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The ugly side of beauty




The soaring demand for cosmetic surgery has made it a big business. Without proper regulations, however, the risks are equally big.

SHE tried to do everything by the book. Melissa (not her real name), 25, equipped herself with necessary information on the fat removal surgery she wanted to do through Internet research and telephone queries. To be extra safe, she even consulted a verified specialist who has a registered clinic.

But when the doctor – yet another one – refused to give the 52kg, 160m tall public relations manager her ideal physique, Melissa decided to turn to one of the more accommodating beauty salons to make her dream of becoming beautiful come true. She was lucky to come out of the surgery alive.

As it turned out, the centre’s trained, foreign “specialist” was a fraud, and the heart complication she got from the procedure was nearly fatal.

Cases like this are common, warns the Malaysian Association of Plastic, Aesthetic and Craniomaxillofacial Surgeons (Mapacs).

Its former president Dr V. Surendranathan says more and more people, especially young women, are falling prey to such unscrupulous beauty centres which feed on their insecurities and desires.






Unlike a responsible doctor who will conduct  thorough examination on the patient before deciding on the best treatment option, beauty centres will bend backwards to follow the customers’ wishes, regardless of the medical risks. – AP


He says it is becoming an obsession in today’s society to look beautiful, and many will not think twice about spending thousands of dollars or going under the knife for enhancements.


“This obsession makes them susceptible to unscruplous cosmetic practitioners. For example, if you are in your 20s and weigh around 50kg, you don’t need to go for surgery like liposuction to be slimmer. The healthiest way is to exercise more and switch to a healthier diet.


“But many are too impatient; they call one of the beauty centres which advertise in newspapers and magazines and ask them for surgery.


“How many do you think will take their money and do it without question?” he asks.He cites the recent case of the 30-year-old company manager who died during a follow-up treatment for her 15th liposuction in Ampang, as an example.


“She had 14 liposuctions before that fatal one and weighed less than 53kg. You don’t have to be a medical expert to see that she may not have had much extra fat to be sucked out. An ethical doctor would have advised her against the procedure and see if she needs any psychological help (with body image issues),” says Dr Surendranathan.


He adds that a responsible doctor will conduct a thorough examination of the patient’s physical condition and medical history before deciding on the best treatment for him or her.


“It’s different with beauty centres. They will bend backwards to follow the customers’ wishes, regardless of the medical risks. Some even promise miracle transformations,” he opines.


Society for Anti-aging, Aesthetic and Regenerative Medicine Malaysia (Saaarmm) secretary Dr Anandan Subramaniam agrees.

“Some patients want to save time and money and request for a few different cosmetic surgeries in one go, like a nose job plus a tummy tuck and facelift. That will be risky, because of the anaesthetic – you cannot go under too long as it might cause complications.


“But for those motivated only by money, they will have no reservations about conducting the procedures on patients,” he says, citing the case of the wife of a former Labuan politician who slipped into coma and died after having a few nip and tuck procedures in Klang as example.


“Although the cause of her death has not been concluded, on the outset, it is clear that the combination and number of procedures she underwent were not advisable,” he says.


Undeniably, the beauty and wellness industry is very lucrative. According to the Malaysian Medical Council, the billion-dollar industry is growing by 15% annually.


“It is a parallel industry worth 10 times more than what the medical industry is worth, paying taxes that are probably double or triple what doctors pay. It employs many people, so it has a lot of clout,” says Dr Surendranathan.


The potential for huge profits, however, has spurred the growth of back-street practitioners with little experience or expertise in handling the surgeon’s scalpel or even other non-surgical cosmetic equipments.Worse, notes Dr Surendranathan, it has lured not only “quack doctors” but also general practitioners who are untrained in the field but want to make a quick buck. Mapacs estimates that at least 80 cosmetic surgeries go wrong a month.


“We have not done a proper research but what we know is that if you conduct a survey among plastic surgeons in the country on how many botched surgery cases they get a month, they will say one to two.


“There are about 40 plastic surgeons in the country, which makes it some 80 botched surgeries a month and 960 cases a year,” says Dr Surendranathan.


Mapacs president Dr Peter Wong concurs.


“These are patients who are prepared to come to us after a botched surgery and spend more money on corrective procedures. Who knows how many more are suffering in silence?” he asks.


Dr Wong points out that the number of advertisements in the media gives a very strong indication of the number of illegal practitioners who are out there.


“Last year, the Health Minister himself said that there are only 1,800 specialists in the country, out of which fewer than 200 are plastic surgeons and dermatologists.


“But we have up to 140,000 establishments in the beauty field. The question is, how many employ qualified medical personnel?” he asks.


In 2007, the Health Ministry drew up a guideline on the dos and don’ts of cosmetic surgery.Under the guidelines, non-medical specialists, including private general practitioners, are not allowed to carry out procedures such as breast implants, liposuction, eyelid surgery, laser and light-based therapies and hair transplant.



They are also prohibited from dealing with unapproved agents and inject non-evidence based products like Vitamin C, placental extract or stem cells.


