Authorities believe a Brazilian doctor, Luiz Carlos Ribeiro, performed liposuction, nose jobs and Botox injections for three years in the Framingham area, mostly for the town's large Brazilian immigrant population and mostly for cash.

Police say DePaula, a native of Brazil, went to Ribeiro for a nose job on July 27, then died three days later after the liposuction. According to the autopsy report, DePaula died of complications from the liposuction, including pulmonary fat emboli, or fat particles in the lungs.

Ribeiro and his wife, Ana Maria Miranda Ribeiro, both 49, were arrested July 31 and charged with manslaughter, unauthorized practice of medicine and drug counts. The couple pleaded not guilty and remain in jail. Their attorneys declined to comment. The owner of the condo was also arrested.

The district attorney said Ribeiro was licensed to practice medicine in Brazil, but his specialty was not cosmetic surgery. Officials have not identified his specialty.

Eliana Miranda, a Brazilian immigrant who owns a clothing store in Framingham, about 20 miles west of Boston, said she doubts Ribeiro had trouble finding customers.

Cosmetic surgery is "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."

Youth and beauty are positively worshipped in Brazilian culture, exemplified by the scantily clad women celebrating Carnival or sunbathing on the beach, a spectacle immortalized in the sultry song The Girl From Ipanema. The best-known plastic surgeons in the country are celebrities.

Other states with large immigrant populations have also seen cases in which people fell victim to others practicing medicine or dentistry illegally. In Miami, for example, which has a large population of Brazilians and others from Latin American countries that put a heavy emphasis on female beauty, many of these cases involve cosmetic procedures.

Some Brazilians around Framingham said it is common for Brazilians to travel back to their native country for all types of operations, that often cost thousands of dollars less than in the United States.

In the Framingham case, at least two other women have come forward, saying they were patients of the doctor. Authorities are using local Brazilian media and a hotline to find other potential victims and explain the risks involved in illegal surgery.

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