Their human interest story (in truth, a paid ad) had been crafted to appeal to the public's sense of sympathy, as if the twins were leukemic six year olds in need of bone marrow transplantation instead of two pimply oddities who more called to mind images of Auschwitz and whale blubber than teddy bears tearing at one's heartstrings and wallet. Predictably, I was their sole respondent.

Not that I am a philanthropist or a pushover. On the contrary, I am a American-educated (Wharton School of Business, Class of 1982; Harvard Medical School, Class of 1986) business-savvy surgeon with the uncanny (and possibly inherited) ability to sniff out unrecognized opportunity. Perhaps you recall the wonders of Laetrile? Much of its appeal was due to the effort of my now deceased Uncle Ernesto, a medical pioneer and entrepreneurial Mexican genius whose most recognizable surname just happens to be one of the three omitted above.

In any case, I happened to be in Los Angeles attending a three day educational convention when I came across the article. My own practice is situated some twenty-five kilometers northeast of San José (the city in Costa Rica, not California) in an area known internationally for its high concentration of plastic surgery clinics.

In my country, I am known as the King of Fat, which is not to say that I am one of those diet doctors concerned with such matters as saturated versus trans, poly-un versus mono, or torturing his patients into counting every calorie.

Rather, I am a cosmetic surgeon who has devoted his full professional energies to the field of the adipose. I suck it out through cannulas or cut it out in chunks. I inject it, transfer it, graft it, and transplant it. I slim down the bloated young and plump up the deflated old. My patients run the gamut, from the corpulent to the cadaverous, from the endomorphs to the ectos, from the twin-sized to the king-sized, ages sixteen to over ninety. Most of my clientele comes from the north since Tican incomes allow for few locals to indulge in such luxury.

In the news article I sensed a great untapped potential, and so I phoned the twins and invited them and their parents south to paradise for a complimentary visit and all-expenses paid vacation.

To most people, fat is just fat and hardly their favorite subject. Even most plastic surgeons would snicker if told that this ester of glycerol with fatty acids constitutes the very essence of physical splendor. The old adage about beauty being skin deep is only close to the truth; it actually resides in the next layer down. In precisely the right amount, it's the water that primes the fountain of youth. Too much padding in certain areas can be embarrassing. Not enough makes one appear old, sick, and haggard.

Yellow and white gooey lumps—the most appealing yet misunderstood tissue in the human body. It goes by many names, most of them vaguely derogatory, from lard to tallow. Some call if grease, while others call it blubber. In Spanish, we call is grasa or adiposo.

Fat Fixers tend to think of it more like crude oil underground. While it is an abundant natural resource, thank God it doesn't grow on trees.

Since I pride myself on my honesty, I was entirely upfront with the twins when they at last arrived at my offices. Engorged and disgorged—the contrast was even more than I'd expected. Honey was all cake, while Apples was purest celery, the contrast that of XXL vs. XS. Between them sat their parents, two well-dressed, well-contoured mesomorphs abnormal only for their high levels of tension and skepticism. Fortunately, the girls were beyond the legal age required to make their own decisions.

I think they were impressed that my English was flawless, our staff was bilingual, and our facility was spacious, architecturally modern, and sparkling clean. Their parents kept staring at the (rented) artwork on the walls.

Despite superb training and skills, I explained to them all, the plastic surgeons of Costa Rica were typically viewed as second-rate compared to their United States counterparts for reasons of simple ignorance, cultural prejudice, and a huge disparity in public relations efforts.

In fact, the region was a Beverly Hills to the south, a stable country offering state-of-the-art medical care but at a much more affordable price.

What I wanted to do for Apples and Honey was to help them once again look like they'd come from the same egg. What I requested in return was good publicity (which, for the benefit of their nervous parents, I believe I termed "public education"). While my fee for the surgery would be zero, this wasn't a case of charity. Ours was to be a business arrangement based not on a fee-for-service model but rather the trading of services. Their obligation to me would be to act as poster children (which, again out of sensitivity to their guardians, I believe I termed "patient representatives").

Their parents acted like they'd been through too much already. Their questions were direct. Forget about the egg, they said. Have you ever done this before? Has anyone done it before? What about risks? What if surgery makes things worse? I sat through their grilling and waited for the anticipated question to surface: How do we even know you're any good?

At that, I  put on a stern face of indignation, stood up calmly, and in a most stately manner informed the family that I refused to be insulted and that my offer of help was rescinded. Of course, the expected ensued. The daughters ordered their parents to mind their own business, quit treating them like babies, and then ushered the hysterical pair to the door.

I complimented the twins on their courage and their willingness to help advance the state of medical knowledge. Their parents' questions, I said, had not been without merit. There were indeed given limits to all surgical procedures, and we would need to put those limits to the test.

