The Chinese government is cracking down on a burgeoning industry involving thousands of illegal "surgeons" tucking in tummies, widening eyes and, more popularly, enlarging breasts of women trying to improve their career prospects or impress potential suitors.
The plastic surgery industry has mushroomed in China with many clinics coming up on street corners in dozens of cities. Even beauticians are known to offer this service illegally to those who cannot afford more expensive institutes, and those that want to keep their decision to go under the knife a secret from family and friends, sources said.
The most popular procedures are double eyelid surgery, liposuction, nose jobs and breast enhancement, industry sources said. This is apart for the large scale use of chemical and ray assisted methods to enhance beauty.
Industry reports suggest that more than half of those seeking surgeries are young people making themselves look sharp and smart to meet the demands of jobs in sales and the hospitality industry besides attracting rich spouses. Middle aged and older people seeking cosmetic help to look younger form the other segment of the market.
The demand for procedures far outstrips the supply of doctors and licenced personnel resulting in a vast industry of unlicenced surgeries. The number of botched surgeries are believed to be higher than 20,000 a year. This is an unofficial estimate, as there are no records covering the large numbers of illegal clinics operating around this continent sized country.
A worried ministry of health has issued new rules and ordered government agencies in provinces and cities to investigate the role of beauticians and unauthorised "medical institutes" in providing this sought-after service.
"Local health administrations at all levels should approve and inspect medical cosmetic institutes strictly in accordance with laws and regulations... With similar qualifications, public-funded ones should be licenced first," the ministry said in a circular last week.
Behind the government move is a hidden sense of unease about the new craze among a large number of people for remaking their faces and bodies, and the dangers people expose themselves to. The government is under pressure because there have been several cases of serious damages caused to people opting for plastic surgery.
Figures released by the International Society of Aesthetic Plastic Surgery show China ranks third after the United States and Brazil in terms of licenced procedures carried out. There were 1.3m licenced procedures carried out in 2010. The market for licenced surgeries which hardly existed a decade ago is now worth $2.4bn largely because of the massive growth in wealth across the country.
Even government and military run hospitals have jumped into the beauty surgery business in China. They have been drawn partly by the new source for generating revenue and reduce their dependence on official budgets because the health ministry is pushing hospitals to become as self-sufficient as possible.
But there is an important, largely secret reason why hospitals run by the tightly controlled People's Liberation Army have set up plastic surgery units that cater to the beauty business outside the usual medical role of helping people who have suffered road and burns accidents. Some believe the PLA's entry into the business is linked with the need for political leaders and senior officials to look young and natural, beyond the standard darkened hair or wigs.
But the public must not know their surgery secrets, critics believe, and the staff in PLA hospitals are the ones who can be trusted to keep the gradual changes in the faces of leaders under wraps.
"We make changes little by little and sometimes even close friends and relatives do not notice it. We usually start with tightening the under eye area," a surgeon in a government hospital said on the condition of anonymity.
"We then make small cuts beyond the ends of the two eyes, and pull up the skin to give a feeling of tautness. Some people also want a jaw job to make them appear more sharp and decisive," he said.
There were 50,000 cosmetic operations conducted at the People's Ninth Hospital in Shanghai in 2011, the busiest public hospital in the plastic surgery arena, local media quoted Qi Zuoliang, deputy director of the hospital’s plastic-surgery department, as saying. The last five years have seen a 50 per cent growth in such surgeries in the hospital, he said.
Given rising demand, most observers believe the number of illegal treatment centres could be three or four times higher than the licenced ones. When surgeries go wrong, many patients tend to keep quiet due to fears of losing face in public.
"Local health administrations at all levels should approve and inspect medical cosmetic institutes strictly in accordance with laws and regulations."
- China's ministry of health
The cosmetic surgery industry has been under pressure for nearly two years after a 24-year-old former television talent show singer Wang Bei died while undergoing facial surgery at a hospital in Wuhan, capital of the central Hubei province, in November 2010. The industry has been criticised for uneven distribution of qualified medical resources, unfair competition, and a lack of official supervision.
Among the first to ring the alarm bell was Ma Xiaowei, a vice-minister of health, who said that during a random inspection of plastic surgery clinics in 2010, fewer than half met national standards. Her concern was echoed in the Chinese parliament the following year when a deputy and leading plastic surgeon, Wang Chulan, called for higher standards after botched surgery complaints reached 20,000 a year.
A major challenge is the publicity blitz surrounding the industry. The central government has ordered restrictions on the screening of advertisements by plastic surgery clinics in newspapers, television and internet sites because they often make misleading promises about making patients look younger and beautiful after a short 30-minute procedure. Some claim to entirely transform the looks and personality of those going under the knife.
In its latest order, the ministry of health asked inspectors to carefully scrutinise the qualifications and abilities of those carrying out cosmetic surgeries to determine if they meet licencing requirements. Those providing the cosmetic surgery services without authorisation should be "seriously dealt with", the ministry said.