REGULARS
Keeping it simple
The general public, for want of a better name for you, tend to get confused and think that investing is really a very complicated area.
This is a myth sometimes perpetuated by investment professionals seeking to justify their, sometimes, exorbitant fees. I have met people with substantial financial assets who are really ignorant of what their investment portfolios contain and what risk their investments entail. There is really no excuse for this unless you have too much money and can’t be bothered to spend time understanding the risks and potential return of your holdings. Investing is really simple on the surface if you follow the formula I would like to present to you. Every investment falls into one of three categories; secure, balanced or speculative. So the next time you are presented with an investment opportunity ask yourself which of these categories it falls into? If you get an e-mail from Nigeria promising you millions of dollars in return for your bank account details you know this is a high risk investment. An equity fund in India which has averaged 40% each year over the past three years is also a speculative fund but has potential to do the same again when volatile markets eventually settle down.
A balanced investment is less likely to fluctuate wildly up and down. A good example is Corporate Bonds. These are debt instruments issued by blue chip companies that pay a return higher than bank interest rates. The higher the return above bank base rates the higher the risk. A secure investment is generally regarded as a no risk one. Bank accounts and all types of deposit investments fall into this category. Property that you have owned for a few years in a first world country (for the moment let’s exclude the USA) may also fall in here. The key to contented investing is to match your individual risk profile with what is available. If you ask most people what they expect from their investments the chances are they will tell you they want very high returns with little or no risk. If I tell them at outset that this is an impossible dream they are less likely to be disappointed when their speculative investment falls, or their conservative one underperforms. For every 1 or 2 per cent gain above deposit rates there is a corresponding rise in risk. Most people understand this when it is explained properly to them. “Know all Joe” down the golf club will boast how his portfolio has gained 30 or 40 per cent this year. Next year when it falls 25 percent he will prefer to talk about his broken relationship. Remember if it does fall 25 percent it will have to grow at 50 percent to get back to even. The answer to all this confusion is to sit with a good broker and develop a mixed portfolio that will meet your investment needs. How much growth do you need? Most expatriates in Thailand with say around 500,000 to invest can live here comfortably on 25,000 per year i.e. 5 per cent of their capital. In addition they would like to see their capital grow by at least another 4 per cent. That would mean in five years their capital is worth around 640,000 and their income then would be 32,000 per year at the same withdrawal rate.
To achieve this means that the portfolio must grow every year at 9 per cent after all charges. This is a reasonable ask from a balanced portfolio. It can also be achieved with investments that you fully understand. One golden rule: if you do not fully understand the investment and its full risk reward implications, don’t touch it.
And most important of all and the first question any sensible investor should ask is what sort of consumer protection do I get. If you hold the safest asset in the world and the company holding it goes bankrupt where do I stand? Why do you think recently in England there were long queues outside Northern Rock building society? : Because they only guarantee the first 20,000 of your investment. A poor return if you had a million invested in this so-called secure sector. Please take professional advice and sleep well and above all keep it simple.
Mag’s Page
This month lets get back to the topics closer to our female hearts, namely clothes, shopping, and diet. Not necessarily in that order!
Not a day goes by now in the UK without some dire new warning about what we eat (or don’t) and what it will, or won’t do to our health. Latest in a string of ‘no go’ food areas are all things processed, which includes bacon, ham and sausages. Apparently it’s the processing process that causes the problem, with all the added nasty stuff that entails, in particular SALT, an extremely no go area right now. So we are supposed to ration ourselves to a couple of sausages and slices of bacon a week. The two sausages allowed must also contain a minimum of 65% pork. Meanwhile ham must be of the pure, straight off the bone variety. Any pre-packed ham with a shiny wet look to it is bad. As is any bacon which spews out that grotty white gunge when cooked. Until I read this new shock horror story I had, like most sensible people, realised that gungy white stuff oozing from bacon cannot be too healthy. Also that wet, shiny ham really isn’t too appetising, and that, surprise surprise, the pork content of a sausage can actually be ascertained by reading the label! All this publicity about good and bad foods seems ridiculously over the top, and aimed at folks who are, sad to say, a sandwich short of a picnic. Until I happened to be shopping with a friend in Morrisons recently and realised that my friend, of mature years and perfect literacy, didn’t realise that the meat content of a meat pie was clearly shown in percentage terms on the label. It was as if someone up above had suddenly thrown a switch, and the light dawned. Same goes for sausages I explained carefully, pointing out the fact that ingredients are listed percentage wise in descending order. There is a point to all this. We deplore the ‘Nanny State’ in the UK, but often fail to realise that maybe it is in fact needed. When a sensible adult fails to understand a simple labelling system, (not to mention those with failing eyesight, who can’t read the miniscule labelling anyway) what chance do younger and less educated people stand? Which brings us to the issue of weight. The size zero has been promoted for quite a while now as the ideal, in terms of super models. It’s actually quite difficult to visualise a size zero, but it must be quite skinny. Very skinny in fact. Then there’s the problem of different sizing in different countries, so whether the size zero referred to is the UK or American variety isn’t clear. Whatever - it’s still pretty skinny. So a 16-year-old size 16 British lass decided to play on her attributes and promote the fact that larger women could succeed in the modelling biz. She did very well, and in fact didn’t look fat at all if media photos are anything to go by. Just a bit chunky really. The sort of person who, if you were being kind, would be described as ‘carrying her weight well.’ Then an expert on diet wrecked the poor girls’ dreams, saying she was setting a bad example to other youngsters by promoting the fact that bigger girls can be attractive. You just can’t win these days! What puzzles me though is where all these women who are either below or above the size 10 to 14 range find stuff to wear anyway. It’s bad enough trying to find jeans to fit in 10’s or 12’s, as I can honestly testify, having tried 8 pairs on this week alone without success. There are so many different fittings, leg shapes, and ‘rises’. Thankfully though the low-rise versions are definitely now ‘out’ which should mark the end of the muffin top.
