I. Introduction
Recently, advisories issued by the Chinese Embassy in South Korea cautioned Chinese tourists about the potential risks associated with undergoing plastic surgery in the country. A remarkable trend in recent years has seen an increasing number of Chinese people travelling to South Korea to undergo plastic surgery. South Korea, touted as the “world capital of plastic surgery, “attracts many Chinese medical tourists. Examining the challenges in regulations and supervision of this trend is crucial for ensuring patient safety and maintaining the integrity of the medical tourism industry.
II. Overview of the Trend
South Korea’s popularity as a destination for plastic surgery among Chinese individuals is fuelled by cultural preferences, cost-effectiveness, and the perceived superior quality of South Korean surgical services. The data shows that the proportion of Chinese patients in the total number of medical tourists visiting South Korea rose from 7.84% in 2009 to 32.73% in 2019, demonstrating a consistent increase in the trend.
In 2022, South Korea experienced a significant increase of 70.10 % in foreign individuals receiving medical treatment compared to 2021, with 248,000 non-resident foreigners seeking medical services. Chinese patients comprised 17.70 % of these medical tourists, coming second after Americans, making up 17.80 %. Despite travel restrictions, there was a 56.80 % increase in Chinese nationals visiting South Korea compared to the previous year.
III. Frequent Plastic Surgery Failures in South Korea, Some Resulting in Death
“Ghost surgeries” refer to a deceptive practice in which the plastic surgeon a patient has chosen and consented to undergo a procedure with is replaced by a less experienced surgeon or even a non-medical professional without the patient’s knowledge or consent. This practice is particularly problematic for Chinese patients seeking plastic surgery in South Korea due to language barriers, lack of familiarity with the local healthcare system, and the often-anonymous nature of medical tourism. These factors make it difficult for patients to confirm their surgeon’s credentials or assert their rights to informed consent. Consequently, Chinese patients may unknowingly fall victim to “ghost surgeries,” leading to a higher risk of complications, unsatisfactory outcomes, or severe health consequences. This highlights the need for more stringent regulations, supervision, and patient education in the international plastic surgery industry.
Some Facts about Ghost Surgery
Case of Ryu Sang-wook: Between November 2012 and October 2013, it was found that 33 patients scheduled for operations by plastic surgeon Ryu Sang-wook had their surgeries performed by other doctors, including dentists and otolaryngologists, while they were unconscious under anaesthesia. These surgeries were conducted without the patient’s consent. Ryu allegedly saved 150.00 million won (US$126,000.00) by doing this.
Estimated Victims: According to the Korean Society of Plastic Surgeons, 100,000 patients fell victim to ghost surgeries between 2008 and 2014.
Surgeon-to-Population Ratio: As of 2020, South Korea had a surgeon-to-population ratio of 5 plastic surgeons per 100,000 population. This starkly contrasts China’s balance of 0.20 plastic surgeons per 100,000 population. This disproportionate ratio in South Korea could contribute to an environment where unethical practices like ghost surgeries might occur, as there is more competition among surgeons for patients.
These figures underscore the urgent need for regulatory reforms and more vigorous enforcement in the South Korean plastic surgery industry. Patient safety and the principles of informed consent must always take precedence in medical practices.
Failure Cases in South Korean Plastic Surgery
Grand Plastic Surgery Scandal (Seoul, 2023): Ryu Sang-wook’s renowned clinic faced legal action over the controversial practice of “ghost surgeries” involving non-specialist surgeons performing procedures. Furthermore, an unfortunate patient death has led to an inquiry into potential anaesthesia mismanagement at the clinic. Despite the allegations, Ryu maintains his innocence.
Unauthorised Clinic Tragedy (Seoul, 2015): A patient lapsed into a coma following a routine operation at a non-registered clinic. Anaesthetic complications are suspected to be the cause. Although she regained consciousness, her mental state post-surgery remains uncertain.
Gangnam Clinic Fatality (Seoul, 2023): A woman in her 20s from China tragically lost her life following a ventricular standstill during her plastic surgery at a Gangnam clinic. An ongoing investigation aims to ascertain the exact cause of death and potential instances of medical malpractice.
Seocho Facial Surgery Case (Seoul, 2014): A 21-year-old university student tragically passed away after a 4-hour facial bone contouring procedure in Seocho. She never recovered consciousness post-operation. The hospital staff are now under investigation to determine any potential culpability.
Rhinoplasty Incident (Seoul, 2014): A 34-year-old woman tragically died during a rhinoplasty procedure. Specific details surrounding the incident remain undisclosed.
Liposuction Tragedy (Seoul, 2015): A 50-year-old woman suffered fatal respiratory complications during an abdominal liposuction surgery. Further details concerning this incident have not been provided.
