Cosmetic Surgery: Cure or Curse?

It's a big and fast-growing business, but as with any other, it's ''buyer beware''

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<P><TABLE cellSpacing=8 cellPadding=0 width=190 align=left border=0><TBODY><TR><TD vAlign=top><P align=center><IMG src=\"/rd/rdhtml/en/magazine/images/spread_cosmetic.jpg\" border=0><SPAN class=MNorGray></P></SPAN></TD></TR></TBODY></TABLE>\'\'I was wrapped up like a mummy,\'\' says Huimin about her tummy in the first week after surgery in October 2007. Her skin turned black and blue and was numb and lumpish because she underwent liposuction to have the fats from her stomach, waist and back removed. The bruises took more than a week to heal and the surgical scars could take longer to fade. </P><P>\'\'I couldn\'t accept my figure after two pregnancies,\'\' says the 31-year-old Singaporean. \'\'The surgeries helped create the Huimin who was there before but whom I couldn\'t return to.\'\'</P><P>Huimin had botox injections on her jaw a month later and surgery on her thighs and she also removed her eye bags in December last year. She is planning future cosmetic procedures to address the pigmentation on her face.</P><P>\'\'Once you start working on yourself, you become a perfectionist. The rest of your body looks unbalanced,\'\' says the human resource executive. \'\'Other people exercise and try to lose the weight. I\'m not a persistent person – I give up easily.\'\' </P><P>To date, Huimin says she\'s spent over S$7000 ($4900) on cosmetic procedures. \'\'I used to feel upset and embarrassed about the way I looked,\'\' says Huimin. \'\'Cosmetic surgery has made it easier for me.\'\' </P><P>Cosmetic augmentation might seem like an extreme method of mid-life \'\'maintenance,\'\' but an ever increasing number of people in Asia – especially women in their 30s and 40s – are choosing cosmetic procedures. </P><P>\'\'Judging from the longer waiting list on bookings and the longer working hours reported by our members of the Hong Kong Society of Plastic Surgeons, there has been an increase in the number of patients undergoing cosmetic surgery,\'\' says Dr Kenneth Hui, a Hong Kong-based plastic surgeon and former president of the Hong Kong Society of Plastic and Reconstructive Surgeons. </P><P>The cost of cosmetic surgery hasn\'t changed significantly, but Dr Hui attributes the increasing numbers to changing social conditions – wider societal acceptance, peer pressure, competitive work environments, widespread advertising – people are less secretive regarding cosmetic procedures. </P><P>And it\'s no secret that people in Asia are travelling within the region for more affordable cosmetic surgery. Countries like Thailand, Singapore and Korea have become hot spots for cosmetic surgery. The Council for Korea Medicine Overseas Promotion, launched in mid-2007, is one of the latest government initiatives to cash in on Asia\'s lucrative medical travel business. The Council markets packages for 28 affiliated hospitals and targets patients from Japan and China. The Council has seen growing numbers, especially from China, seeking to possess the beauty of popular Korean celebrities.  <BR>Behind the lure of more affordable cosmetic surgery is the pressure of living in a world that places increasing importance on appearance. </P><P>\'\'We live in a visual world, a small world, a fast world,\'\' says Singapore-based plastic surgeon Dr Martin Huang, director of The Cosmetic Surgery Clinic. The emphasis on looking good affects our social life and career. This puts pressure on people to change their appearance. \'\'Cosmetic surgery is no longer seen as an exercise in vanity. It is a valid means of self-improvement,\'\' says Dr Huang. \'\'Post-operation, the psychological effects in my patients have been largely positive – ranging from mild pleasure to [ecstacy].\'\' </P><P>Some outcomes are far less reassuring. Dr Hui notes that patients who come to his clinic requiring corrective surgery are significant \'\'both in numbers and in severity.\'\' The worst cases, he adds, are \'\'patients who went abroad for surgery and returned with complications and no follow-up.\'\' </P><P>The psychological health of cosmetic surgery patients has also gone under the microscope recently. </P><P>A 2004 University of Pennsylvania comparison of cosmetic-surgery patients with those undergoing general surgery found that 19 per cent of the cosmetic surgery recipients had mental-health histories, and 18 per cent were taking psychiatric medications, compared to five per cent of noncosmetic patients. At the University of British Columbia\'s Perfectionism and Psychopathology Lab – where perfectionism is classified as a maladaptive personality trait associated with crippling social and personal problems that can even lead to suicide – one recent study found that 79 per cent of \'\'extreme perfectionists\'\' had had cosmetic surgery. In Korea, one study observed that despite short-term psychological benefits, patients experienced little long-term improvements in their general satisfaction of life after cosmetic surgery.   </P><P>\'\'I think the desire to possess perfect beauty is universal,\'\' says Professor Kyung Ja Oh, a clinical psychologist who received her PhD in Psychology from Harvard University and has lectured at the Psychology Department of Yonsei University in Korea since 1989. She warns that patients with perfectionism suffer from deep feelings of inadequacy. They get distressed and feel they have to correct the way they look. Often, these patients do not realise that they have a psychological problem. They believe that they need to get their nose done or their skin peeled. \'\'They are looking for the solution in the wrong places,\'\' says Professor Oh.  </P><P>Increasing cultural fixation on youthfulness as well as exposure to idealised representations of beauty have distorted perceptions of what\'s normal. \'\'We are exposed to celebrities with impeccable features every day. Yet, these representations are unrealistic,\'\' Professor Oh says. </P><P>People internalise those representations as a standard of beauty and create an ideal image of themselves. The inflexible pursuit of a perfect ideal might contribute to the repeated and inappropriate use of cosmetic surgery. Opting for cosmetic surgery, says Professor Oh, can also worsen a patient\'s psychological problems and it can become addictive. \'\'They will never be satisfied with the results. Cosmetic surgery doesn\'t deal with the deep-rooted psychological problems.\'\' </P><P>Dr Huang turns away people with body dysmorphic disorder (BDD), who have an obsessive preoccupation with a real or imagined physical defect. (Among those seeking cosmetic surgery, as many as 15 per cent have it, according to a 2005 St. Louis University study.) </P><P>Dr Huang adds, \'\'These patients can be potentially problematic. They tend never to be satisfied. They also display psychological distress over minor physical flaws.\'\' Such patients would be referred to a professional for psychological treatment instead.   </P><P>But even if a reputable plastic surgeon turns a patient down, he or she may go elsewhere for a fix. Anyone with a medical degree in Asia can legally do cosmetic procedures – doctors, dermatologists, dentists, gynaecologists; even nurses and aestheticians do less invasive treatments such as injectables and \'\'anti-aging\'\' treatments. The bottom line, say the experts, is buyer beware. </P><P>Dr Hui, who turns away five per cent of prospective patients because they have \'\'unrealistic expectations\'\' and \'\'undetermined wishes,\'\' believes patients in Hong Kong are especially vulnerable because of advertising practices. \'\'Doctors cannot advertise in Hong Kong. It may not be easy to find the suitable plastic surgeon,\'\' he says. \'\'But there are no such advertising restrictions for beauty parlours and tour operators.\'\' </P><P>In other parts of Asia, private clinics and beauty parlours advertise rampantly and undercut the fees of approved cosmetic surgeons. Any surgery is risky, but unnecessary elective cosmetic procedures have become risky business – especially if patients do not consult a second opinion and fall prey to pressurising sales pitches by under-qualified practitioners. </P><P>Dr Hui recommends patients choose cosmetic surgeons wisely as the majority of botched surgeries cannot be rectified. He adds that usually well-respected and established surgeons have a long waiting list.</P><P>Consider the tragic fate of thousands of women in China who now suffer serious side effects after receiving injections of \'\'Ao Mei Ding,\'\' commonly known as \'\'man-made fat,\'\' a liquid gel used in beauty parlours for breast enhancement. In serious cases, these women have had their breasts removed in order to expel the liquid. China\'s State Food and Drug Administration officially banned the production of the drug in 2006 following numerous consumer complaints. </P><P>Elaine, who had liposuction surgery with an aesthetic doctor on her tummy, flanks and arms in June 2007, researched her options carefully. \'\'I had to make sure I had the right doctor as I knew this could be a potentially dangerous procedure,\'\' says the 33-year-old sales executive and mother of two. She has gone on crash diets and tried for more than six years after her second child to lose weight. </P><P>\'\'I wanted to lose my ugly fat desperately,\'\' says Elaine. So finally after consulting with four different doctors, she chose the one who made her feel the most \'\'confident.\'\'</P><P>Post-op, she lost three dress sizes and is thrilled by her new figure. \'\'When you achieve nice results, you feel tempted to do more,\'\' Elaine admits. Five months later, she flew to Korea\'s BK Dongyang Plastic Surgery to undergo a combined rhinoplasty and double eyelid surgery. \'\'The result was better than I expected,\'\' says Elaine. \'\'I was so happy. I thought I can be beautiful.\'\' </P><P>With greater social acceptance of cosmetic procedures, plus more affordable cosmetic surgery options through travel within Asia and the constant emergence of new technologies, more people may be tempted, and increasingly able, to have cosmetic surgery. Dr Huang postulates patients have become savvy consumers able to weigh the risks and benefits of cosmetic surgery. </P><P>\'\'When cost becomes an important point of differentiation, patients have to adopt a consumer attitude,\'\' he argues. \'\'Rather than diet and slowly lose the weight, it is easier and affordable to simply opt for liposuction.\'\' And he adds, \'\'We have become so accustomed to instant gratification.\'\' </P><P>But what about the self-control to know when and where to stop? \'\'People might go for cosmetic procedures that might not suit them,\'\' says Elaine. Considering she\'s contemplating a future chin implant, Elaine seems an unlikely critic. \'\'There are a lot of people who go to extremes. They try to reconstruct themselves,\'\' she adds. \'\'For me, I do not want to make a drastic change.\'\' </P><P>Elaine maintains that it\'s important to be realistic. \'\'You should want to look good for yourself and not try to look like somebody else.\'\'  </P>
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