n China today, cosmetic surgeons can change
a face beyond recognition - and the police
are going to have to take notice," a
highly qualified Shanghai plastic surgeon
told Asia Times Online. Before long, he expects,
anyone who wants to significantly alter his
or her appearance will first have to register
with the police, lest wanted criminals evade
capture by gaining a new face through surgery.
In ever-increasing numbers, well-off Chinese
are going under the plastic surgeon's knife
- although more often for vanity and as an
investment in themselves than for criminal
evasion. But as this unevenly regulated market
expands at breakneck speed, some analysts
have suggested that some of the time the
real crooks may actually be the guys in the
white coats.
For many years, Chinese officialdom forbade
cosmetic surgery, seeing it as "bourgeois
vanity". Only 20 years ago, plastic
surgery expertise was restricted to a small
number of doctors specializing in post-accident
repair work. Two decades later, this bourgeois
vanity now represents one of the fastest
growing industries in the country - according
to figures released by the government, at
present the Chinese spend US$2.4 billion
a year on cosmetic surgery, with an estimated
1 million operations performed a year.
Doctors in the busiest public hospitals reportedly
perform 50 operations a day. Meanwhile, government
figures reveal 10,000 licensed private clinics
nationwide - and even this takes no account
of the many operations taking place in unlicensed
venues like beauty salons. These private
surgeries advertise on television, in newspapers
and in the back of taxis; improbable before
and after shots scowl and smolder from street-side
billboards. Over the last two years the popular
media have provided enthusiastic coverage
of the "man-made beauty" phenomenon,
where carefully selected women (and a small
number of men) in cities across the country
have received extensive cosmetic surgery
free of charge, in exchange for promoting
a particular surgery in return.
Chinese interest in cosmetic surgery echoes
attitudes in neighboring East Asian countries.
Encouraged by gaudy promotional TV shows
such as Beauty Coliseum, the Japanese spend
some 2 trillion yen ($18.7 billion) on cosmetic
surgery each year, according to ND Lease
and Service, a Tokyo-based consulting company.
And Seoul is now home to over 2,000 private
clinics, with surveys suggesting that at
least 50% of Korean women in their twenties
have bought some form of plastic surgery
- an estimate some call conservative.
Despite a late start, however, China may
prove to be the most lucrative market of
all - and with Korean surgeons facing a saturated
market at home, many are now looking to China
for future expansion. Certainly there are
social and economic factors which suggest
that, in the former home of footbinding,
the cosmetic industry is a good bet.
Wherever you are in the world, the good-looking,
thin and tall can expect to earn more than
their dowdy, plump or short colleagues -
and this in developed countries, often in
spite of strict anti-discrimination laws.
In China, where employers can freely specify
desired appearance in job interviews, the
relationship between looks and earnings is,
in certain fields at least, even more obvious.
The key expression pinmao duanzhuang, translating
as "appropriate appearance", appears
again and again as a key requirement for
jobs involving contact with customers. In
contrast, the Japanese equivalent youshi
tanrei has been illegal for many years.
And, of course, a pretty face is not only
marketable in the boardroom. Traditional
ideas of husband as the provider survive
in modern China - and in a country where
only a fraction of the population have access
to university education and the opportunities
it brings, many girls clearly see a pretty
face as a means to acquire a rich, maybe
older husband (or patron). At the same time,
as elsewhere, a rapidly expanding and competitive
media provides an increasingly receptive
audience with the basic message that youth
and good looks are central to fulfillment
and self-esteem.
Some domestic critics have expressed shock,
both at the breadth of interest in cosmetic
surgery and also, as they see it, the depths
to which the privately owned clinics and
their media collaborators are willing to
stoop. The "man-made beauty" phenomenon
has attracted particular attention, with
newspaper columnists questioning the underlying
morality of the motley sequence of (perhaps
rigged) beauty contests and unlikely celebrities
like Hao LuLu and Zhang Di (supposedly once
"the ugliest girl in Shanghai")
enjoying their 15 minutes of silicone-heavy
fame.
