Doctors discuss a face-lift for Japan's plastic surgery societies

by Tomoko Otake

Staff Writer

Though it’s hardly talked about in public, cosmetic surgery appears to be an increasingly popular option in Japan for people trying to enhance their looks and defy the signs of aging.

According to statistics released last December by the International Society of Plastic Surgeons, Japan ranked fourth in the number of cosmetic-surgery procedures performed annually, trailing the United States, Brazil and China. Doctors in Japan carried out an estimated 525,790 procedures in 2010, which ranged from liposuction to nose jobs, eyelid modifications and breast implants, in descending order of popularity. The same survey also noted that there were 1,831 plastic surgeons in Japan.

The 35th annual meeting of the Japan Society of Aesthetic Plastic Surgery (JSAPS), held earlier this month at a Tokyo hotel offered an intriguing look into this booming and diverse industry. During the 50 seminars, symposiums and panel discussions, as well as another 50 or so oral presentations given over two days, practitioners shared numerous case studies of patients, showing before and after — and mid-procedure — images and information.

One major focus of discussion this year was the topic of surgical techniques that are most suited for Japanese physical features. Many experts said that, since many of the existing cosmetic procedures were imported from the U.S., they needed to be tweaked and improved to best match the demands and needs of Japanese patients.

In a panel discussion on face-lifts, for example, Dr. Yorikatsu Watanabe of Tokyo Metropolitan Police Hospital said that many patients in Japan sought procedures that don’t require hospitalization, and that are less invasive and less noticeable but still had long-lasting effects. He presented examples of 10 women between ages of 35 and 71, whose MACS (Minimal Access Cranial Suspension Lift) face-lifts were each performed in just a few hours and included some extra minor procedures, such as modifying the shape of the lower eyelids.

However, Dr. Yuki Shimizu of Showa University in Tokyo stressed that there are limits to such quick operations and instead advocated a “fat-reposition” procedure, which involves injections of fat harvested from elsewhere on the face, and hospitalization for a week.

Dr. Yoshiro Suzuki of Spa Clinic in Tokyo, meanwhile, pointed out that the facial skin of ethnic Asians tends to be thicker than that of Caucasians, making it hard for face-lifts to get desired effects.

“Japanese people also like to have smaller faces,” he said. “So we often combine face-lifts with liposuction under the chin, to make the jaw line between the face and the neck more striking.”

In a discussion on eyelids, experts talked about everything from eyelash transplants and reconstruction for victims of dog bites to double-eyelid surgery and lower-lid bag removal. Discussions also included non-surgical topics, including the possible anti-aging benefits of vitamins C and D.

The wide-ranging topics reflect a growing awareness in the plastic surgeons’ community that there is a need for a whole new area of medicine that meets people’s “quest for beauty” — as the two-day symposium, which attracted hundreds of experts, was titled.

Hosting technical seminars is crucial to raising the overall quality of practitioners, which varies quite dramatically at present, said Dr. Kaneshige Sato, professor of plastic, reconstructive and aesthetic surgery at Chiba University, who chaired the academic conference.

“Aesthetic surgery in Japan has a dodgy side to it, in terms of reliability and safety,” admitted Sato, who himself made a presentation on craniofacial surgery — major surgery involving the correction of skull deformities. “Because we don’t have a proper, standardized education system for plastic surgeons in Japan, there are some unscrupulous doctors or practitioners who are not doctors performing (extremely high-risk) surgery.”

What has further complicated the situation, he went on, is that for decades in Japan, there have been two academic societies of doctors that, despite having different English acronyms, bear exactly the same name in Japanese: Nihon Biyo-Geka Gakkai. The annual meeting, therefore, included a session aimed at eventually merging the two societies. Sato belongs to the Japan Society of Aesthetic Plastic Surgery (JSAPS), which is mostly comprised of university doctors with backgrounds in plastic and reconstructive surgery, in which they have traditionally dealt in the reconstruction of facial features after accidents and treatments for congenital deformities.

Doctors in the other camp — the Japan Society of Aesthetic Surgery (JSAS) — practice at private-sector clinics, which are seen as standard bearers of general appearance-enhancing and anti-aging procedures in Japan.

During the session, though he was not present at the conference, professor emeritus of Hokkaido University Dr. Takehiko Oura’s proposal to merge the groups into a single academic society in 10 years was considered. Some speakers, however, pointed to the long-standing rift between the two societies, based on their ideological and work-ethic differences. Dr. Katsuya Takasu, a high-profile cosmetic surgeon who is a member of both societies, said that Dr. Fumihiko Umezawa, leader of the JSAS who heads Jujin Hospital in Tokyo, is dead set against the merger.

Many agreed, however, that eventually, cosmetic surgeons in Japan will have to come under one wing, so that a standardized accreditation and education program will be provided. Currently, many young doctors enter the highly lucrative specialty with little or no training at all.

“Some clinics offer as much as ¥20 million as an annual salary to young doctors who have just completed their mandatory two-year internship training, with a promise of a pay rise to ¥30-¥40 million in several months,” Sato said ahead of the conference. “You would think something fishy must be going on. There are doctors out there who persuade people who don’t really need cosmetic surgery into undergoing a procedure. Those people will often pay hundreds of thousands of yen in monthly installments. There are also cases of people dying from cosmetic surgery and being sexually abused during operations.

“As it is, it’s very difficult for patients to tell good doctors from bad doctors. We need to bring this confusion surrounding the industry to an end as soon as possible.”

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