Written by Jade Wong
In 2014, 32 year-old Latin dance instructor Lee Ka Ying died in the midst of her liposuction surgery in Hong Kong. Seven years later, the surgeon who was responsible for Lee’s procedure, Kwan Hao-chee, was found guilty of manslaughter and sentenced to six years in prison. This ruling aroused considerable interest and discussion regarding the risks of cosmetic surgery.
According to a report by Hong Kong’s Television Broadcasting Limited, Kwan left immediately following the surgery, leaving an unconscious Lee to the care of four untrained assistants. During the liposuction process, the testing equipment emitted warning signals, yet Kwan turned it off believing the machine was over sensitive. The defence was unable to provide documentation certifying Kwan as a registered cosmetic surgeon, and Kwan refused to give details about how much anesthetics she used on Lee. These factors led judge Lee Soo-lan to conclude that Kwan’s sentencing ought to be stricter, citing her “utter lack of remorse” as the cause.
Lee’s tragedy is not the only instance of cosmetic surgery failure in Hong Kong. In 2012, a woman died from septic shock after receiving the DC-CIK therapy by DR Cosmetics. According to a report by CNN, Chair of Infectious Diseases at the University of Hong Kong Professor KY Yuen, stated that the procedure was only used for patients with metastatic cancer. Dr. Ho Pak-Leung, President of the University of Hong Kong’s Center for Infection also added that its application for cosmetic purposes was unheard of.
These instances reflect the weaknesses in institutional regulation of cosmetic surgery in developed regions not exclusive to Hong Kong. According to the research report “Regulation of aesthetic practises in selected places” by the Research office in the Information Services Division of the Legislative Council Secretariat, beauty staff are subject to lax training, with the Specification of Competency Standards under the Qualifications Framework being only voluntary rather than compulsory. In South Korea, an increasingly prevalent problem is that of “ghost doctors,” substitutes who are hired by well-regarded cosmetic surgeons and operate on patients while the patient is unconscious due to anaesthesia. This is especially becoming an issue with the rise of medical tourism where foreigners travel to South Korea with the primary purpose of receiving plastic surgery, and poses a major issue both to patient safety and because it violates informed consent, a fundamental principle of modern medicine.
However a growing number of countries are enforcing stricter regulation in the aesthetic business. According to the Canada Medical Association, practitioners specialising in plastic surgery in Canada must undergo five more years of training at a Royal-College-approved residency in addition to completing medical school. The training incorporates a minimum of two years of foundational practise in essential aspects of plastic surgery, which must be followed with three years of progressive senior training in plastic surgery, including rotations as a senior or chief resident. Furthermore, Canadian residents are encouraged to choose plastic surgeons who are members of the Canadian Society of Plastic Surgeons, which guarantees proper training of members in cosmetic and reconstructive surgery. However, the strict regulation is exclusive to plastic surgery which is more reconstructive in nature. Any doctor can perform cosmetic surgery, such as eyelid lifts, despite many having limited experience, a loophole that is most exploited at unregulated private clinics.
The controversies surrounding plastic surgery are not limited to the regulations, or lack thereof, in the field. Disputes regarding its implications on body image and unrealistic beauty standards have also aroused considerable public attention. One example is South Korea, a place where plastic surgery culture is so prevalent that it encouraged a wave of medical tourism. As per a report by Gallup Korea, one in three South Korean women aged nineteen to twenty-nine have gone under the knife, representing the highest estimated per-capita rate of cosmetic surgery for a nation.
The rapid rise of plastic surgery originated from the Hallyu Wave, where popular celebrities shaped Korean beauty standards to a highly homogenous set of features. However, with the rise of feminism and body positivity ideals, such strict standards of beauty are losing their relevance in South Korean society. South Korea’s feminist progression can be witnessed in the “Escape the Corset” movement where South Korean women actively dress and style themselves in a way that defies existing beauty standards. It comes as no surprise that the same generation of women will reject the notion of going under the knife to conform to social expectations of beauty. According to the Korea Times, Koreans have been complaining that advertisements of cosmetic procedures promote a distorted image of how women ought to look, and these complaints have been growing since 2015. Thus, starting from 2022, the Seoul Metro Station will ban advertisements of cosmetic surgery.
Despite rising opposition, proponents of plastic surgery stand firm. An alternative line of feminism supports women who undergo plastic surgery because it is within their autonomy to enhance their body features. Sesali Bowen from The New York Times criticizes people advocating for “natural looks” for it excludes people seeking to conform to society’s narrow definition of beauty for personal gain. “I don’t think that the women who are staunchly against plastic surgery are worried about women’s health or self-esteem; I think they are motivated by fear that their pretty privilege — the benefits they get to enjoy for meeting those standards without the help of a doctor — is at risk,” she says, and she could be right; “Pretty privilege” does exist in modern corporate culture. Given employment biases towards more attractive individuals, those who are unable to tailor their appearances to fit societal beauty standards may be further disadvantaged economically. In to her paper “Physical Attractive Bias in Hiring: What is Beautiful is Good”, Comila Shannai-Denning, Associate Professor in the Department of Psychology at the University of Hofstra, asserts that existing academic literature supports the notion that being physically attractive is an advantage when applying for a job.
Social implications aside, the cost and insurance policies of aesthetic procedures is also subject to widespread public attention. According to CosMedical, aesthetic surgeries vary widely in terms of cost, with Botox being $750 per injection, while surgeries such as facelifting can cost up to $20000. It should be noted, however, that Botox typically requires a minimum of 12 injections, bringing the overall cost to $9000. With the minimum monthly salary in Canada being $2367.7 in 2020, cosmetic or aesthetic procedures are typically inaccessible to lower-income individuals. In terms of insurance, the Ontario Health Insurance Plan (OHIP) does not cover minor procedures and most cosmetic surgeries such as butt lifting. Under specific circumstances, OHIP may cover breast reduction surgery, typically undertaken together with liposuction.
The controversies surrounding plastic surgery are unsurprising to say the least. Societal shifts towards modern feminist ideals have gradually demolished the longstanding patriarchal standards of beauty, while grave mistakes on the surgery platform have exposed regulation meagreness to the general public. Coupled with high costs of going under the knife, the proliferation of cosmetic and plastic surgery is coming under public scrutiny. Yet femininst voices supporting plastic surgery are equally strong. Policymakers often have to consider the dilemma between individual free will and protection of consumer rights when deciding on the extent to which the beauty industry must be regulated, and with recent introduction of new policies, such as the regulation of beauty clinics in Hong Kong, their effects are yet to be observed.