A WOMAN, let's call her Alice, saw an article in a magazine touting the benefits of Botox injections. She cajoled her brother into paying for her - at $6,000 a go - and underwent the first treatment. Overjoyed with the results, she was back again three months later for 'maintenance', with her brother once more footing the bill. According to Vam Cheung, sales and marketing manager for Allergan, the supplier of Botox in Hong Kong, the company started marketing the product in 2003. That year only about 200 injections were done. By the end of 2004, about 7,000 people had received treatments, with most having two injections a year. In time, Alice will not need injections as frequently, but that is little comfort to her brother because she has now decided she wants a facelift. Love it or hate it, more people in Hong Kong are undergoing plastic surgery every year for facelifts, tummy tucks and other operations intended to improve or transform their physical appearance. No organisation keeps exact records of all the procedures performed, but surgeons agree the number is increasing. A plastic surgeon in private practice might do as many as 100 invasive surgeries a year. By international standards, this number is not high; Hong Kong is regarded as being five years behind South Korea and Taiwan in terms of demand. 'However, we've seen 10 per cent to 20 per cent growth each year and more demand as new procedures become non-invasive,' said Dr Francis Ho, a plastic surgeon with 20 years of experience in Hong Kong working in public and private hospitals. 'General awareness about plastic surgery is increasing.' Local private practitioners still perform mostly non-invasive procedures, such as laser skin rejuvenation, hair removal and Botox injections. Dr Wilson Ho, a plastic and reconstructive surgeon at the Matilda Plastic Surgery Clinic, said the practice was still taboo for many Hong Kong Chinese. He said people would not tell their best friend about an operation, and would do their best to deny they have had surgery. Even if the doctor had created a beautiful double eyelid for someone, he would never get a referral. 'But if they've had Botox or a radio frequency facelift, they are happier to talk about the cosmetic procedure,' he said. 'People regard these as anti-ageing treatments, not plastic surgery.' In such cases, a typical patient might come in during their lunch hour and be back at work the same afternoon. The results are considered to look natural and take effect slowly over weeks or months. People often pass off the fact that they look younger and healthier by saying they have been spending more time in the gym. All doctors in Hong Kong can perform the non-invasive procedures, and some now combine cosmetic medicine with other responsibilities. 'I have patients who suffer from chronic migraine and have noticed a dramatic reduction in the number with Botox injections,' said Dr Lauren Bramley, a general practitioner with four years' experience in cosmetic medicine. She also uses laser hair removal to assist patients suffering from polycystic ovarian syndrome, which affects about 8 per cent to 10 per cent of women and causes excess hair growth. 'It is very rewarding to alleviate these conditions for my patients,' Dr Bramley said. She has also noticed that the removal of facial frown lines and crow's feet for purely cosmetic reasons could make people feel happier and improve their general well-being. 'I get a lot of satisfaction from the artistic side of these procedures,' she said. At present, less than 10 per cent of plastic surgeons in public hospitals and university teaching units are doing cosmetic surgery. Most of the operations done there are classified as reconstructive surgery and may involve treating burns, cleft palates and patients who have suffered from breast cancer. There are about 50 plastic surgeons in Hong Kong, and 70 per cent of them are in private practice. Generally, it is accepted that more are needed, but it is a highly competitive field with limited training opportunities. Only five new doctors are accepted as trainee specialists each year, and some candidates have been on the waiting list for up to five years. The course may take eight to 10 years to complete. There is limited government funding, since public monies tend to be directed first to areas like the treatment of cancer. As a result, the waiting time for patients is getting longer. 'In terms of quality of service, it will inevitably deteriorate, so we are frustrated too,' Dr Ho from the Matilda said. He noted that eight plastic surgeons left the public sector to start their own practice over the past two years. Besides qualifying as a doctor, there are other employment opportunities within the field of cosmetic medicine. 'Specialist nurses are definitely needed to assist and explain procedures to patients,' Dr Bramley said. The long-term prospects are regarded as good. New, less invasive techniques and procedures are being developed. Furthermore, with new medicine keeping us healthier for longer, people will not only want to feel good in their later years, but also to look good.