SARASOTA – It’s a lucrative, cash-up-front business serving wealthy older people with money to spare. Small wonder doctors — both genuine and ersatz — are performing cosmetic surgery in Sarasota, a city known for active people with the means to keep aging at bay.

The results can be abysmal, says a new consortium of local plastic surgeons who sometimes must repair the damage.

Cosmetic surgery is big business. The ASPS estimates 18.8 million procedures will be done this year in the United States at a cost of $10.4 billion.

Twelve surgeons have formed the Plastic Surgeons of Sarasota Educational Cooperative to help inform potential patients about the serious risks involved in “getting a little work done.”

​“It’s unusual, because in a way, we’re competitors,” says Braun Graham, of Sarasota Plastic Surgery Center. “But we share the goal of protecting people.”

All are members of the American Society of Plastic Surgeons, which means they have had at least six years of surgical training, have passed oral and written exams, and operate only in accredited medical facilities.

Cosmetic surgery is big business. The ASPS estimates 18.8 million procedures will be done this year in the United States at a cost of $10.4 billion.

Horror stories have emerged nationally of unlicensed people killing clients by injecting cement or silicone into their buttocks, in hotel rooms and other nonmedical settings. People magazine publishes glossy photos of famous faces wrecked by surgery gone wrong.

The surgeons’ cooperative also is concerned about physicians who start carving with little more than a weekend of study.

In August, for example, an Oregon doctor who practiced internal medicine and was not a surgeon, was charged with manslaughter in the death of a patient seeking a tummy tuck.

The Oregon Medical Board said she did not have equipment to monitor vital signs or resuscitate a patient.

“We’re also starting to see a lot of tourist plastic surgery,” says James Marsh, a longtime Sarasota plastic surgeon and member of the cooperative.

“People get a flight to Mexico or Thailand or the Dominican Republic, have surgery and expect to hang out on the beach,” says Marsh, who started a practice here in 1979. “Then they come in to see me with infections and other bad results.”

Often, those patients are embarrassed, not only for how they look but for being snookered into accepting cut-rate surgery by someone who might not even have a medical license.

The surgeons in the cooperative say state licensing boards do not monitor or restrict practices, meaning any licensed physician can practice the speciality.

Other boards have sprung up that offer a certificate in cosmetic surgery without experience or testing, Marsh says.

“It’s confusing for patients and that’s on purpose,” he says. He added that ASPS forbids its physicians to, for example, auction off a breast augmentation.

Charlatans aside, physicians are drawn to the field because of the continuing financial squeeze in their regular practices. This is due to increasing regulations, decreasing reimbursement both by Medicare and private insurance companies, and the high cost of malpractice insurance. Many also have medical school loans to pay off.

Cosmetic surgery is lucrative and often accessed by people with enough money to pay up front and out of pocket.

“Clearly in Sarasota we have a demographic and the socioeconomic status that goes hand in hand with plastic surgery,” says Graham.

Although data about southwest Florida’s appetite for the surgery is unavailable, the ASPS says surgeons in the region that includes Florida most often work on those 55 and older.

Of all the cosmetic surgeries performed in the region in 2011, the highest percentage were face lifts and liposuctions, followed by eyelid surgeries and breast augmentation, according to the ASPS.

The region stretches along the Atlantic coast, from Delaware south to Florida.

More men are seeking cosmetic surgeries as well, with 1.2 million having work done nationwide in 2011 compared to about a fourth that in 2000.