Going under the knife can be risky business
Going under the knife can be risky business
David Kennedy, Contributor, Jakarta
d_kenn@yahoo.com
Take a look around any of Jakarta's big shopping malls on a busy
afternoon. Notice anything unusual? Now, take a closer look at
the sea of faces as they glide by -- there is a good chance some
of those faces have had some form of cosmetic skin surgery.
A staggering array of cosmetic enhancements is now offered by
dermatologists and cosmetic surgeons across the city and growing
numbers of people -- mostly women -- are availing of them.
From chemical peelings to liposuction, rhinoplasty to
blepharoplasty, Botox to chin and breast implants -- not to
mention the latest laser treatments, demand has increased
steadily over the last decade.
As the growth in the beauty parlors and clinics testifies, the
Asian financial crisis of 1998 did little to dampen peoples'
resolve to improve their looks, often at any price. If anything,
it has boosted the business here as it became much more expensive
in Singapore.
Over the last decade the numbers of qualified plastic surgeons
in Indonesia has doubled from 25 to about 50; in comparison to 10
or 15 years ago. Many surgeons today spend a far greater
proportion of their time on esthetic rather than reconstructive
surgery.
"We treat in the region of 3,000 patients per month," said Dr.
Edwin Djuanda of the Jakarta Skin Center in South Jakarta. He
added that after the financial crisis business continued to
increase.
"There are so many requests for Botox," he said, referring to
the toxin injected to relax muscles in the forehead and around
the eyes to reduce wrinkles and lines, "that everyday is 'Botox
day' here; we do about 100 injections per month".
Apart from Botox, the most sought after cosmetic treatments
include liposuction to remove fat from the body by suction,
chemical peeling of the face and laser treatments to reduce
blemishes or acne scars.
Among clients of Chinese descent, eye surgery, known as
blepharoplasty, to create a crease in the eyelid is in great
demand. Rhinoplasty or nose reshaping is also popular among all
clients.
Business in breast enlargements is also booming. Clinics like
the Jakarta Skin Center use patients' own fat from liposuction or
implants of new bio gels coated in protective capsules that can
be safely removed later.
Dr. Djuanda acknowledged that for some people, cosmetic
surgery had become an addiction.
After the first operation, patients often wanted to change
their appearance entirely as if, he suggested, a hormone had been
released into the bloodstream, willing them to do more.
"A lady from Makassar (South Sulawesi) had surgery and
liposuction here several days ago. She also had her chin done
here and then she went to another doctor to do her eyes," he
said.
"Shopping around" for treatments with different specialists is
a common practice among wealthier cosmetic surgery clients,
according to Dr. Djuanda who said he encouraged patients to wait
before rushing into a second operation.
The rush for new looks has led to many disappointments and
some tragedies. A vibrant and illicit cosmetic surgery trade has
taken root in the country -- exploiting the growing demand and
apparent lack of concern among clients regarding the
qualifications of the person holding the syringe or scalpel.
The proliferation of beauty parlors, illicit clinics and
unscrupulous door-to-door salesmen, performing potentially
dangerous surgical procedures without medical supervision or
adequate facilities is a major cause for concern, according to
leading surgeons.
While it is impossible to know the precise numbers of people
using illicit clinics and beauty parlors, a reliable indicator of
the extent of the problem comes from the number of patients
plastic surgeons are treating for complications.
"I treat about a hundred patients damaged in beauty parlors
each year," said Dr. Gentur Sudjatmiko, senior plastic surgeon at
Pondok Indah and MMC hospitals in South Jakarta.
Dr. Gentur, also a lecturer in plastic surgery and head of the
teaching facility at Cipto Mangunkusumo General Hospital in
Central Jakarta, does not hide his shock at the damage inflicted
by illicit beauty parlors -- 90 percent of which is down to
injections of silicon and other dangerous substances.
"Sometimes people's faces are really frightening. They can
even look like monsters," he said, carefully weighing up whether
the word was strong enough to describe the gravity of the
situation.
From 50 registered plastic surgeons across the country -- 20
of whom practice in Jakarta -- and many of them treating similar
casualties from illicit clinics, the scale of the problem begins
to be alarming.
"At the moment, I am dealing with many injections of silicon,"
said Dr. Dewo Affandi at Tria Dipa Hospital in Central Jakarta.
He added the main problems are infections, allergic reactions
and inflammations. There may also be bleeding from wounds, tumors
and deformities as silicon and other fillers move through the
body, obeying the laws of gravity.
"Only today I had two patients, one who had injections in the
lips and the other with injections in the nose," said Dr. Dewo
who treats about 15 such cases per month in addition to his
regular work in reconstructive plastic surgery.
"We had to open the nose and analyze the material to determine
the pathology before removing it. How many people are being
damaged by these quacks?"
In areas like Mangga Besar in West Jakarta, a thriving
industry of back street beauty parlors and clinics cater for
mostly Chinese Indonesian clients.
Workers in illicit clinics often follow one or two weeks
courses in Taiwan and elsewhere in Asia and they gain clients'
trust despite their lack of formal qualifications or access to
proper medical facilities.
As in all surgical procedures, complications -- ranging from
bleeding to infections and inflammations -- can arise at any
moment and without the proper medical supervision a person may be
badly injured. The results can be disastrous if silicon is
injected into a blood vessel or an artery.
"I have heard of cases where people have had eyelid surgery in
people's homes, sometimes just sitting on a chair," said Dr.
Djuanda incredulously.
The Indonesian Medical Association does not fully recognize
cosmetic surgery but promotes a multi-disciplinary approach, as
is the case in other countries, requiring practitioners to be
qualified surgeons.
While some experts call for stricter regulations of beauty
parlors and unlicensed clinics, others underline the weakness of
any new approach based on laws and regulations.
"The police cannot sue an illegal clinic unless the patient
makes a complaint. However that would take time and money for the
patient so they don't do it," said Dr. Dewo, who has been active
in discussions on the creation of an association of Indonesian
cosmetic surgeons.
Dermatologist Dr. Abraham Arimuko at Kartika Pavilyun in Gatot
Subroto Hospital, Central Jakarta, said promoting more awareness
was crucial.
"Sometime patients know about the legal ways of getting
treatment but they still go to the beauty parlor because it's
cheaper," he said, adding that numbers taking this route may have
risen by up to 10 percent or 15 percent in recent years.
Perhaps there is a need for a greater understanding of the
underlying causes of the growth in illicit cosmetic surgery.
Lamenting the fact that many Asian women want to look western,
Dr. Djuanda highlights the influence of Hollywood. "Now everyone
wants lips like (actress) Angelina Jolie," he said. "Sometimes
they want their lips like one star, their eyes like another and
their nose like another."
Television, film and mass media advertising campaigns often
sell a western ideal of beauty -- an image that signifying
wealth, success and fulfillment.
Dr. Gentur, who performs more than 600 operations per year --
two thirds of them for esthetic purposes, suggests the problem
lies in people looking for short cuts to beauty. "They are
looking for the easy way, with no effort," he said.
The fact that treatments in beauty parlors are usually, though
not always, cheaper than public hospitals is not the major cause
of the problem, according to Dr. Gentur.
At training hospitals like Cipto Mangunkusumo, he said
operations are usually affordable, and in certain cases they are
free. "The big problem is not the price but people don't know
about the treatments and where they can have them."