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BANGKOK — In 2010, Dr Adunchai Thammasangsert fulfilled a dream when he attended a three-day cosmetic surgery course in South Korea. He had been saving up for the 150,000 baht course (about S$6,000) for the last four years, since he received his board certification in plastic surgery in Thailand. Among the 30 participants, he was the sole Thai national and the only plastic surgeon. The rest were general practitioners.
“A doctor asked me why I was even there, since I was already a plastic surgeon,” said Dr Adunchai, 43.
“I told him Korean cosmetic surgery is very popular in Thailand, and getting a certificate from Korea would be considered pretty cool.”
Today, six years later, the workshops offered by the Korean College of Cosmetic Surgery are more popular than ever, and they are even being conducted in Thailand, with a three-day course held in Bangkok earlier this year costing around 400,000 baht.
For some doctors, these courses offer a short cut to the lucrative cosmetic surgery sector, especially since Thailand is a major destination for medical tourism.
Unfortunately, the result is a rise in the number of complications, including horror stories such as silicone implants protruding through the nose weeks after an operation and patients being unable to open their eyes after eyelid surgery.
The number of complaints filed to the Office of the Consumer Protection Board related to aesthetic surgery has jumped in the past three years from 36 complaints in 2013, to 185 in 2014 and 373 in 2015.
In Thailand, medical students have to complete six years of medical school, followed by one to three years of internship and practice in rural areas before they can apply for a hospital residency in a speciality field.
To achieve board certification in plastic surgery in Thailand, a doctor is required to complete five to seven years of specialised residency — with training in both general and plastic surgery — and pass the board exams. Plastic surgery covers both reconstructive and cosmetic surgery.
The number of medical students studying plastic surgery is determined by the Royal College of Surgeons, and averages 20 graduates each year.
In November last year, the royal college issued a statement condemning short-term facial surgery courses for general practitioners, saying such courses are not approved by the medical council, are not up to standard, and could raise the risk of complications during medical procedures.
However, the Thai Medical Council is on the verge of approving short-term courses for a variety of medical procedures, sparking further concerns over patient safety.
Thailand’s Medical Profession Act does not prohibit physicians from practising outside their specialist area. So doctors who want to practise cosmetic surgery can do so, but may resort to unconventional methods to gain sufficient skills.
These range from learning from fellow doctors and foreign lecturers to self-study through textbooks and even YouTube, experts familiar with the issue say, with training conducted at clinics and hotels.
Forums on medical websites are swamped with advertisements offering hands-on aesthetic and cosmetic surgery courses, ranging from one-day facial aesthetic training — which includes Botox, fillers and threading workshops — to more complicated surgical procedures. Upon completion of the training, participants are provided with certificates and patient referrals.
A course advertised by YB Clinic in January offered training in a wide range of cosmetic surgery procedures including chin and nose augmentation, and cheek reduction, with a seven-day full rhinoplasty course priced at 750,000 baht.
Training is conducted at the clinic’s branches in the north-east, with housing, food and a personal driver provided, while qualified physicians are offered positions at the clinic.
Another advertisement offering training in nose augmentation, lip reduction, double eyelid surgery and liposuction guaranteed that a participant would be able to perform the procedures in one day, while promising “professionalism” within a month.
Although they claim to be taught by specialists in the field, experts say the instructors are usually general practitioners who themselves have undergone short-term training.
Such courses are condemned by plastic surgeons who consider short-term training no substitute for board-certified training.
Society of Plastic and Reconstructive Surgeons president Sirachai Kindarak said specialists are more likely to avoid risky procedures.
“Complications can be caused by plastic surgeons, but I believe the problems are much less severe (than surgery performed by non-plastic surgeons),” he said.
Dr Chamnong Chirawichada, a board-certified plastic surgeon, said he treats patients with complications caused by non-plastic surgeons every day.
Dr Chamnong injects facial fillers every now and then, but he always explains the risks to his patients. “Nine out of 10 people back away when they hear me talk about the risks, and that fillers can cause permanent blindness. But non-plastic surgeons never talk about these risks.”
Over the past decade or so, the healthcare sector has enjoyed a surge in medical tourism. Thailand has been ranked as a top global destination for medical tourism by several sources including Bloomberg in 2013.
Government statistics indicate 1.04 million visits by medical tourists in 2014.
There is no official data on the share of the aesthetics market. With the rise in cosmetic surgery mishaps, the Society of Aesthetic Plastic Surgeons has published a cautionary note on its website in English for medical travellers. It warns them not to become a “victim of miserable complications reported by foreigners who had cosmetic surgery done by non-plastic surgeons”.
Thailand has 1,458 clinics providing aesthetic services registered under the Health Service Support Department, representing 13 per cent of all medical clinics in Thailand. Hospitals with Joint Commission International accreditation require board-certified surgeons, meaning that non-plastic surgeons are mostly employed at clinics.
VR International Clinic, for instance, which claims it is “Thailand’s first Korean-style surgical clinic”, posted a job advertisement for aesthetic surgeons for its branches in Bangkok, but did not make board certification a requirement.
It is common for medical associations to invite foreign physicians to conduct seminars and live demonstrations in Thailand, including at hospitals.
The Thai Association and Academy of Cosmetic Surgery and Medicine recently sought the partnership of the Korean College of Cosmetic Surgery under a memorandum of understanding aimed at promoting knowledge sharing.
In April, the Korean college held a three-day course in Bangkok, which highlighted breast augmentation, chin reduction, filler and Botox injections, and face-lifting, using cadavers. The two plan to co-host an Association of South-east Asian Nations (Asean) meeting of aesthetic surgery and medicine in November.
Private agencies are also now bringing in Korean cosmetic surgeons not only for training, but also for treating Thai patients without a licence to practise, which is against Thai law.
Not everyone, however, is willing to put their trust in non-board-certified practitioners. Bussarin Juthasompakorn, 30, said she always researches the background of the physician to ensure he or she is an expert in that area.
“I had a friend who tried to talk me into injecting Botox with a dentist, but I wasn’t confident,” said Ms Bussarin, who now sees a certified dermatologist for her Botox injections. “What if my face suddenly turns stiff?”