Plastic surgery has been around for decades in the West, but it has only came to Russia in the past 10 years when private medical practices were first granted official approval. Cosmetic surgery had no place in Soviet medicine as it was viewed as a self-indulgent practice catering to the whims of the idle rich.

But cosmetic surgery has found a place in the Russian market with the development of privatized medicine. The days of stainless steel teeth are over. Private dental clinics first opened in the early 1990s and now dental surgery is readily available to the hordes of New Russians eager for Hollywood smiles.

But dental work is just the beginning. With the dozens of products and beauty magazines that have bombarded the market has come the impetus to "fix" everything. The wives and girlfriends of New Russians now want their whole bodies Westernized.

But not as many wealthy Russians have turned to Western clinics as would have been expected. Going under the knife is never a pleasant experience, and the language barrier, fear of the unknown and general lack of information have kept Russians away.

Instead, the thousands of potential patients are boosting the domestic market. Today, while the Russian health system barely limps along, cosmetic surgery is a thriving and immensely profitable business.

The beauty industry competes with dentistry to be the most promoted branch of medicine, and advertisements for cosmetic surgery pepper women's magazines.

On the surface, few differences are apparent between the Western and domestic clinics. Russian clinics offer the same range of services as their Western counterparts, and at much the same prices. And inside the clinics, the decor and smiling staff resemble western clinics.

But there the similarities end. Selecting a clinic at random can be a risky undertaking.

Advertisements mabye misleading, and a host of clinics promise maximum effects in minimum time at reasonable costs. Doctors are quick to make offers and promises, and it can be difficult to verify a clinic's reliability. Ultimately, much depends on trust or good recommendations.

The first cosmetic surgery clinic, now the Moscow Plastic Surgery and Cosmetology Institute, was established in the Soviet Union in the 1930s, but there have never been any uniform training programs, formal qualifications or exams. Russian medical schools have never offered plastic surgery as a specialization.

As a result, plastic surgery training has been left largely up to the individual. Some surgeons learned their skills from talented self-taught pioneers, most of who originally specialized in vascular surgery. Some hand over their life savings to be trained in the West. And others believe their general medical and surgical training is sufficient.

It is legal for doctors who are not specially trained to work as plastic surgeons. All they need to open a clinic is a private medical practice license issued by the City Health Department. The rest is just a matter of renting an office and wooing customers. These doctors are of the belief that they can hone their skills on the job.

Rough and ready surgeons are common in Russia, where beauty treatments promise such juicy profits. Moscow alone is home to over a hundred cosmetic surgeons, according to the Russian Plastic, Reconstructive and Aesthetic Surgeons' Society.

The Society is not a professional organization - plastic surgery is still not formally recognized as a specialization - but a voluntary public association. It is therefore not entitled to issue licenses. All the Society can do is issue a certificate stating that a doctor has experience in plastic surgery and that his skills have been recognized by fellow, mostly self-taught, specialists.

The lack of formal qualifications, training, and reliable equipment and instruments has not deterred hundreds of Russian women from running to Russian clinics in their quests to stop the ravages of time.

About 10 percent to 15 percent of customers are show-business personalities or high-paid prostitutes seeking to improve their physical appearance, which they view as the main tool of their trade.

These patients usually come prepared with whole transformation agendas that will turn them into Barbie dolls or Marilyn Monroe look-a-likes. They involve nose jobs, liposuction, face-lifts, and silicon breast implants. Of course, not all of these operations can be performed at the same time, and it takes several months before the entire transformation is complete.

The remaining clients are mostly well-to-do citizens who are not fully satisfied with their appearances. The new-life style inspired by growing incomes encourages better nutrition standards. But unlike successful Europeans who stick to balanced diets, New Russians still have feasts akin to those of the Late Roman Empire. It is no wonder that liposuction is the most requested service for this customer group.

Requests for minor face-rejuvenation operations rank second. Eye-lid lifts, surface peels, wrinkle smoothing with cosmetic gel, and collagen or hyaluronidase injections are all quite popular.

Breast surgery is the third most desired, which brings us to the painful issue of cosmetic gel abuse in Russian plastic surgery.

IPRAS restricts its Western member-surgeons from using cosmetic gel for anything other than wrinkle smoothing or lip enlargements. Most breast enlargement operations performed in the West therefore use coated silicon implants.

As these regulations have no authority in Russia, each year about 1,000 Russian women have their breasts enlarged with cosmetic gel. The consequences are horrifying. The non-coated gel breaks down and starts spreading a few months after the operation, causing breasts to become deformed and hardened.

Nine out of every 10 gel-implanted customers end having to have the gel surgical removed, and sometimes mammal gland ablation is necessary as well.

And only some of the victims are lucky enough to have the damage corrected by a true expert surgeon. Others assume the result of their surgery is due to unforeseen complications or an unfortunate accident, and they remain disfigured, trapped by their ignorance.

There has been much speculation and rumors have circulated that plastic surgery has a criminal background. Gossip has it that many cosmetic clinics operate as screens for their real business, which is to make wanted criminals unrecognizable.

This myth was popular in the early 1990s and spread absurd stories of Russian plastic surgeons transplanting Russian gangsters' toes to replace their fingers, thus altering their fingerprints.

But there are hardly enough gangsters in need of identity-changes in Russia to provide enough work for the top-rated plastic surgeons. Surgeons claim members of the Russian mafia prefer to change their appearances abroad, where they benefit from complete anonymity and quality guarantees.