The Naked Tourist

by Lawrence Osborne

  The most florid exemplar in contemporary Bangkok is the Sena Hotel, a riot of Greek caryatids, busily embellished pediments, and soaring Neoclassic windows worthy of the Louvre. We passed it, its arches lit up in gold, and it occurred to me that the city has a genius for mishmosh syncretism. Did that make it beautifully adaptable to the inherent vulgarity of tourism?

  Before long, I was making daily trips to Bumungrad Hospital to get my malaria, hepatitis, and dengue fever shots. To be nearer the hospital, I moved to the Conrad Hilton on Wireless Road and made the commute on foot. I would go there even when I didn’t have to.

  I couldn’t help becoming intrigued by the recently changed SRSs wandering around Bumungrad Hospital. They were “tourists” too, in essence. They could even be called the quintessential tourists of our age. They set off looking for a transformation—and boy did they find it. Every afternoon I sat in the Bumrungrad cafés, playing the game of spot-the-sex-change. The SRS unit attached to Bumrungrad is called the Preecha Aesthetic Institute, named for Asia’s most famous plastic surgeon, Dr. Preecha Tiewtranon. Dr. Preecha, as he is popularly known, is also perhaps the world’s most famous SRS surgeon, a legend among transsexuals in the West. Preecha’s teams turn out a veritable production line of SRS patients. A fair number of these walking metamorphoses were to be found amid the recovering transplant patients and liposuction beneficiaries, and they were happy to tell me about their experiences with Dr. Preecha. None had a bad word to say about him. He was “the god” of SRS surgery, a “savior,” a sort of enlightened, kindly surgical Buddha. But he was also a prince of the beauty trade. Dr. Preecha, they said, had the eye. Although I had resolved not to go through the predictable routines of a journalistic interview with anyone, I decided to make an exception for Dr. Preecha. In a strange way, I was sure he would provide a critical insight into the inner workings of the Bangkok tourist machine.

  The Web site of the Preecha Aesthetic Institute (PAI) offers a variety of package holidays to Westerners who wish to change their sex discreetly for an all-inclusive price. Package 1 shows a girl in a bright yellow bikini leaning against a New England beach fence and offers free round-trip airport pickups, five nights in one of the institute’s private rooms, all surgeries and supplies, pre- and postop care, and doctors’ fees. Price: $9,260. This includes Penile Skin Inversion or Vaginoplasty, Breast Augmentation or Augmentation Mammoplasty, and Adam’s Apple Contouring. In Package 2, you pay $12,200 for all this plus a Full Face-Lift. If you dispense with the face-lift and the Adam’s Apple Contouring in Package 3, the price drops to $8,700. And so on.

  The PAI is airy and white, with ceramic bowls in niches and signs that read CHECK UP, GOLDEN AGE, PRE-MENOPAUSE, 2,950 BAHT. A Chinese girl with a kind of face splint walked around as if in shell shock. In the Counselor Room, a flat white table held a picture of a bowl of cherries and a cartoon of Dr. Preecha performing tai chi (or was it disco dancing?). Other pictures of dilators completed the minimalist decor, along with a wall of Chinese monkey paintings. A glowing article about the doctor was proudly displayed—from Pink Ink, presumably a gay paper.

  In came Dr. Preecha, wearing a pair of black slippers. He must have been about sixty, bubbling with merry self-importance. Another cartoon showed him as the “Godfather of Cosmetic Surgery.”

  “That’s me,” he said, shaking his head as if disbelieving something.

  Bangkok, Preecha maintained, was the best place in the world for cosmetic surgery. Brazil was still good, he admitted, but more expensive than Thailand. In Thailand, it was actually promoted by the government. They wanted the country to be the tourist surgery capital of the world. And medical tourism was booming: look at South Africa, which was pioneering so-called Sun and Surgery packages. Companies there offered a weeklong safari in which a surgical operation was embedded, as it were, painlessly. But Thailand was still cheaper and had just as much sun. “And other things, too.” He winked. The problem these days was rising expectations. People wanted to be perfect, especially when it came to sex reassignment. Dr. Preecha’s face darkened.

  “They say they want eight-inch dick. No, no, I say, not possible. Yes, dicks! Not possible you have eight inch. More-over”—he guffawed and made a motion like smoking, though there was no cigarette—“if you have poor circulation, flap inside vagina will be problematic.”