Little wonder that women spend so much on handbags is there? At least you don’t have the embarrassment of emerging from a changing room with a pile of clothes, and not a single suitable item to buy. Handbags are all forgiving and useful. Colourful or plain, casual or smart, whatever the occasion you can easily find one to fit the bill without a sweaty struggle behind an ill-fitting changing room curtain. Unfortunately the most desirable versions can also require a second mortgage! The days when you could get by with 2 or 3 basic colours in leather, plus a nice little evening bag, are long gone. Fashion houses produce new styles and colours every season, and the ‘must have’ styles are dished out free to celebs for some useful advertising.
Strangely enough one of the most expensive and sought after names in bags these days is Burberry, who have moved on light years from the traditional checks. One of their summer season styles is retailing at almost £1700 in the UK. So if you want to impress the folks back home seek out some nice fakes to send back.
Happy Shopping!
d'Geek
Britain makes camera that ‘sees’ under clothes
A British company, ThruVision, has developed a camera that can detect weapons, drugs or explosives hidden under people’s clothes from up to 25 metres away in what could be a breakthrough for the security industry.
The T5000 camera uses what it calls “passive imaging technology” to identify objects by the natural electromagnetic rays--known as Terahertz or T-rays--that they emit. The high-powered camera can detect hidden objects from up to 80 feet away and is effective even when people are moving. It does not reveal physical body details and the screening is harmless, the company says. The technology, which has military and civilian applications and could be used in crowded airports, shopping malls or sporting events, was unveiled at a scientific development exhibition sponsored by the Home Office in March.
“Acts of terrorism have shaken the world in recent years and security precautions have been tightened globally,” said Clive Beattie, ThruVision’s CEO. “The ability to see both metallic and non-metallic items on people is certainly a key capability that will enhance any comprehensive security system.”
ThruVision devised the technology in collaboration with the European Space Agency and from research by astronomers into dying stars. The technology works on the basis that all people and objects emit low levels of electromagnetic radiation. T-rays lie between infrared and microwaves on the electromagnetic spectrum and travel through clouds and walls. Depending on the material, the signature of the wave is different, so that explosives can be distinguished from a block of clay and cocaine is different from a bag of flour.
Teens turn deaf ear to risks of MP3 players
Teenagers seem to know that loud music can damage their hearing, yet most see no reason to lower the volume on their iPods, a small study suggests.
In focus group discussions with students at two high schools in the Netherlands, researchers found that the teens were generally aware that blasting an MP3 player could harm their hearing. Yet most said they usually played their own device at maximum volume and had no plans to change that. Like many teenagers, the students often denied their own personal risk. Most knew the general hazards of loud music, but believed they had a “low personal vulnerability” to hearing loss, the researchers report in the Journal of Paediatrics.
Given this, lead researcher Ineke Vogel said, “We strongly recommend parents to inform and discuss with their children the use of MP3 players and the potential long- term, irreversible consequences for hearing capacity.”
Parents can also look for signs of a problem, like when a child complains of ringing in the ears or sounds being “muffled,” according to the researchers at the University Medical Centre Rotterdam. Based on the focus group discussions, though, many parents may be unaware of the hearing risks posed by MP3 players. Of the 73 students in the study, few said their parents had warned them that playing the devices too loud could harm their hearing.
It may also be necessary for MP3 manufacturers to make changes, the researchers say. Many students in the study said they did not know how to tell when their MP3 players were too loud. Volumes at or above 90 decibels (dB) are believed to be hazardous, Vogel’s team notes, but noise levels need to reach 120 dB to 140 dB to become uncomfortable or painful.
Manufacturers, according to the researchers, could equip MP3 players with an indicator that displays the volume level in terms of decibels, along with a signal--such as a flashing light--that goes off when decibel levels reach the danger zone.
The researchers recommend that, as a general “rule of thumb,” MP3 users set the volume no higher than 60 percent of its full capacity when using “ear bud” style headphones, like those that come with iPods. With over-the-ear headphones, they recommend 70 percent as the maximum.
Just as there are safety standards for occupational noise exposure, Vogel and her colleagues suggest that more long-range studies are needed to develop safety guidelines for “leisure time” noise exposure.
Home & Living
First impressions mean a lot. When a visitor walks in your front door, not only will they see your decor, they’ll notice your home’s scent. What will it be? The aroma of delicious food in the kitchen, or a leftover fish or onion smell? Will they breathe in the pine scented cleaner you used when you mopped the floor, or a can of garbage that needs to be emptied? Is the cat’s litter box clean? A home’s scent can also influence the comfort and mood of the family within. Here are a few ideas to make it a pleasant one. There are many products on the market to keep your home smelling nice. Air fresheners come in solid or spray form, and some products plug into an electric outlet to disperse scent. You can choose between the cosy aroma of pine and spices or floral blends. Spray as needed, or place the solid fresheners strategically and replace as needed. A new product heats scented oil, with a sliding control to determine how much scent is released. Be careful with these products, however. Some may be toxic, or trigger allergies. When you use a commercial air freshener, you are introducing chemicals into the home environment. Do not spray air freshener around food or beverages, and avoid the use of these products around small children.
