XING Xin, the leading doctor in the plastic surgery department of the Changhai Hospital and a medical school lecturer, said he did not think South Korean plastic surgeons were better than their Chinese counterparts. They were popular in Shanghai now merely because of "commercial hype".

However, restrictive marketing policies were hampering the development of local plastic surgery operations in large hospitals, which were mostly State-owned, to the point where they were losing both patients and experienced surgeons.

Less competitive

In fact, China has had plastic surgery for many years. Some Chinese movie stars were having the operations before the "cultural revolution" (1966-76). After a 10-year period of stagnation, the plastic surgery "industry" took off once again.

The hospital where Xing works belongs to the Second Military Medical University, which is State-owned.

Unlike the increasing number of privately owned, joint-venture hospitals and clinics, Xing's hospital is not allowed to do any advertising in the media.

However, local newspapers, like the Shanghai Times and the Shanghai Weekly, have many pages of ads paid for by private clinics for plastic surgery and billboards and brochures in taxis continue to attract more and more patients to the clinics.

"Since they make higher profits and pay their surgeons much better, many skilled plastic surgeons in State-owned hospitals have 'job-hopped' to those clinics," Xing said.

Some of his surgeon friends who have set up their own clinics have made huge fortunes.

"If I had opened one myself, I would have become a millionaire," he said.

Less training

Courses in plastic surgery are available only in some junior colleges and none of the medical universities in the country has a plastic surgery major.

Medical students who are interested in the field can choose it as a major only when pursuing a master's degrees.

"It takes a long time to train a qualified plastic surgeon and we don't have many of them now," Xing said.

Many surgeons now in the field have transferred from other medical departments or areas.

They believed it was easy to do a double-eyelid operation - "just a cut on the eyelids" - and while they usually boasted of the effectiveness of the plastic surgery procedure, they did not mention the risks in the operation. "No double-eyelid operations are as good as what they promised," Xing said.

Professional doctors in plastic surgery should dare to say "no" to some of the requirements sought by their clients.

Sometimes the doctors are asked to improve certain features of a client's face. "But it's not possible for everyone to be like a movie star," Xing said.

Risky operations

As well as the competition from private clinics, the large hospitals are also worried about beauty salons claiming they can also perform plastic surgery such as double-eyelid operations.

This is actually forbidden by the health administration. But as beauty salons are registered under the Shanghai Industrial and Commercial Commission Bureau, not under the health administrative commission, the health authorities have no control over them.

Sheng Weiting, a beauty consultant in the Wenfeng Hair and Beauty Co, said the clinic was able to provide double-eyelid and breast enlargement operations.

Xing said the Shanghai Plastic Surgery Association was considering seeking to require that every hospital and clinic had to tell every patient in writing about all the possible risks associated with the operations and the patients would have to sign an agreement before going ahead with the operation.

"We need more regulations and laws to control the market so that fewer people are cheated and fewer medical accidents happen," Xing said.