Cosmetic Surgery in China

Last week my wife and I were having dinner with two good friends of ours, Dr. Charles Pappas and his lovely wife Aprille. Charlie is a retired surgeon extraordinaire who was one of the best on the planet for cosmetic surgery. During dinner I started talking, as I often do, about China. At this point I usually find that people want to either hear about China or they don’t. If they don’t, my beautiful wife Kerry will usually give me a gentle nudge in the ribs – nothing broken. Charlie, however, can’t seem to get enough information on China. Therefore, with my ribs intact, we started talking about cosmetic surgery in the most populous country in the world.

China first threw open its doors, and started trading with the outside world, in 1978. Prior to that time cosmetic surgery was considered bourgeois, and was only allowed to correct physical deformities. However, in the mid-1980s elective cosmetic surgery emerged in China and its popularity accelerated with China’s growing economy and affluence. The earliest procedures were usually focused, according to Rachael Wolff of The World of Chinese, on removal of moles, freckles, smoothing of the skin and skin whitening. Since that time cosmetic surgical procedures in China have grown and are now generally comparable with the types of procedures offered in the West.

Cosmetic surgery in China is a $4.8 billion industry, with over 3.4 million cosmetic surgery procedures performed yearly, and growing at 20% per year according to China’s official Xinhua News Agency. Moreover, there are an estimated 34,000 cosmetic surgery institutions in China, ranging from hospitals and clinics, to beauty salons that offer various types of cosmetic surgery. In fact cosmetic surgery in China is becoming so popular that China currently ranks third, behind the United States and Brazil, in the number of plastic surgeries performed annually.

Chinese women want to look beautiful and they also want to look more westernized. They like the way Western women look. It’s distinctive and individualistic. They especially like a Westerner’s nose, eyes, and jaw. Not surprisingly, these are the three of the most popular cosmetic surgeries in China. Asian blepharoplasty takes the Asian “mono-lid” and makes it the “double-lid” look of most foreigners. Making one’s eyes look bigger and rounder, as one Chinese women puts it, is more attractive as bigger eyes make you look more awake, more beautiful. Cosmetic nose surgery is the second most popular cosmetic surgery and will take the flat Asian nose and make it pointier and more three-dimensional. Jawline surgery is the third most popular cosmetic procedure and will provide for a narrower and more angled jaw.

White skin has always been a big deal in Asia. In the West, we feel someone looks good when they have a tan. They look healthy and, many times, younger. In China, however, the opposite is true. White skin is a sign of beauty. That’s why you frequently see Chinese women holding umbrellas, or wearing hats or scarfs on a sunny day. They don’t want to tan. Look at any Chinese model in print, on billboards, or in a movie. They appear pale by Western standards. Therefore, many women will try to whiten their skin by either using cosmetics or chemical substances to lighten their skin tone. Li Yanbing, vice-secretary general of the Chamber of Beauty Culture and Cosmetics of the All-China Federation of Industry and Commerce reflects that skin whitening has a long history in Asia, stemming back to ancient China and the saying that one white covers up one hundred ugliness. This obsession has not faded over time.

Today you can, according to Jeffrey Hays of Facts and Details, go to the No. 9 People’s Hospital in Shanghai and get a breast implant for $2,500 or a double fold operation for $360. Other procedures such as liposuction and facelifts are also performed.

 Most of those who elect to have cosmetic surgery are women in their 20s, and a third are between 30 and 40. The most common reasons given for plastic surgery are:  job, boyfriend, and self-image. Cosmetic surgery is also considered a status symbol among Chinese women as it demonstrates one’s wealth by showing that that they have the money to pay for such a procedure. About 90% of those who seek plastic surgery are women.

Although men only make up 10% of the cosmetic surgery market, the number of men electing cosmetic surgery in the last five years has doubled. Most are middle-aged men who are job-seekers and who want to appear younger and in better physical condition. Many elect to have breast implants to make them look more muscular, although physical exercise will accomplish the same thing. The implants are differently shaped and harder than a women’s, but otherwise the procedure is similar to a female breast implant and costs approximately $1,200.

As China’s enthusiasm for cosmetic surgery grows, it also attracts unqualified entrants. In July 2006 the Chinese government banned television and radio advertising for cosmetic procedures because of the exaggerated results that many promised. As Keith B. Richburg from the Washington Post reports, with this growing obsession for plastic surgery there have been more and more unlicensed, unskilled, and unscrupulous practitioners entering what’s largely an unregulated industry. Government-run hospitals provide the highest level of care with an experienced medical staff. At the other end of the spectrum there are black hospitals, as the Chinese term them, and unregulated private facilities that perform cosmetic surgery out of the public eye. In addition, not all hospitals and clinics meet government standards. According to the New York Times, out of 11 clinics and hospitals inspected offering cosmetic or plastic surgery, less than half met national standards.

One of these private facilities may be a beauty salon. It’s not uncommon for a beauty parlor to offer cheap cosmetic procedures, performed by doctors who they summon on short notice, known asfiremen. The firemen perform quite a number of cosmetic procedures including Botox injections and eye surgery. Not only is the beauty parlor a cheap alternative to hospitals and clinics, but it also offers almost instant gratification as doctors can be summoned on a moment’s notice to perform procedures. The beauty parlor will normally get the doctor on the phone and have him rush over to perform the procedure thereby giving them the moniker of firemen. In a survey of 24 beauty salons performed by the New York Times, 15 indicated they do either double-eyelid surgery or Botox injections or both, along with manicures, pedicures, and facials.

Cosmetic surgery has also resulted in a $120,000 settlement that a husband received from his wife in a divorce proceeding. In this case the wife had cosmetic surgery to alter her appearance prior to marrying. When the couple had a baby, the baby, according to the husband, was “amazingly ugly”. The man received the settlement for “lost opportunities” in the divorce proceedings.

Cosmetic procedures on Chinese are not only performed in China, but are frequently performed in neighboring Korea where an estimated 30% of cosmetic surgery patients in Seoul is made up of Chinese who seek Korea’s higher medical standards and more experienced staff.

Alan Refkin

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