Putting on a new face (IN THAILAND)
Plastic and cosmetic surgery has never been so popular, acceptable and affordable. But is it for everybody and what does it really take to change the way you look? To find out, Maxmilian Wechsler talks to Dr Chartchai Rattanamahattana, a leading specialist
COSMETIC surgery has become a huge industry in Thailand with thousands of clinics, hospitals and other medical facilities throughout the country competing for business. And there is no shortage of customers, Thais as well as foreigners, from teenage girls to elderly men, who are willing to spend whatever is necessary to achieve their dreams of physical perfection.
Feeding these dreams are advertisements often featuring Hollywood celebrities that may lead people to believe that cosmetic surgery is necessary to improve the quality of their lives, and is almost always safe and effective.
The reality, however, is that only experienced, well-trained plastic surgeons can perform successful operations, granting patients the satisfying results they expect. Cosmetic surgeries carried out by doctors without enough training or proper equipment can result in disfiguration or even death.
To find out more about the pros and cons of cosmetic, or aesthetic surgery, The BigChilli visited one of the most prominent doctors in the field, Dr Chartchai Rattanamahattana, at Samitivej Sukhumvit Hospital in Bangkok.
The fact that Dr Chartchai is based at this prestigious hospital gives the patients a lot of comfort, although he said that he is running his own operation using hospital facilities. He also sees patients at Bumrungrad, another reputable Bangkok hospital, two afternoons a week.
In his consulting room on the 5th floor, Dr Chartchai explained the difference between plastic and cosmetic surgery. "Cosmetic surgery is much more common, and is performed to correct real or perceived imperfections, usually due to aging. The most common facial surgeries include face-lifts, nose jobs, removing 'bags' under the eyes, body contouring, such as liposuction and tummy tucks, or breast surgery, either to enlarge or reduce them, which is being requested even by many men these days."
"Plastic", he says, is derived from the Greek word meaning to mould or shape, while "cosmetic" refers to aesthetics. The two terms are often used interchangeably when describing surgical procedures, but there's a difference in degree. "Plastic surgery refers to when a surgeon is trying to reconstruct any inborn physical anomaly such as cleft lip, cleft palate or any anomaly derived from accidents or previous surgeries."
People often have misconceptions about what is involved when they opt for cosmetic surgery. "Let's say you don't like something about your face. Then you go see a doctor, have the surgery done and walk out from the operation theatre an hour later a new and happy person. In reality it's not so simple.
Dr Chartchai Rattanamahattana
"You can't just walk in, throw the money on my table and say, 'I want you to do this or that.' An ethical and well-trained surgeon will not give you the impossible dream. Some patients do have limits for safe and successful surgery due to his or her physical condition. A good surgeon will tell you everything you should know before you decide."
As a well-respected surgeon, Dr Chartchai advised that patients should definitely pay attention to what the surgeon has to say. "Patients are paying quite an amount of money for surgeons to make them look better. So before you make a decision, you deserve true and comprehensive information about the risk, the recovery periods for a particular procedure, and most importantly, the promised or the expected outcome."
As one of Thailand's foremost plastic and reconstructive surgeons, Dr Chartchai is certified by the Thai Board of Plastic Surgery as well as the Thai Board of General Surgery of the Medical Council of Thailand. He is also an active member of the Royal College of Surgeons of Thailand, the Society of Plastic and Reconstructive Surgeons of Thailand, Society of Aesthetic Plastic Surgeons of Thailand and the National Academy of Medicine.
He specializes in facial surgery including lower and mid-face lifts, neck lifts and endoscopic brow lifts; breast surgeries such as augmentation, lift, reduction and reshaping; and other procedures for the body such as abdominoplasty, liposuction and body sculpting.
He also has impressive records and credentials in the rebuilding of facial and body abnormalities caused by accidents, birth defects and breast cancer. His mastery in microsurgery guarantees minimal scarring for all cosmetic and reconstructive surgical procedures.
As a young man he was influenced by his family's emphasis on the value of education. His parents encouraged him to pursue his goal of becoming a surgeon. He is a graduate of the Faculty of Medicine, Ramathibodi Hospital of Mahidol University in Bangkok, which is one of Thailand's top medical schools. He completed his training at Ramathibodi and Siriraj hospitals. For six years he was a lecturer at Prince of Songkhla University in reconstructive and cosmetic surgery, and microsurgery.
A surgeon for 27 years, Dr Chartchai is married with three children, the eldest of whom is following in his father's footsteps and studying to become a plastic surgeon.
"My current work is mostly aesthetic surgeries. I perform about 600 -700 operations every year. The number is increasing with time. I estimate that I have performed around 10,000 operations during my career, an average of about 400 per year.
