Plastic surgery nightmares

Kirsten Miller never wanted a dramatic transformation.
All she wanted was to look like herself, but better - a little enhancement around her eyes to make them stand out so she would not have to worry about going into the swimming pool with a bare face or wasting too much time in the mornings applying make-up.
Instead she has been left scarred and traumatised by what should have been a simple procedure, a semi-permanent eyeliner tattooed around her eyes.
Now every morning is spent layering on even more products than before in a bid to cover the unsightly blotches and uneven lines she has been left with.
"The whole point of having this procedure was to save me time, but in reality, I now worry about it more than I used to and spend each day patching it up, hoping it starts to fade," says Miller. "I am faced with extra costs to try to correct the work I had done and have been advised it is too risky to treat the inside corners of my eyes, which could take five years to fade or potentially lead to permanent scarring."
She is not alone. Health authorities in the UAE deal with complaints every year about botched jobs, unregistered practitioners and flawed practices.
A convoluted licensing process, laws that are tricky to enforce and the fact that those coming to work in 1,000 plastic surgery clinics in Dubai, plus a handful springing up in Abu Dhabi, have usually trained overseas with qualifications hard to check mean that there are numerous hurdles in monitoring those practising in the country.
Little wonder there are horror stories. In 2008 a 27-year-old Emirati woman who paid Dh90,000 for liposuction died a few days later. Another woman ended up in a coma after having a facelift and liposuction.
Then there was Steven Moos, the discredited American doctor who posed as a top Hollywood surgeon and operated on his kitchen table, butchering the women who queued up for his Dh500 treatments.
Conditions at his flat in Dubai were so basic that fat removed during liposuction was stored in cooking pots and water bottles. His patients claimed he had operated on them using unsterilised kitchen utensils.
Moos was eventually jailed and deported to the US. But Dr Ramadan Ibrahim, the director of health regulations for Dubai Health Authority, has admitted the system is flawed.
"Without complaints, it is very difficult to know who and where we should be targeting," he previously told The National. He says such cases are rare: "Regulations are much better now and are getting tougher. We are aware there are some problems in clinics and that is why we have increased the number of inspections we are doing."
Laws will be tightened in September when only those operating in clinics under the supervision of a dermatology doctor will be allowed to carry out treatments such as semi-permanent make-up, Botox, laser hair removal and micro-needling. Last year, stricter criteria for cosmetic surgeons were introduced by the Ministry of Health and there are regular spot-checks on practices.
But is enough being done to regulate those operating in the Emirates? And what action can be taken to ensure that problems such as those that occurred under Moos do not happen again?
"There is not enough regulation at the moment," says Candice Watson of the Dubai salon Exclusive Beauty. When she arrived here two years ago, she provided the college certificates and personal verification statements from previous employers that were part of the Ministry of Health and Dubai Health Authority requirements for getting a practitioner's permit. But Watson says an exam supposed to rigorously weed out flawed candidates simply involved her being asked one question about skin types and being given the once-over.
She says 70 per cent of her patients come in for correction work after botched jobs elsewhere.
"It is awful; I have people coming in tears because they do not know what to do," she says. "One woman had a green nose because she wanted to camouflage her skin and the pigment changed colour. It is very hard to check the credentials of whoever is treating you."
That is something Kirsten Miller learned to her dismay. She contacted Dubai Surgery Center to ask for her eyeliner treatment and was put in touch with Susan Summers, one of the beauticians registered with the website.
Miller, 38, a secretary for Aramco petrol company in Saudi Arabia, booked a Dh2,000 treatment and flew to Dubai in April last year. But when she took a taxi to the address provided, she was shocked to discover it was a residential apartment in Al Barsha.
Summers, according to Miller, explained that she mainly worked from home, a practice Miller has since discovered is illegal. With a growing sense of unease, she sat on the chaise longue in one corner of the living room and had the eyeliner tattooed on.
"I felt I had been put on the spot and could not say I did not want to do it any more, plus I had flown all the way there," Miler says. "As she was doing the bottom lid, she said: 'I will go right into the inside corner' without checking with me first. I had not wanted the line to go that far but there was nothing I could do about it."
Despite two subsequent treatments, the liner that should have appeared black turned grey and formed uneven lines over the lids and unsightly blotches in the corners of her eyes. Summers told her the pigment was "not taking" and went over the patches with a skin colour, which then took the appearance of a shiny scar as it was a different colour from Miller's skin.