  Looking up, I now saw a hitherto unnoticed painting showing a Thai general whispering into the ear of an old lady. Dr. Preecha’s cell phone then rang: a newly arrived farang patient calling from the airport.

  “Yes, yes. It’s hot, isn’t it? Just get a taxi … no, they won’t rob you. No, no. They won’t rob you. That’s right. All right. See you.”

  He turned to me with a shrug. “A sex-change patient. Man to woman. He’s a little nervous.”

  Who wouldn’t be?

  “And yet,” he said, “it’s a relatively simple operation. The appearance is not the problem. It’s the insides that are tricky. Almost all the Europeans and Americans are male to female. The Japanese and Chinese are female to male. There are more complications, so we like them to be in the region, you see.”

  “So all your patients from the West are men?”

  “Exactly. And out of three thousand sex-change patients, only one ever changed his mind. Before, I mean.”

  He laughed like a general, like the general in the picture.

  “We’re doing forty-five a week now. Mostly from Iran. Yes, the Muslim countries are big customers. The Iranians fill condoms with cash and stick them up their ass. That’s how they smuggle the money out to pay for it. Actually, if they go back as a ‘miss’ it’s okay with the Iranian authorities. But our biggest potential market is China. There are five hundred thousand people in China who want to change their sex. Amazing, no? We already have a thousand lined up. We’re actually opening a clinic in Shanghai soon.”

  The optimistic doctor calculates that worldwide one in every sixteen thousand men wants to be a woman. The math is inexorable: Thailand could be making a lot of money in the years to come.

  “They are not gays,” he went on, raising his voice a little. “One out of thirty thousand women wants to be a man, too. So it adds up to a potentially huge global industry. Three percent of six billion!”

  He then looked me over, wondering probably what I was doing here and what he could do for me.

  “Not here for a breast implant? That’s our most popular business. Breasts. And face-lifts.”

  “Well, I was thinking about my skin—”

  He put on his glasses and peered at my pores for a few moments.

  “Yes. But not a face-lift. Not yet.” He laughed hoarsely. “Even though we do a good price: thirty-five hundred dollars. It’s fifteen thousand in the States. We do the breasts for twenty-five hundred. Ten thousand dollars where you come from.”

  I shrugged impotently.

  “America is so expensive.” He sighed. “It’s ridiculous. Wholly unnecessary. The European health system is so much better than the American. They treat people as patients, not as numbers. The American billing system is so corrupt. People have thirty things on their bill they can’t even read.”

  But wasn’t that driving Americans into his arms?

  “I am not complaining. And obesity is a huge growth sector. The fatter Americans are, the better for us. Liposuction is exploding.” He rapped the table with a kind of military glee. “Exploding!”

  Was it true, I asked, that Thais were unusually tolerant of human foibles, of sexual eccentricities in particular, and therefore of aesthetic obsessions?

  “Oh, yes. Buddhists make good cosmetic surgeons. We’re compassionate pragmatists.”

  One of the strangest aspects of Preecha’s art is the way it is changing the human face. Asians typically want Caucasian eyes and noses, so after Preecha has provided these for them, they possess faces unlike any seen hitherto. A new kind of human face. And a new kind of body, too. Male fat, he said, is fibrous and difficult to suck out, but female hormones m
ake female fat soft and easily extractable. A new kind of female body was therefore emerging in the twenty-first century—a body with novel contours and textures.

  But perhaps I had come to the wrong place, he suggested. For as I now confessed, it was more my internal health that was preoccupying me; my mental health, too—and I explained the trip upon which I was embarked. Papua meant nothing to him, however, until I explained that it was part of Indonesia.

  “Ah, primitive.” He sighed. But I would probably lose a lot of weight. A jungle trip would be like an extreme spa.

  “I would rather lose the weight first,” I said.

  Dr. Preecha rose, and I rose with him. We began to walk briskly through the dazzling white clinic.

  “Have you considered going to a place like Chiva-Som? It’s expensive, but it’s still a quarter of what you’d pay in the West. It’s a scientific nutrition spa in Hua Hin, just down the coast. I would imagine it would be excellent preparation for your ordeal. It will get you used to a fat-free diet, rigorous exercise, healthy thoughts—”

  “Healthy thoughts?”

  I must have pulled a face, for he shrugged in agreement.

