Want a nose job with your pina colada? Increasing numbers of Aussies are heading to South East Asia to combine cosmetic surgery with a luxury vacation. Kate Browne looks at the cutting edge of holiday trends

On a tropical island in Thailand, sailing boats bob in turquoise water and coconut palms sway in the breeze. A woman in a white bikini sunbakes by a pool, her blonde hair pinned up, designer sunglasses glinting in the sun. Slowly she stands up to walk to the water's edge, revealing large black and blue bruises that cover the backs of her thighs.

At a night market, locals and tourists wander through stalls selling everything from noodles to fairy lights. A woman shops happily for souvenirs, despite her bruised and swollen face and two black eyes. She calls to her husband in an Aussie accent, "Darling, should we buy this for Greg?"

Bruised, battered and waiting to be beautiful; these women are part of the new plastic surgery tourism boom in Thailand. Not so long ago, a trip to this South East Asian country, for most Australians, would mean returning home with souvenirs and a tan. But, thanks to the availability of cheap plastic surgery, plenty of tourists are now returning home with a whole new look.

Nicknamed "nip/tuck holidays" by the media, the trade in foreign visitors travelling to Thailand for cosmetic procedures is a sure-fire growth industry. These so-called "medical tourists" are increasingly targeted by hospitals and specialist facilities. The Thai government estimates that 1.2 million tourists travelled to Thailand last year for some kind of surgical procedure.

As a traveller in Thailand, it's impossible to avoid the marketing machine inviting you to indulge in some kind of cosmetic transformation. There are signs in the street, pamphlets in hotels and travel magazines filled with glossy advertisements for boob jobs, facelifts, liposuction, teeth whitening and Botox.

For the converted, the appeal of a little holiday surgery includes low prices, no waiting times and the opportunity to recover somewhere private and peaceful. As the hospitals admit more "clients", an accompanying tourist industry has appeared out of nowhere. Agents such as Gorgeous Getaways in Victoria and All About Beauty in New South Wales can organise flights, accommodation, surgery, post-operative care and even holiday activities (if you feel up to it).

Amanda Burrows travelled from the Gold Coast to Thailand for a holiday ... and to have some major cosmetic surgery. "I've had a breast augmentation and lipo on my thighs and buttocks," says the 45-year-old, while relaxing at The Bodyline Retreat in Phuket.

Bodyline is Australian-run and provides luxury accommodation and care for people who travel to Phuket for surgery with companies such as Gorgeous Getaways. Retreat manager Judith Remar, from Brisbane, says, "Our selling point is post-operative care. A lot of our clients come here alone and we provide that for them."

For Burrows, time to recover at a retreat was key in choosing Thailand for surgery. "In Australia, I was told my procedure was considered day surgery - I would've had to go straight home that night. I look back now and think it would've been bloody hard. Here, Judith is like a combination between your mum and your best girlfriend. She is there when I need her."

Visiting Bodyline seems like another universe, where the guests look like regular tourists, but are actually preparing for surgery or recovering from it. Remar bounds around the resort joking with clients - "her girls", as she calls them. "Amanda has been here for a while; isn't she gorgeous?" she says of Burrows. "And we've got a whole family just in from the UK, they're all having something done. Mum's having her breasts done, one of the girls is having liposuction and the other is having dental." In between doctor and dental visits, Remar organises cooking classes, shopping or trips to the local spa.

"Barbara, do you want to have a barbecue tonight? It's your last meal before surgery," she asks, before stopping to call out to one of the girls lying by the pool. "No more sunbaking that tummy, you've got liposuction tomorrow!"

But is a holiday destination really the right place to consider major surgery? For many, the concept of mixing a relaxing holiday with painful surgery is as compatible as mixing chocolate and mud.

Ruben Toral, the fast-talking US group marketing director of Bumrungrad Hospital in Bangkok, the largest private hospital in South East Asia, agrees that some marketing campaigns and media reports may give some people unrealistic expectations. "I recently saw an article about a lady who wanted to have her tummy tuck and then be out in the jungle in two days time," he says, shaking his head. "Part of this sand, sun and surgery thing is that it is perpetuating this myth that you are going to have surgery one day and then frolic on the beach the next, but it's not the way it works."

And according to the Australian Society of Plastic Surgeons (ASPS), having surgery overseas can also leave you vulnerable if there are complications. Society member and Sydney plastic surgeon Dr Anand Deva says he has "picked up the pieces" of many Australians who've had bad complications after surgery in Thailand. "I've had facial nerves that have been cut after a facelift, I've had eyelids that don't close after eyelid surgery - the list goes on."

Louise Cogan from Gorgeous Getaways says that negative reports from Asia were what inspired her to set up a company that provides a safe and positive experience. "We have done the research, have the best surgeons, the best hospitals and provide high-quality operations," she says.

While the ASPS remain very critical of the standard of clinical expertise in Thailand, Dr Deva says that even with the best surgeon and hospital, an overseas holiday is not the place for surgery. "You book a holiday, you have a limited time over there, and then you are leaving yourself wide open if things go wrong. Here you have the entire Medicare system and, if you need it, you've got trusted specialists; over there you are still just a tourist."

