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http://www.nytimes.com/2002/07/20/nyregion/20BOTO.html

More Illegal Botox-Like Injections Suspected

By JACOB H. FRIES

nside their apartment on the East Side of Manhattan and in another in a two-story home in Queens, Iris and Eliezer Fernandez made grand promises — youth, delivered in a series of injections — and generally asked for only a small amount of cash in return, the authorities said. Men and women came to their door seeking fewer wrinkles, pouty lips, larger breasts.

Instead, the authorities said, the patients ended up scarred, disfigured and in most cases hospitalized after the Fernandezes, who held no American medical licenses, injected them with a drug similar to Botox. Ms. Fernandez told investigators she had a dental license in Venezuela, the police said.

The Fernandezes have admitted to two cases of performing medical procedures without a license, and they are suspected in two more, the authorities said. But they are not believed to be the only ones in the city performing the procedure.

In all, the authorities said, nine cases have been reported since mid-June, and in eight of them, those who had undergone the procedure ended up being hospitalized with life-threatening infections. The police said at least two of those were believed to have been performed by a transsexual named Natasha in Washington Heights, but they provided few details on those cases. One investigator said the total number of victims could grow to 50 or even 100.

The cases, and the possibility of scores of victims who have yet to come forward, prompted the police to hold a news conference yesterday with officials from the city's Department of Health and the federal Centers for Disease Control and Prevention. The officials asked others who may have undergone unlicensed procedures to come forward.

One of the couple's patients, Freddy Borges, 47, a sculptor from Venezuela, said he visited them three times from February to April. "When I know it's not just me, that it's many people that have been damaged, my feelings are strong," he said from his apartment in Carroll Gardens, Brooklyn, after leaving St. Vincent's Manhattan Hospital yesterday after a month of treatment. His face was mottled with purple scars. "I will live with the wrinkles," he said, adding that he had to buy a second small refrigerator to store all his medications. "I will never go again" for any cosmetic treatment, he said.

Botox injections, in which the neurotoxin that causes botulism is injected directly into muscles in the face, paralyzing them and thus erasing wrinkles, are becoming one of the most popular cosmetic medical procedures in the country. But as they have become more popular, unlicensed underground providers have become increasingly common, especially in Miami, investigators and cosmetic surgeons said.

The Fernandezes were arrested on Wednesday, but potential clients were still seeking them out yesterday afternoon. Norma Lopez, 25, a waitress from Brooklyn, went to the apartment on Third Avenue in Manhattan where the Fernandezes lived on the second floor, above Johnny Fox's Bar, for an appointment with Ms. Fernandez. Ms. Lopez went to the apartment, she said, even though Ms. Fernandez had always told her to call beforehand.

"I was going to pay her a thousand dollars" for a weight-loss procedure, Ms. Lopez said. "She told me she had a license. She said she had 18 years' experience," she said.

Ms. Lopez said she first met Ms. Fernandez about a month ago in a Brooklyn beauty salon, after she saw a sign posted inside that read, "If you want to lose weight, see Dr. Iris."

Ms. Lopez said she spoke with Ms. Fernandez, who told her of the various procedures: $280 for lip plumping, about $1,000 for breast enlargement, $1,800 for a nose job, $1,000 for weight loss injections, which Ms. Lopez wanted. Ms. Lopez said she had second thoughts only because of Ms. Fernandez's appearance.

"I got nervous because it looked like she had on a mask," Ms. Lopez said. "She's ugly."

Reina M. Turcios, a doctor with the Centers for Disease Control in Atlanta who came to New York City to investigate the cases, said that most of the victims here were immigrants from Latin America, where people are commonly treated by unlicensed physicians. In the past year, she said, there have been similar cases in Wyoming and Colorado.

Dr. Thomas R. Frieden, the city health commissioner, said the eight people who were hospitalized required drainage procedures that left their flesh mutilated. Dr. Frieden asked anyone who had received unlicensed treatment or doctors who had treated similar infections to call 1-877-NYC-DOH7 (1-877-692-3647).

Dr. Turcios said the drug used by the Fernandezes, Hyacell, is not approved for use in the United States, although it is common in India and parts of Europe. The police said Mr. Fernandez, 52, was from Venezuela and had entered the United States 14 times since 1993 on work visas; his wife, Iris, 49, had entered 7 times in the same period, they said. Detectives are investigating whether the two smuggled Hyacell from there.

Investigators first became aware of the Fernandezes in mid-June, Dr. Frieden said, when one of their victims went to a hospital with a very distinct infection. Doctors at the hospital notified the Health Department, which in turn contacted the C.D.C., he said. It was unclear whether it was the medication or unsanitary conditions that led to infection, he said.

"The bacteria is not common," he said. "It indicates that something went wrong with a procedure."

Other victims then came forward and the Police Department began surveillance at the Fernandezes' apartment in Manhattan and one at 24-17 77th Street in Astoria, Queens, the police said.

Investigators said they believed that the couple also did some procedures in hotel rooms and had hair stylists refer customers to them. "It's like word of mouth: `You want to lose your lines and wrinkles, you go to these people,' " a law enforcement official said. "This is so low-rent. It's like behind the garage that they're doing this stuff."

The authorities arrested the Fernandezes at 7:30 p.m. on Wednesday at 316 Third Avenue in Manhattan, where they lived with a friend and where, the authorities said, they performed some of the treatments. They were arraigned Thursday night on charges of assault, performing medical treatments without a license, scheming to defraud, grand larceny and possession of a weapon, a hypodermic needle. They face 25 years in prison if convicted. Police Commissioner Raymond W. Kelly said the two had admitted performing procedures without licenses.

A woman named Norma, who insisted that only her first name be printed, was at the East Side apartment where the Fernandezes were staying after they had recently moved from Florida. The couple owned a home in Weston, Fla., and owned a medical supply company there, according to business records. Norma said that she had let the couple live with her but that no procedures had been performed in the apartment.

The woman added that Ms. Fernandez had been trained as a doctor about 15 years ago in Venezuela, where she catered to "movie stars and wealthy people."

Five years ago, Norma said, Ms. Fernandez went to Switzerland to seek treatment for a bacterial infection and also learned the cosmetic procedures that she performed here. The couple's troubles started when one patient became ill, not because of the treatment, but because he had AIDS, Norma said.

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