Last year, 88 percent of females and 12 percent of males worldwide elected to undergo plastic surgery, according to the International Society of Aesthetic Plastic Surgery (ISAPS). For most people, it was an attempt to keep or regain their youthful looks, to eliminate wrinkles and sagging caused by aging. Five countries account for 47 percent of all plastic surgery procedures worldwide. These countries are the USA (16.35 percent), Mexico (9.64 percent), Brazil (9 percent), Canada (6 percent) and Argentina (5.96 percent ). Laura Gater looks at a growing trend of combining the plastic surgery experience with a holiday abroad.

Medical spas offer plastic surgery in a relaxed, vacation-like atmosphere of luxury and pampering. Plastic surgery procedures performed in a medical spa provide the patient with a high level of medical care and rest. Patients don't worry about having to hide their surgery bruises and pain from family and friends at home. Instead, they can relax and be waited on.

Medical spas are growing rapidly, with approximately $450 million in annual revenues, and are growing at a rate of 11 to 14 percent annually, according to the International Medical Spa Association.

The high cost of plastic surgery in some countries such as Europe and the U.S. has caused people to look at options elsewhere, Such as Asia, where the cost of plastic surgery is much lower. The savings in surgical costs can be used to visit a medical spa and enjoy a holiday. Many patients also choose to take their spouse and children along to a medical spa, where the family can enjoy a holiday while one parent (usually mom) is recuperating from surgery. Due to the lower costs of plastic surgery in Asia, everyday people can enjoy the pampering and benefits of plastic surgery that are often only given to VIPs.

I think the increase in popularity of medical holidays has several reasons. First would be cost, as it is normally more cost effective for people from many countries, such as Europe, America, Australia and certain countries in Asia to go overseas. Second
would be privacy, as there are outer signs that indicate having undergone a procedure, and many people do not wish others to know, staying in a place where you do not know any people as opposed to staying at home where people will notice. Third would be the holiday aspect, recovering in a beautiful exotic place rather then staying in your bedroom at home. Everything is taken care of; you do not have to worry about grocery shopping, cleaning or doing other household chores. You can focus 100 percent on getting better and recovering. Fourth would be the quality of healthcare, as this is on par with any country in Europe or America, explains Marloes Giezenaar MBA, managing director of Beautiful Holidays, Penang, Malaysia

PEOPLE DO NOT WANT OTHERS TO KNOW THEY HAVE HAD PLASTIC OR COSMETIC SURGERY, WHICH REMAINS SOMETHING OF A TABOO FOR NORMAL PEOPLE

Day spas do not offer medical and surgical procedures, and focus mainly on aesthetic treatments, such as facials and massages. Medical spas, on the other hand, employ at least one physician and medical assistants and have dedicated surgical facilities or contract with a nearby private hospital. The surgical procedures at many medspas, such as Beautiful Holidays, are based upon international medical standards. The physicians and surgeons at Beautiful Holidays have been trained in the UK or US. Staff is on hand 24 hours a day to assist patients in their recovery.

“When we first started, many people were attracted to the price. We can see now that more people come for privacy and recovery in a beautiful surrounding,” says Giezenaar.
“Beautiful Holidays arranges everything apart from flights. Our clients only have to focus on recovering and enjoying the island. We take them everywhere by car ourselves and make all appointments for them. Aftercare is important, as many clients have questions after they came back home, and we answer these via email or phone. People do not want others to know they have had plastic or cosmetic surgery, which remains something of a taboo for normal people. Local doctors are more expensive for most people. Many clients told us there had to be a choice of the wife/mother going for a procedure or the family holiday. Many women feel guilty choosing themselves, and with Beautiful Holidays you can combine the two, a family holiday and the procedure. It’s important to tell people what they can and can’t do while on holiday. With some procedures, the recovery time will take most of the holiday and it’s important that people know what to expect, because it will avoid disappointment.”

In Europe, the Medéspa Ltd., in Glasgow, Scotland, advertises itself as a “Medically Advanced Skin & Laser Spa.” Patients can receive Botox injections, hyaluronic acid fillers for wrinkles and scars, laser treatments, liposuction, chemical peel resurfacing, and other medical treatments.