When choosing a product, consider the reason for its use. Will you be masking an unpleasant smell, eliminating the odour, or simply adding a nice scent to the home? If there’s a bad smell to be hidden, adding additional scent rarely solves the problem. Work on eliminating the odour before introducing additional products to hide it. This might mean storing a trash container behind a door, keeping pet areas fastidiously clean, or using baking soda to absorb odours. Clean carpets often, not only to eliminate stains, but also to keep away bad smells. Forbid smoking in your home – not only does it smell bad, it’s unhealthy for everyone. Wash curtains and draperies, and avoid materials that collect moisture and create a musty smell. If you simply want to make the room smell nice, decide what mood you’re trying to create. Do you want a cheerful, clean environment? Choose scents such as citrus, mint, or pine. If you want to create a romantic environment, choose scents such as jasmine, gardenia, sandalwood, or rose. For a cosy winter environment, choose cinnamon, apple, berry, and pine. Some scents encourage activity and alertness, while others help people relax and unwind. Candles are a great way to introduce scent into the home. Not only do they smell wonderful, they also create a lovely glow and add to the room’s visual appeal. Take care, however, not to burn candles near curtains or drapes. Place them in containers made for that purpose, and don’t let them burn too long at one time. Some candles may contain toxins in their wicks, so they shouldn’t be burned without proper air circulation. There are candle companies that advertise “healthy” wicks, with many wonderful scents to choose from. You can purchase potpourri burners, which heat a small container of water and dried materials to scent the room. Some are heated by a tea candle, some by electricity. Be careful not to let all of the water evaporate, or the container may crack and possibly ignite. Many of these can also be used with scented wax chips, and similar safety measures apply. You can also try simply leaving a dish of potpourri or wax chips in a dish, but that’s usually not enough to add enough scent unless the room is very small, such as a bathroom or closet. If there is a specific occasion for which you want to add a cosy scent to your home, try simmering a small pot of apples, cloves, and cinnamon sticks on the stove. Or bake a batch of cookies, an apple pie, cinnamon rolls, or other aromatic food. This trick works particularly well for selling a house. Cook the food or simmer the pot on the stove about an hour before the house will be shown, or before an open house is to begin. You might even leave the plate of fresh cookies on the counter for prospective buyers to nibble. Another simple tip is to put a drop of vanilla flavouring on a baking tray in a low oven, which fills the home with a welcoming smell.
Earth report
Disappearing ice shelfs in Antarctica and record wind power in Spain in this month’s.
A huge chunk of ice has collapsed in Antarctica and an ice shelf about seven times the size of Manhattan is “hanging by a thread,” the British Antarctic Survey (BAS) have reported, blaming global warming.
“We are in for a lot more events like this,” said professor Ted Scambos, a glaciologist at the National Snow and Ice Data Centre at the University of Colorado at Boulder. Scambos alerted the BAS after he noticed part of the Wilkins ice shelf disintegrating on February 28, while looking at NASA satellite images. Late February marks the end of summer at the South Pole and is the time when such events are most likely, he said.
The Wilkins ice shelf lost about 6 percent of its surface a decade ago, the BAS said in a statement on its Web site. Another 220 square miles -- including the chunk that Scambos spotted -- had splintered from the ice shelf as of March 8, the group said.
Scambos’ centre put the size of the threatened shelf at about 5,282 square miles, comparable to the state of Connecticut, or about half the area of Scotland. “Wilkins is the largest ice shelf on the Antarctic Peninsula yet to be threatened,” David Vaughan of the BAS said. “The ice shelf is hanging by a thread -- we’ll know in the next few days or weeks what its fate will be.” But with Antarctica’s summer ending, Scambos said the “unusual show is over for this season.”
Ice shelves are floating ice sheets attached to the coast. Because they are already floating, their collapse does not have any effect on sea levels. Scientists say the western Antarctic Peninsula has warmed more than any other place on Earth over the past 50 years.
Scambos said the poles would be the leading edge of what’s happening in the rest of the world as global warming continues. “Even though they seem far away, changes in the Polar Regions could have an impact on both hemispheres, with sea level rise and changes in climate patterns,” he said.
Wind power is breaking new records in Spain, accounting for just over 40 percent of all electricity consumed during a brief period over Easter, the country’s wind power association has reported.
As heavy winds lashed Spain on Saturday evening wind parks generated 9,862 megawatts of power, which translated to 40.8 percent of total consumption due to low demand during the holiday weekend, AEE said. They added that between Friday and Sunday wind power accounted for an average of 28 percent of all electricity demand in Spain, which is a leading world producer of such energy.
The record for power generated by Spain’s wind parks was set on March 4 at 10,032 megawatts, but as it was a regular working day this accounted for less percentage demand.
Spain’s wind power generation equalled that of hydropower for the first time in 2007.
The government has approved legislation that will allow offshore wind parks to be set up along the nation’s vast coastline in an effort to boost the use of renewable energy sources. While more expensive than land-based wind farms, offshore wind parks can take advantage of stronger, steadier coastal breezes.
Spain, which along with Germany and Denmark, is among the three biggest producers of wind power in the European Union, is aiming to triple the amount of energy it derives from renewable sources by 2020.
Arts & Culture
After reviewing the iconic Alfred Hitchcock followed by the immensely influental Akira Kurosawa, this month we move on to a director whose view of the world certainly doesn’t allow us to sit comfortably in our seats munching popcorn.
Although less than prolific Stanley Kubrik’s films have been highly influential. If you have managed to get through life without viewing one then you have missed out on being challenged and entertained. Read on to find out what you should be adding to your must see list.
