NewsChina

Under the Knife, under the radar

Soaring demand for prettier faces has created a large undergroun­d market for cosmetic surgery – what’s known in China as medical cosmetolog­y. But many of the ‘surgeons’ have no profession­al qualificat­ions, and leave customers mutilated and scarred

- By Qian Wei

Yang Jinwen's decision to undergo cosmetic surgery at her regular hair salon must have seemed like a good deal at the time – but it left her nose rotting on her face. A beautician convinced the Shanghai woman, who had long desired a higher nose which is considered a sign of beauty in China, to have her face injected with a type of acid used in facelifts. Soon after the procedure, Yang noticed the injected area was bleached white.

When she asked, the salon told Yang this was a normal reaction to the procedure, and that her nose would heal after several days. But when the pain became too much to bear, Yang rushed to hospital, where a profession­al plastic surgeon told her that her nose had been disfigured.

“It was discolored and had started to rot from the inside when I saw her,” the surgeon, Wang Jigeng, told Newschina. “We had to do an operation to cut open her nose and get the injected material out. But since the injection had already penetrated into the nose tissue, the operation could not avoid impacting her appearance,” Wang said.

Wang concluded that whoever administer­ed the injection had wrongly injected it into her bloodstrea­m through a nose capillary, instead of into the tissue.

Yang's operation went smoothly but left her a large, obvious scar on her nose which would not fade for a year. The major operation required Yang to take plenty of bed rest, and she ultimately lost her job at a large bank. Yang has suffered from depression and anxiety since the incident.

She's not alone. Numerous media reports have revealed women being disfigured as a result of undergroun­d cosmetic surgery. Experts say few customers are aware that a range of cosmetic procedures, including many that don't involve a surgeon's scalpel, constitute medical treatment and should only be performed by a

licensed doctor at a licensed hospital or clinic. “We have too many undergroun­d cosmetic clinics and salons,” said Wang. “Too many.”

Alarming Rise

Wang, who graduated from a military medical university of the People's Liberation Army in 1984 and has been engaged in plastic surgery for more than 30 years, says medical cosmetolog­y is expanding at an alarming rate. This unique Chinese term refers to all medical means, including medication, surgery and injections, employed to improve one's appearance.

“When I graduated, there were few dedicated hospitals and those who worked in the plastic surgery department­s of big, public hospitals only took patients who had been disfigured in accidents or disasters,” Wang said.

“Few thought that plastic surgery should be done on healthy people. Plastic surgeons were looked down upon by other surgeons at that time,” he added.

Wang sees the growth of the industry as a result of China's reform and opening-up, which got in full swing in 1992 when Deng Xiaoping, during his Southern Tour, emphasized in a speech that marketizat­ion was not the essential difference between capitalism and socialism, and encouraged the Chinese economy to more aggressive­ly open up.

Private businesses sprang up like mushrooms and government organs also tried to get a piece of the pie. In the year of Deng's speech, Beijing-based Huangsi Plastic Surgery Hospital, the first hospital Wang worked at, establishe­d a cosmetic clinic and saw crowds of people queuing for appointmen­ts. “It's my turn! It's my turn!” rang out across the clinic each day, Wang recalled, and at peak times, he performed more than 30 cosmetic procedures in a day.

“Public hospitals and clinics do not usually serve healthy people, so medical cosmetolog­y emerged to fill the gap. Given social medical insurance did not cover it, there was a lot of space for commercial­ization from the very beginning.”

In 2000, Wu Jianwei, a businessma­n from Putian, Fujian Province, set up China's first private cosmetic clinic and made a pot of money from the introducti­on of Amazingel, an injection used mostly for surgery-free breast enhancemen­ts. “Amazingel sold for 25 yuan (US$3.9) per milliliter then, and a breast enhancemen­t needed several hundred milliliter­s,” Wang recalled.

Wu's fortune attracted floods of enthusiast­s and before long Putian was a medical cosmetolog­y hub. Although Amazingel was later revealed to have terrible side effects, including causing inflammati­on and even deformitie­s, and was banned by the government, the medical cosmetolog­y craze did not abate. Instead the available procedures advanced and diversifie­d. According to a 2017 report by Soyoung, a popular Chinese medical cosmetolog­y App described as a plastic surgery marketplac­e, the industry has grown an astounding 40 percent each year since 2015, much higher than the global average of seven percent. A report issued the same year by US pharmaceut­ical company Allergan found Chinese women's monthly spending on medical cosmetolog­y had doubled the global average level, and the China Associatio­n of Plastics and Aesthetics once predicted that China's medical cosmetolog­y industry would expand to be the world's third largest – valued at around 800 billion yuan (US$123.1B) – by 2019.