  I’d never heard of Chiva-Som, no doubt because I had never considered going to a spa. But now, I reflected, I had a bona fide reason. I wanted to get fitter, leaner, stronger. More jungle-ready.

  “It’s in Hua Hin, on the coast three hours from Bangkok. I believe your Liz Hurley goes there.”

  Many cosmetic patients went there, in fact, to recover from their wounds—physical, psychological, or both.

  We had now come upon a Japanese girl with fluffy cotton buds stuck to her eyelids. She peered at us like a wounded seal with paralyzed eyelids.

  “How are your eyes, Miss Chieko?”

  “Me pain.”

  Dr. Preecha turned to me proudly.

  “Another Asian eye patient. They all want eyes like yours.” He laughed, I thought, rather pointedly. My own was still puffy and the good doctor had shot it a quick glance. “Miss Chieko, we can take those plasters off tomorrow.”

  She bowed and tried to smile. Tomorrow she would wake up with Caucasian eyes.

  Once resolved to try Chiva-Som, I had to conserve money by leaving the pampered milieu of the luxury hotel. Bangkok abounds in “four-star” places that cost $30 a night instead of $200, and so the economy was nothing if not eminently feasible. But the cramped family hotels along Sukhumvit were not my scene, for there always seem to be pointless arguments at reception between harassed daughters of the owners and irate cheapskate tourists from Portugal or Israel haggling over their local phone charges. There is much shaking of pieces of paper, broken English attempting a suave put-down, and superb stares of contempt from the gorgeous Thai girls, who make it known that they know what a barbarian looks like. I prefer the large, anonymous fake-luxury piles constructed around the world in the 1970s when the Soviet Union was still admired. One such place is the Grace on Soi 3, a place that has the added advantage of being a notorious knocking shop for Bangkok’s indigent Middle Eastern gentlemen, who shack up there for weeks on end as they try to assuage the desires that their own cultures so spectacularly fail to sate. When you mention the Grace, Thais politely snicker and roll their eyes, a gesture that—miraculously—implies no disapproval whatsoever. The Grace’s advantages are also that, with hundreds of cheap rooms, there is no need to book ahead or even phone. All comers are accommodated with perfect anonymous indifference.

  The Grace’s driveway rises in a curve to a busy series of glass doors thronged with Middle Eastern men talking on cell phones. Inside, the Grace is not just a hotel: it is an erotic installation. In a twenty-four-hour coffee shop, the Arab men sit with their teas and cakes watching plump Thai girls trawling through a lobby fitted with long leather sofas. At the end of this same lobby, an oud orchestra plays from eleven p.m. to five a.m. to an Arabian Nights club.

  With my new teeth, intestines, skin, and psyche, I was robust enough to endure three nights here to make a grand saving of some $300 or so—enough at least for a night at Chiva-Som at the discounted press rate. There are no frills at the Grace, and none are expected. Surly mama sans patrol the landings, where an incredible number of girls come and go—laughter in the night—and the men seem docile, satisfied, and meekly bashful as they cram together in the tiny elevators. Downstairs, the Arabian Nights was in full swing all night. The walls were lined with yellowed murals of Bernini’s Rome. I ordered a cocktail called Knockout. It tasted of anise and, in due course, it knocked me out. As I sipped at it, the orchestra played its Egyptian classics and a beautiful Arab girl pranced around the stage in a blond wig. The Arab men isolated in this high-tech Buddhist city clapped along. Two old men in velvet hats tried clumsily to pick up a pair of young Thais, with much head cocking and bashful smiles, and by the pool tables outside the trade came and went at lightning speed. A stairwell descended from the lobby to a twenty-four-hour Turkish bath from which wisps of steam rose like the fumes of a soft but indisputably pornographic inferno.

  THE SPA

  Hua Hin lies three hours southwest of Bangkok on the Gulf of Thailand. In the 1920s it was a popular bathing spot for the Thai aristocracy, and the royal family built a summer home here, bringing much of the Bangkok hoi oligoi with them. Rama VII still passes much of his time here, sleeping it is rumored by day and working by night. Today, it’s a tourist mecca far less known than Phuket or Ko Samui but dominated by the same factors: an international leisure class, a rich spa health sector, towering Hiltons, and girlie bars. Wealthy Thais dominate the last two; foreigners flock to the spas. The beach is flat and ethereal; inland, innumerable square windmills spin over miles of paddies. Patronized by the royals, the town affects an indifference to formality that reveals, paradoxically, a deep love of formality. There are few farangs buying sea snails in the night market, but the Thai families in shorts eating squid on the wooden piers have chauffeured Mercedeses waiting for them. Along the beaches, immense American and European resorts sport flaming braziers, tai chi pavilions, and outdoor yoga platforms set among frangipani trees.

