenburg, who lives on a military budget, insisted her best hope was to go for the free fix-up.
She said she couldn't take a chance with an American doctor. "I can't financially. I have no guarantee if I spent $25,000 in the United States to do it, that it wouldn't have gone wrong as well," she said.
Lorenc and other American doctors warn, however, that dealing with surgical complications when your doctor is thousands of miles away can be tricky.
"Beware of a bargain when it comes to surgery and your health," Lorenc said.
Finding Bright Spots
"20/20" reached Vredenburg's surgeon, Federico Macaya, in Costa Rica after she returned for more surgery, and talked to him about her problems. In spite of Vredenburg's complications, he said her surgery had been done well. "It's not a botched surgery. Plastic surgery's not magic. We have limitations," he said.
He added that in 25 years of practice and 1,000 patients, Vredenburg was his first patient to require such serious repair. He also said he fully expected her to heal properly with time.
Even Vredenburg was determined to find a bright spot. She sent us a photo two months after her surgery and says she's reasonably happy with her new appearance, especially her flatter stomach and softer eyes.
Brown and Firth were generally happy with their results as well — though Firth wished her breast enlargement was not quite so large.
How would the women respond to people who say that plastic surgery is superficial and that they should learn to be happy with themselves?
Brown said, "If it's something that makes you feel better, why not? It's like going out and buying a new car. Why drive a Pinto if you can look like a Mercedes?"