Nguyen Thi Kim Phuong is 42 and she fears what middle age will do to her face. Like many of her friends, she sees cosmetic surgery as a way to extend her youthful looks.

Phuong originally planned to undergo a face-lift procedure and nose job at a beauty clinic in Saigon's District 10 next month that would cost her more than VND80 million ($3,438).

But she's changed her decision, fearing for her life after a series of plastic surgeries went fatally wrong at private clinics in Vietnam's southern metropolis.

"I want to look younger and more beautiful as the Lunar New Year is coming near. But I'm afraid of dying and I don't dare to risk my life," the grocery store owner said.  

"They (beauty clinic consultant staff) guaranteed that the surgery would be 100 percent successful and advised me to keep an optimistic mind.

"But these recent deaths and accidents from plastic surgery in private clinics have really scared me. It seems that going under the plastic surgeon's knife in Vietnam is a gamble."

Unlike Phuong, Nguyen Ho Thanh Nhi has not thought of going under the knife in Vietnamese beauty clinics though she has far more "legitimate" reason to do so.

Nhi has a high cheekbone and many of her friends keep advising her to undergo a cheekbone reduction surgery, fearing that she would never get married, otherwise. 

It's a long standing Vietnamese superstition that men are advised not to marry women with high cheekbones, unless they want to die early. Even today, in the 21st century, such notions are embedded in Vietnamese people's minds.

But, Nhi says: "I’m more frightened of death than being left on the shelf." 

"Improving their appearance is something all the women in the world want, but all this advertising has made people think surgeries are a commodity you get as easily as buying something in a market," said the 26-year-old English teacher in Saigon.

Capitalizing on the widespread desire to look younger and better, a whole range of products and services are advertized, often making very tall claims and offering steep discount to entice consumers.

As it happens, this has also attracted a lot of unscrupulous and unqualified people, and many people have been lured into their plots, some with tragic outcomes.

Cheapest, dangerous

Vietnam has been drawn to the plastic surgery makeover for several decades now as a result of rising incomes and the adoption of Western ideas of what constitutes beauty and therefore a desire for Western features (round eyes, long nose, bigger breasts and so on). The idolization of celebrities and ensuing aspiration to look like them has also played its part.

While the fad has not reached the levels of countries like South Korea, home to the world’s biggest plastic surgery industry, and China, its fastest-growing market, it is still growing in the country .

Vietnam was adjudged the cheapest country in the world for plastic surgery by the Beauty Price Index last year – with a nose job costing just under $1,000 and breast augmentation done for $2,000.

However, these cheap prices have come with risks of false claims and unqualified quacks and difficulties in making out who is real or fake.

In such a scenario, disasters are no longer uncommon.

On October 14, a 59-year-old Vietnamese American woman died after undergoing a facelift surgery at the South Korean-run Kangnam Plastic Surgery Hospital in HCMC's District 3. Heath officials said she died from anesthetic shock.

Just four days later, a 33-year-old Vietnamese woman died after undergoing a breast augmentation surgery at the EMCAS Cosmetic Surgery Hospital in District 10. She suffered respiratory failure and pneumothorax (collapsed lung) that led to a cardiac arrest.

It was found that Dinh Viet Hung, the surgeon who operated on the EMCAS patient, was using a fake certificate. EMCAS was ordered to terminate all contracts with its employees and ot review their qualifications.

Even after this, all that the city’s health department has done is to request directors of the two hospitals to review their shortcomings and prevent similar incidents in the future.

Last month, a 65-year-old woman fell into coma and suffered respiratory arrest after having her eyebrows tattooed at a local clinic in District 1.

Also last month, in Hanoi, a 28-year-old woman fainted and suffered convulsions after having abdominal liposuction at a plastic surgery clinic on Kim Nguu Street and had to be rushed to a nearby hospital.

The most shocking instance of a plastic surgery going wrong happened in 2013 when a woman in Hanoi died during a liposuction and breast enhancement procedure. Her body was thrown into the Red River by the surgeon himself. The surgeon was sentenced to 19 years in jail in December 2014.

Lucky escapes?

Some people who have undergone plastic surgery say it is an experience they never want to repeat.

Getting anaesthetized, lying unconscious in a room and waking up after the surgery looking worse than they did earlier is not an uncommon occurrence.

Vietnamese American woman Janie Phuong Nguyen paid more than $3,000 for a double eyelid surgery at a local clinic in Hanoi last year and she felt lucky to return home safely.

"All my friends say I look like a different person and now I look ferocious," said Phuong, who lives with her four-member family in California.

She had the surgery done during her trip back to Vietnam to celebrate the Lunar New Year, or Tet.

"It felt like lying on the delivery table and depending completely on fate," she said.

Quacks quacks

Vietnam has over 100 licensed plastic surgeons in Hanoi and Ho Chi Minh City, but thousands of unlicensed practitioners are operating across the country, according to local health departments.

Dang Thi Xuan Huong, vice chairwoman of Vietnam Beauty Association, said beauty clinics have been springing up like mushrooms in Vietnam’s biggest cities as demand for beauty services and plastic surgery soars.

"These clinics do not have doctors but only technical workers who are trained for a few months before doing the real things. Their customers would be lured by catchy advertisements to undergo surgeries that may lead to complications," she said.

The situation has arisen mainly because of loose management by local authorities. Huong said plastic surgery clinics do not care about consequences and are focused on making profits. Meanwhile, customers cannot be sure whether the clinics where they are risking their lives are licensed or not, she added.

Professor Le Gia Vinh, vice chairman and general secretary of Vietnam Medical Association, said many women want to be more beautiful quickly and prefer cheap plastic surgery, so they do not mind unlicensed or low-quality facilities, which is extremely risky.

Authorities in HCMC will take measures to tighten control over cosmetic surgeries, deputy director of the city Health Department Tang Chi Thuong said at a recent meeting.

He said related violations include illegal medical examinations and treatment services, filler injections and eyelid surgeries, unauthorized or false advertising and selling of expired cosmetics or ones without clear origin.

Nguyen Van Nguyen, head of the health division in District 10, said cosmetic surgeries are often carried out very quickly, taking only 15 to 20 minutes per case, and some facilities use surveillance cameras to watch out for inspectors.

This makes it difficult for local authorities to deal with incidents and the city also lacks manpower to inspect and control illegal plastic surgeries, he said.

Many health experts have said that authorities need to check whether hospitals, clinics and facilities with cosmetics surgery services are offering legal services, increase public awareness on pursuing safe surgery practices and publicize a list of qualified facilities in the media.

Nguyen Thi Thoa with HCMC health department highlighted another aspect of the problem, saying some beauty clinics did not examine the medical history of their patients. "This explains why these facilities tend to panic when their patients are in trouble."

Vietnamese American Phuong, who had the double eyelid surgery done in Vietnam, is upset and scared.

"I want to have another surgery to adjust my eyelids to look more beautiful and friendly, but I don't dare risk my life again.

"I'd have to accept my current facial appearance."