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Image Credit: Getty Images/iStockphoto

Dubai: It's an industry on the rise, driven by social media before-and-after ads.

And it's ramping up the speed by which Dubai is fast becoming the "new Beverly Hills of the Middle East."

Already, cosmetic surgery has topped the list in medical tourism in Dubai. According to a Dubai Health Authority (DHA) report, the emirate has the highest number of cosmetic surgeons per capita in the region — about 50 specialists for a million people.

It's a huge market. And a money-spinner: Price ranges from Dh150-250 for a filler to Dh40,000 for a detailed body sculpting procedure.

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PLASTIC SURGERY, ANYONE?: Procedures include 360-degree contouring, various types of liposuction, tummy tucks, face lifts, fat transfer and facial rejuvenation, among others.

Globally, the cosmetic surgery market size is projected to reach $21.97 billion with 7.8% annual growth rate by 2023, according to a Medgadget report.

These are the most common surgery options:

  • 360-degree body contouring (tummy tuck, breast lift, others)
  • Liposuction
  • Eyelid and Nose Surgery
  • Face lifts/Facial reconstruction
  • Cosmetic implants (chin & cheek implants, breast augmentation, buttock implants)
  • Fat Transfer

To put this in perspective, we talked to several people.

Myra J., a belly dancer working at a Dubai hotel. She was unhappy. Saddle bags on her thighs were making her performance less graceful. She honestly feared she would be jobless soon.

Choosing the right cosmetic and plastic surgery in Dubai

On a weekend, she checked into a leading aesthetic clinic and the surgeon trimmed the pockets of fat around her thighs, sculpting her body back into perfect shape.

It took her a week to recover and get back to work, but she is delighted with her shapely thighs and feels happier than ever before.

'Ageing gracefully'

Nina M., (52), always loved how beautiful her eyes were and how youthful her cheeks looked.

Last year, nowever, as she got busy with her son’s marriage preparations, she started to experience bouts of anxiety at the sight of slowly encroaching bags under her eyes and a slight droop in her cheeks.

“I wanted to look and feel my best and thought a filler and a round of botox were harmless indulgences. It took me just an hour at the clinic and the results were amazing. I am glad I was able to stop the onslaught of aging in time.

"It’s beautiful to age gracefully, but we all do use creams and gels to delay the process. I think of these minor injectibles as tools in our make-up bag.

"I have used fillers and Botox twice since last year, combined with my beauty regimen. I feel it has given me not just confidence but also psychological boost. I would recommend it to everyone.”

Anna M was a physical trainer but vexed with her body shape as she had a masculine build.

It’s beautiful to age gracefully, but we all do use creams and gels to delay the process. I think of these minor injectibles as tools in our make-up bag.

- Anna M, a physical trainer

This was affecting her work. Most women were intimidated by her personality and she was losing self-confidence.

Four years ago, she went in for breast implants and her life changed.

Addiction to surgery?

“People talk about getting addicted to cosmetic surgery. But that is not so. Most people approach a cosmetic surgeon only when they cannot deal with a physical issue themselves and just like one needs medicine when one is ill, cosmetic surgery acts as a solution to boost confidence and self-esteem.

"Look at how people have reclaimed their health with gastric bypass!”

The field has grown beyond expectations and much of the credit goes to the development of a world-class infrastructure in this field and the corresponding health regulations.

- Dr Sanjay Parashar, chairman, Scientific of the Emirates Plastic Surgery Society

Changing the world one person at a time and providing them with an incredible burst of confidence, aesthetic and cosmetic surgeons in the UAE have built a practice of reliability that can take as little as one hour to a day to transform your personality.

Welcome to the multi-million dirham cosmetic surgery industry in the UAE.

It is the toast of medical tourism in the region, with a high footfall of Gulf and Asian medical tourists — as well as resident expatriates.

The industry has accelerated at a speed that is making Dubai be hailed as the new Beverly Hills of the Middle East.

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Closeup of woman having plastic surgery performed. Image Credit: Getty Images

Cosmetic or Plastic Surgery?

These are two different concepts. Cosmetic surgery refers to aesthetic surgery and revolves around enhancement of physical features of an individual and is elective.

