Saving Face by Guy Nicholls

Flaunting the fact that one has spent a lot of money on oneself is par for the course in Hong Kong. That is until one start discussing cosmetic surgery. It is a subject surrounded by a wall of silence. No one will talk about it.

Guy Nicholls tracked down two of the territory’s most famous plastic surgeons who were candid enough to discuss their handiwork. But there was one stipulation: no names were to be mentioned – their patients’ right to privacy would be honoured. Thus who has and who has not had plastic surgery remains a matter for private speculation and public scrutiny.

For a population which seems to spend an awful lot of its time giving or keeping face, and in a place where stress means stretch in cosmetic terms, Hong Kong is miles behind the United States and Japan when it comes to attitudes about cosmetic surgery. In those countries, talking about having parts of your surface anatomy cut, tucked, reshaped and sewn up again is as popular as going to a baseball game or sipping sake.

            This is not to say that cosmetic surgery is rare here. It is simply shrouded in a veil of secrecy and speculation. This face-saving arrangement is not merely a matter of personal preference or societal deference. It is the law. Doctors are not supposed to artvertise in Hong Kong, and, on the whole, they do not. The ones who do are invariably Chinese – as the chances of other doctors having the same name are high, the Medical Council finds it difficult to be sure that it is not pointing the finger at the wrong “Dr Wong”.

            There is, no doubt, a seething mass of latent liposuctionees and sad faces out there wanting something done, but they may not know specifically what, or how to go about it. Making the decision to have plastic surgery is only half the battle. An expert with steady hands then has to be tracked down. Some of the world’s leading plastic surgeons operate here, but locating those qualified is a different ball game.

            Because of the publicity restriction imposed on the medical profession, it seems that word of mouth is the only way to find a cosmetic surgeon who will lend an ear to your problems. The concept of cosmetic surgery here has not been harnessed to the manic media found in countries where the other cheek is turned to medical ethics.

            Plastic surgery is a big field, of which cosmetic surgery is just a tiny but pretty little acre tucked away in the corner. It is a profitable business. One jocular cocktail party person heartily pointed out that the only scar he had received from his node job had been on his wallet. Talking to Mr Anon was a delightful but rare experience; indeed, talking to anyone about this delicate subject is most unusual.

“Big busts are in at the moment, partly because of the way that fashion designers are going through a show-off-your-body phase”

            This brings us to the only really usable source of information on the subject: the doctors. I managed to track down a couple of Hong Kong’s leading specialists who have dedicated their lives to making people feel better about their appearance. Dr X and Dr Y were both quite charming, and when they actually sat down and started talking about how they spend their days, they took on a godly air. They deal in creation, or at least a part of the power to do so, and bandage up this gift in an eerie confidence that was both comforting and austere.

            Both doctors are senior plastic surgeons and operate their separate practices within a hundred yards of each other. The gaily coloured, merry-go-round furniture and décor in the waiting room of Dr Y bears testament to the fact that he has been around for quite a while. Nearly 30 years, in fact: he began in the Sixties when the beauty bandwagon started rolling in earnest in Hong Kong.

            As the world recovered from the Second World War and economies started to prosper, personal incomes rocketed and the communications revolution took hold. “People want to look better. What’s new?” explains Dr Y. “They have the money to do it. The business world is becoming more competitive. People live longer and hold onto their jobs longer. And then, of course, there is a trend in everything these days. The ‘good look’ and the ‘serious business look’ are in high demand, and this is where cosmetic surgery comes in.”

            Dr Y gives a pointed example. “Big busts are in at the moment, partly because of the way that fashion designers are going through a show-off-your-body phase,” he explains. “Breast augmentation is an extreme, however. People just want to look good, to look young, to get rid of that tired, older look.” The result: “open-the-door-and-enter eyebrow surgery, wrinkles surgery and face jobs”.

“In the US, everyone will show their face-lift to their friends and ask them what they think of it. This never happens in Hong Kong” – Dr Y

            According to oft-quoted statistics, 98 per cent of cosmetic surgery patients in Hong Kong are women. Referring to the lopsided sex ratio, Dr X says: “Men are conscious about their looks, but they are just too darn busy. Men also seem to be more conservative and shyer, but that doesn’t mean they don’t want to do it. It is easier for a woman to approach the subject as they spend a lot of time doing themselves up and being involved with make-up and the like.”

            “The few men who have cosmetic surgery have a special reason for wanting something cosmetic done – they have changed their environment, they are going for a new job, they’re married to a younger lady,” opines Dr Y. “Women of all ages, though, just tend to want to look better.”