Professor Zhou Xun, a sociologist at Beijing's
Renmin University, has been an outspoken
critic, explicitly likening contemporary
plastic surgery with the footbinding of yore
- a particularly potent criticism in view
of the propaganda value which the Party attaches
to its (substantial) success raising the
status of women in the Middle Kingdom. "The
way our society gawps at beauty today has
become a huge problem," Prof Zhou says.
"The reality is these people don't work
hard or live plainly, and their behavior
is neither modest nor moderate [a reference
to the 'two musts' set out by Premier Wen
Jiabao]. The media today talks endlessly
about beauty contests and plastic surgery
- all of which is invisibly but violently
increasing the divide between rich and poor."
Some clash with party values is no doubt
inevitable - but not all analysts agree that
Chinese enthusiasm for cosmetic surgery has
become a social problem. Chen Huinan - a
trained sociologist herself - is a journalist
at Shanghai's respected Oriental Morning
Post, for whom she has written extensively
about the man-made beauty phenomenon. "I
don't think we can call it a social problem,"
she tells Asia Times Online. "In the
West, some women take extreme measures to
lose weight - and wasn't Michael Jackson
the first man-made beauty? In China also
these people are a minority."
Rather, she believes, the phenomenon tells
us more about the increasing commercialization
of the Chinese media and the way it has intersected
with the ambitions of a rampant beauty industry.
"The 'man-made beauty' phenomenon is
largely a media event. I would say, though,
that we need tighter regulation of the cosmetic
surgery industry. The media coverage of,
for example, Zhang Di's transformation puts
ideas in girls' heads - when, really, cosmetic
surgery is something you need to think about
very carefully. The coverage doesn't always
bring that out sufficiently."
Many surgeons agree that the industry requires
tighter regulation. Dr Zhang Wei is the owner
of Shanghai Kinway, a well-known private
clinic located within the (publicly owned)
Xuhui Central Hospital on the city's fashionable
Huai Hai Road; he is also the presenter of
a weekly show on Shanghai Educational Television,
introducing aspects of cosmetic surgery to
the public. "Only 1% of doctors in this
field actually have PhDs," he told Asia
Times Online. [Ed: medical education in China
differs from the West. Most physicians have
only a five-year Bachelor of Medicine degree,
after which they must pass an exam in order
to practice. A minority obtain master's or
PhD degrees in medicine, which require further
study.] "It's relatively easy to get
a license in China - you only need an associate
degree."
In smaller towns, where regulation is much
looser than in the big cities, many surgeons
have no formal qualifications at all - although
prices can be much lower. "Prices fluctuate
according to local income - a "double
eyelid" operation, for example, tends
to cost a month's salary wherever you are,
and of course the quality of the surgeons
fluctuates too," Dr Zhang says. "You'll
also find that the latest technology tends
to come to small cities first, and much of
it is untested. In cities like Shanghai we
doctors need to be more cautious - we tend
to sit back and wait to see what works in
the provinces."
Unsurprisingly, anecdotal evidence suggests
that against this background of cut-price
doctors and unproven technologies, accidents
are frequent. Definite figures are hard to
come by, although in 2002 the China Quality
Review newspaper reported some 200,000 complaints
to officialdom in one form or another in
the preceding decade. No doubt in the years
ahead the Chinese media will have an important
role in drawing attention to sloppy cosmetic
surgery practices - one which should play
to its strengths, inasmuch as the topic combines
the opportunity for moralizing editorials
with shock value and lurid photo-ops.
Industry insiders certainly anticipate increasing
regulation over the next 10 years. For his
part, Dr Zhang believes a major challenge
will be fending off a new breed of seasoned
litigant - professional trouble-makers taking
surgeries to court over allegedly botched
work. "We'll need firm pre-agreements,"
Dr Zhang concludes. "These guys will
cruise from hospital to hospital looking
for weak contracts which they can punish
in the courts."
The cosmetic surgery boom is certainly an
interesting snapshot of the conflicting forces
impacting Chinese society today. Meanwhile,
in Shanghai, the Discovery Channel has just
spent a month filming the transformation
of the latest man-made beauty, Eliza Qian,
and surgeries report an ongoing 20% increase
in business year on year.
(First appeared in Asia Times, June 8, 2005)
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