The pain of betrayal was almost too much to stand. I thought about the parting kiss and hug and felt all the more jilted. Stupid? Embarrassed? Here, I'd earned degrees in both medicine and business and yet had shown all the commercial sense of a Mother Teresa out saving the world. The King of Fat had been treated by the twins like their servant, a naive sucker to be used and then screwed!, and precisely during the time when the these little angels had been finishing their final course of completely free treatments (free to them, that is).

Stabbed in the back, I ended up with substantial out-of-pocket medical expenses, the production and marketing costs for Jorge's extravagant documentary, repeated rejections from the producers of Extreme Makeover, and a bilingual CD-ROM video series sold only via infomercial and online.

None of the print or television publicity helped to build brand awareness for Costa Rica. Yes, my local practice benefited slightly from word of mouth, but since the parents and twins referred to me only as Dr. Tonio, even name recognition experienced little boost.

Despite the fact that I may well have saved their lives, relations between us first grew cold and then dead.

Three years passed. The twins' time in the media spotlight was over (book sales were mediocre, although the publisher's advance was theirs to keep; the television movie bombed), and they graduated from college. Despite their duplicity, I felt an odd sense of pride as I watched them mature from insecure and ugly teenagers into confident and attractive young women. Then a strange thing happened.

Though still somewhat heavier than Apples, Hungry Honey, not one for exercise or dieting, began to lose weight. It happened quite slowly over a period of several months, but even the first five pounds were noticeable and the trend held steady. Anorexic Apples, still counting calories when not at the gym, grew elated, so much so that she noted the return of a long-lost sensation — hunger! Over the next month, she added three and a half pounds.

As in days prior to their surgery, their know-nothing weight doctors offered an assortment of technical theories and names for phenomena both girls and everyone around them already understood. Four years after its supposed death, Honey's satiety center had been exhumed.

Apples' anorexia, a psychological reaction to the stress of monitoring her sister's gluttony, waned. Almost overnight, she rediscovered chocolate shakes, cheeseburgers, and pepperoni pizza.

The twins had experienced a remission, but everyone was only overjoyed until the next five pounds of normalization.

At first, Apples' soft lumpiness and Honey's shallow depressions were noticeable only in the nude. As Apples continued eating, however, the bumpiness grew more evident at the very sites where she had received the most fat injection. With light grazing at an even a sligt tangent, her body resembled a stretch of low sand dunes shadowed by the setting sun.

Honey, on the other hand, developed a progressing form of cellulite in precisely those spots where she'd been liposuctioned the most aggressively.

The next five pounds of gain and loss worsened the situation so much so that the distortions in body contour became noticeable even through their clothes. Like honey with lumps and apples turned rotten, the twins were growing more and more deformed.

Of course, the sweet girls panicked.

Apples and Honey phoned, apologized profusely over their family's past insensitivities and their lack of communication, and then begged for an urgent consultation in Costa Rica.

I acted coolly and informed them that my next available appointment was not for another three weeks.

Over the course of a lifetime in practice, how many surgeons are ever offered a second change to become rich and famous working on a previous case gone bad? Well, at least one that I know of. You see, only I had the solution for their problems.

Understand: this crisis had nothing to do with the absolute number of fat cells each girl now possessed but rather their uneven distribution. Surgical removal from areas of (previous) relative excess and grafting into areas of (previous) relative deficiency are crude and inexact processes, shortcomings camouflaged at the time of surgery by each twin's respective metabolic flaw. But, remember what I told you about the honeycombs? Remember what I said about their sizes not being that important? What was important, I'm sure I mentioned, was only the number of bees.

With the twins' metabolisms normalizing so unexpectedly, well— as Jorge had prophetically predicted, when unanticipated results befall a good surgeon, the fault can nearly always be assigned to the patient (although, I will concede, had the twins and I never met, they both would probably now be fine). But life is like that, right?, and so let's try to focus on the future rather than the past.

This time when the twins and their parents met me in my office, I was waiting for them with my C.P.A. To my surprise, they were accompanied by two gruff attorneys, one licensed to practice in Costa Rica and the other in the United States. Neither man seemed impressed by the floral arrangements and finger foods I had selected with greatest care.

My accountant, a nervous little man, made up a lame excuse and quickly exited.

Not only was I shocked when I once again saw the girls, but I actually mixed them up. Their weight reversal had continued and (formerly Anorexic) Apples now weighed four pounds more than (formerly Hungry) Honey. Both girls had normal appetites.

As an experiment, they had begun consuming the same exact foods at the same time of day as well as precisely matching their levels of physical activity. Yet even on this srictly controlled regimen of equal calories in and equal calories out, Apples continued to gain weight while Honey went right on shrinking.

Of equal concern was just where that weight was being distributed, the way so much of it seemed to end up or disappear from all the wrong places. Apples' knobby bumps and Honey's chewed up dents now bordered on the grotesque.

The voluminous medical records the family brought with them posed a couple of little questions but provided no bigger answers.

The twins had been evaluated by eight Mayo Clinic specialists who had documented different levels of metabolic efficiency in each girl. The only anomaly of note, however, was Apple's unexplained lower production of thyroid hormone. And, of course, they'd discovered the presence of Apples' assorted implants, but so what?

At first, I suspected that the attorneys had been brought along to try to frighten me into blurting out information they might then use to blame me for this latest imbalance. Because I am not so easily intimidated, I examined the records methodically and found no proof of wrongdoing. Their medical experts seemed to be more into testing and less into thinking.

