Every year tourists descend upon Guadalajara, often referred to as the most "Mexican" of Mexican cities, where the crooning of mariachi music originated.
But first-time visitor Jennifer Guerra, from Houston, pays no attention to Mexico's most celebrated symbol. She's here for one reason alone. "I'm getting a 'tummy tuck' tomorrow," she says, nervously.
Indeed, Guadalajara, Mexico's second-biggest city, has become a new "in" place for Americans like Ms. Guerra seeking plastic surgery, fuelled by the same cheap prices that have given rise to the growing phenomenon of medical tourism worldwide, word of mouth, and tour operators that make planning for surgery south of the border as simple as booking a vacation.
"The number of those traveling [outside the US for plastic surgery] has grown dramatically," says Tony Staffieri, marketing and public relations manager for International Society of Aesthetic Plastic Surgery (ISAPS). "Mexico is one of the fastest-growing markets in the world."
Guadalajara's proximity to tourist spots like Puerto Vallarta and Lake Chapala, where one of the largest American retirement communities resides in Mexico, has helped boost its appeal as a place for Americans to seek plastic surgery.
While ISAPS could not confirm the ratio, those in Guadalajara like to boast that the city has more certified plastic surgeons per capita anywhere in Latin America outside Rio de Janeiro. Guadalajara also has a public hospital that gives poor people access to plastic surgery at discounted rates, says plastic surgeon Jose Guerrerosantos.
"We say that no one is unattractive in Guadalajara," jokes Martha Venegas, a resident here. "There are poor people, but no ugly ones."
On a recent afternoon, Jose Amezcua fights through rush-hour traffic in Guadalajara on his way to visit Guerra and her sister-in-law. Mr. Amezcua spent his professional life in tourism, until he moved into the plastic surgery industry six years ago: Today he is the driver for Air Lift Inc., a North Carolina-based company that connects women who want liposuction or an eyelift with a bilingual driver, a room and all meals at a private home, and a surgeon in Guadalajara.
He picks them up from the airport, takes them to their initial appointments with the doctor, and drives them home after surgery. "The women are often nervous," he says, "but these two at least understand some Spanish."
When he arrives at their bed-and-breakfast, Guerra is sitting at the kitchen table. "I was always scared to go to Mexico," says Guerra, rattling off the botched jobs she's heard of. But Imelda Baldini, who provides the shelter for Air Lift Inc., dotes over Guerra in her home. The mother of four grown children, she giggles over her own fussiness. "My children are gone," explains Ms. Baldini, who serves her patients food in bed when they don't feel well. "I think about if I went to another country for surgery, I would want a parent there."
"She's better than a mom," says Guerra.
As it is for other types of medical tourism, to places as far away as India and Thailand, price is the driving factor in going abroad for care. Jose Guerrerosantos, who is doing Guerra's surgery, says that a "tummy tuck" that costs $4,000 in Mexico would be $15,000 in the US. At least three Americans a month receive his care, he says.
Tour operators like Air Lift Inc. make the process much easier. Beverly McCarter has been running the company since 2001, and says since then some 600 Americans have traveled to Guadalajara for the firm's services. Her company works exclusively with Dr. Guerrosantos, a widely respected doctor who trained in the US. The public hospital bears his name, and he does reconstructive surgery for free there.
He says Guadalajara is a beauty-conscious town. At the public hospital, patients can receive cosmetic surgery for a reduced fee. And of six surgeries he does a week, five are for aesthetic purposes.
Ms. McCarter says her tour differs from other plastic surgery operators because they don't market this as a holiday. "You see some of the companies on the web, and photos of women with Margaritas in their hands," she says, scoffing. "This is serious."
Leaving the US for health needs is not new, but as US medical costs soar and insurance remains out of reach for many, and elective care like face lifts become less taboo, organizations like ISAPS are moving to issue guidelines on medical tourism and warn patients of risks.
Although ISAPS has members in many countries and does not endorse or condone medical tourism, Mr. Staffieri urges patients to consider the risks.
In some cases tour operators are not legitimate and connect patients with unqualified doctors.
In other cases, he says, patients run into problems if follow-up care is needed.
His organization is currently carrying out a survey to get a better glimpse of who is going where, and for what. "Save money on soap power," Staffieri says, "not on a new face."
Still, the trend is not expected to let up any time soon. Guerra says a handful of friends back in Houston are curiously waiting in the wings – to see how she comes home, and whether they'll be the next to "book" a surgery.
It's no vacation. "I wasn't planning on sitting by a pool," she says. "But this is better."