            During the past two decades, younger people have been coming forward in greater numbers for ‘beauty enhancement’. The most popular age group at the moment is between 20 and 40 years, and the average age of customers is continuing to fall. The younger the patient, the longer he or she will have to live with the changes the doctor has made. It should be noted, too, that a face will age in a different way once it has been altered. “A young person who has had the highly desired crease put into the eyelids might find, 20 years later, that the crease has relaxed to such an extent that the fold actually droops over the eyelash,” warns Dr Y.

            The previous day Dr X had examined a 14-year-old girl who had come in with her mother to demand an eye operation to make her “look more beautiful”. Does a girl this age really know what she wants? It seems that the impetus for cosmetic surgery is a mishmash of vanity, confidence, or lack of it, outside influence and a quest for ‘a better life’. Better how? Better than before for the benefit of the beholder or for the benefit of the patient? Vanity, it seems, is a very fine line – or should that be a tiny but expensive-to-smooth-out wrinkle?

            “Let’s say you have a person with a very ugly nose. A big nose. Well, where do you draw the line between vanity and wanting to be normal?” asks Dr X. It is an interesting point; each case is different in terms of this delicate balance.

            Both doctors agreed that the most popular cosmetic operation in Hong Kong is eye enhancement. Certain Oriental eyelids, apparently, do not seem “normal”. “They want ugly Oriental features turned into normal Oriental features,” says Dr X. It is not a case of Chinese clients seeking a ‘European look’, but reacting against a ‘Mongolian look’. The majority of people, says Dr Y, want a “double crease in the eyelid and a better-defined curvature and crease in the upper lid”. “If you change an Oriental eye to a Western eye they’ll scream from here to Western market,” assures Dr X. “All doctors here and abroad teach their students that they should never change an Oriental eye to a Western eye.”

            An eye enhancement is all sewn up within a couple of hours and heals very quickly: the actual wound recovers in a couple of days, and minor scarring and bruising disappears in 10 to 30 days. The head is the most important part of one’s body, hence the speed with which it heals itself. The two most basic eye operations – crease creation and the removal of bags under the eyes – cost in the region of $12,000 each. An eye job can last years, if not an entire lifetime.

            Nose jobs come next in order of popularity in Hong Kong. Nose construction, of the insertion of a bridge in the nose, is in high demand. Flat noses abound and are not popular. Most people here want a ‘higher’ nose, whereas many people in the West spend a lot of their time, and a lot of their money, have nose reduction operations. Building up a nose is a relatively simple task, as long as it doesn’t involve breaking the bone.

            “Europeans tend to want a smaller nose, and that’s much more complicated,” says Dr Y. It can take hours of work. Building up a nose you can do in minutes.” The simple nose job usually requested by Chinese patients costs about $9,000. Healing time is about the same as for an eye job, but as a nose operation is more noticeable, patients tend to spend more time hiding behind closed doors during convalescence. With an eye job, however, one can be out and about within days, donning a pair of wrap-around Raybans.

“Europeans tend to want a smaller nose, and that’s much more complicated,” says Dr Y. It can take hours of work. Building up a nose you can do in minutes”

Hand enhancement (eliminating wrinkles and veins) is not popular here. According to Dr Y, there is little local demand for cosmetic hand surgery. This, again, is in contrast to the West, where women may consider that having their face done is a waste of time if their tired, old hands are going to give their age away.

            Bosom enhancement is fashionable overseas, and demand for this service is now growing in Hong Kong. In general, however, a large bosom is not the aim of such surgery here, but the enlargement of small breasts to an average of ‘socially acceptable’ size. The most popular and most modern method of breast enhancement is to make a three- or four-centimetre incision in one of the creases under the armpit, through which is fed a gel implant that fits behind the muscle wall of the chest. This method is popular because it is both fairly simple and reversible – if a Twiggy-like stature suddenly became de rigueur again, on could move back with the times. It also avoids any contact with breast tissue and any possibility of unsightly scars. It does, however, require a general anaesthetic and an overnight stay in hospital. The fee requires a deep breath: $35,000.

            The more traditional breast enlargement technique involves an incision at the front of the breast, either under it or around the areola, and the insertion of either a silicon implant or a saline formula in a small inflatable pouch. The beauty of this method is that it is cash-and-carry cosmetic surgery: pop into the doctor’s office and the procedure is finished in a couple of hours and without the extra risks that a hospital visit might entail. Internal scarring is a potential problem, however.