Given the recent death of Arthur C. Clarke, the author of 2001: A Space Odyssey, it seems appropriate that this month’s Arts and Culture looks at the director who made the film version, Stanley Kubrick. Stanley Kubrick (July 26, 1928 – March 7, 1999) was born in New York, and after a dismal education he eventually found a job as an apprentice photographer. This led him into the movie world, and in 1950 with friend Alexander Singer, Kubrick sank his savings into making the documentary Day of the Fight (1951). This was followed by several short commissioned documentaries (Flying Padre (1951), and The Seafarers, (1952)), but by attracting investors and hustling chess games in Central Park, Kubrick was able to make Fear and Desire (1953) in California. Filming this movie was not a happy experience; Kubrick’s marriage to Toba Metz did not survive the shooting, but despite mixed reviews for the film itself, Kubrick received good notices for his obvious directorial talents. Kubrick’s next two films Killer’s Kiss (1955) and The Killing (1956) brought him to the attention of Hollywood, and in 1957 directed Kirk Douglas in Paths of Glory (1957). Douglas later called upon Kubrick to take over the production of Spartacus (1960), by some accounts hoping that Kubrick would be daunted by the scale of the project and would thus be accommodating, but Kubrick took charge of the project, imposing his ideas and standards on the film. Many crew members were upset by his style: cinematographer Russell Metty complained to producers that Kubrick was taking over his job. Kubrick’s response was to tell him to sit there and do nothing. Metty complied, and ironically was awarded the Academy Award for his cinematography. Kubrick’s next project was to direct Marlon Brando in One-Eyed Jacks (1961), but negotiations broke down and Brando himself ended up directing the film himself. Disenchanted with Hollywood and after another failed marriage, Kubrick moved permanently to England, from where he would make all of his subsequent films. Kubrick’s first UK film was Lolita (1962), which was carefully constructed and guided so as to not offend the censorship boards, which at the time had the power to severely damage the commercial success of a film. Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb (1964) was a big risk for Kubrick; before this, “nuclear” was not considered a subject for comedy. Originally written as a drama, Kubrick decided that too many of the ideas he had written were just too funny to be taken seriously. The film’s critical and commercial success allowed Kubrick the financial and artistic freedom to work on any project he desired. Around this time, Kubrick’s focus diversified and he would always have several projects in various stages of development, some of which were never finished.
The next film he completed was a collaboration with sci-fi author Arthur C. Clarke, 2001: A Space Odyssey (1968), is hailed by many as the best ever made; an instant cult favourite, it has set the standard and tone for many science fiction films that followed. The merits and meanings of this film could easily fill this whole magazine, and Kubrick always said that interpreting the film was a matter for each individual viewer. Kubrick co-wrote the screenplay with science fiction writer Sir Arthur C. Clarke, expanding on Clarke’s short story “The Sentinel”. The screenplay and the novel were written simultaneously. The screenplay is credited to Kubrick and Clarke, while the novel, published in tandem with the film’s release, is credited only to Clarke. The novel and the film deviate substantially from each other, with the novel explaining a great deal of what the film leaves deliberately ambiguous.
The film’s primary themes include: the origins of evolution; sentient computers; extraterrestrial beings; the search for one’s place in the universe; and rebirth. All these themes are seen within a cold, foreboding light. Even Arthur C. Clarke is on record as being ignorant of what Stanley Kubrick really had in mind when making the film, going so far as to say that 2001: A Space Odyssey is ninety per cent Stanley Kubrick’s vision. Kubrick followed this with A Clockwork Orange (1971), which rivalled Lolita (1962) for the controversy it generated - this time not for only for its portrayal of sex, but also of violence. Barry Lyndon (1975) would prove a turning point in both his professional and private lives. His unrelenting demands of commitment and perfection of cast and crew had by now become legendary. Actors would be required to perform dozens of takes with no breaks. Filming a story in Ireland involving military, Kubrick received reports that the IRA had declared him a possible target. Production was promptly moved out of the country, and Kubrick’s desire for privacy and security resulted in him being considered a recluse from then on. Having turned down directing a sequel to The Exorcist (1973), Kubrick made his own horror film: The Shining (1980). Again, rumours circulated of demands made upon actors and crew. Kubrick’s subsequent work was well spaced: it was seven years before Full Metal Jacket (1987) was released. Seen by one critic as the dark side to the humanist story of Platoon (1986), Full Metal Jacket (1987) continued Kubrick’s legacy of solid critical acclaim, and profit at the box office. In the 1990s, Kubrick began an on-again/off-again collaboration with Brian Aldiss on a new science fiction film called “Artificial Intelligence (AI)”, but progress was very slow, and was put on hold until special effects technology was up to the standard the Kubrick wanted.
Kubrick returned to his in-development projects, but encountered a number of problems: “Napoleon” was completely dead, and “Wartime Lies” (now called “The Aryan Papers”) was abandoned when Steven Spielberg announced he would direct Schindler’s List (1993), which covered much of the same material.
While pre-production work on “AI” crawled along, Kubrick combined “Rhapsody” and “Blue Moon” and officially announced his next project as Eyes Wide Shut (1999), starring the then-married Tom Cruise and Nicole Kidman. After two years of production under unprecedented security and privacy, the film was released to a typically polarised critical and public reception; Kubrick claimed it was his best film to date. Special effects technology had matured rapidly in the meantime, and Kubrick immediately began active work on Artificial Intelligence: AI (2001), but tragically suffered a fatal heart attack in his sleep on March 7th, 1999.
