In November last year, Ros Sokny, an ambitious and friendly 36-year-old businesswoman from Kratie in eastern Cambodia, made the five-hour journey to Phnom Penh’s De Beaute Clinic, a private cosmetic surgery hospital tucked away in the capital’s western fringes. She had been considering breast augmentation surgery for several months, but in October, the mother of four came across an advert from De Beaute promoting the procedure at a discounted price on her Facebook feed. After discussing the idea with her husband, she booked in the operation, handed over a reported $3,000 to De Beaute and drove to Phnom Penh for a consultation.
What should have been a relatively straightforward surgery took a tragic turn once Sokny was anaesthetised. Following an undisclosed complication, she was rushed to the intensive care unit of a nearby private hospital with an organ infection. Three days after going under the knife, she died. The clinic was subsequently closed and is currently under police investigation for possible evidence of malpractice. Sokny’s death made national news headlines but, according to police officials, suspects at De Beaute “escaped” before they could be questioned. Despite being unclear how many suspects were at large, deputy municipal police chief Song Ly assured a reporter from the Cambodia Daily that the police were “looking for them”.
Speaking to Southeast Asia Globe almost a month after his late wife’s death, Phai Veasna expressed his anguish. “My tears have run dry. Right now, I’m scrambling to my feet to pay back the loans that we took for the surgery and to take care of my children’s school fees and expenses. I don’t really know if I can do all this alone without her,” he said, adding that the clinic had not contacted him or offered any compensation.
“My wife was still young and full of life. This was the biggest mistake of our lives. When her condition became serious, the cosmetic surgeon told me to go to another clinic for treatment because he did not have the equipment to treat her.”
The fact that a growing number of middle-class Cambodians such as Sokny are seeking such procedures indicates that cosmetic surgery in the fast-developing country is shifting away from being an industry aimed at the cashed-up, glamorous and famous.
This increased demand has partly been fuelled by a flood of new and often unregulated clinics such as De Beaute that offer cheaper services to lure in a wider spectrum of the Cambodian population, according to Thida Khus, a prominent women’s rights campaigner and the executive director of Silaka, a local capacity-building NGO. She has a number of reservations regarding the safety of such clinics: “It is dangerous. There is no effective monitoring or restriction on the people training and operating in the business”.
“The problem is the state, who do not accept their responsibility to monitor this industry. Competition among [the clinics] themselves isn’t enough [to improve safety standards],” she added. “There have been many cases of people who wanted to get a nose adjustment but have had horrible complications because the procedure was badly performed with poor materials.”
Despite the dangerously under-qualified clinicians, doctors and quacks working in Cambodia, the country’s – and more broadly Southeast Asia’s – cosmetic medicine sector is thriving. A report released last November by research firm MarketsAndMarkets found that while North America is the world’s largest medical aesthetics market, the Asia-Pacific market is set to grow at the fastest rate from now until 2021. By that year, the global medical aesthetics market will be worth $13.29 billion, with a compound annual growth rate of 10.8% from 2016-21, the report stated.
A separate report released by Grand View Research in June 2016 contended that by 2014, the Asia-Pacific region was already the biggest aesthetic medicine market in the world. Although South Korea, China and Japan are by far the largest contributors to the market size, Southeast Asian nations such as Cambodia have also anecdotally seen a growth in the industry.
Preedinoot Sripradoo is the director of Vita Longa clinic in Phnom Penh’s affluent Boeung Keng Kang 1 suburb, which specialises in placenta-based and stem cell rejuvenation treatments. She believes that the industry growth is driven by insecurities, and that a smooth, wrinkle-free face and full, collagen-injected lips are markers of perfection in an increasingly appearance-driven Cambodian society. “Imagine you are not beautiful but ugly. You would be uncomfortable and not confident in yourself. You would be afraid of going everywhere and to do things. There would be no use in having life,” she said in a stark commentary.
Clinicians in Phnom Penh interviewed for this story expressed contradictory sentiments about the level of regulation and safety within the beauty industry. Sripradoo claimed that over the past five years, the Ministry of Health has been “working hard” due to the mass proliferation of new clinics. “They are very strict with regulations,” she added.
Yet others expressed concern over a lack of regulatory oversight. Sem Rotana, the owner of Dr Skin clinic, located in a condominium near Boeung Trabek, said: “To open a licensed clinic through the Ministry of Health, you need to be a qualified doctor. Unfortunately, many clinics these days open without any qualifications at all.”
“Patients are not that ready to trust cosmetic doctors at the moment. There have been too many stories of people having bad experiences. Nowadays, they really want to see certificates,” she added.
But certification is not a guarantee of quality, according to activist Khus. “The [private beauty clinics] that provide these services also provide training. If you pay enough money, you can get certified quickly.”
Somany Yen, the clinic manager at MD7 clinic in Phnom Penh’s south, agreed that a significant number of practitioners claim to be qualified after minimal training. “They go to learn a short course for three months or four months and think they know how to do plastic surgery, and then they do it,” she said.