  Chiva-Som began as a private medical retreat and beach home for the former deputy prime minister, Booncha Rojanestien. Inspired by Champney’s spa in Hertfordshire, to which he was a frequent visitor, Rojanestien tore down his summer home and erected this serene replica of a Buddhist monastery. In 1996, it was opened to the public, which is to say to rich Thais. Western celebrities soon followed. Chiva-Som offers a kind of holistic purification based on water treatments and a restaurant serving food designed by a nutritionist: no salt, no sugar, and no oil. In other words, you go there to lose weight.

  As befits Thailand’s preeminent spa, Chiva is gated, with heavy security. Hua Hin itself is assiduously screened out. Each guest has a detached Thai-style chalet with pointed gables. In the lobby, a small Buddha presides over a rectangular pool dotted with lotus blooms. The word “spa” is an acronym derived from the Latin salus per aqua, “health through water,” which Roman legionaries believed could cure wounds. (A fourteenth-century town in Belgium later took the name Spa to advertise its water cures.) Chiva-Som decided to go back to the spa’s roots in water.

  At the resort’s heart lies a thalassotherapy center, made of pools, pebbled tunnels, and splashing fountains. Underwater shiatsu is a popular treatment; they call it Watsu. One could call it Ayurvedic Lite with a dash of Switzerland.

  The “spa and resort concept,” as it’s known, has been adopted by most of the hotel brands, from Sofitel and Hilton to Anantara and Marriott, and it acknowledges that tourists are driven as much by the pursuit of personal beauty as by curiosity about other cultures. Virtually every luxury hotel now contains a branded spa on the premises. Indeed, the spa is now a cornerstone of global travel, with a galaxy of brands that merge effortlessly with other brands, whether hotels, cruise lines, or resorts.

  The largest supplier of spas worldwide is Steiner Leisure, a British company that started out as a Victorian phar
macy, became a hairdressing salon, and then made its name in the 1960s designing the first seaborne spas for Cunard Line cruise ships. Steiner owns two spa lines, Mandara and Elemis: the first is an Asian spa line that can now be found inside Marriott hotels and on Carnival cruise ships; the latter is a range of beauty products that Steiner manufactures for its own outlets. At the same time, Steiner also operates three beautician campuses in the United States, including the Florida College of Natural Health and the Virginia Massage School, which train technicians to fill “beauty positions” in Steiner companies. Thus, the spa business has its own synergies: campuses, factories, skin care lines, hair products, and spa facilities are all part of a single manufacturing system. The spa itself is not a spiritual retreat, as it pretends to be; it’s a self-contained corporate brand coolly aimed at maximizing its profits from what could be called the anxiety of health and beauty. The soothing wave sounds that flow from the company’s Web site and the Eastern lore (Mandara Gili, it says, was a sacred mountain that promised eternal life) are wrapping that easily separates form from substance. Steiner posted profits of $341 million in 2004 from 50-odd land spas and 118 cruise ships. Its share performance on NASDAQ is stellar.

  In her article “What Fast Food Taught Me about Spa Management,” American spa expert and consultant Melinda M. Minton compares the modern spa to food franchises like McDonald’s or Bennigan’s, made cost-efficient by relentless employee brainwashing and marketing rhetorics. For the luxury medical spa, for example, the problem is how to verbally repackage a humble facial. “If you are a clinical spa,” Minton suggests, “why not go for a living cell therapy hydration under the multi layer masquing?” Industry seers now say that the future lies with “medical spas,” which are increasingly being designed with input from resident doctors. And as spas and medicine fuse, spa marketers will make their language more and more “medical” and biological. Having a massage and a facial will be made to sound like having some kind of complex (but enjoyable) beauty surgery. Then there is the sensual displacement of the spa, its odd similarity to a voyage of some kind. “Offer a temporarily thatched floor. Allow your client to be in Thailand for ninety minutes. Charge them handsomely for their excursion.”