KUALA LUMPUR: The recent tragic death of a young local model, pursuing aesthetic beauty, raised alarm bells among medical practitioners.
In fact, the reported death of Coco Siew Zhi Shing, 23, following a liposuction that went awry opened a can of worms, said an expert in aesthetic medicine.
More shockingly, Associate Prof Dr Ramamurthy Subramaniam alleged that an estimated 1,800 medical doctors in the country were illegally performing aesthetic procedures.
"From what I learnt, only about 340 general practitioners have the Letter of Credentialing and Privileging (LCP) license by the Health Ministry to administer aesthetic procedures.
"There are also tens of hundreds more beauticians whom I suspect do not have any medical qualifications, yet carry the prefix 'Dr' before their names and indulge in aesthetic procedures.
"Some of these lot may have dubiously earned the academic 'doctor of philosophy' (PhD) degree and thus also carry the 'Dr' prefix," he claimed, adding that there were about 71,000 GPs in the country, with 19,000 of them in the private sector.
Dr Ramamurthy is the former founding president of the Malaysian Society of Aesthetic Medicine.
He currently treats aesthetic complications referred to him and trains aesthetic practitioners at the Aesthetic Academy Asia in Bangsar South.
"I am a staunch believer that the code of medical ethics must always prevail and that no one should die for the sake of beauty," he said in reference to Coco Siew's death.
The deceased, who reportedly died after undergoing a RM2,500 liposuction surgery for her arms at a beauty salon in Cheras on Oct 17.
It is believed that she died after being injected with anaesthetic in her arms, where her heartbeat allegedly slowed down and she experienced convulsions.
Dr Ramamurthy said there had been numerous reports on complications, including deaths - from botched liposuction, tummy tuck, skin necrosis, disfigurement and breast augmentation - due to unregulated practices of invasive cosmetic procedures by beauticians at health spas or salons.
"Despite warnings and wide publicity, the health and enforcement authorities are unable to take action against errant beauticians who carry the medical doctor's prefix 'Dr' (for PhD qualification), who exploit loopholes in the system.
"Many of these 'doctors' mislead the public, posing as aesthetic dermatology or medical specialists," he said.
He classified aesthetic procedures into non-surgical (aesthetic medicine) and surgical involving specialised cosmetic fields, anti-ageing and regenerative science.
He cited examples of aesthetic medical procedures as chemical peels or laser treatment for skin rejuvenation; laser hair and tattoo removal; botulinum toxin for facial lines and wrinkles (Botox, Dysport, Xeomin); dermal fillers for facial augmentation; skin tightening procedures using devices such as infrared, radiofrequency and High Intense Focused Ultrasound (HIFU); and sclerotherapy (treating spider veins and broken capillaries).
Aesthetic surgical procedures by qualified plastic or cosmetic surgeons include blepharoplasty (eyelid surgery); rhinoplasty (nose surgery); facelift; liposuction; tummy tuck; breast surgery; buttock augmentation; and penile enhancement.
"There are other specialised cosmetic fields such a cosmetic gynecology procedures by gynecologists and cosmetic dentistry procedures by dental surgeons," he said.
As for anti-ageing and regenerative procedures, he said these included cell replacement therapy; hormone replacement therapy; and stem-cell placental injections.
"It is imperative to note that all of these procedures must be done by medical doctors or specialists who have undergone extensive training in the field of aesthetic medicine or surgery and have been granted permission by the Health Ministry to carry them out," he said.
He warned that beauticians were not trained to audit pharmacological products with some allegedly using expired medical supplies to save costs, that were hazardous to the patient.
"Beauticians are not trained in pharmacology, thus, are not aware of terms such as MLD (median lethal dose), the maximum permissible dose per kg body weight, the maximum dose allowed in a given time period, bioavailability, etc.
"This may lead to serious consequences such as overdosing the patients, resulting in fatalities," he said.
Dr Ramamurthy added that beauticians would not be able to determine if patients were on medications for hypertension, cardiac conditions, diabetes or other underlying medical or surgical conditions.
"They may be unaware of devastating cross-reaction between one drug to another, like when administering local anesthetic agents such as lidocaine for dermal fillers, thread-lift and mole removal," he said.
More dangerously, he said, most beauticians learn the procedures from either watching videos or attending short courses, locally or abroad.
"Beauticians are not supposed to meddle with needles, syringes and biohazards soiled with blood, in the first place.
"Many are suspect of not adhering to hygienic and sterile protocols.
"This puts the patient at severe risk from contracting infectious diseases like hepatitis, sustaining necrosis, blindness, stroke or even death," he warned.
Many victims of botched aesthetic procedures do not come forward to complain because of embarrassment, are duly compensated financially or threatened by the offenders with intimidating indemnity clauses.
"The victims are unaware that such indemnity clauses can be challenged in a court of law," he said.