South Korea is a truly amazing country and has, over the last thirty years, transformed into one of the most dynamic and innovative economies in the world. It has not all been easy due to external influences such as the Asian Financial Crisis in 1997. Three of the country’s worst affected were South Korea, Thailand and Indonesia. Thailand saw an opportunity to develop from a ‘sun, sea and sand’ tourist destination. By adding surgery to the mix, it became a flourishing medical tourism destination. South Korea did not have the ‘sun, sea and sand’ attraction, but was emerging as a high technology medical environment. A key aspect of the ensuing medical tourism in South Korea was in the field of cosmetic surgery tourism (CST). The role and continued presence of cosmetic surgery as a major contribution to the Korean economy is described in a detailed, narrative paper with an intriguing title, ‘Trading Faces: the ‘Korean Look’ and Medical Nationalism in South Korean Cosmetic Surgery Tourism’ (Holliday R, Cheung O, Cho JH, Bell D. Asia Pacific Viewpoint 2017;58(2):190-202).

One quote that sets the scene is the following answer given by a Korean surgeon to the question: Are “East Asian patients…going for a Western look?

“Dr K: Well, it is more complicated than that. First we had no cosmetic surgeons in South Korea, and then Dr B he was the first, he went to train in the US and he wrote the textbooks we all studied from. We were the next generation, and he trained us and we used his books. But pretty soon we realized that Western techniques were totally inappropriate for the Korean body, so we, the next generation, had to rewrite the textbooks from scratch to account for this. Now we practice surgery that is right for the East Asian body”.

The drive and innovation of the Korean surgeons, together with a favourable regulatory oversight has allowed cosmetic surgery to flourish and South Korea is now regarded as “Number 1 in the world regarding cosmetic surgery” (another quote from the ‘Trading Faces’ paper). Figures from the first decade of this century indicate that at least 20% of Koreans have undergone cosmetic surgery. This is the highest per capita uptake of cosmetic surgery in the world and is considered a conservative estimate. With regard to cosmetic surgery tourism to South Korea, the patients include those from the widespread Korean diaspora, but the largest proportion are patients from China. A 2015 survey by the International Society of Aesthetic Plastic Surgery (ISAPS) indicated that South Korea was performing well over one million aesthetic procedures annually, accounting for over 5% of the worldwide total. This is despite the fact that the population of South Korea represents only 0.66% of the global population.

Returning to the case of Dr Vanessa Kwan; at the time when she graduated from Hong Kong University there was no formally recognised specialty of cosmetic surgery (and / or medicine) in Hong Kong. Unsurprisingly, there were no formal training programs in cosmetic surgery or aesthetic medicine. As she wished to develop a career in cosmetic surgery, it was a logical step to go abroad and seek training from some of the best cosmetic plastic surgeons in the world. As noted above, the place to go to learn about cosmetic surgery with a special emphasis on East Asian patients is South Korea. And so that is where she went.

An issue that needs to be looked at in some detail is how various jurisdictions regulate professional behaviour. This is a problem in medicine, which has traditionally been a self-regulated profession. It is necessary, however, for governments to intervene if it is apparent self-regulation is not working. This also applies to the ‘beauty sector’ and that was the situation the HKSAR Government found itself facing following the 2012 death in a beauty centre. This was the tragic event that led to the incarceration of Dr Mak also convicted of gross negligence manslaughter (GNM). The research office of the Information Services Division of the Legislative Council Secretariat produced a report in November 2014, looking at regulation of aesthetic practices in selected places. It is immediately obvious from the report that accurate data is difficult to obtain but some interesting comparisons emerge: in 2013, Hong Kong had a population of 7.2 million, compared to 51.2 million in South Korea. Hong Kong had 53 specialists in plastic surgery compared to 1,851 in South Korea. Hong Kong had 13,005 ‘general practitioners’, whilst South Korea had 107,221 medical practitioners (I am using the terms from the report.)  Two points of relevance to the ongoing discussion is that in 2014, in Hong Kong, there were “No specific requirements on the competency or experience of the medical practitioners in performing specific aesthetic procedures”: and with regard to “Requirements on personnel performing anaesthesia for surgical procedures in medical clinics”, Hong Kong was noted to have “No mandatory requirements”. The report can be downloaded here.

In the next blog I shall be looking at propofol and why this drug needs to be treated with respect.

The following are some publications accessible on the web that give more insight into cosmetic surgery tourism (pre COVID-19). It will be fascinating to see how the post-COVID world adapts and responds.

  • Holliday R, Bell D, Cheung O, et al. Brief encounters: Assembling cosmetic surgery tourism. Social Science & Medicine 2015;124:298-304.
  • Stevenson A. Plastic surgery tourism brings Chinese to South Korea. The New York Times 2014;23.
  • Bell D, Holliday R, Jones M, et al. Bikinis and bandages: An itinerary for cosmetic surgery tourism. Tourist Studies 2011;11(2):139-55.
  • Jones M. Clinics of oblivion: Makeover culture and cosmetic surgery tourism. Portal: Journal of Multidisciplinary International Studies 2011;8(2):1-17.
  • Holliday R, Bell D, Jones M, et al. Beautiful face, beautiful place: relational geographies and gender in cosmetic surgery tourism websites. Gender, Place & Culture 2015;22(1):90-106.
  • Holliday R, Bell D, Jones M, et al. Sun, sea, sand and silicone: mapping cosmetic surgery tourism. Research Report. University of Leeds, 2014.
  • Livingston A. Plastic paradise: the trends & effects of cosmetic surgery tourism in economically growing countries. The Cohen Journal 2015;2(1):2.
Andrew Burd (Prof)

The Chinese University of Hong Kong.

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