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Cosmetic surgery that saves you money, uses only local anesthesia and lets you control the results: Sounds like a great deal, right? In reality, the new Awake procedures are a way for barely trained surgeons to profit from dangerous operations no hospital would let them do. SELF investigates the true price of "bargain" makeovers.

Paulette Hacker couldn't stop screaming. Lying on her side on a gurney, wearing only a bra and panties, she felt as if she were being stabbed again and again. In a way, she was. Through incisions in her upper back, a stainless steel tube called a cannula was suctioning out her excess fat.

"Please stop! You're hurting me!" she cried to her doctor. Because although Hacker's body was limp and her mind bleary from an unknown combination of drugs she'd been given through pills and a gas mask, the 38-year-old was awake partway through the second day of liposuction on her back, underarms, abdomen, hips and neck. That was the whole point: She was undergoing the new and aggressively marketed Awake cosmetic surgery, which is performed under local anesthesia.

"You can't scream, Paulette," a gruff voice answered her. Hacker hazily realized that the voice did not belong to her doctor; the man performing her operation was a stranger whom Hacker would later discover was a physician's assistant. According to Hacker, whose experience is also detailed in a Los Angeles Superior Court complaint, she could see people coming and going into the "operating room"—more like an oversize exam room—at the Rodeo Drive office of Craig Alan Bittner, M.D., a "liposculpture" practitioner in Los Angeles. (Through his attorney, Dr. Bittner strongly denies all of Hacker's allegations.)

"Move her into the TV room—she's making too much noise," a confused and terrified Hacker heard another voice say. Her gurney was rolled down the hall and into a second room, where she could see the assistant jab her while he watched a basketball game playing in the background on a wall-mounted television. The volume was cranked up loud enough to drown out her cries.

After the five-hour operation, Hacker says the assistant and an office clerk yanked her to her feet and squeezed her into compression garments. Dazed and sobbing, she struggled into her clothes and found herself face-to-face with a beaming Dr. Bittner. The doctor gently asked why she was crying, she says. Then he maneuvered her beside him and told her to smile for a photo.

Hacker had been excited to fly down two days earlier from Sacramento, California. The stay-at-home mom weighed 233 pounds and was trying to slim down; she'd lost 22 pounds on her own through diet and exercise—mostly jogging—and now felt she could use some help. But she'd never had elective surgery before and feared having general anesthesia.

Surfing the Web, Hacker had discovered the Awake procedure, which was advertised as a cheaper and more medically advanced alternative to lipo—and, for those inclined, to abdominoplasty and breast enhancement, too. The price was right: Awake lipo with Dr. Bittner would cost only about $700 for each body part, versus about $3,000 if she had regular plastic surgery. She found it comforting that the lipo would be performed in a doctor's cozy office, not in an intimidating outpatient surgical center or hospital. Best of all to Hacker, Awake ads promised that patients would remain lucid throughout the operation and even be able to interact with their doctor. "I liked the idea that I'd be awake and in control," Hacker remembers. "The surgery really looked like it was for me."

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