Ghost Doctor Case (South Korea, 2020): A 34-year-old lady called “Law” died during a plastic surgery procedure performed by an unlicensed practitioner, referred to as a “ghost doctor.” It’s alleged that no anaesthetists were present during the operation, violating surgical protocols.
Reasons and Risks Associated with Ghost Doctor Phenomenon
The phenomenon of “ghost doctors” in South Korea’s plastic surgery industry presents substantial patient risks. There are several key reasons why such practices have emerged:
Surplus of Surgeons and Economic Incentives: South Korea has an abundance of plastic surgeons, far exceeding the domestic demand. Consequently, the government has encouraged cosmetic surgery procedures to stimulate economic growth. The plastic surgery industry contributes significantly to South Korea’s GDP, which reached a value of about 1.95 billion during 2018–2022. It is expected to grow at a CAGR of approximately 13.20% in the forecast period of 2023–2028.
Profit Motivation of Clinics: Many plastic surgery clinics are driven by the pursuit of higher profits. Employing interns or unlicensed doctors can increase profit margins, despite the associated ethical and medical risks.
Loose Regulatory Oversight: Before 2019, South Korea had relatively lax laws and regulations governing the plastic surgery industry. This lack of stringent oversight contributed to the emergence and persistence of unethical practices like “ghost surgeries.”
Lack of Awareness Among Foreign Consumers: Many foreign consumers depend on intermediary agencies for their arrangements due to geographical distance and lack of specialised knowledge. Their ability to accurately identify reliable and reputable medical institutions is often limited, making them more vulnerable to unscrupulous practices.
IV. Regulatory Framework in South Korea
The regulatory framework governing plastic surgery in South Korea is complex. Licensing requirements include rigorous education, professional training, and certification examinations. Several regulatory bodies supervise these practices, from issuing licenses to setting professional standards and ethics.
Measures To Regulate the Cosmetic & Plastic Surgery Market Targeting Medical Tourists
· International Medical Business Support Law
· Act on Mediation of Medical Disputes
· Action on Remedies for Injuries from Medical Malpractice
On 31 Aug 2021, the National Assembly finally passed a bill to revise the medical law requiring CCTVs to be installed inside surgery rooms. It appears that the closed-circuit television (CCTV) in the operating room (OR) should be started when:
The patient or the patient’s guardian requests it. In this case, the head of the medical institution or the medical professional must record the surgery scene when the patient is unconscious due to general anaesthesia or similar conditions.
The head of the medical institution or the medical professional cannot refuse to record the surgery unless there are legitimate reasons defined by the Ministry of Health and Welfare, such as emergency surgery, high-risk surgery, or situations that significantly hinder the achievement of the purpose of training hospitals.
Navigating Through Plastic Surgery: Officially Recognised Institutions with High Standards
In the vast field of cosmetic and reconstructive surgery, knowing that the institution to select adheres to the highest standards of care and professionalism is crucial. South Korean government offered a list of appropriate certifications, skilled and licensed medical professionals, and patient safety and satisfaction records.
V. Impact on Chinese Patients
In recent years, South Korea has enacted numerous legal measures to limit and regulate the phenomenon of “ghost doctors” (unqualified personnel performing surgeries). However, for Chinese patients seeking to understand these measures, this information cannot be easily accessed from a government website or other readily available sources. Instead, a deep dive into the laws and regulations is necessary to protect their rights.
The revised law in South Korea stipulates that “The patient or the patient’s guardian requests it. In this case, the head of the medical institution or the medical professional must record the surgery scene when the patient is unconscious due to general anaesthesia or similar conditions.” This law only applies when a patient or their guardian requests explicitly that the surgery be recorded. However, patients must be made aware of this provision or make such a request due to a need for knowledge about the law to ensure their rights are adequately safeguarded.
Chinese patients seeking cosmetic surgery in South Korea face several specific challenges:
· Language Barrier: Legal provisions and consent forms are published in Korean and sometimes in English. This could lead to misunderstandings or potential “language traps” due to translation issues. There are only 1.76 million Korean language users in China within a population of 1.41 billion, which means only 0.13% of people in China may understand the law and the certifications in Korean.
· Lack of Legal Knowledge: Patients might miss opportunities to protect their rights due to unfamiliarity with South Korean laws and regulations.
· Information Gathering: Finding reliable information can be challenging. Search engine results often direct users to intermediary agencies in Korea, with varying levels of quality and trustworthiness. These agencies usually charge high fees, with 50–70% of the costs being service fees, leading consumers to believe they are choosing qualified cosmetic surgery services.
Given these challenges, Chinese patients seeking medical procedures in South Korea must be provided with accurate and accessible information to protect their rights. This includes clear and comprehensive translations of legal provisions and consent forms and verified information about the qualifications of medical professionals and the specifics of proposed procedures.
