The medical specialty of plastic surgery actually arrived relatively late in Taiwan. According to the statistics of the Plastic Reconstruction Surgical, qualified plastic surgeons--those who received three years of general surgical training and three years of specialized training in plastic surgery-- number as few as 120. And the vast majority of these work in the plastic surgery departments of major hospitals, where they mostly perform such major surgical operations as fixing cleft palates, harelips and all variety of exterior scars. Only some 20 have made their careers in opening clinics offering "cosmetic" surgery.

Is skin deep a small matter? This being the case, are the more than 1000 plastic surgery clinics whose signs line Taiwan's streets all run by quacks? Not necessarily. Some are run by older surgeons, certified to practice plastic surgery in Japan, America or other foreign countries, who were in medical school before training in plastic surgery was given in Taiwan. But in many cases, the numerous certificates in foreign language covering the "doctors" walls are from crash-course "plastic surgery cram schools." Practitioners of this latter sort have a most superficial understanding of their discipline. Lacking a grounding even in such basics as anatomy and anesthesia, they're still happy to take a knife to a patient. It's enough to make you break out in a cold sweat.

Lu Hsu-yen, the director of the plastic surgery department of a famous major general hospital in Taiwan, points out that though most plastic surgery operations are only skin deep, as it were, treatments requiring anesthesia for the whole body, such as face lifts and breast implants, involve the functions of the liver, kidneys, heart and lungs, as well as blood sugar and blood coagulation--all matters requiring great care. It is said that one patient getting a breast implant died at an uncertified clinic because the surgeon simply wasn't careful enough. "Sometimes it's not only the doctor who will lower his guard. The patient may think that it's just a trifling matter, not requiring her to pester the doctor with a lot of chatter," says Dr. Lin Ching-yun, who once had a patient who neglected to mention beforehand that she had a myocardial infarct.

Nevertheless, the secretary of the Plastic Reconstructive Surgical Association points out that over the last couple of years a growing number of people are calling to ask, "Is doctor so-and-so a member of your association?" Chasers of personal beauty are indeed beginning to worry about protecting themselves.

Ten operations a day is no big deal! Even if a certified doctor does the operations, there may be room for improvement. Since plastic surgeons are in many ways "psychiatrists with a knife," they are supposed to try to have an understanding of the patient's motives, profession and family back-ground. In particular, they need to make a factual report about the possible complications and undesirable after effects of a treatment. Yet while this sounds great in theory, putting it into practice is difficult indeed.

Chiang Hsiao-shan, an owner of one plastic surgery hospital, points out that in Taiwan doctors are few and patients are many. In bigger hospitals, it is not unusual for a doctor to operate more than ten times a day. In some advanced countries, he points out, doctors are asked to see no more than three new patients a morning, and each patient must come to the clinic at least twice before lying down on the operating table. This is "to give them the chance to hear what the doctor has to say and have a night to sleep on it." Chiang puts this demand on himself: "At the very least patients on their first visit should not be allowed on the operating table." But as a result, some patients who want "secrecy, convenience and speed" make their way to the quacks' clinics.

The quacks may use a knife as skillfully as the certified surgeons. It's just that if they make a mistake they'll never admit it, and they won't take responsibility to right what they've wronged. Or they'll use cheap materials and cut a few corners with their techniques. Of all of their unsavory practices, silicone injection is probably the most infamous.

No surgery, no scars? Most plastic surgery, such as nose jobs where the bridge of the nose is raised, breast implants, cheek implants and chin extensions, all require that fillers be added to a person's physical structure. There are many different kinds of fillers. Beside coming from the patient's own body (her own bone or own fat) they also include silicone foam and silicone jelly, which are frequently used in mainstream plastic surgery. The silicone injection procedure that was popular in the seventies used needles to inject liquid silicone used for medical purposes into the body. This method has a medical basis, but because liquid silicone will by nature flow around, the way it is used and the amount to be used should be strictly controlled.

Using a needle to implant silicone is fast and cheap and is a classic example of a technique that neither requires surgery nor leaves scars. It was an immediate hit. There are records of women from central and southern Taiwan coming north on chartered tour buses for "head-to-foot" plastic surgery. But the silicone injection operations practiced in Taiwan, where they never were legal, were greatly botched by the uncertified practitioners. Not only were dosages virtually without limitation and mistakes made regarding injection depth, but at times cheaper industrial-use liquid silicone might even be mixed in. The result was that while most patients were very satisfied with the short-term results, just a few years later they would begin to bear interminable unpleasant after effects.

Because the silicone used in these treatments is in a liquid state, it forms small droplets which spread throughout the body tissues. In defense, the tissues create thin membranes to encircle the invaders. As time goes by, the thin membranes grow thicker and get entangled with the muscles and nerves. Red swellings, abscesses and other deformations are the result. Once implanted, extracting all of the silicone is next to impossible. And because of liquid silicone's tendency to flow and move about, the original "heightened forehead" may turn into drooping eyebrows and eyelids. A "high" nose may become a "big" one, where an overly large bridge brings to mind the hooked witches' noses found in comic books.

Beauty has its price: Over the years, silicone implants have permanently scarred the bodies and souls of numerous women who had wanted to look beautiful. And today there are still a small number of doctors, lacking both accreditation and conscience, who will perform this operation for the ignorant. "Even if they love being beautiful," says Lin Ching-yun poignantly, "they ought to learn to love and pity their own bodies."

Silicone implants are perhaps an extreme example, but even if current mainstream plastic surgery can be considered to be quite mature, there are still numerous shortcomings that are hard to overcome. For example, the body often rejects or is allergic to the implanted material, resulting in swelling and infection. If the implants are not performed skillfully, they may shift and change shape. Undoubtedly, there are also yet-unknown dangers that could burst forth at any time.

Recently, the news that silicone breast implants are linked to cancer frightened the tens of thousands of women around the world who have undergone such treatments and for whom it's too late to reconsider. Perhaps those after a beautiful appearance ought first to pause and think. If health has to be sacrificed for beauty, are the unending troubles that follow worth it?

[Picture Caption]

(photo courtesy of Shiseido Cosmetics)

Pages full of ads making seductive promises. How much risk is entailed, one may wonder. (photo by Huang Li-li)

A full figure! How many women have endured the pain of the knife for your sake? (photo by Cheng Yuan-ching)

Pages full of ads making seductive promises. How much risk is entailed, one may wonder. （photo by Huang Li-li）

A full figure! How many women have endured the pain of the knife for your sake? （photo by Cheng Yuan-ching）