This includes procedures such as:

  • Rhinoplasty
  • Face and cheek enhancement,
  • Brow lifts,
  • Neck and eyelid lift
  • Face peels
  • Laser resurfacing
  • Botox fillers
  • Peels
  • Laser hair removal
  • Breast augmentation
  • Tummy tucks
  • Liposuction
  • Hair implants
  • Dental veneers

Plastic surgery, on the other hand, is a surgical speciality dealing with life-saving procedures of re-construction of the face and body owing to congenital defects, disfigurement due to accident, trauma, burns, tumour removal due to diseases such as cancer.

In most cases, plastic surgery is not elective.

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Medical tourism sales in 2018

Since the time pop stars began to inundate Instagram with images of their perfect bodies, dazzling smiles, flawless skin and enviable hair volume, elective procedures have become commonplace with teenagers as young as 13 who are going in for instant fixes.

While some procedures require a couple of days of hospital stay and being out of circulation for a while, many quick fixes are carried out during lunch breaks in one-hour durations.

Highest per capita cosmetic surgeons in UAE

Dr Sanjay Parashar, chairman, Scientific of the Emirates Plastic Surgery Society, told Gulf News: “Cosmetic surgery tops the list in medical tourism in Dubai and according to a 2015 report of Dubai Health Authority (DHA), Dubai has the highest number of cosmetic surgeons per capita in the region — about 50 specialists for a million people.”

In the last five years or so, there have been tremendous advancements in cosmetic and plastic surgery in the UAE. We have the top plastic surgeons of the world come here to do surgeries and the UAE hosts two major international plastic surgery conferences each year.

- Dr Zuhair Al Fardan, President of the Emirates Plastic Surgery

Dr Parashar added: “The field has grown beyond expectations and much of the credit goes to the development of a world-class infrastructure in this field and the corresponding health regulations.

"Today, in Dubai, most Day Care Surgery centres where most of the plastic surgery procedures are carried out have the best international accreditations.”

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Syringe on the face of a patient, Botox treatment. Image Credit: Agency

Dr Zuhair Al Fardan, President of the Emirates Plastic Surgery, said: ”Much of the advancement in plastic and cosmetic surgery is work in progress as surgeons are constantly upgrading themselves with techniques, technologies.

The UAE is keeping abreast of the best that is taking place in the world. In the last five years or so, there have been tremendous advancements in cosmetic and plastic surgery in the UAE.

BEVERLY HILLS AND PLASTIC SURGERY
Beverly Hills, a city in Los Angeles County, California, is known for its vibrant plastic surgery industry.

It's where leading practitioners are rated by customers who give feedback and grade their experience with plastic surgeons according to a five-star rating system.

In this posh district, located within 5.7 square miles and surrounded by the cities of Los Angeles and West Hollywood, one of most popular procedures is breast augmentation, according to online directory and crowd-sourced review forum Yelp.

"We have the top plastic surgeons of the world come here to do surgeries and the UAE hosts two major international plastic surgery conferences each year.”

Soaring revenues

With greater acceptance and broadening of scope for the discipline, it is evident that plastic surgery is a major revenue earner and places UAE as one of the leading medical tourism destinations in the region.

From a price range of Dh150-250 for a filler to Dh40,000 for a detailed body sculpting procedure, these procedures are money-spinners.

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Together, the plastic and cosmetic surgery is a multimillion dirham business in the UAE. While there are no exact figures available, safe estimates can be made, say surgeons.

MULTIMILLION BUSINESS
There are 30 hospitals in Dubai, of which 70 per cent are internationally accredited. The emirate aims to build 22 hospitals by 2020 — 18 private and 4 public hospitals.

In Dubai, at least 50 per cent of its 30 hospital offer cosmetic and plastic surgery options.

30

number of hospitals in Dubai, of which 70 per cent are internationally accredited

Besides that there are about 150 Day Care Surgery centres and 400 aesthetic clinics in Dubai.

All of them offer a bouquet of cosmetic surgery procedures and their average annual revenue is between Dh4-6 million a year.

400

Number of aesthetic clinics in Dubai

If one were to compute that with the numbers of facilities including hospitals, the annual revenue from cosmetic surgery would run into many millions of dirhams annually.

