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A surgeon marks for double-jaw surgery, a way of reducing or sculpting the jaw.

Beauty's dark side: Chinese tourists lured by South Korean cosmetic surgery face risks

Tourists hoping for a makeover in South Korea face many risks, including non-specialist surgeons

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South Korea is well-known as the country where you arrive with one face and leave with another – hopefully, a more attractive one. But not everyone goes home happy after visiting the plastic surgery capital of Asia.

In one shocking case in January, a Chinese tourist was pronounced brain dead at the operating table in Seoul while underdoing plastic surgery. Such tragedies have prompted many online sources and media in China to warn against the risks and possible complications that can occur from plastic surgery.

In February, the South Korean government pledged to give the plastic surgery industry its own dramatic facelift. It announced a series of measures to prevent illegal medical tourism practices and better ensure the health and safety of foreigners.

We cannot say 100 per cent that all the hospitals and clinics [we partner with] do not work with shadow doctors
Natalie Oh, former nurse

Regulations were to include tighter surveillance of plastic surgery agents or brokers, ensuring only those with official licences can solicit foreign patients; as well as the publishing of a book with standard prices of medical services so foreign patients can avoid potential scams.

However, the government has yet to provide an update on when these changes will kick in. Many experts also believe greater changes need to take place before the industry can truly live up to its world-class image.

The South Korean plastic surgery industry currently faces a myriad of issues that may compromise the health and safety of patients. The industry’s lax regulations towards medical practitioners; lack of emergency training and equipment at clinics; and high numbers of illegal plastic surgery agents have begun to affect the country’s reputation as a top medical tourism destination.

Under current laws, doctors are unrestricted when it comes to their practices. Non-specialist doctors may perform any type of surgery, says Dr Cho Soo-young, a board-certified plastic surgeon and spokesperson for the Korean Board of Plastic Surgeons.

“For example, I am a plastic surgeon [specialising in cosmetic and reconstructive surgeries], but I could do brain surgery and even conduct a C-section if I wanted to.”

Cho says the lax regulations were created during times of need when there were few medical practitioners. “This rule was made over 100 years ago when there was a shortage of doctors. But it is now outdated and the government still hasn’t changed it.”

“Every time we [the Korean Association of Plastic Surgeons,] ask the government to change the laws, they do not accept our suggestions.”

According to Cho, there are 10,000 non-specialist doctors in Korea performing plastic surgery. “Chinese patients are usually not aware if doctors are board-certified or not,” he says.

Board-certified plastic surgeons are much fewer in numbers: 2,000 who after getting a medical degree must go on training courses, do a one year internship and a four year plastic surgeryresidency before getting their certification.

Certified medical tourism agent, Lyan Chang says lax regulations can cause some confusion for mainland clients looking for a doctor in Korea. “In Korea, it’s not required to do your surgery with a specialist. Non-specialist [doctors] can even advertise their services in China, it’s not illegal.”

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Plastic surgery clinics can only be established by board-certified plastic surgeons. But these clinics may employ doctors who are non-specialists to perform surgeries.

Such lax regulations enable plastic surgery clinics to use “shadow doctors”. These doctors are non-specialists who often take over the surgery in secret once the patient is on the operating table.

The government has called for a higher degree of transparency outside and within operating rooms, pledging to rebuild the industry’s reputation by 2017.

However, with 362 plastic surgery clinics in Gangnam district, Korea’s plastic surgery mecca alone, experts say it will be very difficult to regulate each clinic’s practices.

Natalie Oh, a former nurse and current general manager of the government-run Gangnam Medical Tour Centre, has been working to connect foreign patients with the safest clinics in Seoul over the past few years. But even her organisation cannot guarantee that patients will be in trustworthy hands.

“We cannot say 100 per cent that all the hospitals and clinics [we partner with] do not work with shadow doctors… We try to monitor them but it’s very difficult,” she says.

As they are tourists, many patients often do not have the luxury of choice. “Each clinic has star doctors whom everyone wants to do their surgery with. But they have limited time. And visitors only have 1-2 weeks in Korea, they can’t wait to get the surgery, so other doctors may perform it for them,” says Oh.

Some patients cannot endure [the allergic reaction] and they stop breathing
Dr Cho Soo-young

Proper application and emergency training on anesthesia usage is also a worry. A recent national report, the first of its kind, by Samsung Medical Centre, found that 82 patients died from anaesthesia-related accidents between July 2009 and June last year; while another 23 patients during that period survived but were left with some form of permanent affliction due to these accidents.

Experts say these cases were only recorded because they were filed as lawsuits, and that actual numbers may be even greater. “The government doesn’t announce the total number of accidents to us,” says Dr Cho Soo-young. “Only medical insurance companies know [these numbers].”

The drugs used for anesthesia are usually very safe, says Cho. However, in rare cases, patients can still experience allergic reactions.

As was the case with the Chinese tourist who died while undergoing surgery this January “I heard the patient was receiving three operations,” says Cho.

“Eyelid surgery, rhinoplasty and lipo-injections [liposuction, then fat grafts] to her forehead... and then the patient fell into a coma during the third surgery”.

“Some patients cannot endure [the allergic reaction] and they stop breathing… But very seldom does a patient die or end up in a vegetative state, this happens 0.001 per cent of the time.”

To make matters worse, not all clinics are properly trained or equipped to handle such emergencies.

Among the clinics the government-run agency, Gangnam Medical Tour partners with, only half are properly equipped. “Not all of them have emergency kits or AEDs (Automated External Defibrillators),” says Natalie Oh.

In its February address, the South Korean government announced that it will create new measures to prosecute illegal plastic surgery agents and crack down on scams.

For many Chinese tourists, plastic surgery agents are equal parts regular tour agents and plastic surgery consultants and bookers. “People visit not just for surgery but also for Korean culture too,” says plastic surgery agent Lyan Chang.

Legal plastic surgery agents must be certified and may only bring foreign patients to board-certified specialists. However, there are a large number of illegal agents who choose not to register their businesses as they can earn a higher profit.

“About five years ago, there were over 1000 legal agents... now, they are more illegal ones working [than legal agents]. Illegal agents can make more money and pay less tax,” says Dr Cho Soo-young.

It is also significant that registered agents cannot solicit South Korean customers, and can only focus on foreign markets. “[The government banned this because] it is dangerous to [local Korean] patients’ health and life... Agents want money,” explains Cho.

“But they allow foreign patients to book through agents.”

Others argue that registered agents are a necessary link for foreigners who need to book procedures from abroad, without easy access to local resources.

Lyan Chang says that Chinese customers in general, often pay a higher premium for expedited services and efficient booking.

“For Chinese clients, they need to do all this and finish the surgery within 5-7 days… This requires more resources, for example translation, transport, and so on.”

Natalie Oh, of Gangnam Medical Tour, echoes the sentiment. “Right now, the problem is not that there are agencies, it’s the brokers [agents who] are not properly registered,” she says.

“Some agencies have good systems working for them. [But at the same time,] we cannot encourage everyone to go to agencies... Before a patient comes to Korea, they need to know exactly what they need [to have done].”

Yang Wan-zhi, from Shenzhen is interested in coming to South Korea to undergo plastic surgery and knows vaguely of the risks, but still prefers to trust her surgeon. “I heard that method of the surgery will mostly be up to the doctor’s advice,” she says.

“If I go for a big surgery, I will be really scared of possible complications. However, for the sake of becoming more beautiful, you can’t avoid certain surgeries…You can only hope that no issues will occur.“

This article appeared in the South China Morning Post print edition as: The deadly side of cosmetic surgery
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