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Changing Patients' Sexes, and Korean Mores
By Howard W. French
New York Times
June 21, 2003
PUSAN, South Korea - There are precious few hints of the social revolutionary about Kim Seok Kwan, the 52-year-old doctor who single-handedly brought sex-change surgery to this deeply conservative country.
Indeed, first impressions of this medical pioneer, a man who seems to hide shyly behind his oversize, gold-framed eyeglasses, tend to be marked by his self-deprecation. In occasional blasts of comic relief, the mild doctor also reveals a flash of goofy, off-color humor, and an Austin Powers grin to match.
But there is no gainsaying Dr. Kim's audacity in introducing sex-change operations here in 1986, nor do many South Koreans dispute the impact his surgery has had on a society where even quite recently, sexual matters were mostly whispered about, and where few dared live openly as homosexuals.
That all began to change with the emergence as a superstar of Ha Ri Su, a slinky, silky-haired singer, actor, comedienne and model, armed with a 35-24-35 figure, who is now a fixture in the Korean entertainment firmament. Miss Ha, whose adopted stage name is a play on the English phrase Hot Issue, lived most of her 28 years, unhappily, as a man, until Dr. Kim transformed her into a ravishing transgender beauty three years ago.
"Ha Ri Su was of great benefit to social awareness of this issue," Dr. Kim says, with customary humility. "I had no idea who she was, nor how important her example would become. She has encouraged other transgender patients, who have always had trouble holding jobs; for most of them, living in secret, working in bars or as prostitutes was the only thing they could do." Nowadays these people can live regular lives, as teachers, office workers or students.
Dr. Kim, who grew up in an upper-middle-class family in the Gyungsang region, near Pusan, is a plastic surgeon whose training was in facial and cranial operations. He got his start in sex-change surgery almost by accident, and for years performed the operations largely in obscurity, with awareness of his special skills with a scalpel spreading mostly by word of mouth among transvestites.
"In 1986, a male transvestite approached me and asked me if I could perform a sex-change operation," Dr. Kim said, speaking in his white surgeon's coat in a narrow office at Donga University Hospital, lined with thick professional tomes bearing titles like "The Annals of Plastic Surgery." "At that time, nobody knew anything about this sort of thing in Korea, and I told him I couldn't help him."
A couple of months later, the doctor said, another man approached him asking for a sex change. With that, Dr. Kim said he became intrigued enough to start reading up on the subject. Within a short time, Dr. Kim called the patient back and said he would operate. The surgery was a first for Korea. Not only that, but Dr. Kim also rejected the use of skin grafts for vaginal construction, which was the standard at the time, boldly adopting for the first time, instead, a technique from vaginal cancer surgery known as the Singapore flap.
Although the operation's success exceeded expectations, soon afterward Dr. Kim went to the University of California at Davis for a year to study more about sex change surgery. When he returned, he found a long list of candidates desperate for the operation.
Word of the operation spread fast among South Korea's transvestites, but the country's tradition-bound medical community was anything but amused. Senior doctors and other colleagues approached Dr. Kim privately, questioning the appropriateness of his work. "They all asked, `Is this something doctors should be getting into?' " he said. Others whispered insults behind his back.
More troubling to him, Dr. Kim said, were the opposition of his wife and pastor, both of whom were strongly opposed to his involvement with sex-change surgery. "My minister came and said to me bluntly, `I wish you would not do this,' " the doctor said.
"I questioned the religious aspects of this operation," he said, "whether it was right to change the gender of a patient, whether it was right to alter their most essential nature. I really hesitated."
In the end, Dr. Kim said what persuaded him to work with transgender patients was the urge to heal and comfort that drives nearly every other realm of medicine. "What almost no one appreciated was how much trouble I myself had accepting this kind of work," he said. "But gender surgery is performed to rescue people who are trapped in the wrong body. We are offering the possibility for normal lives to people whose minds and bodies don't match, and even the psychiatrists I consulted told me that this is their only hope."
For the first few years of performing gender change surgery, Dr. Kim said, his patients were overwhelmingly working class or poor, and few could afford to travel abroad for the operation. Even now, Dr. Kim keeps the price of his operations to $8,000 on average. He maintains a lucrative practice in more traditional forms of plastic surgery.
The first glimmers of celebrity came to Dr. Kim in 1991, with his first female-to-male surgery, which he also pioneered here. That operation caught the attention of the nation's news media, and Dr. Kim saw his face emblazoned under screaming newspaper headlines. He briefly became a popular guest on, or topic of, television programs.
The brouhaha eventually died down, but by the time it did, something had changed in Korean society. A taboo had been lifted, and sexual mores were suddenly being discussed much more openly in the media and portrayed with more realism in film.
Nowadays, several other doctors perform sex-change surgery in South Korea, and a bill before the South Korean Parliament would legally recognize the new gender of patients who have undergone the operation. "Even my minister has come to understand the need for the surgery," said Dr. Kim, who described himself as a devoted Presbyterian. "In fact, I've had other ministers and clergy approach me for the operation."
If few criticize his surgery today on moral grounds, or even out of prudery, some still object that sex-change operations here are the ultimate expression of a plastic surgery culture in South Korea that has run amok. By most estimates, South Koreans go under the knife for cosmetic alterations more than anyone else in Asia, with everything from eye and nose operations aimed at achieving a more Western look, to breast augmentations and calf remodeling among the most popular types of surgery.
Dr. Kim brushes off such complaints, just as he hesitates to take credit for the social changes set off by his operations. "These operations are a difficult form of surgery, and can last as long as 12 hours," he said. "Other than that, there is nothing particular to be proud of. Yes, perhaps South Korea has changed, but what gratifies me is knowing that a lot of people can live happier lives now."