There are many medical spas in the U.S., which are mostly found around the New York City area and on the West Coast. The Westside Medical Spa in Los Angeles, California, owned by Alexander Rivkin, MD, a plastic surgeon, offers Dr. Rivkin’s trademark new procedure, an injection rhinoplasty, “non- surgical nose job.” Dr. Rivkin believes that “modern medical technology can provide today’s patients with superior alternatives to invasive, painful surgeries that require a long recovery time.”

The European Medical Spa, in Bloomfield, New Jersey, owned by Aurora De Juliis, MD, offers LipoDissolve, the “hottest” new treatment, according to Dr. De Juliis. LipoDissolve is a plant- derived compound that is injected into fat cells to dissolve the fat. She also offers patients the Microcurrent (M2) Technology, which is the latest in facial lifting, breast enhancement, body toning and acne skin care. M2 has been available in Europe for more than 20 years, and was just approved by the U.S. Food & Drug Administration (FDA). M2 uses low levels of energy to retrain muscles to resume their normal and more youthful position. The European Medical Spa offers a “unique combination of the latest non- invasive cosmetic laser techniques, along with anti-aging approaches to create healthy and youthful-appearing skin,” according to Dr. De Juliis.

Kurotel Longevity Center & Spa, in Gramado, Brazil, has been in operation for more than 20 years, and offers patients plastic surgery procedures and technologies that are found in other medical spas worldwide.

Types of Procedures Available Most medical spas offer a wide variety of plastic surgery procedures, for both males and females. Many also offer LASIK (Reshapes the cornea of the eye in order to produce clearer vision) and dentistry procedures, such as teeth whitening and even root canals. Dentistry in Malaysia, for example, is of the same level as in the US or Europe, although prices are often a third less.

MEDICAL SPAS WILL CONTINUE TO GROW AS LONG AS PEOPLE ARE INTERESTED IN HAVING PLASTIC SURGERY IN A LUXURY SETTING WITH THEIR FAMILY NEARBY. SAFETY IS ALSO AN ISSUE FOR FUTURE GROWTH OF MEDICAL SPAS

Face slimming, nose enlargement, sex reassignment, and calf slimming are all surgeries of choice in various countries. According to www.time.com, calf slimming is most popular in Korea and Japan. The nerve in the leg muscle is severed, causing the calf muscle to atrophy and shrink. Nose enlargement, in which synthetic cartilage or another substance is surgically inserted into the nose, is also popular in Korea. Nose reduction is popular in Indonesia, while face slimming is most in demand in Korea and Japan. Face slimming requires an injection of botulinum toxin (Botox) into the cheeks to paralyze the facial muscles, which then shrink. Thailand is a popular country for sex reassignment operations, while penis enlargement is most sought-after in Indonesia and Japan.

“Forty percent of our procedures [at Beautiful Holidays] are breast augmentations,” states Giezenaar. “We now offer a warrantee against capsular contraction and leaking. This is unique in Asia.”

General and local anesthesias are available at Beautiful Holidays, depending on the surgeon’s and patient’s preference and also on the type of procedure performed. Other medical spas offer both types of anesthesia as well. According to the ISAPS, Botox is approved in most countries except Denmark, Greece, Japan and Great Britain. Silicone gel- filled implants are not approved in South Korea, Japan, Taiwan and the U.S., while soy-oil filled implants are only approved in Brazil, Lebanon, Rumania, Turkey and South Africa. Internal ultrasound liposuction is not approved in Japan. Collagen application has dropped because surgeons can now utilize other options, such as Restylane and Perlane.

BOTOX APPLICATIONS HAVE BEEN THE MOST SOUGHT-AFTER NON-SURGICAL PROCEDURE FOR THE LAST THREE YEARS. IT IS INTERESTING TO NOTE THAT AMONG MEN, BOTOX PROCEDURES MORE THAN DOUBLED FROM 2001 TO 2003

Botox applications have been the most sought-after non-surgical procedure for the last three years. It is interesting to note that among men, Botox procedures more than doubled from 2001 to 2003.

Blepharoplasty, or eyelid surgery, is the most common plastic surgery procedure performed worldwide, followed by breast augmentation, lipoplasty (liposuction and liposculpture), rhinoplasty (nose surgery), breast reduction, facelift and abdominoplasty.