            Popular in Hong Kong and the world over are slimming-orientated operations such as fat reductions from the torso and legs. Stomach reduction is particularly widespread here, a likely reason being that locals enjoy their stodgy food. Most of these operations involve the liposuction technique, in which a tube is inserted to suck out excess body fat. A general anaesthetic, and therefore a stay in hospital, is required.

            The maximum amount of fat one can have removed in one sitting is five per cent of one’s body weight (and fine per cent is really pushing it). So, if you are five feet, four inches tall and weigh 240 pounds, you have a long road to fit down. The woman who appeared recently in a Sunday tabloid, delighted with the results of having 50 per cent of her body weight liposucked out of her, is either making it up or is now dead, according to Dr X.

            An operation on legs and thighs is usually completed in a day. But do not imagine that you can show your cellulite-free thighs at the swimming pool the next day. Having fat removed in this manner leaves folds of skin which need to be tightened over time.

            Liposuction techniques are also used on the face. Fat can be extracted from the thighs, knees or abdomen and spun in a centrifuge to separate fat cells from collagen. The latter us used to fill deep wrinkles or scars, while fat cells can plump up aging faces and hands. These autologous fat and collagen injections work best in patients whose faces have grown gaunt with age, while surgical face-lifts and chemical peels, in which the skin’s outer layer is burned or scraped off, work best for severely wrinkled faces. Face-lifts once involved manipulation and stretching of the skin, but surgeons nowadays deal directly with muscle tissue manipulation. These techniques go a lot deeper and ensure that a patient’s new-found youth will last longer.

            Cosmetic surgery to remove varicose veins, and hair treatment are as popular here as in the other parts of the world. But while other nationalities spend money to have their ears pinned back, Hong Kong people prefer to keep imposing ears. Local superstition suggests that having elephantine ears helps one find money and is good for hearing gossip.

            According to the doctors, it is very rare for the Chinese to demand a complete cosmetic overhaul, the likes of which cover the tabloids in the US and Europe. Instead, perfection is obtained piecemeal. Hong Kong people are more conservative than their Western counterparts and veer away from major surgery.

            What can go wrong? Apart from your sweetheart rejecting your new look, or being arrested for not looking like the picture on your ID card, there is the possibility that you might not be happy with the result (although less than five per cent of people who have cosmetic surgery feel let down after tightening up). Like everything else in life, anything can go wrong, but the chances of disaster are low provided you go to a qualified practitioner. Dr X claims he can count on one hand the number of patients who have had infections as a direct result of cosmetic operations, and he has tended to more than 100,000 satisfied souls over the years.

            A convenient new local anaesthetic accounts for cosmetic surgery’s irritation-free appeal. As few operations require a general anaesthetic, patients can often avoid hospital stays – which is just as well as hospital charges tend to read like international telephone numbers. Without getting too technical, this new drug has a sedative quality which enables hassle-free office operations, boosting the popularity of beauty enhancement for those with tight schedules.

            This convenience, however, could be a double-edged scalpel. Illegal cosmetic surgery is a problem here, and with the increase of in-office surgery, keeping tabs on the quacks becomes more difficult. “Second-rate beauty parlours issue referrals to people in the back streets ,” warns Dr Y. “There is an awful lot of illegal cosmetic surgery in Hong Kong.”

            What is really scary about this black market cosmetic surgery is not just the higher risk of infection, or the fact that the chap in charge of your face is probably not qualified to do the job, but the chance that the operation will not be right for you. The diagnostic aspect of cosmetic surgery requires a great deal of skill. If a muscle problem is wrongly diagnosed as a skin problem, it could be a disaster for the patient.

            Self-diagnosis – why the patient chooses cosmetic surgery in the first place – can also be inaccurate. An awful lot of people enter the doctor’s surgery, magazine in hand, wanting to look like a particular actor of pop star. “One has to be very careful that what the patient wants is realistic and in proportion,” says Dr Y. It is an important point. What people want and what they need are often two different things. To some degree, doctors are required to perform a psychological analysis of their prospective patients. 

            Hong Kong seems to be lagging behind the rest of the world in this area not because of Chinese conservatism, but because of the restrictions placed on doctors when it comes to advertising. Once cosmetic surgery comes out in the open and up on the billboards, people will face up to the fact that enhancing one’s looks is nothing to be shy about or ashamed of. When that happens, cocktail party chatter could include open discussion of so-and-so’s face-lift. Alas, at the moment, we are limited to stabs-in-the-back and behind-hand whispers.