Natalya Manturova about the aesthetic medicine market in Russia

Development of plastic surgery in Russia

The situation in the early 1990s looked something like this. It was a fairly large market, with expensive services, completely uncontrolled by anyone. Carcinogenic materials for prosthetics, banned in Canada, the USA, and Western European countries, that do not meet FDA or CE standards, poured into Russia like a river. Today experts say that plastic surgery in Russia is nationally colored and specific. The most popular surgeries include nose reshaping and liposuction.

Plastic surgery has long been no longer perceived as a luxury or: specialized clinics will be opened in all Russian regions in the near future. Plastic surgery specialists say: beauty is not something worth saving on; it’s better to eat less.

Plastic surgeons: the domestic market is in crisis

October 25, 2020

In the first half of 2018, 6 patients died almost one after another in aesthetic medicine clinics. This situation alarmed the supervisory authorities, who initiated strict inspections of medical institutions and introduced new standards for the provision of services in this area of medicine. Due to the strictness of the new rules, a number of organizations hastened to surrender their licenses. After this development of events and ongoing inspections by Roszdravnadzor and the Ministry of Health, about 15% of private plastic surgery clinics were closed by September.

At a specialized meeting in Moscow in September, Roszdravnadzor employees reported on the interim results of a nationwide inspection. By the fall, the department had managed to inspect 540 clinics, in 67% of which violations of various types were identified.

Meanwhile, not all experts agree with the requirements of regulatory authorities. Doctors believe that such a massive closure of clinics will reduce the financial performance of the domestic industry market. Let us remember that last year in Russia plastic surgery was performed on more than 158,000 patients. The total amount of services provided exceeded 12.3 billion rubles.

New rules for clinics: exaggerated requirements?

After inspections, about 15% of private plastic surgery clinics closed

Mindrav Order No. 298n “On approval of the Procedure for providing medical care in the field of plastic surgery” alarmed everyone - from clinic managers to plastic surgeons themselves. The adopted document contains new requirements for determining the qualifications of a plastic surgeon and equipping his office. According to the order, 25 pieces of various equipment must be present at the doctor’s workplace - a portable resuscitation kit, a dressing table, an emergency medical aid kit, a sterilizer for medical instruments, etc. The clinics themselves must now have equipment for audio and video broadcasts from operating rooms with two-way communication capabilities.

But most practicing doctors did not understand these innovations. Thus, the head of the Frau Klinik plastic surgery clinic, Sergei Blokhin, spoke about a biased attitude towards the private sector of the industry, while in public clinics, according to the doctor, there is no such high level of service and quality:

«No budget hospital can meet the requirements of commercial clinics. Licenses can simply be taken away from state medical centers. As for the death of several patients in the spring and summer of this year, it was found that the death was not a surgeon’s mistake, but the delivery of a low-quality drug that was contaminated with clostridia. This is not the fault of doctors, this is a production problem in factories. But for some reason no one is in a hurry to hold them accountable, since they belong to someone ».

This position is also shared by the head of the plastic surgery department at SM Clinic, Galia Saratovtseva. The expert considers the new standards in relation to plastic surgery exaggerated, because no new rules have been introduced in the field of general surgery:

«The order came into force very quickly and few people were ready for it. Let's say you need a 24-hour computed tomography scan. However, it is difficult to imagine that it can save a patient’s life. Despite the fact that the equipment costs millions. Small clinics will definitely not be able to handle such amounts, but large medical centers, of course, will still make purchases and continue to operate ».

The specialist expressed the opinion that such innovations would negatively affect the domestic industry. According to her, in the near future we can expect an increase in the number of patients injured by illegal plastic surgeons operating “undercover.” Dr. Saratovtseva also said that a number of her colleagues have noted a decrease in the number of patients who began to fear surgery after cases with fatal outcomes. They fear that “something is wrong in the clinics.” At the same time, as the plastic surgeon says, the reason is not in clinics and doctors, but in a low-quality drug, however, inspection authorities do not disseminate this news and do not inspect manufacturing plants.

The new rules were not discussed with any of the plastic surgeons!

"Raider seizure"?

This is exactly how Olga Byakova, head of the Olvia Center for Plastic and Aesthetic Surgery, perceives the goal of the new Order of the Ministry of Health. In her opinion, in this way large clinics want to displace small medical centers in order to become a monopoly in the market.

«Laboratories that carried out an independent examination confirmed that the cause of death of the patients was poor-quality anesthetic propofol. There have been deaths associated with the drug in regular hospitals, but no one talks about it, but they began to spread information that plastic surgeons were to blame for everything.

As for the new document, I do not see any justification for these requirements. The new rules were not discussed with any of the specialists, and no time was given for preparation. It immediately came into force and within a week inspections by Roszdravnadzor began. Will anyone have time to prepare in such a short time to buy and license new equipment? This process usually takes about a year. It is not surprising that many clinics “do not comply,” according to inspectors ».

Olga Byakova also believes that the new rules will lead to a large number of illegal clinics. Licensed medical centers will increase the cost of operations to recover the funds spent. Due to such changes, many patients will want to undergo surgery in other countries, where services for aesthetic correction of appearance will be much cheaper.

Investment in beauty

It is curious that the financial crisis did not hit the plastic surgery market in Russia that hard. There were few clients who were willing to afford an expensive operation, even during times of economic growth. Financial difficulties drove only middle-class consumers out of clinics. A considerable number of Russians are willing to spend from 40 to 50 thousand rubles a month on beauty salon services and incur additional costs for operations.

