WESTERNERS say they go in for plastic surgery to find "self-fulfillment". Asians, more down to earth about their looks, believe that higher cheekbones, folding eyelids or whiter skin helps them in their careers.

Whatever the justification, it isn't merely about vanity anymore. The fact of the matter is that changing social mores and new technologies have made "cosmetic enhancement" both popular and lucrative.

Not long ago, pretty stewardess Jenny Liew's desire for a sexier sniffer would have elicited the advice of an appointment with a psychiatrist. But by the time she died of an apparently bungled nose job in November 2004, her motives were barely questioned.

The need for such control was quantified by Dr R. Angamuthu, president of the Malaysian Association of Plastic, Aesthetic and Craniomaxillofacial Surgeons, who estimated that for every legitimate procedure, 10 more are done by quacks. Should these include any use of the scalpel, such as in breast augmentation or nose surgery, the Malaysian Medical Council is right to be alarmed and to pursue the charlatans with the full force of the Medical Act.

Going under the knife, however, is not for the faint-hearted. You would have to be credulous or desperate to the point of neurosis to risk a back-street liposuction when one is readily available from Dr Angamuthu's association.

The criminality of such an enterprise is evident, and doctors, who are ever watchful of the public's health (not to mention their businesses), will eventually get wind of it.

Of equal concern is the proliferation of "minimally invasive" procedures, such as Botox injections and laser skin treatments, which appear so cheap and easy to administer that they beguile both practitioners and patients. All of them, however, are potentially hazardous.

Yet these innovations form the bulk of a multi-billion dollar global industry that is expanding by 25 per cent a year, mainly in Asia. Not surprisingly, most of the quacks are said to come from China and Taiwan, two of the biggest regional markets for reconstructive surgery of the milder sort.

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