By Kaewmala

Athitiya Eiamyai, 33, a product presenter, was pronounced dead at 10:35 a.m. on October 2, 2012 in the intensive care unit at a Bangkok hospital.

Ms. Athitiya, nicknamed ‘Kratae’ (Rabbit), fell into a coma after a botched filler injection in the buttocks two weeks earlier. Sad and needless though her death was, Ms. Kratae was not the first and unlikely to be the last victim of beauty.

‘Kratae’, 33, fell into a coma and later died after receiving a filler injection by an unlicensed practitioner in Bangkok. Source: Daily News

Kratae was a pretty woman. It was her job to be pretty. The title of her job was ‘pretty’. But she felt she could look prettier and lost her life in the process of shaping herself into the ‘pretty’ ideal. Kratae worked as a hired product presenter, locally known as ‘pretty’, for over a decade and was the breadwinner of her family.

Becoming ‘pretty’–quick, easy, and risky

In my previous article I wrote about the Thai craze for ‘white’ skin which has invaded women’s intimate parts. The kind of craze that has lead to vaginal bleaching may induce a laugh but as Kratae’s death has reminded us, it’s not always a laughing matter.

The cultural, social, and commercial pressures on many young Thai women to look fair, shapely and beautiful are real. The pressures are particularly strong for young women in this relatively new and lucrative profession of ‘pretty’. Two pretties, Yim (Smile) and Pla (Fish), told the Thai-language newspaper Matichon in a recent interview that “Nobody wants a dark-skinned pretty to show their products. They are not eye-catching. Some jobs give you a spec, such as ‘white, 170 cm. tall, 34+ inches bust.’”

Pla: Every [pretty] will do at least one thing. The nose. The rest is often Botox or filler [injection] in places where you want to look good.

Yim: Other than that we will take [supplements] orally or by injection, and apply Gluta [Glutathione, antioxidant supplement used with cancer patients] on the skin to create an aura, or have collagen injections. Rip-naa is shaping the face into a V-shape. Take vitamins and pills to make the arms small and slender. Breast augmentation.…

There’s a Thai expression “suay duay meed” (“beautiful with the knife”). There should also be a twin expression “suay duay khem” (“beautiful with the needle”). Though I haven’t heard the latter, this other saying sums up one reason why many women brave the knife and the needle: “suay lueak daay” (“beautiful with choices”). In other words, when you are beautiful, you have plenty of choices.

Cosmetic surgery and injection have long been with pretties, Yim and Pla said. They are not that hard to get either, if you are not too afraid of the risks, that is.

Pla: Botox filler [injections] are easy to get in the pretty circle. If someone has had a nice job done then it’ll spread by words of mouth and we’ll follow suit.

Yim: Generally if a pretty has had lots of work done, she’ll likely be a Botox and filler dealer too. Many of us would buy the stuff and take it to a clinic for injections because it’ll be a lot cheaper than using one of the beauty clinics which can set you back tens of thousands of baht.

In another interview with Matichon, another ‘pretty’ with 9 years in the business concurred with Yim and Pla. The highly successful ‘Stop’, dubbed “the million baht pretty,” said cosmetic surgery and treatments are a “normal” part of life for celebrities, singers and actors, as well as ordinary people in society. She herself has had a nose job and Botox injections.

‘Stop’, 30, a highly successful pretty dubbed ‘the million baht pretty’, Source: Matichon

‘Stop’ explained how things have changed in the past ten years during which staying beautiful in the ‘pretty’ business has become sort of a competitive sport:

Stop: In the early years of my career (nearly 10 years ago) most pretties were naturally beautiful. At the most they would have a nose job. But with rapid medical advancement, the younger generation feels they can get prettier a lot quicker and lot easier…

The basic jobs in the old days were the nose job, the eye job, and then it was the breasts which was then considered out of ordinary but is now rather common. These days there are breaking the cheekbones, trimming the lips… I’ve seen [girls] who had their lips trimmed and from the beautiful smiles they used to have now their lips are misshapen, which can’t be fixed. For injections, nearly everyone does it, including ‘meso’ which is fat burning injection, and Botox injection on the face to reduce the size of the jaw. Filler and collagen injections are for filling specific areas to address deeply-set eye sockets [and] to fill in the lines around the mouth. Oral pills are usually for weight loss.

Glutathione is very popular for whitening the skin. Although it can cause skin cancer, many use it because of the Thai value that pretties must be fair-skinned. Some have had so much of it that they have become so pale white, with lots of acne on the face and the back, which really doesn’t help. Some look rather better in honey-colored skin.

One factor that makes Thais accept and favor cosmetic surgery is the Korean fever in Thailand, which comes with the Korean surgery. We must admit that Korea is really No. 1 in this area.

It’s tough if you are not pretty in this business. Most do it because if you’ve been around for a long time then you don’t look fresh any more. You are afraid that you don’t look as good as the younger girls so you need to upgrade yourself.

But at what price? The harmful effects of skin whitening products, filler injections and other procedures may not be as swift and won’t materialize for many years. Will the benefits of the quick and easy beauty outweigh the risks?

Rolling the dice for beauty

Apparently many are taking their chances. And it’s not just the pretties who go for the risky procedures, often administered by the so-called “moh kra-pao” (“bag doctors”), who are unlicensed practitioners or beauticians often unqualified to do the job.