After Kubrick’s death, Spielberg revealed that the two of them were friends that frequently communicated discreetly about the art of filmmaking; both had a large degree of mutual respect for each other’s work. “AI” was frequently discussed; Kubrick even suggested that Spielberg should direct it as it was more his type of project. Based on this relationship, Spielberg took over as the film’s director and completed the last Kubrick project. How much of Kubrick’s vision remains in the finished project - and what he would think of the film as eventually released - will be the final great unanswerable mysteries in the life of this talented and private filmmaker. Kubrick made only 13 major films in his life, mostly due to his methodical slowness in completing just one film, but nearly all of his films are recognised as classics of both their respective genres and cinema in general by many sources. Notable modern-day directors such as Steven Spielberg and Ridley Scott have cited Stanley Kubrick as a great source of inspiration for them. Kubrick’s famously stylish usage of camerawork, which was near unique at the time, has often been repeated by other directors in other films. Wether you are a fan of Kubrick’s or not it is undeniable that he has had an influence on many up and coming directors for some of his trademark features. Next time you watch one of his films you will notice that most contain a narration at some point. To create a sense of scale he often featured shots down the length of tall, parallel walls, e.g. the head in Full Metal Jacket (1987), the maze and hotel corridors in The Shining (1980) and the computer room in 2001: A Space Odyssey (1968). Something that can often be disturbing was the theme of dehumanisation and the dark side of human nature in many of his movies often based on three-way conflicts. He was known for his exorbitant shooting ratio and endless takes, he reportedly exposed an incredible 1.3 million feet of film while shooting The Shining (1980), the release print of which runs for 142 minutes. Thus, he used less than 1% of the exposed film stock, making his shooting ratio an indulgent 102:1 when a ratio of 5 or 10:1 is considered the norm. Most dramatic was his use of previously composed music (such as The Blue Danube and Thus Spake Zarathustra in 2001: A Space Odyssey (1968) which remain in the memory. He often used music to work against on-screen images to create a sense of irony. In A Clockwork Orange, Alex sings “Singin’ In the Rain” while raping Mrs. Alexander. In Dr. Strangelove, images of nuclear holocaust are accompanied by the song “We’ll Meet Again”. The final scene in Full Metal Jacket has the battle hardened Marines singing the Mickey Mouse Club theme. Much of his films consist of wide-angle shots that give the impression of a wide-screen movie, wide up-and-down as well as wide sideways. From the Killing onward, his films looked increasingly odder, bigger, and more properly viewed from the rows closer to the screen. One of his signature shots was “The Glare” - a character’s emotional meltdown is depicted by a close-up shot of the actor with his head tilted slightly down, but with his eyes looking up - usually directly into the camera. Examples are the opening shot of Alex in A Clockwork Orange (1971), Jack slowly losing it in The Shining (1980), Pvt. Pyle going mad in Full Metal Jacket (1987) and Tom Cruise’s paranoid thoughts inside the taxicab in Eyes Wide Shut (1999). Even HAL-9000 has “the glare” in 2001: A Space Odyssey (1968). An idiosyncrasy of all of his films is that they end with “The End”, when this became out of style in later years because of the need to run end credits, he moved “The End” to the end of the credits.
The End
Health Issues
It is a paradox that the techniques now used to make cosmetic changes to patient’s faces in order for them to appear more attractive were developed to help young men whose faces had been effectively destroyed during the war.
As a connection through to our main article this month Dr. Moreton gives us the run down on cosmetic surgery from a medical professional’s point of view. It isn’t all boob jobs and face lifts as many believe, and in most cases is necessary surgery after terrible accidents or birth defects, which uncorrected can cause both physical and mental anguish. Carol was unhappy with her looks; she is a woman who is careful about her health, eats well and exercises regularly. She takes pride in her appearance and the normal aging effect processes and loss of her good looks saddened her. She was in her fifties and did not expect film-star good looks but her jowly appearance made her uncomfortable each time she looked in her mirror. After talking to a friend who had had cosmetic surgery in Bangkok, she made an appointment at the Aesthetic Centre at Bangkok Hospital and consulted one of our cosmetic surgeons. She learnt what could be done to improve her appearance and about the art and science of cosmetic surgery.
Carol had a misconception concerning Plastic Surgery that many people share; she believed that it is so named because synthetic plastics are used in performing the operations. This is not true. The word actually comes from a Greek word “plastikos” meaning to mould or shape. She also believed that it is concerned only with efforts to make patients to improve their looks by altering those parts of their bodies that they feel need improvement. This is indeed one area of Plastic surgery; another important one is reconstructive surgery, where damaged parts of the body can be repaired or recreated after injury. Cosmetic surgery understandably gets more publicity but reconstructive surgery is as important, as it can creates an improved appearance for the truly damaged. Plastic surgery may be one of the oldest forms of surgery. There is evidence that Indian surgeons performed skin grafts as long as 3000 years ago. A Roman medical writer, Celcus, mentions reconstructive facial surgery at about time of Christ and one of the earliest accounts of the repair of cleft palates in China was in the time of the Chin dynasty which flourished from 229 to 317 A.D. The techniques of skin grafting have been known in Thailand for several centuries and reconstructive surgery performed from early in the last century. It is interesting that this form of surgery, usually connected with beauty and performed mostly on female patients was often advanced during the time of war when young men who were subject to horrifying injuries and deformities needed repair. An American surgeon John Jones published a surgical workbook on fractures and wounds in 1775 and it was used like a bible by medical teams during the Revolutionary War. It described techniques that are by their nature examples of Plastic Surgery. The first American plastic surgeon is considered to be John Peter Mettauer who performed the first operation for cleft palate in 1827. The great battles of the Civil War, the first modern war, produced thousands of wounds where surgery was needed and many plastic surgery techniques were developed during this conflict. It took a World War to produce the surgeon generally recognized as the father of modern Plastic surgery. Harold Gillies (1882-1960) was a New Zealander working in Britain as an ENT surgeon. At the outbreak of World War 1 he was posted to France and there he worked with a French dentist reconstructing the jaws of soldiers wounded in the warfare. During this war the men were in trenches and their bodies were protected but their shoulders and heads were exposed to enemy fire and this situation produced many facial injuries. Gillies returned to Britain and established a large hospital outside London devoted to this type of surgery. He invented and developed techniques of bone and skin grafting in order to serve his patients by building new jaws and other facial structures using the patient’s own tissues. After the war Archie McIndoe, his cousin and another New Zealander, joined him in his practice in London and when the Second World War broke out McIndoe become the leader of a team established to provide surgical care to members of the Royal Air Force. Many of the aircrew had been horribly burnt and had hideous injuries. McIndoe founded a unit at a hospital in East Grinstead, Sussex in order to provide care for them, reconstructing their faces and rehabilitating them back to life. It was McIndoe who realized that psychological care was as important as surgical care in order to rehabilitate these young men. Surgeons from all over the world came to work with McIndoe and took the skills that they had acquired back to their own countries after the war. McIndoe was also the surgeon in the first sexual reassignment operation ever performed. It is a paradox that the techniques now used to make cosmetic changes to patient’s faces in order for them to appear more attractive were developed to help young men whose faces had been effectively destroyed during the war. Reconstructive surgery does just what its name would suggest. Healthy tissue can be taken from one part of the body and used to replace tissue in another. Bone cartilage, tendons and even nerves can be used in the new construction. A surgeon can take cartilage from a rib bone and rebuild an ear. It is not quite as easy as it sounds, as these pieces of tissue have to have a blood supply to keep them healthy. One technique is to use a ‘flap where a piece of tissue to relocated and its blood and nervous supply is ‘dragged’ over to service the tissue at the new site.