"I chose this profession because as a medical student I was inspired by one of my teachers who did reconstructive surgery on a patient who had a large tumor removed from his jaw. That complicated but successful operation was amazing. It made me want to be a plastic surgeon. Now my work is mostly cosmetic rather than reconstructive, but I know that I have chosen the right profession. I love it.
"These days my patients are comprised of about 60% foreigners and 40% Thais. For the Thais, the most common requests are for breast and nose augmentation. My expat patients usually want to do facial surgery, mostly facelifts, eye and nose procedures, and, of course, breast surgeries.
"Most are Australians, followed by Americans. They are usually over 40 years old and middle or upper class. Foreigners tend to want their noses look more shapely or slimmer, while Thais want theirs higher."
He also sees Asians from other countries. "Some Koreans have high cheek bones and a very wide jaw bone and want to have skeletal surgery to modify their face. I tell them they will look totally different,
and their passport photo may be unrecognizable. It is possible to do but they must keep in mind the consequences that follow.
"The number of male patients is increasing, but women still make up about 80% of my patients. The most common surgery for men is face lift, followed by gynecomastia, meaning they have some breast tissue they want to get rid of."
In the past Dr Chartchai conducted sex changes, but he abandoned the practice. "I have nothing against transvestites but I just don't feel comfortable with the procedure. It has nothing to do with the third gender, it's just my personal preference."
Asked if there should be a minimum age requirement for cosmetic surgery, Dr Chartchai said that for scientific and biologic reasons the patient should be at least 18 or 20 years old. "Most young people are already blessed with good skin and nice figures. Of course, if they are not happy with what they were born with, this can be modified and improved, but they should wait until they reach the appropriate age.
"In my opinion, young people these days are much too obsessed with their looks. As a father I think they should spend more time studying and concentrate on education first. After they have a job and are earning money, then it is nothing wrong to look for ways to enhance their looks."
Dr Chartchai said there is no reason why older people shouldn't have cosmetic surgery. "As for women who are 60 to 70 years old, surgery is not at all a problem, given that they are in good health. The oldest patient I have had was an 84-year-old lady. She came to me to have her eyelids enhanced. They were drooping so badly that her vision was impaired. I did her lower eyelids as well. After the successful operation, she can see much better. Her face looks better too."
The doctor is not a big fan of the injections that are so popular these days: "As for the current injectables, you have two kinds, botox and artificial fillers. The botox is used to temporarily paralyze the facial muscles so that you don't have any wrinkles, but I don't like it because it doesn't look natural. It takes away facial expressions, and instead of appearing graceful and charming, people look like funny plastic dolls.
"Genuinely beautiful people do have some facial wrinkles that come with age, but not too many. This is where my surgery comes in. Injections don't really help in the long run.
"As for the fillers, they get rid of wrinkles and circles by filling up skin depressions and pumping the skin upwards. However, fillers give the patient the unnaturally swollen face. I do neither botox nor fillers for my patients.
"Nowadays there are many doctors out there who are happy to do it as it is highly profitable. I am sorry to see more and more patients going for a quick-fix, and not doing their research well enough and falling for this misconceived fad. Many of them come to see me afterwards to have their face or parts of their body corrected.
"Both treatments can cause serious medical problems," he warned. "Many doctors don't know how to use botox correctly or sometimes it's just their pure negligence. It is possible that they paralyze the wrong set of muscles and cause facial asymmetry. Luckily it is usually just temporary – maybe three to six months. Artificial fillers will also gradually disappear in about six months. But if you get an infection it will be a disaster. I don't think it is a good idea at all."
"People should be extremely cautious when choosing a plastic surgeon. There are so many clinics out there and some of them don't even have qualified or registered surgeons operating. They are total fakes. It is your own face and body we're talking about here."
Dr Chartchai doesn't worry about competition. "Patients come to me, not the hospital. I don't advertise. A doctor, no matter in what field, should never publicize. This is my philosophy. My patients are the most powerful advertisement. People come to me through word of mouth.
"As for complaints, I have had some, of course. Any doctor who says he or she has none is lying. But I have successfully kept them at a minimum and I haven't had, in my entire career, any complaints claiming catastrophic or severe damage. But some patients may expect more than I can deliver. This is why I require at least one face-to-face consultation before the surgery. That way I can clarify most concerns the patients may have."
Dr Chartchai doesn't use computer imagery to show potential patients how they will look after an operation. "Computer-generated images can be useful. But once you have shown the patient the computer image and printed it out, they may come back later and say, 'you promised I would look like this.' Of course I will do my very best to make you look the most beautiful, within the range that is safe for you. But I am a surgeon, not a photocopying machine.
