FRAMINGHAM, Mass. – Her quest for beauty took a Brazilian nanny to a condominium basement, where she paid an unlicensed doctor $3,300 for two cosmetic surgeries performed on a massage table.
But something went terribly wrong during the second procedure, leaving 24-year-old Fabiola DePaula dead and area residents stunned by the underground network used by some Brazilian immigrants trying to look their best.
"Somebody has to speak out. Go to the Brazilians, open their minds and let them know it's dangerous," said Jacque Foster, a friend of DePaula's. "This is totally beyond unsafe. You have to think about what you are doing."
Authorities believe a 49-year-old Brazilian doctor, Luiz Carlos Ribeiro, performed a number of plastic surgeries in Framingham, such as liposuction, rhinoplasty and Botox injections, mostly for the town's large Brazilian immigrant population and mostly for cash.
One witness said in an arrest affidavit that the doctor had been performing "beauty procedures" in the area for three years.
Police say DePaula went to Ribeiro for a rhinoplasty on July 27, then died three days later after the liposuction procedure. According to the autopsy report, DePaula's death was caused by complications of the surgery, including pulmonary fat emboli, or fat in the lungs.
District Attorney Martha Coakley said doctors in a hospital could have dealt with the complication, which she called a rare, but known risk.
Ribeiro and his 49-year-old wife, Ana Maria Miranda Ribeiro, were arrested on July 31 and charged with manslaughter, unauthorized practice of medicine and drug counts. The couple, from Belo Horizonte, Brazil, has pleaded not guilty to the charges and remain in custody.
The woman who owns the residence where the surgeries allegedly took place, Ana Celia Pena Sielemenn, also faces drug charges for allegedly giving illegal narcotics to patients, according to the DA's office.
Eliana Miranda, a Brazilian immigrant who owns a clothing store in downtown Framingham, about 20 miles west of Boston, said she doubted Ribeiro had trouble finding potential customers. Brazilian women are not afraid to turn to surgery to meet their high expectations for their appearances, she said.
"I think it's big here too, but in Brazil, it's much bigger," she said. "We suffer all day in high heels, just to look good. Americans think about what is comfortable. Even the underwear is more underwear."
Miranda and others interviewed said it was common for Brazilians to travel back to their native country for all types of surgeries — not just cosmetic — where they often pay thousands less than in the United States for the same procedures. Maxine L. Margolis, a professor of anthropology at the University of Florida who specializes in Brazilian immigrants, said unlicensed doctors offering cheap procedures here could be particularly appealing to illegal immigrants, who do not want to risk being unable to return to the United States.
In DePaula's case, her mother, Beatrice Barbosa, said she asked her daughter to wait until they could go to Brazil for the procedures, but she chose to visit Ribeiro instead after hearing about his work.
Ribeiro also may have drawn customers because, as a Brazilian, he spoke the women's language and understood their cultural ideals of beauty, Margolis said.
"I think the language thing would be the big thing," she said.
Two other women have come forward saying they were patients of the doctor. The investigation remains open, with authorities using local Brazilian media and a hot line to find other potential victims and explain the risks involved with illegal surgery.
"There should be a lesson learned from the death of this young woman," Coakley said. "People think this is an extension of getting my nails done, getting my hair done."
Dr. William Beeson, past president of the American Academy of Cosmetic Surgery, said people in the United States tend to assume their doctors are qualified, so they do not ask questions about their training or history and do not expect complications.
"We just accept that we're so regulated that those things just don't happen in the United States," he said.
Foster said DePaula was naive and did not understand the risk she was taking with her health.
Now her family and friends are left struggling to understand her death. Barbosa said her daughter had a good job, was beloved by those around her and was so organized that she managed to buy her own car and home by the time was 21.
Foster said her friend had no need for cosmetic surgery.
"She was absolutely gorgeous, not only on the outside but on the inside," Foster said.