A Bangkok Post article entitled “The needle and the damage done” tells a story of ‘Looksorn’, a gay man who has used the services of a ‘bag doctor’ after having seen his friend suffering no ill effects from the procedure. “So I just threw the dice and took my chances,” he said.

The president of the Dermatological Society of Thailand Dr Krisada Duang-urai told the Bangkok Post that botched cosmetic jobs like what happened to Kratae are on the rise, pointing to the growing number of people seeking treatment to repair the damage done to their faces.

Dr Jinda Rojanamatin, acting director of the Institute of Dermatology, said that there are several different types of filler used by certified dermatologists and surgeons and ‘bag doctors.’

Each gives similar results but they differ in the way they work on the skin and in their duration. Certified dermatologists and surgeons prefer hyaluronic acid-based products while backroom operators tend to use a cheaper filler made from polyacrylamide. Sub-standard procedures and the use of unsuitable materials can cause undesired results including the migration of filler material from the original sites and under- or over-correction of wrinkles.

Filler that is good for one region might not suitable for other areas. Dermatologists and plastic surgeons are trained to choose the substance that will work best in a specific area. Potential complications can be as simple as bruising, bleeding, skin rashes, redness and localised swelling. More serious side-effects occur when a sustained allergic reaction is triggered.

If filler is accidentally injected into an artery, for instance, that artery can become blocked and the area of skin it supplies with oxygen could die. The problem can become more severe if the filler obstructing a blood vessel travels to another location in the body and causes an embolism. This can occur in the legs or sometimes in the brain or heart. Blockages in any of the body’s major organs can be fatal.

Allergic reactions might have been the case with Kratae who could not breathe and lost consciousness minutes after getting a filler injection in her buttocks by the ‘bag doctor.’ She fell into a coma and was on life support for two weeks before passing away. The doctors who treated her said her death “stemmed from brain damage due to swelling from the lack of oxygen or the death of brain cells resulting in the organ’s failure.” More will be known after an autopsy.

Others have died for the same reason before Kratae. Nearly everyone knows that it is safer to have cosmetic procedures done by certified practitioners, although such procedures are never risk-free even at the hands of professionals. Yet, many are willing to trade safety for lower costs.

According to the ‘million-baht pretty’ Stop, many pretties use bag doctors because they have seen good examples done by them. “Admittedly some bag doctors are really good and can make girls look truly much better. We don’t know what the future effects will be, though.”

But costs may be the real deciding factor. Kratae went with the bag doctor for her buttock filler injection because his price was just 40,000 baht instead of 70,000 baht at a regular beauty clinic. The savings with the bag doctors can be even three or four times lower.

30-something Looksorn said he paid only 2,000 baht for a filler treatment with a bag doctor which would have cost 8-10,000 baht with a certified dermatologist.

I’m satisfied with the results… If I could afford to pay for a legit doctor, I would of course go for the best and safest treatment every single time.

Paying the ultimate price

‘Dr. Pop’, 24, offered his apology to Kratae after the botched filler injection that put Kratae in a coma. Source: Daily News

It’s too late for Kratae to realize that the price she paid was too high. She lost her life and future, while her parents lost their daughter and the breadwinner of the family. Twenty-four-year-old Thanat Natveerakul, known in the pretty community as ‘Dr. Pop’, who has no medical training and administered the filler injection to Kratae is now facing a criminal charge of reckless endangerment causing death of another person, which is punishable by up to 10 years.

Bad luck?

Tragic and terrible Kratae’s death may be, she is unlikely to be the last victim. Surely you can say it was her decision and she was unlucky. But was her tragic death really just the matter of bad luck or ill-advised decision? Was it just narcissism that drove Kratae and many other young Thai women in her profession to reckless cosmetic enhancement procedures? Or is there something more lurking behind the narcissism, the need of these young women to put themselves at risk? What role do the values in our society play in recurring tragedies such as this?

I can’t help thinking about illegal doping in the athletic community. Is what Thai pretties are doing to themselves any different from the professional athletes doping, taking steroids and other performance-enhancing substances to give themselves an edge over the competitors?

Perhaps there are a few differences. The risk for professional athletes is getting caught and getting banned, while the risk for professional pretties is a damaged body, an injury or death. Professional athletes also generally know better not to mess with substandard drugs as they are particularly concerned about their health which strongly affects their performance. Those at a high level also have coaches, managers and doctors to advise them.

Professional pretties, on the other hand, tend to put their appearance over their health and performance. Some top-earning Thai pretties may be able to afford expensive beauty enhancement drugs and cosmetic procedures from expensive beauty clinics and surgeons, while most low- or mid-range pretties only have friends and the bag doctors to rely on–perhaps not unlike lower-end athletes. What both the athletes and the pretties have in common is the drive to succeed–sometimes at all costs.

It’s hard to say to what extent Kratae’s death will affect the way Thai pretties approach their beauty enhancement–or the cavalier attitude towards health and safety in the larger Thai society. And how this case will have any effect on the Thai government regulation of cosmetic procedures remains to be seen.

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About the author:
Kaewmala
is a writer, a blogger and an avid twitterer. She blogs at thaiwomantalks.com and is a provocateur of Thai language, culture and politics @thai_talk. Kaewmala is the author of a book that looks at the linguistic and cultural aspects of Thai sexuality called “Sex Talk”.