WASHINGTON - It started with a face lift, in Malaysia.

That was four years ago, when Kathy Bogardus, 63, called her well-traveled, international businessman son at home in Odenton.

Bogardus had a hunch that the $16,000 to $20,000 price tag she had been quoted for cosmetic surgery could be reduced if she had the procedure done overseas.

That hunch paid off for both her and her son, Judson Anglin, 36. He investigated prices and surgeries in Malaysia and Thailand, where his wife Patty is from. Eventually, Bogardus had the surgery in Malaysia for $5,000.

Astonished at the low cost, Anglin quit his job two weeks later to found what he said was the first "medical tourism" consulting business in the country. He's part of a growing trend of entrepreneurs in consulting businesses that help people travel to exotic locales for surgery at a fraction of the cost they would pay back home.

"The price difference is so dramatic," said Anglin, who founded Odenton-based MedRetreat in 2003. "I knew that story had to be told."

MedRetreat does not have physicians on its staff, though medical professionals are involved in the scouting of new hospitals and surgeons. They pre-screen all doctors and facilities to ensure quality and patient safety.

"These aren't just little clinics on the side of the road," said Anglin's business partner, Patrick Marsek. "They're elite hospitals."

MedRetreat offers destinations in Argentina, Brazil, Costa Rica, India, Malaysia, South Africa, Thailand and Turkey.

"We've been there," said Anglin. "We've sent clients there. We can tell them the pros and cons. That's a tremendous value."

The value is also in the savings, especially for those without insurance.

For example, a hip replacement here without insurance can cost from $35,000 to $45,000, while the same procedure would cost $12,000 in Thailand, said Anglin. Knee surgery costs about $6,000 in Malaysia, one-third what it typically costs in the United States.

Most of the doctors speak English and are board-certified in the United States, England or Australia, said Marsek.

Hospitals overseas use the same technology and equipment as the most sophisticated American hospitals, he said. And between the quality of care and the exotic ambiance, "you go through them and they're like five-star resorts," said Anglin.

Clients pay 20 percent up front and MedRetreat negotiates with hospitals to receive a discount on surgeries. Patients end up paying the same amount that they would if they were booking it themselves, said Marsek.

Starting his own company was daunting, said Anglin, who now lives in Fulton with his wife and two children, but the good feeling he got helping others was worth the travel time and trouble.

MedRetreat is "for middle-class families that have no options," said Anglin. "A lot of them are in tremendous pain."

There are risks, some professionals point out, such as associating surgery with vacation or patients signing over their medical care to business people with little medical training.

"This is not like booking a regular travel trip," and patients need to remain vigilant about the screening process, said Kathryn Serkes, a spokeswoman for the Association of American Physicians and Surgeons.

"We need the same buyer beware that patients would use for surgery in the U.S.," she said.

Medical care is inexpensive in other countries because wages are lower, said Dr. Bruce Cunningham, past president of the American Society of Plastic Surgeons.

Plus regulatory standards of cleanliness can be "wildly inconsistent," even within the same country, he said, contributing to lower costs.

"There is the opportunity to get really good care," said Cunningham. "But equally so you could walk into a clinic in South America, India or Indonesia and find people who are completely untrained, unqualified and standards that are unacceptable."

While public health professionals urge caution, they acknowledge that medical tourism is on the rise and that the trend should be studied in order to produce resources for patients seeking surgery oversees.

"(Medical tourism) has had some bad press, but it's a freight train that's going in one direction. . . . I don't see any way of stopping it," said Christopher Jones, a research associate at the Johns Hopkins Bloomberg School of Public Health. "The important thing is making sure patients have the best treatment."

For some patients, it's their only option.

In 2001, about 2 million Americans experienced medical bankruptcy, three quarters of whom had insurance, according to a Harvard study published last year in the journal Health Affairs. This makes health care costs the leading contributor to bankruptcy in the United States.

Anglin believes that there is a viable alternative.

"Bangkok is not Third World," he said. "Kuala Lumpur is not Third World. When it comes to health care, they've caught up."

About 80 percent of MedRetreat's clients have cosmetic surgeries, followed by orthopedic surgeries and gynecological procedures such as hysterectomies.

By the end of this year the company will have worked with 550 patients, he said.

MedRetreat does all of the leg work. The company inspects hospitals, books procedures, airfare and hotel, facilitates questions and provides information about the destination country.

But sightseeing takes a back burner to recovery.

"Even if it's cosmetic surgery, it's still surgery," said Anglin. "That's got to be the No. 1 focus."

Anyone who isn't happy with their choice once they arrive has the option of backing out and going home with a full refund minus the price of airfare and hotels, said Marsek. "At the very worst they would have a small vacation out of it."