With just two medical schools in the country specializing in cosmetic surgery and only 104 registered plastic surgeons, other doctors and specialists are getting in on what’s fast becoming a booming industry.
Among the more popular of what have been termed “aesthetic doctors” are dermatologists.
Dr. Djoko Widodo, head of the East Java chapter of the Indonesian Association of Dermatologists (Perbeki), says demand for beauty treatments are driving skin specialists like himself to also perform cosmetic operations.
“Dermatologists with an interest in aesthetics and who understand the procedures may perform facial operations such as nose surgery and eyelid surgery,” he tells the Jakarta Globe.
Perbeki itself was established in 1985 when the Ministry of National Education decided medical schools should also offer skin surgery as a specialization program for prospective dermatologists.
“I believe aesthetic surgery is no longer exclusively the domain of plastic surgeons,” Djoko says. “General practitioners and dermatologists who have taken courses on aesthetic surgery can also perform beauty-enhancement procedures.”
Most doctors are taught about the basics of surgery in medical school anyway, he adds.
“Besides, dermatology is related to aesthetics because we deal with the skin — just as ophthalmologists can do cosmetic eye surgery and ear-nose-throat doctors can do a nose job,” he says.
According to the Indonesian Association of Plastic Surgeons (Perapi), there are only 104 registered plastic surgeons in Indonesia, or a tenth of its membership of more than 1,000.
In addition, the medical schools at Jakarta’s University of Indonesia and Surabaya’s Airlangga University are the only ones in the country that teach plastic surgery. At most, only six to eight plastic surgeons in total graduate from the two universities each year.
“Aesthetic surgery isn’t actually included in the top three of primary needs,” says Dr. Siti Handhayani, from Perapi. “Those who feel the need and have the money to do it constitute less than 1 percent of Indonesia’s population.”
Her colleague, Dr. Kristaninta Bangun, says the growing demand for plastic surgery is the result of greater public access to information. “From 24-hour fashion-related TV to news of famous people having procedures done, the public has became more and more familiar with cosmetic surgery,” he says.
Cipto Mangunkusumo General Hospital (RSCM) in Central Jakarta says it has received a steady stream of patients seeking cosmetic surgery since 2007.
A study by Perapi that same year showed the country’s cosmetic surgery industry had grown by 400 percent since 2005.
“Originally, our pro bono plastic surgery department was established in 1998 to help the victims of illegal silicone injections, or to offer reconstructive procedures for patients suffering from heavy burns or cleft lips,” says Sutrisna, an administrator at RSCM’s plastic surgery department.
Today, however, more and more people are coming in for purely aesthetic reasons, he says.
According to Sutrisna, the department carries out at least one procedure a day, although most of the operations there are still reconstructive surgery.
“The ratio between the aesthetic and reconstructive surgeries that we do here is one-to-three,” he says.
Because aesthetic procedures at the hospital are less expensive than at specialist clinics, it sees a lot of business from people who might not seem like obvious candidates. “Those who come for aesthetic surgery are usually from the low-income bracket,” Sutrisna says.
There are at least 20 clinics and hospitals in Jakarta and Tangerang with at least one registered plastic surgeon, and 27 elsewhere in the country.
Dr. Juli Karijati Njoto, a spokeswoman for the Indonesian Association of Aesthetic Doctors (Perdesti), dismisses the idea that GPs are muscling in on the lucrative market for plastic surgery and dermatology.
“Since low-income people are beginning to take an interest in beauty treatments, GPs are on the front line to provide correct information to the public,” she says.
Established in 2006, Perdesti now has more than 800 members. Juli says the association is not an academic institute and seminars do not qualify members to perform certain procedures.
“The association is more of a gathering where doctors can trade information,” she says.
Regional health offices are responsible for issuing permits for beauty clinics, which fall under the category of “specialist group practices” and are distinct from dental clinics. In 2009, Jakarta had 140 such clinics registered with its health office.
Jakarta only last year separated the permit for beauty clinics from that for beauty salons.
“The treatments given to customers at these so-called beauty clinics have grown far more sophisticated and complicated in recent years, so we’ve had to revise the standards,” says Sugeno, head of the health service unit at the Jakarta Health Office.
The new standards, issued in June, list two types of beauty clinics: One supervised by a GP and the other by a specialist such as a plastic surgeon or dermatologist.
“Only those that are supervised by specialists are permitted to carry out plastic surgery,” Sugeno says. “The new guidelines require clinics be under the responsibility of a GP or specialist with training in aesthetic medicine.”
The standards also require clinics to have a written statement of collaboration with a hospital, a schedule of doctors and lists of the medicines and equipment used in the clinic. For their part, regional health officials are required to monitor these clinics to ensure compliance with guidelines.
“A clinic also has to have a team of nurses and at least one pharmaceutical assistant on its payroll, not just beauty assistants,” Sugeno says.
“However, we have limited human resources and there are many such clinics and salons in Jakarta. If anyone finds indications of illegal health or medical practices, they can report it and we will follow up on it.”
Dien Ernawati, head of the Jakarta Health Office, says the terms “salon” and “clinic” are not interchangeable and there are rules in place on classifying the various establishments.
Dr. Chaula Sukasah, from Perapi, says the problem with GPs and dermatologists taking up plastic surgery is that they are not professionally accountable.
“Plastic surgeons have to study for years to handle complications,” she says. “These other doctors only know how to carry out a procedure, but they won’t know what to do when something goes wrong. ”
Specializing as a plastic surgeon requires 11 years of higher education. Those who graduated before 2000 are also required to undergo another three years of general surgery training.
Dr. Imam Susanto, head of the Jakarta chapter of Perapi, says the association has published a guidebook of 137 safety procedures necessary for plastic surgery, including diagnostics, complications and follow-up.
Dr. Slamet Budiarto, secretary general of the Indonesian Doctors Association (IDI), says only GPs should operate at clinics.
“Specialists should be resident at a hospital and they should be referred to by a GP,” he says.
However, he is in favor of dermatologists carrying out cosmetic surgery or GPs performing simple procedures like Botox, “as long as they are properly trained and have IDI accreditation.”
Slamet says beauty fixes constitute only about 5 percent of a doctor’s total work. “But this 5 percent also makes more money,” he says.
Additional reporting by Elisabeth Oktofani & Yuli Krisna