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Part of the problem is that it's much harder to exact legal retribution in Asia than in the West, where medical malpractice suits often yield enormous settlements. Most Asian lawyers avoid malpractice cases, since so few result in victory and financial payoff. Above all, though, it's the bargain-hunting instinct that leads patients astray, tempting them to use unqualified cosmetic practitioners. "At the end of the day, the government will have to make a decision on whether to restrict surgery to specialists," says Dr. Woffles Wu, a plastic surgeon at the Camden Medical Center in Singapore. "This is a time bomb waiting to go off."
It may seem reckless to undergo medically unnecessary operations that could disfigure or even kill you. But who's to say that good looks aren't worth the risk? "The Japanese have a saying: 'It's not the face, it's the heart,'" says television producer Koji Kaneda. "But when I asked around, everyone acknowledged appearances count—often more than anything." With that in mind, Kaneda dreamed up a show called Beauty Colosseum that launched last fall. Each week, women pour forth tales of woe, and a panel of beauty experts offers makeover advice. The most desperate cases are referred to the show's "miracle doctor of beauty," Toshiya Handa, a surgeon at the Otsuka Academy of Cosmetic & Plastic Surgery, a chain of 13 clinics across Japan. The regular appearance of tanned, telegenic Handa on Beauty Colosseum has inspired a flood of young TV viewers to sign up for surgery at Otsuka. In 2001, 64% of the patients there were in their teens or 20s. One of the program's most memorable guests was Yumi Sakaguchi, a 26-year-old from Osaka. Even today, her lips tremble as she recounts her life. Born with droopy eyes, a receding chin and prominent buckteeth, Sakaguchi endured merciless teasing in her youth. Classmates even drew caricatures of her on the chalkboard. "I always walked with my face to the ground," she says. After high school, when her diabetic father racked up big medical bills, Sakaguchi sought work as a bar hostess to pay off the family debt. "They turned me away flat, saying, 'You'd make the customers sick,'" she recalls. "It was then I realized I had only my body to sell." Sakaguchi found work at a brothel, but many customers rejected her because of her looks. "I was at rock bottom," she says, softly. "I kept thinking, something will work out, somehow. My life depended on it." Last October, Sakaguchi appeared on Beauty Colosseum and won free dental, eye and chin surgery that would otherwise have cost over $30,000. She quit the skin trade, landed a high-paying hostess job, and plans to study psychology. But nearly a year after her surgical windfall, Sakaguchi sounds circumspect, as if the enormity of the change has come to weigh on her. Though open about her surgery and her past, she was hurt when a recent boyfriend told her he would not have dated her before her surgical alteration. "I always wanted to believe people were ultimately judged by what was inside," she muses, her gaze hesitant and sad. "But I knew from my personal experience that this wasn't true. It's always the pretty girls who win the good things in life." Alvin Goh, a slight, impeccably dressed stylist and creative director of a soon-to-be-launched lifestyle magazine in Singapore, understands better than most our tendency to judge a book by its cover. So, a year and a half ago, Goh, now 24, decided to get an eye job. "We live in a cruel society where everything is based on first impressions," he says. "If you look in the mirror and don't feel good about what you see, it won't help you in your life, in your work or in your relationships." Much more so than women, men cite their careers as the driving reason to go under the knife. Taiwanese comedian Tsai Tou was once known as the ugliest man in show business. While his face helped win him laughs, he felt it limited his chances of hosting a talk show: so he too had surgery two years ago, adding folds to his eyelids, getting his eye bags removed, having his nose heightened and his wrinkles flattened with botox. A face free of bags and wrinkles, Tsai explains, captures the "trustworthy" look that TV viewers prefer. Dr. Kenneth Hui, a plastic surgeon in Hong Kong, remarks: "It can be a matter of necessity, not vanity." Necessity drove Ching Wei to plastic surgery. Desperate for work, the struggling Taiwanese entertainer took a TV role in 1997 that required him to escape chains and a wooden box as it was set on fire. Instead, he found himself trapped. Covered with third-degree burns, Ching saw his career evaporate and attempted suicide. Five years and $60,000 worth of surgery later, Ching, now 37, is an award-winning media personality and owner of his own communications company. "It's a miracle," he says. "Everything you see about me is the work of plastic surgery—my facial skin, implanted hair, and restored retina." Some people find tragedy in the plastic surgery clinic. Others, like Sakaguchi and Ching, are reborn. Most are somehow looking to achieve that most elusive of goals: to halt the march of time. "All of Asia is ruled by a youth culture," says Hiromi Yamamoto, a Tokyo hair and makeup artist who has written extensively about plastic surgery. "We may respect the old, but it's the young who play the lead roles. So it's no surprise that the old want to look young, and the young want to look fabulous." In a plush cabaret in the Akasaka entertainment district of Tokyo, a slender woman in a slinky, red dress croons Amazing Grace. Despite her rich voice and charming stage presence, Teri Hirayama is, at 36, pushing the upper limits of the business. So, over the course of six months, she has had her baggy eyelids lifted, her nose and chin shaped, and her wrinkles smoothed away. Now the politicians and foreign executives who frequent the joint ply Hirayama with requests. "I'm the one who urged her to get it done," boasts cabaret owner Kirisa Matsui, herself a gorgeous specimen of 60. "I don't hire homely girls. These are difficult times, you know, and I've got a business to run." Whether for vanity, ego or cold hard cash, we all want to look better, younger, more fabulous. Think of all the clichEs about beauty: that it is in the eye of the beholder, that it slayed the beast and, of course, that it is only skin deep. Teri Hirayama and millions more throughout the region seem to be buying into that last conceit as they go under the knife in the quest for an aesthetic beauty as malleable as silicone in a surgeon's hand.