Regulations crucial

Malaysian Association of Standard Users chief executive officer Ratna Devi Nadarajan, however, firmly believes that stronger laws are needed.


“Currently, there are no laws to govern beauty parlours or spas and centres offering cosmetic surgery. Without a law to at least require them to register cosmetic surgery operations, it will be difficult for the authorities to monitor them. Even medical practitioners like doctors need to register.


“According to the Health Ministry, there are about 8,000 to 10,000 beauty centres operating illegally. You know the figure, so why is nothing being done to regulate them?” she asks.


Ratna stresses that it is time to enact the much-talked-about Cosmetology Bill.


“The last two incidents should have set the platform to hasten the Bill. The ministry has been talking about it since 2006 but nothing has come out of it. It keeps postponing it. Every time someone dies from an illegal cosmetic surgery, it is brought up but until now it has not been legislated.”


Malaysian Beauty Therapy Association –CIDESCO Section Malaysia President Datin Dr Clara L. Chee agrees that regulations are urgent.


“The Government should enforce clear guidelines that differentiate medicinal from cosmetic treatments. The control on the cosmetic industry is for the safety of the public.


“It is not the customers’ fault, it is the fault of the people in the industry who over-promise and compromise a lot to make profit. But with stringent laws, we can avoid botched jobs and unwanted incidents.”


She adds it will help create a more positive image of the cosmetology practice in Malaysia.


“The beauty industry is being tarnished by these illegal practitioners. Contrary to popular belief, beauticians also have ethics in their profession. Those who want to enter the aesthetic field need to undergo training. We also want to maintain high standards in our field and not cross the boundary,” she says.


When contacted, Health Ministry director-general Tan Sri Dr Ismail Merican assures that the Bill will be enacted soon.

“It is taking a while as there are many issues to settle. The coverage is just too wide. But the present guidelines as stated are still applicable. The cosmetologists must know their limitations and the public must be cautious. They should now know what can be done and what cannot be done by non-doctors.”


Adds Dr Ismail, once the Cosmetology Bill is legislated, unsafe practices will be regulated and controlled, besides ensuring patient safety and quality of care provided.


“The objective of the Bill is to ensure cosmetologists do not cross the line between cosmetology and medical practices,” he notes.


Dr Surendranathan, however, stresses that a new law would only be effective with strong enforcement.


“The law needs to be clear about the do’s and don’ts, so a Cosmetology Act will help but without enforcement, it will mean nothing.”


He highlights, for example, that under existing laws, illegal cosmetic “surgeons” have to be caught in the act before they can be charged.


“What are the chances of that happening? More often than not, they will get information that enforcement officers are coming and they can run.


“Patients, meanwhile, will be pushed out the back door so they get terrified and run away. They wouldn’t wait to talk to the enforcement officers and help in the investigation,” he says.


Until the proposed Cosmetology Bill is enacted, self-protection is the best protection for consumers.


“It is the Government’s responsibility to regulate the industry and protect consumers with the necessary laws. Without such laws, consumers have no other choice but to protect themselves. A main problem, however, is the lack of information available,” he adds.


Chee concurs and advises those who decide to undergo any cosmetic surgery to consult a doctor,


“A thorough research is important before one undergoes any cosmetic procedure. And when you do get a treatment from a doctor, ensure that the doctor is qualified.


“The simplest way is to look for the qualifications on the wall. Same thing with the beauticians at the beauty saloon – you can look out for the certificates.”


She says those concerned can contact CIDESCO Section Malaysia to ensure that the beauticians they are getting consultation or treatment from are verified. The association has a registry of beauticians which customers can check to verify that they are trained.


Need for caution

It is best for the public to exercise some caution before committing themselves to any form of cosmetic treatment or surgery, echoes Dr Wong.


“They should find out more about the treatments that they intend to undergo, and make sure that they actually require the procedure.


“It is very important that one should actually consult a bona fide doctor who is appropriate for the particular cosmetic treatments sought.


“One always has to make sure that he/she gets to consult with the doctor or specialist who is actually going to do the treatment procedure and not some ‘cosmetic advisor’ who acts as the middleman. Consultation, clinical examination, rationale for the choice of the procedure, the pros and cons, type of anaesthesia, place of surgery, backup supports and the after-care are all relevant and important considerations,” he stresses.


Dr Anandan warns that sometimes, things can still go wrong even if trained doctors conduct the procedures.


“That is why it is important for you to check what emergency support system the doctor has in the clinic.”


More importantly, says Chee, a person must first analyse their needs honestly before going under the knife.


“They need to ask themselves if they really need to have surgery or just get a healthier lifestyle,” she says


Ultimately, opines Dr Anandan, the final say on whether to perform the surgery or not is in the hands of the practitioner.


“If a patient goes down on her knees and begs for cosmetic surgery, my duty is to look at the safety aspect – whether it will bring side effects or harm her.


“I cannot just fulfil the patient’s wishes without looking at all aspects of the problem and weighing the advantages and risks. I have to be careful not only about the physical aspects but also the psychological effects,” he says.


Copyright © 2009 Designed by Prof Dr Chua Chung Nen

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