MANILA - Plump breasts, firm buttocks, a slimmer figure, and an aquiline nose. These are the "beauty ideals" that drive millions of people all over the world, including many Filipinos, to avail of cosmetic surgery every year.

However, while cosmetic surgery appears to be growing in popularity, cases of injuries caused by cosmetic procedures under unqualified doctors prove that there is still a lack of consumer knowledge on the subject.

Dr. Mariano R. Agcaoili Jr., the secretary of the Philippine Society of Cosmetic Surgeons (PSCS), said some patients have died or suffered complications under well-known cosmetic doctors and clinics, many of whom do not have the necessary credentials to perform surgery.

Based on first-hand accounts from his peers in the medical community, he described how a doctor performing liposuction mistakenly punctured a patient's stomach, causing peritonitis.

In another case, he said, a doctor performing penile enlargement surgery used hydrogel implants, which turned out to be toxic to the kidneys and is unauthorized by the U.S. Food and Drugs Administration (FDA) and the Bureau of Food and Drugs (BFAD).

"These self-proclaimed cosmetic surgeons, and there are many of them, are monsters created by the media. Because of celebrity endorsements, false advertising, and a failure to investigate whether these people are qualified. Media hype lang yan," said Agacoili, who has 30 years experience in cosmetic surgery.

Agcaoili added that there are certain limitations in governing laws like the Medical Act of 1959. "Technically, by law, licensed doctors can practice medicine, and practicing medicine involves surgery. However, just because you practice doesn't mean you're qualified," he said.

Before surgery, consider this

Injuries allegedly caused by a failed buttock augmentation surgery involving silicone oil. Photo courtesy of Alex Santos, ABS-CBN News.

One of the first things patients should do before going under the knife is to check their doctor's credentials, whether they had completed their medical residency and if they received specialized surgical training from a reputable hospital.

Examine their diplomas, do background research online, and check official rosters from professional organizations like the PSCS or the Philippine Association of Plastic, Aesthetic, and Reconstructive Surgeons (PAPRAS), which thoroughly screen every member's qualifications.

The PSCS, founded in 1972, and the PAPRAS, the only certified plastic and reconstructive organization in the country, both require members to qualify for national board exams and have several years of formal training.

"The results should also be examined. Kunyari magpapagawa ka ng ilong, tignan mo ang itsura ng ilong ng mga lumalabas (sa clinic). Magtanong din dapat ang patient," said Agcaoili, who completed his 4-year general surgery training at the St. Clare Hospital in the U.S.

Be wary, too, of impressive-sounding titles like "anti-ageing specialist." Although there are international anti-ageing conferences and fellowships, there are no specific medical training programs for anti-ageing.

Agcaoili said it is also crucial to ask the doctor what substances he or she will be using in the surgery. The approved products listing of the BFAD and FDA should give you an idea of whether materials, like implants, are safe or not.

"Boob jobs" typically use silicone gel implants, while "butt jobs" use slightly thicker silicone gel for extra padding. "Nose jobs," meanwhile, use custom-made silicone rubber.

He advises patients to avoid liquid injections (paraffin wax or silicone oil), since this practice has been condemned since the 1960s, the period when cosmetic surgery slowly became available in the Philippines. Botox is accepted because it only paralyzes the muscles, and is not used to fill the body's tissues.

"It's not logical to inject the face with liquid kasi it does not stay where you injected it, it migrates and travels. The accepted procedure is surgery - gagawa ka ng cavity or space tapos isusuot mo yung implant," Agcaoili said.

Lucrative business

Samples of silicone rubber nose implants.

The Philippines is an emerging destination for cosmetic surgery patients since procedures here are cheaper than in countries like the United States, Europe, or Latin America.

"Boob jobs" in the Philippines cost P120,000 or more, while the same procedure costs $5,000 or about P240,000 in the States.

The business is so lucrative that it has spawned a "turf war" of sorts between surgical societies the world over. They quarrel on which organization should have exclusive rights to perform cosmetic surgeries in a particular country.

The industry's profitability also explains the proliferation of doctors who perform cosmetic surgeries without the appropriate qualifications.

"All over the world, ganyan ang problema. Sa Pilipinas ganyan din, pinag-aawayan ang cosmetic surgery practice. There are doctors who say they can perform the surgery better. But that's just greed," Agcaoili said.

However, despite its lucrative nature, the Philippine cosmetic surgery industry has also been affected by the economic crisis. Agcaoili said there are fewer patients now, both here and abroad.

Agcaoili said about 50% of cosmetic surgery patients are "balikbayans" or overseas Filipino workers, who avail of all types of surgeries from eyebag removals to facelifts.

"They undergo the surgeries for the same reasons as others - to beautify, to look younger. And they have money kasi mura dito ang cost ng cosmetic surgery compared dun sa cost sa States. So kahit kasama na ang plane fare nila, mura na iyan," he explained.

Despite the decline in demand for these services, however, Filipino cosmetic surgeons like Agcaoili are confident that the business will survive. Despite flawed regulation and numerous risks, the endless quest for "ideal beauty" still keeps patients coming. Report from Kristine Servando, abs-cbnNEWS.com/Newsbreak.