Another important form of reconstructive surgery is to replace tissue that has been removed for medical reasons. Women who have a breast removed for cancer have to suffer added psychological pain, as they may feel defeminised and deformed by the loss of a breast. Techniques have been developed to insert an implant the size of the removed tissue, at the time of the surgery, so that the patient’s appearance when clothed is unchanged. Birth defects can also be corrected by surgery. Harelip and cleft palate are devastating deformities for a young child. Techniques have been developed to repair these defects and leave the child with just a small scar on the upper lip.
Cosmetic or Aesthetic surgery is surgery performed solely for the purpose of improving the appearance of the patient. It is done to improve the patient’s self-image and give them more self-confidence. Care has to be taken to make the patient understand that the surgery is unlikely to change their life dramatically. If you have a big nose and are sad and lonely after surgery you may have a small nose but are still sad and lonely. Patients who feel that their noses are too large can feel very self-conscious and the surgery to reduce the size, a ‘nose-job’, is performed frequently. Most patients are very happy with the result particularly as there is no scarring visible after the operation. Breast enhancement is also very popular. This operation has gone through many stages and the original results were not always a success. The technique has now been improved. Bags of saline or silicone are inserted behind the natural breast tissue through an incision in the armpit or under the breast. Silicone has acquired a bad reputation, as in many cases the bags burst and the silicone spilled and produced a painful inflammation, which then healed to leave scarring.
In recent years the results have been excellent and the appearance more natural. In many cases women who became pregnant after the insertion of the implants were able to breast-feed their babies. Patients seek help for the opposite problem, where their breasts are uncomfortably large. This may cause neck and back pain due to the weight of the breasts and they can be made smaller by surgery. The signature operation of the Plastic surgery world is the face lift. An operation where the tissues on the face are readjusted to improve the patients looks. These procedures need to be planned very carefully and the arrival of computer-generated images has helped the patient and surgeon plan the procedure. Changes can be simulated on the computer image so that the patient can help indicate their needs and have an idea of the expected outcome. It is also essential to plan the operation around the natural lines, folds of the face. The Plastic Surgeon needs to have the flair of an artist to be really good at the work.
Blepharoplasty or surgery around the eyelids is the most common procedure performed on men. The bags under the eyes can be removed and excess skin taken off the upper lids to give a more youthful appearance. The treatment of burns is part of the work of the Plastic Surgeons. After the Phuket Air crash, a number of patients were transferred for Phuket to Bangkok Hospital Medical Centre and underwent extensive grafting over many weeks to replace the burnt shin. In this technique skin is taken from healthy areas of the body and grafted onto the areas that have lost skin. They were also placed in the Hyperbaric Oxygen chamber everyday, which has a wonderful effect of improving and accelerating healing and preventing scarring.
All surgery has risks. Post-operative bleeding and infection being the two most feared. These risks were carefully explained to Carol. The surgery is done carefully and steps taken to avoid infection. Our hospital has meticulous infection control protocols and we have few problems. Carol had a very realistic idea about what she should expect, not hoping or expecting that this surgery would change her life. The surgery just made her feel happier about her appearance and she was very happy with the result. In order to arrange an appointment with one of our Doctors, Email: medinfo@bgh.co.th.
Dr Michael Moreton is the International Medical Coordinator at the Bangkok Hospital Medical Centre, he can be contacted to answer any Health Care questions.
Moreton@bgh.co.th.
The Big Snip : Plastic Surgery
Plastic surgery dates back to around 700 years before Christ.Physicians in ancient India including Sushruta were using skin grafts for reconstructive work as early as the 8th century BC. Knowledge of what we call ‘plastic surgery’ existed in India up until the late 18th century and some of the techniques were reported in the October 1794 edition of ‘Gentleman’s Magazine’.
In ancient Rome, army surgeons were able to perform simple techniques such as repairing ears damaged in close quarter combat. If caught in time, an ear sliced off in battle could be carefully sewn back onto the wounded man’s skull, thus allowing grafting to take place naturally over time. But this was not new even then: Alexander the Great (356-323 BC), who studied medicine among other skills, oversaw his Macedonian surgeons use the technique on wounded troops during his campaigns in Egypt, Persia and India from 336 to 324 BC. In mid-15th century Europe, Heinrich von Pfolspeundt described a process ‘to make a new nose for one who lacks it entirely, and the dogs have devoured it’ (!) by removing skin from the back of an arm and then suturing it into place on the face. However, because of the dangers associated with surgery in any form, especially delicate operations involving the head or face, it was not until the 20th century that such surgery became widely practiced.