High on medical tourism

Currently, Dubai aims to attract 500,000 medical tourists a year by end 2020.

In a short priod of time, Dubai has managed to be ranked 17 among the top 25 global destinations for medical tourism and cosmetic surgery, along with fertility, orthopaedic, dental and wellness disciplines in the list of most-billed medical procedures.

40%

percentage of tourists who come to Dubai come only for medical tourism. Medical tourism sales topped Dh12 billion in 2018, a 5.5% jump in the number of medical tourists

Based on official data, about 46 per cent of the current medical tourists in Dubai come from Asian countries. About a quarter (25 per cent), come from GCC and Arab countries and 13 per cent from African countries, and the remaining 16 per cent from other countries, mainly the UK and Commonwealth of Independent States (CIS) countries.

In fact, 40 per cent of tourists who come to Dubai come only for medical tourism.

Given the prestigious reputation of the hospital and the Dubai government’s plan to promote medical tourism, I have noticed a huge influx of patients from Africa, Nigeria and Ghana in particular.

- Dr Francis Conroy, consultant plastic, cosmetic and reconstructive surgeon at the American Hospital, Dubai

Medical tourism sales topped Dh12 billion in 2018, with a 5.5 per cent overall increase in medical tourists.

Medical tourists

Dubai attracted a total of 640,542 international and domestic medical tourists in 2018 (51 per cent were international patients).

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Image Credit: Atiq Ur Rehman/Gulf News

European tourists consisting mostly of UK, French and Italian citizens, share 16 per cent of health and wellness tourists.

A substantial medical tourism revenue, it is evident, is earned through plastic and cosmetic surgery.

Dr Francis Conroy, consultant plastic, cosmetic and reconstructive surgeon at the American Hospital, Dubai, remarked: “American Hospital Dubai, is one of the few facilities offering both comprehensive reconstructive and cosmetic surgery services.

"Our plastic surgeons are fully trained in both reconstructive and cosmetic surgery so we see a wide-ranging case mix, from severe trauma cases to cancer cases and of course, those opting for cosmetic surgery."

Most popular cosmetic surgery
The most popular cosmetic surgery is body contouring — namely abdominoplasty and liposuction, sometimes combined with a breast lift – the ‘mommy make-over’.

Typically, these patients would be female, who done with having children and raising them, now wish to address the changes in their body. I also see a large number of male patients who want to correct problems associated with their chest with the help of liposuction.

Source: Dr Francis Conroy, consultant plastic, cosmetic and reconstructive surgeon at the American Hospital, Dubai

Most popular cosmetic surgery

"Typically, these patients would be female, who done with having children and raising them, now wish to address the changes in their body. I also see a large number of male patients who want to correct problems associated with their chest with the help of liposuction,” said Dr Conroy.

“Non-surgical treatments (neuro-modulators, fillers, etc) are still very popular and I have seen a trend in that patients are starting with such treatments at an earlier age.

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American Hospital Dubai, one of the leading pioneers of private healthcare in the Middle East, has revealed its expansion strategy with a focus on making quality healthcare accessible and closer to patients.COURTESY American Hospital Dubai

“Given the prestigious reputation of the hospital and the Dubai government’s plan to promote medical tourism, I have noticed a huge influx of patients from Africa, Nigeria and Ghana in particular.

"These patients come mainly for cosmetic surgery, knowing that they are in the hands of a highly qualified surgeon, in a safe, luxurious facility, with standards second to none,” said Dr Conroy.

Top six cosmetic surgery procedures in town

The procedures can be divided into categories:

  • Injectibles: These include wrinkle smootheners such as Botulin and Plasma Rich Platelet therapy (PRP), Fillers, Stomal Vascular factors (stem cells for hair and skin rejuvenation), hyaluronic acid fillers for skin lifts.
  • Body contouring: This includes liposuction to trim pockets of fat and sculpt arms, belly, pelvis and hips.
  • Breast augmentation: This includes reduction and enlargement procedures, lifts, reconstruction (in case of birth deformities and mastectomy following breast cancer).
  • Hair transplant: Earlier, the main subjects for hair implants were men but now there's rising trend of women looking to fill up their partitions, and enhance their receding hairlines and thinning hair.
  • Cosmetic reconstruction: This includes aesthetic reconstruction especially of facial features with prosthesis such as nose, jaw, chin, brow. Reconstruction of the nose bridge (rhinoplasty especially is a very popular category).
  • Laser hair removal: Permanent removal of body hair using painless laser light is another popular category which has gained currency and is carried out frequently at all aesthetic clinics. This spares women of the pain of regular waxing and rids patients of facial hair in case of conditions such as hirsuitism.
Does health insurance cover plastic surgery?
Dr Parashar said: “Lumps, bumps, nerve and tendon transfer, skin transplant, etc, are all covered. Few people know that plastic surgery has a regenerative and reconstructive role to play in case of congenital and disease deformities.

"Reconstructive surgery such as correction of birth deformities such as a tuberous breast, cleft lip, hand deformities, skin transplant following burns, road trauma and breast augmentation and reconstruction following a mastectomy and rebuilding after a tumour resection is all covered under all leading health insurances. There is also new kinds of stem cell therapy being used to regenerate tissues and nerves especially in diabetic patients.”

Know the rules:

The DHA has made it mandatory for all Day Care Surgery Centres, most of who carry out aesthetic procedures, to have one leading international accreditation from Canada, US, UK or Australia.

These accreditations were earlier mandatory for hospitals only, but from 2020, all Day Care Surgery centres compulsorily must have an international accreditation.

This ensures that an independent, international medical body enforces global health standards to grant them certification and in case of a ‘sentinel’ event, conducts its independent inquiry and downgrades these places in case of a serious lapse.

DHA on its own has issued a 25-page manual on quality and regulations that is to be followed at all centres.

A close examination of the Day Care Surgery centres indicates several layers of quality control.

• Pre surgery quality

This involves free consultation, especially in case of a second opinion or a first time patient seeking to enquire about a procedure based on his/her requirement. When a patient uploads a request on the website of a centre from anywhere in the world, the centre has to provide a detailed consultation free of charge.

• Services available to a patient

Once the patient is convinced and comes in person to consult the doctor, quality is upheld in the pre-diagnostic tests that the patient has to undergo.

• Infrastructure quality

DHA has graded Day Care Centres into A, B and C categories based on the level of medical facilities that can be accessed by a patient. Anaesthesia methods such as oral, epidural and general also help classify centres. For instance, hair transplant procedures can only be carried out in B and above grade clinics. Day Care Centres that conduct surgeries under general anaesthesia much be equipped with the Advance Cardiac Life Support (ACLS) with their surgeons and registered nurses being certified as trained in administering ACLS to a patient.

• Patient safety protocol

There are very specific guidelines for patient safety and the doctor/surgeon must explain the procedure in detail to the patient and his/her family and obtain a written consent to go ahead after ascertaining that all risks and side-effects have been clearly explained to the patient.

• Post-operative regulation

There are specific protocols for discharge of patients undergoing cosmetic surgery.

Although ambulatory care means the patient has to be discharged within the same day, there is a specification about asking the patient to desist from long-distance travel, specific rehabilitative work to be carried out from the next day for which the patient has to be within Dubai and also specific instructions when an overseas patient is declared fit to fly out of the country.

When a patient flies out, he or she is provided with a proper review and notes, with instructions for overseas rehabilitation protocol with reference notes for the rehabilitation instructor and instructions for medication and periodic reviews.

Accountability
Despite well-laid out protocols, there have been cases of misconduct and misdemeanours and deliberate negligence from hospitals and Day Care Centres that has lead to permanent disability and even the death of patients after a cosmetic surgery procedure.

The law is clear, said Dr Al Fardan, “The DHA regulations constitutes an accountability committee and holds an enquiry to fix the liability. If the centre is found guilty, its licence can be suspended or cancelled depending on the extent of guilt. If the surgeon, anaesthesiologists, nurse and technicians are found guilty, their license to practice is suspended or cancelled. If the crime is lighter, then both the centre and the team are let off with serious warnings.

"In case of disability following a surgery, the team examines the extent of disability and calculates the financial compensation to the patient. In case of fatality following a surgery, the is provision to pay ‘blood money’.”