Other medicos worry about the emotional state of Australians rushing to embrace the surgeon's knife. Dr Kerry Wardlaw of Monash University, who has researched the topic, says cosmetic surgery has become "normalised" in Australian society, which puts pressure on all of us to conform. "Advertising for cosmetic surgery often implies that it's like dyeing hair or having facials or using make-up. Cosmetic surgery is also sold as a form of empowerment, without exploring why women have such negative bodily self-image to begin with."

Those in the medical tourist industry disagree, saying their patients have never been happier. "The happiest customers are, strangely, the ones that get the most done," claims Cogan. "Because they have such a massive change - they are transformed."

One thing the players in this booming industry all agree on is that cosmetic surgery, at home or away, is here to stay. And if that's the case, say the experts, we all need to understand that, unlike a tan, going under the knife is permanent.

Says Dr Norm Olbourne of the ASPS, "Your health is serious, and some people think cosmetic surgery is frivolous, like surgical beauty therapy. People don't appreciate that cosmetic surgery is as serious as any [other surgery]."

Yet despite some obvious risks, business is booming in Thailand. At The Bangkok Hospital, Phuket, marketing executive Ulf Mikaelsson shows me around the Aesthetic Center, manned by nurses in crisp white uniforms. "We have taken a holistic approach. We provide cosmetic surgery, non-surgical procedures and we even have a spa," he says, showing off a mood-lit room filled with aromatherapy oils and soft music. As we pass two blonde women reading brochures on cosmetic surgery at the front desk, Mikaelsson remarks, "It's amazing; three to four years ago, this industry didn't even exist."

To date, Gorgeous Getaways' Cogan has sent more than 250 cosmetic surgery patients to Thailand and Malaysia. A quick trawl through her website reveals an astonishing array of packages. There is the "Bride to Be" where you can have breast surgery or liposuction before your big day, or the "Yummy Mummy" package that provides childcare while you undergo surgery. There are packages for groups, individuals and even couples.

According to Cogan, the number of men using her services is on the increase. She says facelifts and liposuction are popular - as is the privacy of recovering from your procedure overseas. At Bodyline, Remar says they are also seeing more men. "Chin implants are popular, to get a nice, macho chin. And we had one gorgeous Aussie guy from the country who came here alone; he had his whole body re-shaped. I think men can treat themselves more these days and get away with it."

In the bustling Thai capital, the options for beautification are many and varied. There are Botox salons on the street and cosmetic dentistry clinics in the hulking shopping centres that line Siam Square. Even down in the backpacker ghetto of Khao San Road, signs for teeth-whitening salons jostle for space next to tattoo parlours, body-piercing shops and fake dreadlock stalls.

Young English backpacker Emily tells me she intends to get her teeth whitened before she goes home. "It's just so cheap. In fact, I would have even considered having some liposuction done on my thighs if I had the time," she laughs.

At the other end of the scale are modern facilities such as Bumrungrad. Stepping into its massive marble foyer, the first smell that hits your nostrils is not disinfectant but coffee. Sporting a Starbucks cafe, a McDonald's, an Italian fine-dining restaurant and specialty shops, it's hard to believe the place, situated in the heart of the city, is actually a hospital.

This, according to Toral, is exactly the ambiance they're aiming for. "We've taken the model of healthcare and turned it upside down," she says adding that the hospital sees about 400,000 international patients a year (including at least 80 Aussies a month for cosmetic surgery). "Not so long ago, no one would've put Thailand and top-quality healthcare in the same category. If you could buy a Mercedes product at a Toyota price you would do it every day - and that's exactly what's happening here in Thailand."

While most overseas clients plan their trips to Bangkok especially for surgery, the hospital also sees a lot of "walk in" tourists who decide they want dental and other non-surgical cosmetic procedures while on holidays. And then there are the spontaneous types. "We had two girls, 21 years old, travelling the world together. They read about the hospital and said to each other, I've always wanted to do that. So they came and had cosmetic surgery."

Perhaps that is the ultimate appeal. With low costs and no waiting time, you can change your body even if you are so young you probably don't need it. If you're on holidays and feeling spontaneous, in Thailand, it seems, nothing is impossible.



SURGERY SHOPPING LIST

Breast augmentation: Australia $7000-$10,000; Phuket $4690.

Liposuction (hips, thighs and buttocks): Australia $8000-$12,000; Phuket $5330.

Full facelift (jowls, neck, brow and upper and lower eyes): Australia $10,000-$18,000; Phuket $7890.

Eyelift: Australia $5000-$8000; Phuket $2964.



FOR MEN

Liposuction (chest and abdomen): Australia $8000-$12,000; Phuket $5650.

Rhinoplasty: Australia $10,000; Phuket $5970.



Prices provided by Gorgeous Getaways for Phuket, Thailand. Phuket prices include all surgery, consultations, products, medication and nursing, airport transfers, five-star accommodation for 10 nights, daily breakfast and ground support. Australian prices do not include tax.

Copyright - Kate Browne 2006