Speaking to Southeast Asia Globe last month, Sok Kanha, deputy director of the Ministry of Health’s planning and health information department, seemed unclear whose jurisdiction the regulation of cosmetic surgery clinics fell under, while the ministry’s hospital department did not respond to requests for comment. “All I can tell you is that we provide licences only to hospitals, polyclinics and private clinics. I’m not sure if within the ministry we have policies about cosmetic clinics,” Kanha said.
Plastic surgeon Reid Sheftall – also an MIT graduate, former physics lecturer at the University of Southern California, author, actor, film director and professional golfer – operates out of his own private clinic in Phnom Penh Central Hospital. He emphasised that his operating room was “very clean, very modern” and that “you couldn’t find a better one even in San Francisco”, yet he confided that there was a lot of “faux-medical stuff that goes on” elsewhere in Cambodia.
“When I first got here, women were going to these beauty clinics and having negative suction cups put on their breasts and then pulled very hard. Women thought this would make their breasts bigger but all it did was tear the ligaments. It was terrible,” he said.
Sheftall also highlighted the dangers of Cambodia’s popular skin-whitening treatments, often acknowledged as the Asian beauty industry’s cash cow. Whitening creams, serums, peels, injectables and pills can be found almost everywhere in Phnom Penh, from tiny local market stalls, roadside pharmacies and supermarkets right through to swish, costly clinics and international aesthetic franchises. “I have had a couple of patients crawling into the clinic vomiting after applying too much [whitening cream] on their skin. You shouldn’t put that poison on your skin,” he said.
In 2011, a study by Phnom Penh’s University of Health Sciences found that 15% of commercially available skin whitening creams and 30% of those found in specialist beauty clinics contained illegally high levels of toxic compounds such as mercury. The treatments also often contain salicylic acid, arsenic and lead, which can not only burn the skin but also cause the liver and brain to swell.
It is difficult to establish the scale of the market in Cambodia, due to the lack of reliable data and an abundance of unregistered clinics. However, every practitioner that spoke to Southeast Asia Globe reported a growing demand for aesthetic medicine procedures in the country. “There has been a big increase in the number of beauty clinics in Phnom Penh,” said Rotana.
Corroborating this, Sheftall said: “Over the years, demand for my services has increased tenfold. It has gone way up.” He attributed this largely to the swift growth of Cambodia’s middle class. “In the past, the prices here were super low, but people still couldn’t afford it. But now, there is a middle class that didn’t exist here before.”
Khus added that the stylistic influence of Korea has also helped to grow the aesthetics market. “Korean cinema has invaded Cambodia and had a big impact on the population,” she said.
Social media is undoubtedly a key driver of the industry and is used extensively by beauty clinics to market their services. Sripradoo claimed that “Facebook is the main media source in Cambodia” and that her clinic utilises the platform extensively. Indeed, the Vita Longa Clinic page is updated with glossy photos of white-skinned, round-eyed patients with great frequency. Special promotions for ‘meso-fat therapy’, intravenous ‘liver detox’, ‘brain booster’ and ‘beauty booster’ treatments, as well as various laser treatments are employed regularly.
The now defunct and shuttered De Beaute Clinic still has a public Facebook page; a series of posts last year advertised procedures such as ‘rhinoplasty and peeling’ for less than $2,000, ‘dimples’ for $250, liposuction for $1,600 and breast augmentation for “about $3,500”.
Dr Skin, meanwhile, uses Cambodian pop stars, actors and models to promote treatments such as ‘mega-botox’ and ‘V-shaped face’ procedures. Dalice Katam Sovandalice, an assistant at the practice, said that famous Cambodians receive
“discounts” in exchange for their help with promotion.
Slick marketing is not the be all and end all, however, and in a climate of stiff competition, results are also critical. “The middle class is growing and very informed. They learn, they search and they check before they go,” said Sripradoo. “Right now, the medical treatments and the beauty industry standards are getting higher.”
The clinic director also added that improved education would raise competency among practitioners. “The University of Health Sciences in Cambodia is promoting a dermatology department so they can train dermatologists and plastic surgeons. I think it is going to leave the Cambodian beauty industry with better standards,” she said.
Surgeon Reid Sheftall relies simply on word of mouth. “I get people from Australia, France, Singapore, Hong Kong. Everybody flies here. You do one, they go home, show their friends and then ten more come,” he said.
One Cambodian woman, who asked to be identified as ‘Bopha’, explained to Southeast Asia Globe how she convinced herself to get a recent rhinoplasty procedure. “I highly trust the clinic that I went to. You can’t trust every beauty clinic in Phnom Penh, however. Sometimes, a recommendation is the only way to ensure quality,” she said.
However, for Phai Veasna, still coming to terms with the loss of his wife, the industry can never be endorsed. “Some of those doctors are not even sure about the results themselves,” he said.
As standards improve, pricing remains competitive and treatments become increasingly fashionable, it seems certain that the beauty business will only continue to grow in Cambodia. In the words of Dr Skin’s Rotana: “People love it and come back for more and more. Today they’ll do one injection, tomorrow they’ll do another.”
Additional reporting by Kounila Keo