"There is no way you'd look 100% percent like a computer-generated image. But you will definitely look more beautiful and feel better with yourself. That's the meaning of a professional and realistic surgery.
"However, in some cases, I do show photos of patients (with their consent) to explain the improvement. I usually spend time explaining and giving the patients a realistic expectation about what can be achieved so they won't have any illusions."
Is cosmetic surgery cheaper in Thailand than in other countries? Dr Chartchai says it depends on the country, but he stresses that patients should also compare quality, not just the cost.
"My fees might be higher than some doctors in North America, United Kingdom or Australia. But if you are comparing the same level of quality treatment, it is definitely cheaper here. I think Thailand is still the best place in the world for plastic surgery in terms of quality and cost. Thai plastic surgeons are second to none.
"I do everything myself, even removing the stitches. Of course, I have nurses and other staff helping, but the person I trust most is myself."
Dr Chartchai gave some guidance on how to choose a plastic surgeon. "Patients should take time and do research. If anything sounds too good to be true, it probably is. During the past ten years there have been a lot of advertisements on the internet and social media, and many times they are pure frauds. You must be cautious.
"Find a respectable website with genuine reviews from patients who are willing to share their real experiences. The best way is, if you know somebody who already had a surgery you are considering, ask them and see how much satisfaction they have with the procedure and the doctor.
"Just because a surgeon works in a first-class hospital is not an automatic endorsement. Some people who regularly come to a certain hospital for other medical treatments may go elsewhere for cosmetic surgery because the doctors they trust are there. But if you don't know any doctors personally, just one face-to-face consultation with that doctor should help you decide whether or not you should walk away."
Complications can arise during and after surgery. "Bleeding and infection is common, but doctors have to keep it to a minimum. If you are well-trained, there shouldn't be any major damage. But of course, unexpected complications can occur any time. Any plastic surgeons in this world can't, and shouldn't, guarantee a 100% safe result."
The doctor usually refuses patients who were operated on elsewhere and got bad results. "I have to be extremely cautious about whether or not the patient can accept the less-than-expected outcome, or if they are in the middle of a legal process. Also I have to determine in the first place if it is possible to repair the damage. But honestly I don't like fixing other doctors' messes.
"I also refuse patients who expect the impossible outcome, or whom I feel uncomfortable with for other reasons, usually medical. Before a surgery the patient needs a thorough checkup. If they have uncontrolled heart disease or diabetes or any other conditions which can be dangerous then we won't do it. I also refuse patients if they have super unrealistic expectations. Finally, I think that when the patient is mentally or psychologically unstable it is better to back off."
Dr Chartchai also carries out surgical procedures to correct major facial injuries caused by car accidents. "The hospital can call me in the middle of the night. There are some younger surgeons who can help, but if the patient specifically asks to see me, I have to attend to them."
His most difficult operation occurred 22 years ago, while doing reconstruction surgery for a patient with a cancer in his throat that had to be removed. "Long story short, I had to perform a surgery that required a lot of craftsmanship under a microscope. It was my first case of its kind and it turned out successful."
Dr Chartchai said various procedures have different "shelf lives." Nose operations will last long but procedures for the eyes and face-lifts lose effect over time. As for breast enlargement with implants, even the best available brand may start to leak after 15 years.
"Operations to make Asian noses higher might take up to two hours, depending on the person. A simple augmentation with implant takes me about 20 minutes. It usually takes over two hours for a Caucasian nose job.
"I still enjoy my work and I will continue as long as my hands and eyes are still good," said Dr Chartchai, who admitted he gave his wife a face-lift.
To keep himself up to date, Dr Chartchai attends plastic surgery seminars in North America or Europe once or twice a year. He has a number of celebrity patients, but declined to name them.
"When patients come and ask me to change something on their face or body, my first question is why they aren't happy with it. I want to know if they are really serious and if what they want is realistic. I even tell some patients who come for a cosmetic surgery, 'You look just fine already. Please, you don't need a surgery.' And they really don't. Some will say 'thank you' and take my word for it. But some just don't believe me as they've already made up their minds. Money is not their problem so they will just turn to other doctors.
"Some young people are obsessed with their looks and they see plastic surgery as their shortcut solution. They want to be beautiful like people they see on TV, but sometimes it is just not realistic. So, it is my job to tell them what is possible and what's not.
"I have a 30-year-old daughter and she looks pretty without any surgeries. But if one day she asks for a nose job or a liposuction,
she will receive the same amount of effort I give to all my patients. That's what I do every day. Be professional."
Patpong
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