Unhappy with her treatment, Miller complained to Dubai Surgery Center, which initially blamed "an excess acidity level in the skin" and then denied responsibility, saying Summers was sponsored by a separate clinic.
While Summers offered Miller a full refund and a follow-up treatment with a specialist, the secretary was terrified of doing further damage to her appearance and refused. She has since sought advice from dermatologists in the UK, who all say they would not tattoo the inside corners of the eyes because of the risk of the pigment spreading or damaging the tear ducts.
Summers, who was suspended by Dubai Surgery Center in the wake of the incident and is now living in Australia, says in an e-mail to M magazine that she worked from home "knowing it was not entirely legal". She says she did so as her patients were too embarrassed to sit in waiting rooms "being stared at by other patients" and to save them "undue distress".
When contacted by M, Jennifer King of Dubai Surgery Center claimed Miller's treatment was "normal". She said the practice was a website run from the UK, adding "our non-disclaimer on the site makes it very clear we are not responsible for qualifications".
Miller's case is a cautionary tale, certainly, but the point is not whether her grounds for complaint are justified. It raises the much more disturbing question of who is liable when things go wrong?
With the woman who treated her having left the country, and the clinic she booked her through denying responsibility, what recourse do patients such as Miller have to protect themselves?
In a city where appearances are all-important, Miller is not alone in seeking out treatments to transform her look. On a drive down Al Wasl Road, it seems every other building houses a plastic surgery outlet. The availability of cheap treatments and the abundance of clinics mean those who might not have considered surgery in their homeland are tempted to experiment with self-improvement.
It is thought that many of Moos's victims were aware he was not a real doctor but went ahead with surgery because he was so cheap. They were not to know they would pay a much heavier price with the emotional trauma caused by his disfiguring operations.
Dr Maurizio Viel, a leading cosmetic surgeon from the London Centre for Aesthetic Surgery, says: "As surgery becomes more readily available to the masses, more people are tempted. With some groups of women, we see cosmetic surgery treated like a candy store or as easy as buying a lipstick over the counter. Patients must remember they are dealing with their bodies and should do their homework."
Some of the botched jobs Viel has seen include liposuction where the surgeon has operated too close to the skin, creating waves on the surface; unequal amounts of fat removed from different sides of the body; oversized breast implants inserted; and a flawed facelift that left the patient partially paralysed.
"It is not because of a lack of legislation as the UAE has rules and regulations, but there are untrained professionals operating under the radar who are hard to control," he says. "Often nothing is heard about them until something goes wrong. There are also unethical doctors agreeing to perform unnecessary surgery on patients or surgical procedures which are not their strength."
Dr Najm Khan, a consultant plastic surgeon at EuroMed clinic in Dubai, says "cowboys" slip through the net in the UAE because practices outsource and recruit doctors who are not based here, then leave after operating with no aftercare or follow-up.
"There is no general medical council or governing body and there are separate licences for each emirate rather than a uniform system," he says. "There should be a system of malpractice where patients can go to make a formal complaint and an organisation is set up to investigate."
Lara Tarakjian, the executive director of Silkor beauty clinics, does not offer cosmetic surgery at her outlets in the UAE; instead, 400 patients a year fly to Lebanon for operations such as rhinoplasty and liposuction.
"Ninety per cent of our doctors there are trained in Lebanon so it is very easy to do background checks," she says. "That is difficult here where there are so many different nationalities trained in different places."
On the popular expatwoman.com forum, a search for discussions about cosmetic surgery fields numerous threads, from those asking for recommendations to women rejoicing over their treatments. Few, if any, seem concerned about the safety procedures and checks in place. But considering how often things can go wrong, perhaps they ought to start asking.
 
Eight tips on cosmetic surgery
1. Word of mouth is the best recommendation. Good surgeons and doctors are well-known, and often the same names come up.
2. See two or three surgeons to get a better understanding of the procedure you are about to undertake and to ensure you are comfortable with the person treating you.
3. A good surgeon will explain the risks as well as the benefits. Every surgery carries risks and it is important patients decide for themselves whether to take them.
4. Ask lots of questions and, most importantly, about the procedure on dealing with complications.
5. Take time to think about whether it is right for you.
6. Ask to speak to previous patients and do your research into their background and what equipment was used on them. Most surgeons should have a portfolio of their work with "before" and "after" photos.
7. Cheapest is not always the best. Do not be fobbed off by cheaper products.
8. Make sure machines are covered in film and fresh needles are used to meet hygiene standards.