On second analysis, I concluded that the real goal of the lawyers was to bully me into reversing the results of my earlier surgery at no charge.

Fat chance, I made it very clear to them all. Because I knew the twins' bodies far better than any other surgeon, I was their one and only logical choice. My investment gone sour was about to reap a profit.

Now pay close attention: The areas of fullness and depression on Apples and Honey were indeed related to our experiment with fat. But their contour problems appeared only because of their differering densities of fat cells in treated areas and not because of the different number of fat cells in each girl's entire own body.

So, yes, perhaps I am in part to blame for the lumps. That said, let's not forget the significant contribution made by Honey's no-good satiety center. Still, none of the above even begins to explain the girls' total weight gain/loss scenario during and after treatment. Recall the reality of fat cells, that one's absolute number of fat cells has nothing to do with one's weight since the available cells merely adjust up or down in size as needed? So forget about the fat, okay? Just forget it! Confused? Thank God you're not the only one. None of the girls' highly-paid experts seemed to grasp this issue, either.

My successes with bettering the twins' weight problems had absolutely nothing to do with redistributing fat and absolutely everything to do with adjusting caloric equilibriums. But more about that later.

The fat surgery had been strictly for the cameras, a media event orchestrated by my clever and savvy consultant Jorge to help to boost Costa Rica's standing in the world's adipose adjustment market.

The actual solution had been far more revolutionary than meticulously moving around a lot of goo. It had also been a lot more simple. While none of the twins' brilliant doctors had figured it out, any one of them could have pulled it off.

But now it time for me alone to again come to the rescue, this time not for free but on a very generous fee-for-service arrangement.

Because I am an honest man who loves to teach, please allow me this short private confession followed by several hypothetical scenarios presented merely to illustrate a point.

First, the confession: the previously referenced customized nutritional supplements that I, with the help of a trusted and well-compensated pharmacist, concocted for the girls' use prior to and throughout their treatment contained a tiny bit more than merely protein powder and local herbs. End of confession.

Now, for the two scenarios, neither of which is entirely original or untried and thus neither of which could be construed as reckless or experimental: Consider the effect from the oral ingestion of live samples of Asedia intestinocentralis, the recently discovered and rare tiny tapeworm living in the bottom-feeding flatfish found only off the Atlantic coast of Costa Rica and, to my knowledge, so obscure as to still be unknown to North American gastroenterologists.

An infected fat person eating like a pig might grow gradually thinner as the parasites sucked away passing calories. A person of normal weight consuming a well-balanced diet might grow rapidly skeletal. Once diagnosed (quite unlikely), treatment with the correct (but obscure) medication would be safe, quick, and easy.

Similarly, consider the effect of the oral ingestion of trace amounts of radioactive iodine that then became concentrated in the thyroid gland and caused partial scarring leading to decreased production of hormone. A thin person eating next to nothing might gradually put on weight. A normal person consuming a normal amount of calories might blow up almost overnight. Once diagnosed (as had already been done), treatment would consist of a single pill daily.

Of course, I neglected to discuss such examples with the vile attorneys or my back-stabbing former patients. And since the above considerations are meant to be considered only in the hypothetical, please affirm our strict confidentiality agreement by clicking here.

Do remember—few pioneers and heroes are ever pure. As agents for change, the most they can really offer is to provide the confused with a catalyst.

Besides, parasites and iodine are all-natural organic substances taken directly from the earth.

Considering Jorge's lack of performance during the first go-around, he consented to a much reduced fee and sent down his most experienced film crew.

The twins, flush with cash from their book and movie bonanzas as well as multiple interviews on afternoon television, signed away most of their resources and all (all!) of their legal rights. Regarding fees, this time they were offered a very special price — 150% of normal.

Once I got started, the process felt familiar and the logistics seemed less complex. First came the customized nutritional supplements (for take two, of very different ingredients). Removing Apples' implants used up no time at all—easy in, easy out—although she did request that I leave the breasts balloons in place. Then came the many tedious operations to extract grafted fat from Apples and return it to donor Honey, all the while attempting to reshape their hills and valleys into flatland, a task made more daunting by internal scarring from the first series of operations.

While the States-side weight specialists were again at a loss to explain cause and effect, the girls' body weights did indeed move in precisely the desired directions until they stabilized at a rock steady 126 pounds, a transfiguration that took them back to square one before Honey's motorcycle accident. Restoration of perfect contouring proved more difficult, but still provided spectacular cosmetic improvement with their clothes on. The ordeal finally over, the twins were once again almost physically identical (well, apart for Apples' bust) and very pleased with the outcome.

While we treated one another cordially on our last day together, there were no parting kisses or hugs, just a casual wave goodbye.

Their surgical results, though not perfect, were still amazing enough to generate book and movie sequels (different author—guess who) and a three episode mini-series for sensationalized American cable television, since which our local cosmetic surgery industry has been booming.

Personally, I have progressed from regional King to international Guru. Because Costa Rica is predominantly Catholic but not particularly reverent, in San José I am often referred to both in awe as well as for fun as Papa Gordo, el primer: Pope Fat, the first.

Our heaviest rains will be returning shortly. Having recently been invited back to Los Angeles as a visiting professor of surgery at USC, I plan to be gone during the wettest part of the season lecturing there and around the States on my accumulated insights into fat (minus, of course, a few trade secrets).

Uncle Ernesto, bless his soul in heaven, would have been most proud of me.