Adrian doesn't look like a pharmacist. He's not wearing a white lab coat and hasn't shaved in a few days. He pats the breast pocket of his shirt to show me the best spot to stash pills when crossing back over the border.

"They won't check here, and if they do, just tell them you have a medical condition," he explains.

Out in front of his little shop, under his neon pharmacy sign, a busty mannequin done up in a skimpy nurse's uniform and holding a heart-shaped sign for Viagra beckons more customers off the street. No prescription? No problem.

Tijuana, Mexico, just across the border from San Diego, has long been a favored destination for Americans in the market for cheap and illicit meds, among other things. The city was a seedy refuge for Hollywood pleasure-seekers during Prohibition, and then came decades as a playground for hard-partying co-eds and service personnel too young to imbibe north of the border.

But times are changing. Discount pharmacies such as Adrian's are slowly disappearing as Tijuana turns its attention to American medical tourists looking for more than painkillers and sex pills. Savvy comparison shoppers, they stream in from California and beyond for deep discounts on everything from cosmetic and weight-loss surgeries to hip replacements and stem-cell transplants. Some are uninsured in the United States. Others are hoping to save on the high cost of elective procedures back home.

And then there's me, just here to do a little browsing. I'm not in the market for an operation, but I'm curious about the people who are. In a city where you can't drink the water, can it be safe to go under the knife?

I duck out of Adrian's onto Tijuana's main drag, Avenida Revolucion, a riot of garish neon signs extending south from the border. Until a few years ago, this strip would be reliably packed on weekends with American girls and guys gone wild. But a triple whammy of swine flu, recession and drug violence has hurt business, and thatch-roofed dance clubs and strip bars sit shuttered with "Se Renta" signs out front. Though the security situation here has improved dramatically - and daylight shootouts are thankfully a thing of the past - the continued State Department warning against travel to Mexico has kept many visitors away.

Deprived of these tourists and their easy dollars, Tijuana has turned inward. The city's cultural life, as well as its emerging medical tourism sector, has migrated from the seamy border zone farther south to Zona Rio, a newer district along the banks of the river that gives the city its name.

A little nip and tuck



Traffic is heavy in late afternoon along Paseo de los Heroes, the stately boulevard that bisects Zona Rio. I leave the main road and turn down leafy side streets filled with the newer stores and restaurants where upwardly mobile Tijuanenses spend their money. There's an imposing mall with a modern multiplex, a cluster of expensive hotels and, next to a Domino's Pizza, the building I'm looking for: the gleaming glass-and-concrete tower that houses Medica Norte.

A modest-sized clinic specializing in plastic and cosmetic surgery - tummy tucks, nose jobs, you name it - Medica Norte gets 80 percent of its patients from the United States. It even offers a pickup and drop-off service in San Diego and can help you get a deal at the swanky Camino Real hotel a few blocks over ($85 a night for patients).

Marco Rodas, a soft-spoken plastic surgeon, is one of several doctors who work out of the clinic. "I want to show you this because my patients are my best publicity," he says, apologizing for his English, which is actually quite good. He brings out a small photo album filled with dozens of before and after shots collected over his 25-year career: noses slimmed, bellies flattened, breasts enlarged or reduced. He leafs through, pointing and commenting like a proud father.

I ask what draws so many American patients to Tijuana. "The most important thing is the price," he says. "You're going to pay 50 or 60 percent of what you pay in the U.S." A full facelift - neck, face and eyelids - goes for $4,800 at the clinic, a bargain that even the shadiest of strip-mall surgeons in the U.S. would be hard-pressed to match.