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Beauty for sale

Cosmetic surgery has become so pervasive, it is now a $4 billion industry, and is said to be growing at a 30% rate per annum. Now that it’s more accepted, where do you head for the next fix?

The story, seeming like an urban myth, even made it to the pages of Asiaweek Magazine: a wealthy Filipino executive in his 60s took his mistress to a plastic surgeon to make her look like his wife when he married her. Unknowingly, the wife went to the same doctor to undergo cosmetic surgery herself, in a bid to keep her husband. After all the nipping and tucking, the wealthy husband left his mistress to return to the surgically rejuvenated wife – but only after undergoing surgery himself, as he started feeling insecure about his own aging appearance.

In a society that is willing to pay the top price for a youthful look, over $160 billion is spent annually worldwide on cosmetic and toiletry products, including deodorants, shampoos and soaps, makeup, lotions, and fragrances. In 2002, Filipinos spent P70 billion for the same, with the figure estimated to reach P89 billion in 2007.

However, more belatedly, cosmetic surgery has become the somewhat simple, yet long-term answer to the pursuit for beauty. Having a hard time losing the gut despite hundreds of sit-ups every day? Opt for abdominal liposuction (price starts at $1,400). There are even muscle implants for the gym body without ever lifting a gym equipment. Losing hair too fast? Consider hair transplant (from $1,500). Insecure about your manhood? Have a penile enlargement and/or lengthening operation (from $450). For women, the vaginal opening can be tightened (from $550) for another “Like a Virgin” experience. Getting edged by younger guys simply because they look better – and, well, younger? Mull over facelift (from $1,000). And, while doing so, you may consider adding a dimple and a cleft chin (from $360) for the Brad Pitt/Alec Baldwin look.


The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

According to former Philippine Medical Association (PMA) president Bu C. Castro, M.D., Ll.B., FPSP, the Philippines is actually a premier destination when it comes to availing of cosmetic surgical procedures, among others. In fact, balikbayans (returning overseas Filipinos) are known to come home to undergo such treatments “Overseas Filipino workers (OFWs), especially those in the entertainment industry, (are among the biggest markets of cosmetic surgery in the Philippines, as it allows them) to level with their competitors, particularly Caucasians, (by giving them similar physical attributes),” he says.

Plastic and reconstructive surgeon Carlos I. Lasa Jr., M.D. agrees. “First, comparing (our costs with) the costs (of medical treatment) where they are working right now, say in London or New York or Japan, where the charges are very high, they can save by coming here,” he says. The balikbayans are also familiar with the Philippine medical system, so they “have more or less this trust in our medical system.” And third, the treatments are merely side trips when they come over to take a vacation, so their visit becomes one trip for everything.

COMPETITIVE ADVANTAGES

The general acceptability of cosmetic surgery helped spawn an industry all its own – medical tourism, which pits the medical practitioners of developed countries, once regarded as the elite bastions of medical expertise, with the developing countries, now also offering highly qualified and well-trained medical professionals using the most advanced in technology.

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“This is a $4 billion industry, which is said to be growing at a 30% rate per annum,” Eddie Uy of rxpinoy.com, the first online community of Filipino doctors and dentists that serves to connect various sectors with the health industry, says. Combined with affiliated industries like tourism, India’s BusinessWorld Magazine estimated that millions of travelers actually spend over $40 billion a year. “We should – and can – break into that.”

The local industry has been changing over time, however. According to Uy, although OFWs continue to be the major market of cosmetic procedures, their portal had been receiving inquiries on these procedures from Europeans, particularly from Germany and Denmark. Also, other procedures mainly attract foreign nationals, such as Australians for dentistry, Japanese and Koreans for ophthalmology, and Americans and Europeans for bariatric surgery.

Once derided as vanity medicine, cosmetic surgery has gone a long way, as it is now largely recognized as a legitimate arm of medicine. While it was once only discussed in hushed voices, now anybody who underwent one or more cosmetic surgical procedures actually boasts of having them – men and women alike.

The biggest edge of the Philippines over other countries, particularly in Asia, is its relatively cheap rates for the procedures. For example, breast augmentation could cost up to $5,043 in the US, and at a much lower price of $2,500 in Thailand’s Preecha Aesthetic Institute, but would only cost $2,100 in the Philippines. Similarly, full facelift could cost up to $5,000 in the US, and $4,000 in Thailand, but only $2,500 in the Philippines.

“Among others, there’s an interest in general surgery and cardiovascular surgery because (if they have the surgeries in their home countries) they are sometimes required to co-pay, which they can’t afford, and cosmetic surgery because it is not covered by medical insurance offered to them abroad. So they see (us),” Lasa says. He nonetheless stressed, “The reality is we can’t have fees as high as our counterparts in US and Europe. We also have to have fees that are affordable to the local patients. So when I put up my rates and publish them on the website, it was with due cognizance of the rates in other countries, and of course, the prevailing rates in the Philippines.”

“If you compare the (rates) in peso, (they may look expensive),” Castro says. “But if you go to Singapore, (it’s even more expensive). Even (compared to) Hong Kong, we’re still cheaper when you convert (the rates) to peso. A P150,000 procedure here could cost P250,000 in Hong Kong, and even more in Singapore and Thailand.”

It helps, too, that the standard of living is cheaper in the Philippines by foreign standards. “The Philippines’ highly favorable exchange rate can benefit both local and foreign patients,” Lasa says. With the foreign exchange rate averaging at P56 per $1, the amount brought in by a foreigner visiting the Philippines “can get more for less.”

Another advantage Lasa sees is that “over Thailand and India, the language barrier is non-existent (in the Philippines) for those who speak English well.”