Moreover, further research is needed to evaluate the effectiveness of the new South Korean law in safeguarding patients’ rights, especially for foreign patients who might need to become more familiar with the legal and medical systems in South Korea.
VII. Recommendations and Solutions
Strategic Sino-Korean collaboration is indispensable as the public’s demand for cosmetic surgery remains persistent. We propose importing technologically advanced and highly competent South Korean medical facilities into China, allowing citizens to undergo secure procedures under the aegis of Chinese law, thus fundamentally eliminating the phenomenon of “ghost doctor” incidents.
Given the challenges Chinese citizens face abroad — namely intermediaries, language barriers, and unfamiliarity with foreign legalities — the Chinese government’s structured management of domestic third-party agencies is advisable. Such measures may include auditing the compliance of South Korean medical institutions or appointing recognised institutions, significantly reducing risks associated with inadequate qualifications or illicit surgical practices.
With the escalating trend of Chinese tourism in South Korea, a bilateral legal system could lower the risks associated with medical cosmetic procedures. This could involve pre-operative assessments and post-operative recovery protocols implemented domestically through collaborations with local institutions, ensuring comprehensive patient support.
It is essential to reconsider societal perceptions of beauty and plastic surgery. It must be questioned whether physical attractiveness achieved through cosmetic procedures truly encapsulates holistic beauty. This societal misconception warrants revisiting in the face of potential post-operative complications such as facial stiffness and botulinum toxin infections.
It behoves the government to foster a balanced understanding of beauty, separate from surgical alterations, and educate citizens about cosmetic surgery’s benefits and risks. A robust public awareness campaign would debunk plastic surgery myths and emphasise its potential risks, promoting informed decision-making driven by self-acceptance rather than societal pressure.
A radical shift in the beauty narrative, promotion of natural appearances, and a thorough understanding of potential plastic surgery risks could decrease the demand for overseas cosmetic procedures. Such a strategy presents a sustainable solution to the ongoing trend of seeking foreign plastic surgery and significantly mitigates associated risks and challenges.
VIII. Conclusion
In summary, the trend of Chinese people seeking plastic surgery in South Korea presents several regulatory and supervisory challenges. While significant efforts have been made to address these issues, much remains to be done. Continued emphasis on robust regulations, adequate supervision, and improved patient protection measures is essential to ensure the safety and satisfaction of all patients involved in this trend.
Reference
- Korea Health Tour. https://www.koreahealthtour.co.kr/post/9995
- Korea Medical Dispute Mediation and Arbitration Agency. https://www.k-medi.or.kr/eng/index.do
- Medical Korea. Officially Recognised Institutions with High Standards. https://english.visitkorea.or.kr/enu/ATR/medical/img/pdf/directory_enu.pdf
- Korean Legislation. (2023). Act on Remedies for Injuries from Medical Malpractice. https://www.law.go.kr/LSW/lsInfoP.do?lsiSeq=217291&ancYd=&ancNo=&efYd=20201008&nwJoYnInfo=Y&ancYnChk=0&efGubun=Y&vSct=*#0000
- Medical Korea https://www.medicalkorea.or.kr/en/global
- Statista. Cosmetic Surgery. http://statist.891788.xyz/topics/3734/cosmetic-surgery/#editorsPicks
- “South Korea turns to surveillance as ‘ghost surgeries’ shake faith in hospitals”, The Business Times, 16 May 2022 https://www.businesstimes.com.sg/international/south-korea-turns-surveillance-ghost-surgeries-shake-faith-hospitals
- “中国驻韩国大使馆：来韩整容中国公民须谨慎” 22 Mar 2023, https://www.xhby.net/index/202303/t20230322_7874432.shtml
- “In Another Warning Sign, S. Korean Woman Dies after 4-Hour Plastic Surgery”, 22 Dec 2022, Korea Bizwire, http://koreabizwire.com/in-another-warning-signs-s-korean-woman-dies-after-4-hour-plastic-surgery/26803
- “Foreign Medical Tourism Returns to 50 pct of Pre-Pandemic Levels: Data”, 25 Apr 2023, Korea Bizwire, http://koreabizwire.com/foreign-medical-tourism-returns-to-50-pct-of-pre-pandemic-levels-data/246640
- “partially revised bill of the Medical Service Act.”, http://likms.assembly.go.kr/bill/billDetail.do?billId=PRC_I2N1B0L8C2K3F1X2U1R1W0V7Z9I5X4
- “中国医美行业2022年度洞悉报告”, Deloitte, https://www2.deloitte.com/content/dam/Deloitte/cn/Documents/dtt-china-medical-aesthetic-industry-outlook-2022-zh-220816-whitepaper.pdf