Biases on Beauty Draw Thais to Illegal Surgery

By Jocelyn Gecker 26 October 2012

BANGKOK—Her dream was to look less Thai and more like Jennifer Lopez, so the 25-year-old street food vendor went to the Internet and typed in “cheap Botox.”

That was the start of a five-year makeover for Ratphila Chairungkit that included two nose jobs, two eye-widening surgeries, chin augmentation, lip trimming, skin whitening and dozens of Botox-type injections.

The goal had been to redesign her entire face, but things went horribly wrong. “I started to look like a witch,” she recalled. Her upper eyelids sagged; her lower lids erupted in tapioca-like bumps. Her chin drooped and her nose swelled.

After costly and painful corrective surgeries, she is now content with her appearance, though it bears no resemblance to her American pop idol.

Thailand is swarming with cheap but risky cosmetic clinics, thanks to two powerful forces—Their prices are designed to attract the poor, and Thai society defines beauty as fair and delicate. It looks down on the ethnic facial features associated with the lower classes—the wide noses and dark skin most of the country possess.

“I used to look like a factory worker,” said Ratphila, now 30, cringing at an old snapshot of her smiling former self. “Now, when I look in the mirror, I’m happy. With a better face, you have better chances in life.”

Her quest for beauty at bargain prices was a painful mistake. A pseudo-beautician injected commercial-grade silicone into her cheeks, chin and under her eyes; it all needed to be surgically scraped out. She spent 500,000 baht (US $16,000) over five years, a huge sum by her humble standards, mostly to fix his handiwork.

“I’m lucky I didn’t die,” she said, trying to smile through her cosmetically corrected face.

Far from having regrets, she says, her ordeal has turned into a business opportunity and she plans to open her own cosmetic clinic later this month. “Now, I’ve become a beauty guru. Everyone comes to me for advice,” she said.

Not all of Thailand’s beauty victims live to tell. The death this month of a 33-year-old aspiring model from a botched collagen injection has focused nationwide attention on the illegal beauty industry and intensified a government crackdown.

Nearly 40 illegal beauticians have been arrested in Bangkok, the capital, in the past two months, but authorities believe nearly 200 are still operating. Advertising in plain sight on the Internet, they’re commonly known as “bag doctors” because many make house calls or meet customers in vans to administer cheap injections straight from their bags.

Last week, the Health Ministry and police declared a small victory after arresting someone they called “the most dangerous” operator to date—a 37-year-old former beautician’s assistant with no medical training who had set up an all-purpose clinic in her home.

Inside the woman’s pale yellow town house in a working-class Bangkok neighborhood, authorities found box-loads of counterfeit Botox, cheap facial fillers, intravenous skin-whitening chemicals and a variety of banned products known to have dangerous side effects. The arsenal of potentially toxic beauty products underlined the lengths that women—and some men—take to improve their looks.

“This is terrifying,” said Phasit Sakdanarong, chief adviser to the Public Health Minister, who joined the raid and has since advised the government to expand the crackdown nationwide. “This woman was not a doctor. This clinic has no license, and the products she was using are not FDA-approved.”

“We are facing a very, very serious problem,” said Phasit. “When people go to illegal clinics like this, it is very easy to get an infection—and sometimes it is easy to die.”

The clinic operator, Jiratha Saraban, told authorities through tears that she had ordered her products cheaply off the Internet and catered to low-paid office workers and college students.

“I wanted to help people who can’t afford to do these procedures at expensive clinics,” Jiratha said. She faces up to 11 years in prison on three charges that include posing as a doctor and illegally selling medication.

She offered standard black market rates: $30 Botox shots and $50 filler injections, a popular method for elevating the nose bridge to look “less Asian.” In licensed Bangkok clinics, Botox injections range from roughly $150 to more than $400.

Dangerous beauty treatments have become a worldwide problem as people seek cheaper alternatives to plastic surgeons. In Hong Kong, a woman died last week of septic shock after getting a blood transfusion that a clinic claimed would whiten her skin. An American woman died in March from an illegal buttocks implant in Georgia, caused by suspected counterfeit silicone.

But Thailand sets a particularly stark example, partly because Thais of all income levels are striving for a uniformity of beauty that for large parts of the population would be impossible without surgery.

“People here are not seeking to look unique or different. They’re all trying to look the same,” said Lakkana Punwichai, a Thai feminist and social commentator who hosts a popular TV talk show.

Thais with darker skin, flat noses, round faces and full lips—features associated with the working-class descendants of Lao, Khmer and other ethnic groups—are enduring needles, knives and hazardous chemicals to emulate the Bangkok elite, whose porcelain complexions and more chiseled features traditionally stem from Chinese ancestry.

“The rich already have the look that Thai society values, they just work to maintain it,” Lakkana said. “But the lower class has a dream of upgrading themselves. For them, cosmetic surgery has become a shortcut to a better future.”

The cost of cosmetic procedures is low enough in Thailand that many Thais can afford licensed beauty clinics. There are 500 of them in the capital, and most have sprung up in the past five years, the Health Ministry says.

Bangkok’s Yanhee Hospital, one of the country’s best-known beauty emporiums, performs 30,000 cosmetic treatments a month, a dramatic increase from five years ago when dermatologists at the hospital say Botox was much less popular.

Some of those procedures are for foreigners—part of Thailand’s “medical tourism” industry. But a large portion are for Thais, including young people who are using Botox long before the onset of wrinkles.

At a cafe in Bangkok, a group of fashionable young professionals said most of their friends no longer have their original faces.

“Almost all my friends have had something done,” said Nuttida Kruapanich, a 23-year-old student and aspiring actress who recently had a nose job and injects Botox to make her face look slimmer. “If not cosmetic surgery, they’ve had Botox or filler. Nowadays, there’s so much importance attached to how you look. What matters is that you’re beautiful.”

Her friend Surasit Areesamarn, 24, joked that he’s a victim of both beauty and fashion. His nose job two years ago was modeled after what he called “the Western nose,” but now he wants “a Korean nose,” which is flatter at the top and pointy at the end.

“It’s like changing shoes,” he laughed. “You want the fashionable model.”