Until the techniques of anaesthesia, (which involved putting patients into a coma so that they were unable to feel anything), became well established, all surgery on healthy tissues involved great pain for the patients. Infection from such operations was also reduced once sterile techniques and disinfectants were introduced. The invention and use of antibiotics beginning with sulpha drugs and penicillin was another step in making elective surgery possible. In 1791, a doctor named Chopart performed an amazing procedure of repairing a damaged lip by using a flap of skin from the patient’s neck. In 1814, Joseph Carpue successfully performed an operation on a British military officer who had lost his nose to the toxic effects of mercury treatment. In 1818, the German surgeon Carl Ferdinand von Graefe published his major work entitled ‘Rhinoplastik’, and Von Graefe modified an Italian method, using a free skin graft from the patient’s arm instead of the original delayed pedicle flap.
Johann Friedrich Dieffenbach wrote a comprehensive text on rhinoplasty in 1845 entitled ‘Operative Chirugie’, and introduced the concept of a re-operation to improve the cosmetic appearance of a reconstructed nose. In 1892 Robert Weir experimented unsuccessfully with xenografts (duck sternum) in the reconstruction of sunken noses and in 1896 James Israel and George Monks both described the successful use of heterogeneous free-bone grafting to reshape saddle nose defects.
RECONSTRUCTIVE SURGEONS OF TWO WORLD WARS: The famous New Zealander Sir Harold Gillies developed many of the techniques of modern plastic surgery in treating soldiers who suffered horrendous facial injuries in the trenches of France during World War 1. His work was expanded during World War II by one of his former students – his cousin Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns during aerial combat. McIndoe’s radical
experimental treatments led to the formation of the RAF’s ‘Guinea Pig Club’ in 1944.
Plastic surgery as a specialty evolved very quickly during the 20th century in the USA. One of the founders of the specialty, Dr Vilray Blair, was the first chief of the Division of Plastic and Reconstructive Surgery at Washington University in St Louis, Missouri. Beginning in 1917, Blair treated soldiers with complex facial injuries and his paper on ‘Reconstructive Surgery of the Face’ set the standard for craniofacial reconstruction. Blair also taught many surgeons who later became leaders in the specialised field of plastic surgery.
TECHNIQUES AND PROCEDURES: Common techniques used in plastic surgery are: incision; excision; microsurgery; chemosurgery; electro surgery; laser surgery; dermabrasion and liposuction. The transfer of skin tissue, known as ‘skin grafting’ is one of the most common procedures. Autografts are skin grafts taken from the recipient, Allografts are skin grafts taken from a donor of the same species, and Xenografts are grafts taken from a donor of a different species.
Usually, good results can be expected from plastic surgery that includes careful planning of incisions so that they fall in the line of natural skin folds or lines; appropriate choice of wound closure; use of the best available suture materials, and the early removal of exposed sutures so that the wound is held closed by buried sutures.
RECONSTRUCTIVE AND COSMETIC SURGERY: Reconstructive plastic surgery is performed to correct functional impairments caused by burns; traumatic injuries, such as facial bone fractures; congenital abnormalities (such as cleft lip or cleft palate); developmental abnormalities; infection or disease, and removal of cancers or tumours, such as a mastectomy. be removed from the body, moved to another site on the body and then reconnected to a blood supply by suturing arteries and veins as small as 1-2 millimetres in diameter.
Aesthetic surgery
The real breadwinner these days however is what is commonly known as ‘cosmetic surgery’. In 2006, nearly eleven million plastic surgeries were performed in the USA alone. And within the USA, it is legal for any doctor, regardless of speciality to perform cosmetic (also known as ‘aesthetic’) surgery; which is defined as procedures to improve appearance rather than dealing with life-threatening injuries.
Among the numerous procedures in this area are Abominoplasty (‘tummy tuck’), which is reshaping and forming the abdomen; Blepharoplasty or ‘eyelid surgery’, which involves reshaping of the eyelids or the application of permanent eyeliner, including Asian Blepharoplasty.
Breast augmentation is commonly known as ‘breast enlargement’ or a ‘boob job’, which often involves saline or silicone gel prosthetics. Also offered are breast reduction or breast lift (Mastopexy), which requires the removal of breast skin as opposed to glandular tissue.
Enhancement of the buttocks can be performed by using silicone implants or fat grafting and transfer from other areas of the body. Reshaping the nose is known as Rhinoplasty, and reshaping of the ears is Otoplasty.
Rhytidectomy is the removal of wrinkles and signs of aging from the face; a procedure much favoured by ageing rich American women from rock star Cher to former first lady Nancy Reagan. Tissue filler injections in this area often require hyaluronic acid, and in their zeal for the elusive elixir of eternal youth these women will pay any price to halt the ageing process. In recent years a growing number of patients seeking cosmetic surgery have visited other countries to find doctors who will perform desired operations at a lower cost than the patients can expect to pay at home. These ‘medical tourists’ seek to find their cost-saving surgery in such places as Argentina, Cuba, India and Thailand and also some areas of Eastern Europe. Unfortunately the risk of complications and after-surgery care are often overlooked by those simply looking for the cheapest option. The most common surgical procedures include breast reconstruction for women; cleft lip and palate surgery; contracture surgery for burn survivors, and also creating a new outer ear when one is congenitally absent. Another common procedure is closing skin and mucosa defects after the removal of tumours in the head and neck region. Plastic surgeons developed the use of microsurgery to transfer tissues for coverage of a defect when no local tissue is available. Tissue flaps of skin, muscle, bone, fat or a combination of these may SEX REASSIGNMENT SURGERY: Sexual identity is probably the most profound characteristic humans have, and it takes place early in life, impacting on a complex set of biological factors. So why do people want to change sex? Probably because they do not feel comfortable with the gender they were awarded at birth, and the vast majority of people in this category want to change from male to female. This dissonance, called ‘gender dysphoria’, is often so pronounced and uncomfortable for them that many individuals experiencing it have a desire to be surgically altered.