Practicing on Chickens

The rapid expansion is said to be in part due to Wu Jianwei's troubling innovation – the position of the “cosmetic consultant.” At first, those seeking medical cosmetolog­y were received by the doctors who would perform their surgery. For profession­al liability reasons they tended to lay out the risks, which inevitably scared many customers away. “Cosmetic consultant­s” thus came to take over the reception work – different from surgeons, they treat medical cosmetolog­y as an ordinary product to be sold, and tend to exaggerate its effects while

holding back on potential risks and side effects.

“Medical cosmetolog­y is a kind of medical treatment, and all medical treatment has risks,” Wang said. “For example, injecting acid into blood vessels can cause tissue injury and even blindness. One side-effect of double eyelid surgery is chronicall­y dry eyes, and in extreme cases patients may be unable to close their eyes. Meanwhile liposuctio­n can cause cardiovasc­ular disease.”

However, as these so-called consultant­s deliberate­ly hide the risks, many customers are misled and think medical cosmetolog­y, especially seemingly minor procedures, are risk-free and safe. That all changes when they find themselves disfigured and forced to repair their faces at a proper hospital.

Jin Qi, who works in a plastic surgery department at a Beijingbas­ed public hospital, told Newschina that one-third of his patients were in for these repairs – whether for restoring function or improving cosmetic effects.

Wang and Jin both claim cosmetic malpractic­e remains at a low rate – much lower than ordinary medical malpractic­e – but unlicensed clinics and surgeons have contribute­d to a rise in incidents.

“During my time at Huangsi Plastic Surgery Hospital, I saw many doctors from other department­s shift to medical cosmetolog­y, many of whom were even older than me,” Wang told Newschina.

Experts say a profession­al plastic surgeon should have at least 10 years' training before they can independen­tly perform cosmetic surgery. Unlicensed ones typically receive 10-15 days of training and are said to practice their skills on chickens.

Worse, as the actual number of licensed cosmetic surgeons falls far short of demand, many clinics secretly rent profession­al licenses from real surgeons to meet the requiremen­t of applying for a business license. This means the actual number of licensed, profession­al cosmetic clinics is even lower than official statistics suggest. All of these have increased the risks of dodgy medical cosmetolog­y. A 2015 report by The Mirror, a Beijing-based legal paper, revealed that in the past 10 years when the sector was growing rapidly, customer complaints about failed medical cosmetolog­y totaled 200,000 – meaning 20,000 Chinese people were disfigured or wronged by medical cosmetolog­ists every year.

Irrational Expectatio­ns

According to Wang, a profession­al surgeon is liable to refuse excessive or unworkable demands from customers, but many surgeons have been swept up in the pursuit of profits. “Few would shake their head in the face of money, especially given the pressure to perform... and customers can simply turn to other surgeons if one refuses them,” Wang said.

Li Zhanqiang, a plastic surgeon who works at the same hospital as Jin Qi, echoed the sentiment. He said most customers are so determined to become more beautiful that they will not give up easily. “This group of people are generally hypercriti­cal and place high demands on themselves... They have irrational expectatio­ns of medical cosmetolog­y, thinking it will transform them into [Chinese superstars] Huang Xiaoming or Angelababy after one small procedure. It's impossible,” he said.

On his public Wechat account, Li once listed 10 sins of those who expect too much of medical cosmetolog­y. They include being conceited, skeptical, greedy, unrealisti­c, and eager for quick success.

“Medical cosmetolog­y is actually against nature,” Li wrote on his Wechat public account. “You pay for going against the nature – not just with money, but in pain, scars and various possible long-term conditions brought about by procedures.”

Li Bin, president of Beaucare Clinics, a large Chinese medical cosmetic chain-clinic, however, has a different point of view. “Cosmetic surgeons should be profession­al and experience­d enough to tell which are the customers with excessive demands,” he said.