No problem, the girls said as their optimism only seemed to build, we trust your judgment implicitly. I took their lack of inquisitiveness to mean that they really didn't want to know any more, that they had already taken that leap of faith that all patients must before going under the knife.

During a hastily-prepared dinner of arroz con pollo with black beans and sour cream and a bright bowl of exotic red and yellow fruits (Honey scavenged every scrap, while Apples molded her food into little piles), I vaguely outlined a plan while omitting graphic details (after all, two of us were eating).

I found the girls intelligent but naive. They were clean-cut kids, no tattoos or body piercings, no wild hairdos or heavy makeup, just two polite and soft-spoken teenagers who were probably half scared to death. We took an immediate liking to one another, and so rather than risk dashing their confidence, I glossed over the subject of unexpected outcomes and assured them that they were going to look gorgeous. We sealed our agreement with a handshake.

To a Tican, risk is not as scary a subject as it seems to be for North Americans. Gambling is one of our national pastimes, so second-nature that one can purchase lottery tickets on almost any street corner and even modest hotels lacking a cafe may still house a small casino and row of slot machines.

The same holds for limits, which are viewed as arbitrary or unnecessarily self-imposed by the unimaginative. Fraud and trickery are common and not on the whole that condemned. Good fortune comes to those bold enough to take the risk of challenging limits.

But then, so too does disaster. I was raised in Costa Rica but educated in the United States and so have mixed views when it comes to caprice, calculation, and accident. This much I know for certain: when risks are high, it pays to be prepared.

Because I am an honest man, I wish to clarify an earlier statement. The educational convention that brought me to California was a seminar more devoted to advances in the field of medical marketing than to performing surgery.

During the rainy season in my country, the downpours approach torrential, the rivers swell, and the interminable cloud cover and drizzle grow depressing. That's when the lights of the City of Angels always seems the most attractive.

The gathering was exclusive, an assembly of but two, accomplished mentor and willing student inside of a modern operating room filled with giant cameras and spotlights. It was my tutor himself, Jorge Godinez, for a short time a Brazilian surgeon but now a Hollywood television director, who not only showed me the newspaper article on Apples and Honey but arranged for the introductions.

Repeated surgery can extract a severe physical toll. Because their operations were to be aggressive and frequent, Apples and Honey first needed to be primed to withstand the upcoming stresses. Following a metabolic assessment by a dietician, each was begun on a regimen of mild exercise, plenty of rest, a balanced diet, and a customized nutritional supplement customized specifically for each girl's needs. Electrolyte imbalances brought on by extreme catabolism or anabolism can kill a person, and so proper nourishment would be essential.

Outside of the rainy season, Costa Rica is an especially beautiful place to undergo plastic surgery.

My clinic is located hear the foot of Braulio Carrillo National Park. Our patients recover on a 90 acre resort surrounded by lush tropical flowers, a coffee plantation, a butterfly farm, and magnificent views of dormant volcanoes. It's a short ride into the city of San José, a most cosmopolitan place with a respectable museum and a decent national theater.

The twins seemed to most enjoy the casinos, cantinas, nightclubs, and loud discos, where they could easily blend in among the tourists and freaks. Standing next to each other, they made an odd pair, one girl well on her way towards exploding, the other growing more invisible by the day, in silhouette each having long ago shed any suggestion of the feminine form.

Outwardly I smiled but inwardly I cringed while watching them dance to our hypnotic Latin rhythms, a roly-poly jelly-belly beside a skin-and bones broomstick. The local young men, typically flirtatious and overly amorous after even a single beer, ignored them.

Despite my positive face in public, I was privately worried about the chance of success for the twins' upcoming restoration.

Maybe smug Jorge had encouraged me too much because of his own self-interests. Maybe I'd allowed our Latin machismo to interfere with reasoned judgment. Maybe I shouldn't have let him talk me into soliciting the twins' case without giving their predicament more careful thought.

Because there were no precedents, and any attempt at surgical rehabilitation would constitute more of a search and rescue operation. Theirs was not a simple matter of restructuring but closer to a faith healing that would require more than a little magic. Moving around so much fat was going to be a slippery undertaking.

Why so? Because fat itself has next to nothing to do with controlling weight. One's weight is more dependent upon calories. Weight remains stable because caloric intake matches energy expenditure. Rates of metabolism and the efficiency of processing food are factors, too, but serve only to explain why we all can't eat the same number of tamales and enchiladas and still fit into our pants.

The absolute quantity of total fat cells in a person's body is of minor significance. Fat cells are simply storage depots that puff up or deflate but don't change in number after adolescence.

Although the identical twins possessed an identical number of such little honeycombs, Apples' had been drained down to empty . . .

. . . while Honey's were overstuffed and bulging. Adding or subtracting honeycombs might alter the average level of filling but would have no effect on the total amount of honey.

To make any difference, what needed to change was the number of bees.

(continued on page two)