A woman undergoes a rhinoplasty procedure. Photo: CFP

July and August have become the period when students on summer vacation looking for a facial or body renovations boost the numbers of people seeking cosmetic surgery. This year, in July and August, students seeking plastic surgery might have to go further afield. City authorities have launched a major crackdown on illegal cosmetic surgery clinics and practices.

Although the Ministry of Health introduced regulations governing cosmetic surgery in 2002 and cosmetic surgery clinics have to be properly licensed and their procedures approved and registered, illegitimate clinics and operators are burgeoning in the city.

According to the Shanghai Municipal Health Inspection Institute, alongside the city's 197 licensed cosmetic surgery institutions (there are 100 general hospitals, 14 specified cosmetic surgery hospitals, and specified outpatient departments and clinics), illegal cosmetic surgery is growing.

Many illegal procedures are being done at non-medical premises like beauty salons and spas. In 2013, the health inspection institute raided 591 beauty parlors and found 54 conducting illegal procedures.

The income confiscated from these was worth more than 240,000 yuan ($38,670) and the institute inspectors confiscated more than 12.5 boxes of medicines and drugs alongside 681 pieces of medical equipment. The operators of these illegal clinics were fined a total of 234,800 yuan.

Looking legal

Many of these premises offer cosmetic procedures in so-called beauty treatments to make them seem legal. This can appeal to customers who are uncertain about surgery and medical procedures - many beauty parlors advertise in newspapers and magazines claiming to be able to carry out eyelid operations without surgery.

Sun Baoshan is the chief surgeon and professor from the cosmetic surgery department of the Shanghai Ninth People's Hospital and he sees the end results of botched operations. He said the illegal clinics were taking advantage of uncertain definitions of beauty treatments and cosmetic surgery. An easy way to define surgery, he suggested, was when instruments of any nature cut into the skin.

"This is why Botox and restylane injections are cosmetic surgery. Yet, many people have no idea and think it is perfectly appropriate to have this done in beauty parlors. In fact, most of the people in Shanghai receiving Botox and restylane injections are not having this done in proper medical institutions."

It's not just beauty salons that are practicing illegally. From January to May, the authority's inspectors found another six unlicensed businesses, some of them obviously operated by fraudsters. Cao Xiaohong is the head of the Shanghai Municipal Health Inspection Institute's medical institution supervision department and she said some unlicensed businesses rented apartments or even used hotels for their cosmetic surgery.

"With the advances in communication technology, these people advertise on microblogs and instant messaging apps with fake 'before and after' photos, and promise door-to-door service," she said.

In one recent case, two licensed cosmetic surgery practitioners teamed up with two unemployed men to perform face-lifts. According to Liu Hong, the head of the investigation team, they had treated more than 300 people before some who were unhappy with their results, complained to the authorities. The practitioners were struck off and the two unemployed helpers lost the revenue earned from the venture and were also fined.

Very risky

"In this case the operators were licensed practitioners who wanted to make extra money, but there are many illegal operators in the city who are not licensed at all. Even with relatively simple injections, people without intensive professional training can be very risky," Sun pointed out.

The most popular procedures offered by unlicensed operators include rhinoplasty, eye enlargements, Botox and restylane injections.

"At the cosmetic surgery department at the Shanghai Ninth People's Hospital, about 20 percent of the patients we see everyday have been disfigured by beauty salons and fraudsters and come to us for a fix," said Sun.

One of the victims was a woman from Shaoxing, Zhejiang Province. She saw an advertisement for an "expert" at a Shanghai beauty parlor and paid about 200,000 yuan for him to perform a breast enlargement procedure with injections at her home. However shortly after the procedure her breasts became infected.

Sun said that another problem beside the unprofessional approach of these operators was that some used fake chemical products. "Even at major fairs, and cosmetic surgery exhibitions and conferences, there are fake cosmetic surgery products on sale. The intended customers are mainly illegal cosmetic surgery operators and sometimes private hospitals," Sun said.