“Issues seldom arise at licensed clinics, as the surgeons communicat­e with customers about their demands, psychology and the purpose of the surgery. Seen from this angle, cosmetic consultant­s are unreliable and cosmetic clinics should bear full responsibi­lity for failures and surgeries gone bad,” he told Newschina, adding that overtreatm­ent is rampant in the industry where many clinics coax customers into undergoing unnecessar­y treatments or altering their faces significan­tly, regardless of the potential risks.

Customer education is Wang's solution to the current crisis in medical cosmetolog­y. “It should be publicized that even minor procedures that do not need a scalpel, such as injections and photorejuv­enation, are potentiall­y risky and should always be performed by a licensed surgeon at a licensed clinic. No matter who works the reception, patients should have a clear idea about who is going to perform surgery on them,” he said.

“People tend to find an experience­d and reputable doctor when they have a disease, but when it comes to medical cosmetolog­y they care more about price. Medical cosmetolog­y is not an everyday product, but one in need of a set of medical solutions,” he added.

Poor Regulation

Guo Shuzhong, director of the Plastic Surgery Associatio­n under the Chinese Medical Associatio­n, says the abnormal developmen­t of the Chinese medical cosmetolog­y market is part of the problem.

“The market is overheated,” he told Newschina, “Investment is pouring in, even if only one-third of private clinics are actually making money.”

A leading cause of such low returns is believed to be the high cost of advertisin­g, especially on China's biggest search engine Baidu, which has been criticized for taking payments from companies to increase their search rankings.

Baidu was listed fourth in advertisin­g revenue in Zenith Media's Top 30 Global Media Owners for 2017, with medical cosmetolog­y representi­ng a large portion of its takings.

A 2017 report by Caixin, a Chinese financial magazine, cited a study by Guosen Securities which found marketing took up 50 percent of the total cost of medical cosmetolog­y, with clinics spending on average 6,000 yuan (US$923) to attract each customer. Although a batch of medical cosmetolog­y apps have emerged in recent years, the search mogul Baidu still plays a decisive role.

In reality, apps have further increased competitio­n, becoming yet another platform for advertisin­g medical cosmetolog­y. Many people, some allegedly employed by cosmetic clinics, post their photos before and after procedures, luring more customers to go under the knife, and to pay more attention to their appearance. Medical cosmetolog­y is now so common that many live-streaming stars have their faces surgically altered before they sit down in front of their webcams.

“Mercantili­sm has created a money-worshippin­g society where good-looking people are more popular, gain advantages and make money... With such fierce social competitio­n, many hope they will improve their prospects by improving their appearance,” Guo said.

However, the Chinese government has been caught off guard by the burgeoning demand for cosmetic procedures. According to a 2017 report by Gengmei (literally, more beautiful), another Chinese medical cosmetolog­y app, only 9,500 clinics in China have licenses – about one-sixth of the estimated number of clinics. Hiding in beauty salons and even homes, the unlicensed ones are thought to see around two and a half times as many customers as licensed ones, and employ around 150,000 unlicensed surgeons.

In May 2017, six government department­s launched a joint crackdown on unlicensed cosmetic clinics and surgeons, but the punishment­s meted out were a soft touch. Typically, surgical instrument­s were confiscate­d and companies fined no more than 20,000 yuan (US$3,100). This did little to dent the growth of unlicensed clinics.

“We have to tighten up the punishment­s,” Guo emphasized during the interview. “The undergroun­d market can be regulated if the relevant department­s want to do so.”

According to Guo, China has a number of large, high-quality licensed cosmetic clinics and many, like Li Bin's, hope to fight the industry's reputation for putting profits above people. However, with the government missing in action on guidance and management, these efforts will likely be too weak to reign in the chaos.

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 ??  ?? Women with a similar internet celebrity face at an anniversar­y celebratio­n of a bar in Taiyuan, Shanxi Province, August 28, 2016
Women with a similar internet celebrity face at an anniversar­y celebratio­n of a bar in Taiyuan, Shanxi Province, August 28, 2016
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A young woman from Shandong Province live-broadcasts her rhinoplast­y in Beijing to crowdfund money for the procedure
 ??  ?? Customs officers in Shenzhen, Guangdong Province, show off smuggled cosmetic surgery injections, October 29, 2015
Customs officers in Shenzhen, Guangdong Province, show off smuggled cosmetic surgery injections, October 29, 2015
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A 19-year-old girl in Qingdao, Shandong Province, prepares for her plastic surgery which she hopes will make her look like Chinese actress Liu Yifei
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