Whilst some, known as ‘transvestites’, merely dress as women and ape female looks and behaviour; others yearn to ‘get the snip’ and change their sex completely. Note that here in Thailand; however, no Thai ‘katoey’ or ‘ladyboy’ can legally alter the gender written on his birth certificate. Newspapers in Thailand have also taken to referring to katoeys as ‘women of the third category’. The commonly used terms ‘sex change’ or ‘sex change operation’ are considered factually inaccurate by medical experts in this lucrative area. The preferred terms are ‘Sex Reassignment Surgery’ (SRS) or ‘Gender Reassignment Surgery’ (GRS), whilst medical professionals refer to ‘Feminising Genitoplasty’ or the very rare ‘Masculinising Genitoplasty’.
However, many people in the transgender community find these terms offensive. Implicit in the term ‘reassignment’ is the idea than someone other than the person involved can ‘assign’ or otherwise decide a person’s gender. This is in clear conflict with the concept of ‘gender identity’ that is a person’s internal comfort with their own gender. Others feel that the term ‘sex reassignment surgery’ might be more accurately called ‘genital reassignment surgery’ or ‘gender reconstruction surgery’. It is important to note that the operations related to transgender transition go beyond genitalia, and that the medical procedures go beyond surgery. The earliest identifiable recipient of male to female sex reassignment surgery was Lili Elbe in Berlin, Germany in 1930. Dr Magnus Hirschfeld operated on Elbe, removing his penis. Lili went on to have four more operations, including an unsuccessful uterine transplant, and when this was rejected ‘Ms Elbe’ unfortunately died on the operating table. By the time most adults decide to undergo sex change surgery, they may have lived for many years with dissonant identity. The average age in one study was 29 years. Even then the candidate may not be fully aware of the implications of becoming the other sex. Apart from the surgery, changing gender identity requires unique social, legal and hormonal involvement. Experts recommend the support of a broad range of skilled professionals well versed in gender-identity issues. Ideally, these professionals should include a doctor, surgeon, psychiatrist, psychologist and endocrinologist who all work together to provide the client and family with a comprehensive support network. The entire process is often referred to as ‘sexual transitioning’ as it truly does require a transition over time. Social reassignment, which is often highly recommended before the individual commits to SRS, entails living and working for about two years as if the individual were already a member of the opposite sex.
Hormonal reassignment usually takes place well before SRS. For male-to-female transsexuals, estrogen therapy helps suppress the physical male characteristics and encourages physical female characteristics. Estrogen is the female sex hormone and the client (patient) will take estrogen pills or injections for many months before surgery. Electrolysis of facial and body hair is still necessary, however, as estrogen does not halt hair growth, or raise the voice pitch in the male-to-female transsexual.
The goal of male-to-female SRS is to create female organs that look natural and allow as much sexual arousal as possible. This includes removal of the penile muscle and tissue, the testicles, and reshaping external genitalia to appear female.
Several techniques can be used to create the vagina, but the most favoured and least invasive one is to use the inverted skin of the penis to line the newly created vaginal cavity. An incision is made from the base to the head of the penis, and the skin is peeled away from the shaft while remaining attached to the torso. In many procedures, a portion of the penis head (the glans) with its nerve supply intact is formed into a clitoris. This technique hopefully preserves sexual stimulation and enjoyment. If the penis is long enough, no additional skin grafts will be necessary. If the penis is short, however, a skin graft will be necessary to line the deepest part of the vaginal cavity. This skin may be taken from lower flanks, sides or above the pubic bone. To keep the vagina from closing, a balloon-type device called a vaginal tent is inserted and remains in place for the length of the hospital stay, which averages around six days with complete bed rest. Demerol or morphine is usually given intravenously to ease the pain, and the surgical area is kept packed with ice to decrease swelling and bleeding. Because the entire reconstructive procedure cannot be performed in one operation, many patients choose to have a second operation three months after the first to enhance the cosmetic appearance of the labia and clitoris.
Thailand, with its large community of transsexuals, is well known as the world centre for male-to-female surgery, and many doctors in Bangkok are renowned as being among the world’s leading experts in this area. Prices for this operation usually start at around 100,000 baht. The rarest of sex change operations, however, is from female to male, and perhaps the most famous person in modern sport to undergo this change was the former East German shot putter Heidi Kreiger, who became Mr Heinrich Kreiger after extensive therapy and specialised treatment in the mid 1990’s. In her competitive days, Kreiger took so many steroids that she became known as ‘Hormone Heidi’. But that, as they say, is another story.
Useful Telephone Numbers for Hua Hin
Railway station
032-512 770, 032-511 073
Bus station of Hua Hin
032-511 654, 032-512 543
Bus station of Prachuabkirikhan
032-601 901
Bus station of Pranburi
032-621 443
Hua Hin Hospital
032-520 401
Dog Rescue Center
0-1981 4406
Wild life Rescue Center (Tayang)
032-458 135
Department of Land Cha-am office:
032- 430 846-7
Department of Land Hua Hin office:
032-536 164, 032-512 407
Department of Land Prachuabkirikhan:
032-611 211
Department of Land Pranburi
032-622 199
Local Government (Hua Hin)
032-521 340, 532 471
Local water supply
032-511 677
The Power Board of Hua Hin
032-512 215, 032 513 165
Observer office:
032-531 078
Red Cross.
032-512 567
San Paolo Hospital
032-532 576-85
Polyclinic International
032-516 424, 032-516 425
Shell Cooking Gas
032-511 144, 032- 515 620
The Communication Authority of Thailand
(Hua Hin)
032-511 351
Rotary Club of Hua Hin
0-1916 6637
Meeting every Thursday 8.pm
at Hua Hin Grand Hotel & Plaza
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