Other operators obtain imported genuine products and prescriptions but then grossly inflate the prices for the customers. Sun said a bottle of restylane usually costs $100 in the US or $120 in Europe, and one treatment at a city public hospital will cost a patient about 4,000 yuan. When the Global Times asked several established leading beauty salons what the price for a treatment would be some were asking for more than 10,000 yuan.

Koreans the key

Why do people prefer to pay considerably more for a face-lift on unlicensed premises? Sun said one reason was that many of these "clinics" targeted customers by hiring South Korean surgeons and marketing them as the key members of their staff - in China it is commonly believed that Koreans have the greatest skills in cosmetic surgery in Asia, if not the world.

When the Global Times visited the cosmetic surgery department of the Shanghai Sixth People's Hospital in early July, one of the patients was a young woman with a noticeably swollen, ugly nose. She told the Global Times that she had gone for a "100 percent Korean-style rhinoplasty procedure" at a local beauty parlor, for she believed that was the best she could get in Shanghai.

"When I went for the consultation I met the Korean expert who was advertised. The way he presented everything it seemed organized and professional so I had a good feeling about it. But it backfired quickly.

"Now I think of it, I ought to have spent more and flown to South Korea to have the surgery," she added.

Some of the Korean qualifications are dubious. Tang Jianli is a lawyer and former head of the Shanghai Lawyer Association's medical and health law research team and has dealt with many cases where procedures have gone wrong. He believes most of the so-called Korean practitioners in Shanghai were operating illegally.

"Many beauty salons use Korean doctors as a selling point, but they don't follow the law which says that these doctors have to be registered with the local authority and they must obtain temporary licenses to work in China.

"What's more, most of them don't have licenses in South Korea in the first place - they're medical school graduates who can't find employment in their home country," Tang told the Global Times.

Some licensed cosmetic surgery clinics use similar promotions. When the Global Times accompanied the health institute inspectors on a raid on the Weikai clinic in a townhouse on Huaihai Road Middle on June 30, a Korean practitioner (whose picture was the center of the entrance hall's photo wall) could not show inspectors his license.

Even if the operators are professionally trained and registered, not all licensed cosmetic surgery clinics are legal. The health supervision institute said all these clinics are rated and given one of four rankings - clinics cannot perform procedures that they are not rated for. However at the Weikai clinic the raid unearthed evidence of chemicals and patient records that suggested procedures the clinic was not allowed to perform were being carried out there.

No heavy penalties

Both the lawyer Tang and doctor Sun emphasized that a very serious problem is that these illegal clinics and operators can escape without heavy penalties. Apart from fines and the confiscation of earnings, equipment and drugs, few illegal operators have been jailed. According to the health supervision institute, every year dozens of illegal practitioners are imprisoned. The institute did not provide precise figures but said fewer people were imprisoned for conducting illegal operations.

The institute said that under the law, unlicensed practitioners can be imprisoned for their first offence. Licensed practitioners can be imprisoned on their third arrest - if they have not previously caused physical harm to a human being. "It is down to the police to investigate and determine whether harm has been caused."

Sun said the vagueness of the regulations had made it difficult to imprison offenders and he believed a revision of the law was the key to cleaning up the cosmetic surgery market. "In China, practicing medicine without a license is not a criminal offence but a civil matter, so the consequences are generally limited to financial compensation and the like. This means that many illegal businesses lose some money then reappear under another name and in another place, and continue doing harm. This would not happen if they could be imprisoned immediately."

Lawyer Tang confirmed that it was very rare for unlicensed practitioners or licensed practitioners working in illegal clinics to be sent to prison. "In some Western countries, this is unimaginable - 99 percent of the unlicensed practitioners in China would be in jail if they were in Australia for example.

"Apart from being struck off and fined a lot more is the case in China, in a Western country a practitioner loses his credibility and cannot survive unless he changes career. But apparently this is not the case here," Tang said.

He told the Global Times that only a fraction of the disfigured victims chose to sue the operators. "Most of them want to handle it privately, for many cosmetic procedures are very private and they want to keep it as low-key as possible."

Usually a private settlement involves financial compensation. The girl with the deformed nose at the Shanghai Sixth People's Hospital said that she received tens of thousands of yuan from the private cosmetic surgery clinic she had used and would now spend the money at the hospital to fix her problem.