Dr. Castro, however, believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

“And with many of our professionals trained abroad, they don’t mind coming here for their treatments,” adds Lasa.

TAKING WINGS

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However, while the Philippine government acknowledges that medical tourism is a potential source of dollar income, there are currently no “nationally palpable efforts done (to advance it), so we’re still off the radar of most Europeans, Americans and other nationals (who are considering availing of medical services outside their home countries),” Lasa says.

Lasa contends that government support will help develop a young industry. “For example, the Indian government (gives certain) incentive to dollar earners,” he says. “We need something like that to really promote (medical tourism in the Philippines). As it is right now, we just (get involved in medical tourism) as part of our regular practices.”

That Philippine government has, in fact, included the medical profession in the expanded value added tax (E-VAT). “The government thinks that by taxing, they can generate more income. Actually, they may be mistaken in that assumption,” Lasa says.

“Necessarily, we’ll have to increase the prices also – we’ll have to throw to the patients the costs of the E-VAT. That’s the problem,” Castro says. “The E-VAT has a negative effect on medical tourism – it will jack up the prices. But it will be costly not only to medical tourism but to local patients, who will primarily bear the burden because of the E-VAT.”

Lasa, however, said that while not necessarily translating to increase in prices, “the implementation of E-VAT will mean a decrease in our net income – it will amount to that.”

A bigger problem bothering the local medical tourism industry is its lack of cohesion. “Aside from the medical, dental, cosmetic and other procedures, medical tourism actually bundles hotel stays, destination tours, concierge services including interpreters, caregivers and tourist guides, and many others” Uy of rxpinoy.com says. “But at the moment, most of these (related) industries and sectors (go it alone).”

Castro recommends the establishment of a national call center for medical tourism, preferably with the assistance of medical staff because they would know what the industry is all about and has to offer. “When prospective clients would call up to ask specific questions, our agents should be able to answer them. Else, they’d ask their questions elsewhere – it could be India, Singapore or Thailand – then end up going there,” he says.

While there are entrepreneurs interested to open services like Singapore’s MNC, a one-stop information center for all medical services offered by the country state, “they want it to be outright business operations, not service-oriented, which increases the prices,” Castro says. “If that happens, then we lose our competitive advantage over our competitors.”

Pinoyrx.com is gearing towards the establishment of a “specific hub for medical tourism” when it recently established http://mtpshow.rxpinoy.com, which lists accredited hospitals, current rates and the credentials of Filipino practitioners. “But beyond that, we would like to cross sell other services in the country – if a person undergoes dental implant that requires for him to stay for up to 10 days in the country, then he has to choose accommodation. While here, he could go on tour. And while touring, he may need other services. rxpinoy.com could help arrange all those,” Uy says.

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Dr. Bu Castro believes that the country’s biggest edge is the expertise of the Filipino medical practitioners. “We can be competitive – especially with the skills we have. For example, the medical education in China is only four years, (while) ours is 16 years. So how could you rate their qualifications with ours?” he says.

Another problem the industry is facing is the lack of “related infrastructure,” Lasa says. In Thailand, for example, Bumrungrad Hospital has its own hotel facility, connected by a walkway to the hospital, so families can be close to a family member undergoing treatment. “If local hospitals can afford such facilities, it will definitely help promote our medical tourism,” he says.

The urgency to address this situation varies, nonetheless, says Castro. “Makati City, for example, has hotels not far from hospitals. It is in other places like Quezon City that problems arise, since they are far from each other,” he says. Already, however, efforts are already done to establish a hospital cum accommodation facility in Subic Bay Metropolitan Area, among others.

The lack of solidity in the industry also poses a problem when it comes to regulating practitioners. “The Philippine law allows all licensed doctors to do any kind of surgery – mainly, this is to allow doctors in provinces to be able to give emergency treatments without worrying about legal consequences,” Lasa says. “This is good for the provinces, but (in cosmopolitan areas) this is problematic.”

While the PMA and other professional associations can regulate medical practitioners, their grasps are limited only to members. “(Medical tourism) is a very good concept,” Castro says. “But it could be subject to abuse with the sprouting of fly-by-night cosmetic centers that we need to control. The government should issue a listing on the qualified and accredited (practitioners). There should be some kind of a regulation to tell the customer that they are also protected.”

At the end of the day, Castro believes it all boils down to marketing. “When you say tourism, marketing is very important,” he says. “And when you say medical tourism, you’re not only marketing the medical services, but the Philippines itself – places to go to, accommodations and services, everything. We should realize that marketing is an indispensable arm of medical tourism.”

GROWING DEMAND

“I think there is a future (for medical tourism in the Philippines),” Lasa says. “Definitely, as long as there is an economic need for people abroad, as long as there is a perceived benefit of coming (here) to have treatments given by competent – let me emphasize competent – practitioners, there will always be people coming here for such reasons, so medical tourism will continue to prosper.”

Uy says that people live longer, “and you need to provide people to look after them (as they age).” “Coupled that with the escalating cost of health care – instead of chasing the expenses, they might as well outsource it,” he says. “With the advent of technology, information has become fluid, so it helps our cause (to promote the Philippine medical tourism). Who knows, this may just avert the brain drain of our medical professionals.”

While arguing that a concerted effort needs to be done in order for the local industry to realize its full potential, “I do not conduct my practice with grandiose visions – I conduct my practice with a simple philosophy: providing excellent patient care on a one-to-one basis. I don’t regard this as a business. I went into this field because I like treating patients on a one-to-one basis. If dadami ang patients ko (the number of my patients grow) because (they were referred to me by satisfied patients) then well and good,” Lasa says. “In the end, it is because of how good we are at our profession that is the driving force of people coming to avail of our services.”

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