Despite its late entry into the Asian cosmetic surgery arena, China may turn out to be the region's predominant player in not too many years.

Until 2001, plastic surgery undertaken in China for purely cosmetic reasons was banned, presumably with the intent of preserving traditional appearances and styles. Illegal, however, did not mean unavailable.

Without formal regulation, trained Chinese reconstructive plastic surgeons as well as untrained lay practitioners known as "firemen" offered (and still offer) cosmetic procedures to eager patients behind closed doors.

Lacking good education, experience, facilities, and supervision, results were not first-rate and horror stories abound. Many patients maimed by the untrained suffered not just serious deformity but death.

Times are changing, and the plastic surgery industry in China is undergoing a transformation. Today, delivery of cosmetic services is an approved discipline with strict training requirements, formal certification, and official licensing.

Nevertheless, the "underground" trade still persists much more in China than in other East Asian countries, and the government has been slow to address this problem.