“You have decided on an expensive operation, but you can count on the effect that will last for a long time. We also buy a good car with the hope that we will drive it for a sufficient number of years,” comment the cosmetologists.

LifeInterview with the chief plastic surgeon of Russia

If we compare plastic surgery in Russia and in other countries of the world, what level are we at now?

The quality of development of plastic surgery can be compared, but the level of development cannot. For example, in 2012, 402 thousand mammoplasties (breast enlargement operations using implants) were performed in the USA, 436 thousand in Brazil, and 22 thousand in Russia. Rhinoplasty was performed in the USA by 106 thousand, in our country - 6 thousand. Of course, our Russian statistics are generally unreliable, because many private clinics hide the number of operations, and not all patients go through the cash desk. Plastic surgery consists of two sections: reconstruction and aesthetics. Reconstruction is the correction of post-traumatic, oncological defects, and congenital pathologies. And aesthetics is the correction of age-related changes and those features that the patients themselves want to correct. Aesthetics is a commercial industry, reconstruction is a budgetary one.

Reconstruction also includes gender correction operations. Are they free too?

Some operations for transsexuals were subject to quotas (financed by the state as part of treating patients with the help of high technologies. - Ed.), some were not. I will explain. If an operation to remove the uterus is a quota, no one tries to find out who had it done - a transsexual or not. Urethroplasty (restoration of the patency of the urethra. - Editor's note) is quotable if a transsexual has changed his gender and is undergoing surgery. She will have a quota in urology. Mastectomy (breast removal - Ed.), when a woman is turned into a man and his documents have not been changed, is, of course, a paid operation. And then, when the most visible organ of the sex (breasts) is removed, they decide: either they go further or not. A certain contingent stops at this. The passport changes when an organ is removed that does not allow it to return to its previous state: if the uterus is removed, that’s it, you can already change the passport.

In all countries of the world, the ratio of men and women who want to adjust their external characteristics of gender is approximately the same: four men to one woman.

Yes, more men want to become women than vice versa. Only the ratio is changing: it was 1 to 9, now it’s 1 to 4. Previously in Russia there were more women who wanted to change their gender than men. Everyone joked then that it was easier for a man to survive than a woman. It’s hard for me to say what the statistics are now: when we started doing this in the 90s (at the All-Russian Research Center for Surgery of the Russian Academy of Medical Sciences - Ed.), no one but us did this, and all the statistics depended on us . Then commercial clinics began to perform these operations. Given their dullness, such operations were not always carried out according to indications. They don’t care who they operate on, so recently there has been a fairly large contingent of patients with schizophrenia who have begun to have their sex changed. A person comes and says: “I want to change my gender, remove my breasts,” or: “I want to change my gender, enlarge my breasts.” And forward. Although in normal clinics that deal with transsexuals, breast enlargement is the last thing: the bottom is done first, and then the top.

What do you think about transsexualism?

When it comes to the so-called “nuclear type”, a pronounced real transsexualism, this is a mistake of nature. They don't live, they try to commit suicide. We had a lot of suicides in Soviet times, 30% of them tried to commit suicide, 18% brought it to the end. For nuclear transsexuals, sex life does not come first; for them, appearance in the gender in which they want to see themselves, and life in the gender in which they want, comes first. This (admission to operations to correct external characteristics of gender. - Ed.) is dealt with by commissions of several people, they have their own methods for identifying this. Transsexuals are absolutely normal people. Among them there are a lot of talented and capable people - perhaps even more than among the ordinary population. They stick to each other very much and help each other. This is a certain group of people who used to be outcasts, but now you wouldn't know they were trans.

Financial issue

The price of an operation in plastic surgery, as a rule, is formed on the basis of three main items - the cost of the surgeon’s work (the operation itself), the cost of a hospital stay, and the cost of anesthesia.

Average cost of plastic surgery:

abdominoplasty will be performed for 115 thousand rubles;
blepharoplasty (eyelid surgery) – for 44 thousand rubles;
aginoplasty – for 75 thousand rubles;
hymenoplasty (with restoration of virginity) – for 30 thousand rubles;
labiaplasty (with labiaplasty) - 37 thousand rubles;
liposuction (tumescent, 4 zones) – for 58 thousand rubles;
breast lift – for 113 thousand rubles;
face lift (circular, 3 zones) – for 135 thousand rubles;
rhinoplasty - for 100 thousand rubles;
breast augmentation (with the installation of an anatomical implant) – for 147 thousand rubles;
breast augmentation (with the installation of a round implant) – for 132 thousand rubles;
breast reduction – for 118 thousand rubles;
otoplasty (with elimination of protruding ears) – for 35 thousand rubles.

Non-surgical procedures

Botox (injections, 1 unit) RUB 320;
Restylane (injections, 1 ml) 3 thousand rubles;
laser hair removal (1 zone) 2.4 thousand rubles;
hair transplant (1 graft) RUB 110;
chemical peeling (1 zone) 2.2 thousand rubles.

When agreeing on the price of plastic surgery, do not forget to clarify whether the price of anesthesia and hospital stay is included in the stated price. Is it possible to pay for the operation in installments or on credit? Is it possible to reduce the price of the operation and under what conditions?

Elena Svet-doctor