Eyelid surgery and nasal augmentation are the two types of surgery that Seum Chung, MD, who owns Seum Chung, MD Plastic Surgery, Inc., Seoul, Korea, performs the most. “Bigger eyes and a refined nose are very much sought after,” he says. Most of his patients are women in their 20s, 30s and 40s, but more Korean men are having plastic surgery to improve their standing in the job market. “Men do not want to look older than their supervisor or boss,” explains Dr. Chung.

Gwendy Aniko, plastic surgeon, University of Indonesia Faculty of Medicine, Jakarta, Indonesia, has noticed an increase in the number of those having plastic surgery in the last five years in Indonesia. Most of his patients believe in cosmetics and come to him for surgery after cosmetics have not provided any improvement in their looks.

The most popular types of plastic surgery in Indonesia are facial aesthetics, such as rhinoplasty, blepharoplasty, and face lifts. The most popular plastic surgery procedure that Dr. Aniko performs, however, is body contouring, because “it gives a quick result and most Indonesian ladies are fat in the thigh belly, waist and arm,” he says. Indonesian men are also turning to plastic surgery more often to improve their appearance, according to Dr. Aniko.

Hannelore R. Leavy, Founder & Executive Director of The International Medical Spa Association, points out that beauty enhancement procedures and actual plastic surgeries have seen a decline because of new technology coming into the industry, such as non- surgical face lifts.

“New technology enables us to retain our youthful looks and help us stay vibrant, energetic and therefore enjoy a better quality of life as we are getting ‘up there in age!’ Those who do opt for surgery will see quicker healing and less down time due to pre- and post operative spa treatments and pre- and post-operative care,” she says. “People prefer the nurturing, relaxed atmosphere of a spa over the physician’s clinical offices and clinics. They also prefer the complete attention that the doctor and staff devote to their clients and patients. It [a medical spa] is not a doctor’s office where you are ‘whisked in and whisked out.’”

Are Medical Spas Safe? Plastic surgery is like any other type of surgery – surgeons must be knowledgeable about their skills and their patients. Whether the surgery is performed in a clinic, hospital or medical spa, precautions must be exercised. Most spas realize that their reputation is at stake and so they strive to make their medical experience as safe and comfortable as possible for their patients.

“Plastic surgery is not dangerous if performed by a properly trained and board-certified plastic surgeon in an accredited facility,” notes Dr. Chung.

Dr. Aniko acknowledges that physicians must not give in to patient demands if the surgery is not right for the patient or if it is beyond the doctor’s skills.

Leavy of the Medical Spa Association says that medical spas depend on their reputation to bring in customers. “If they do not have quality service that produce results, the word gets out fast. If a patient or client gets hurt, lawsuits are very expensive,” she says. Leavy says that medical spas are here to stay because complementary and alternative medicine (CAM) is becoming more and more recognized as an alternative to stay healthy and beautiful.

The Future of Medical Spas Medical spas will continue to grow as long as people are interested in having plastic surgery in a luxury setting with their family nearby. Safety is also an issue for future growth of medical spas.

“We can see an increase from when we started in 2002 to date and we expect this to continue to rise,” says Giezenaar. “Our industry is a lot of word of mouth. You get a client who has a great experience and they will talk to friends about it. The friends will most likely come to you if they are interested in surgery. This is not a fast money making industry. It takes time to build a reputation.”

The aging world population is looking for ways to remain youthful and energetic. For many people, their looks help them feel better and look younger.

“We must realize that we cannot stop the clock. The world’s population is getting much older than generations before us. We must take care of ourselves to stay healthy and vibrant. We have a choice getting old and sick or getting old and enjoy a quality of life that has not been had by our forefathers!” explains Leavy. “We can do this with knowledge, new medical breakthroughs and new technology — staying vibrant, energetic, alert, healthy and beautiful. The medical spa industry has the wonderful opportunity to counteract melanoma, obesity and other illnesses related to modern living. Governments should take notice of this trend, as it will reduce healthcare costs for the general population as well as for the growing aging population!”

HEALTHWORLDSMAGAZINE // JAN 2005