by Mandy Yeh for MochiMag.com

If you were to ask me five years ago whether I would ever consider cosmetic surgery, my answer would have been something along the lines of “Hell, no.” Ask me now and I say, “Not now, but who knows?”

My change in attitude has nothing to do with a heightened insecurity toward my looks—rather, it has to do with my newfound exposure to the cultural phenomenon of cosmetic surgery in East Asia, especially in the countries of South Korea, Taiwan, Thailand and Japan.

The prevalence of cosmetic surgery in Asia has reached a point where getting double eyelid (blepharoplasty) and nose (rhinoplasty) surgeries has become akin to getting braces. While cosmetic enhancement is common in the U.S., the social stigma surrounding the issue is much greater than that of Asia. Young Asian American women are in a unique position, as they’re influenced by both Asian and American cultural aesthetics. While many are against getting cosmetic surgery, others have jumped on the bandwagon.

Dr. Haowen Liu, M.D., a plastic surgeon in Taiwan, says that most of his Asian American patients are college girls or high school teenagers who come in with their moms or other family members during summer or winter vacation. Twenty percent of his patients ask for combined eyelid and nose surgeries, and the female to male ratio is about 5 to 1.

Despite rising acceptance of cosmetic surgery in the U.S., reactions still vary widely. After interviewing several Asian American young women and men, mainly between the ages of 18 to 25, I observed that while some girls simply accepted the nature of cosmetic surgery as a popular trend, others strongly repelled the entire culture of cosmetic surgery.

Hazel, a 16-year-old Korean American from California, falls under the former. “It would be an exaggeration to say that I completely support the practice, but I’m not against it either. It’s just a part of modern life,” she said. Jinee, a 22-year-old Korean American from New York, has also come in terms with the prevalence of this procedure. “I used to be very against it, but now that so many people seem to get plastic surgery, I think I’ve made myself think that it’s okay or acceptable.”

For girls who strongly view cosmetic surgery in a negative light, their main issue is with the fixation Asians have with one particular look as their standard for beauty: big eyes, oval face, pointy nose, pale, white skin and stick-skinny body.

Sandra, a 20-year-old Korean American from New Jersey, finds the obsession with this standard, especially in South Korea, absurd. “I think the biggest gripe I have is that all Korean women don’t just want to look beautiful by enhancing their own natural-born beauty, but they want to look like the Korean standard of beauty…for some reason, all Korean women think they must get their eyes and nose done,” she said. “God or nature or fate no longer produces Korean beauty. Dr. Lee in Apgujeong does, for $10,000.”

When thinking about the psychology behind the Asian standard of beauty, a frequent argument that comes up is whether Asians are getting double eyelid and nose surgeries in order to look more like Westerners. Some of the girls I spoke with admit that there’s logic in this assertion. “Euro-centricism has always played an important role in our modern cultural society, and I think plastic surgery is an inevitable result of our world’s history, given that Caucasians have been the world’s most powerful racial group for centuries,” said Hazel.

Others, however, believe that it’s a poor assumption to make. “Of course bigger eyes and pointier noses are more associated with Caucasian attributes because facial features are prevalent with the race. However, I don’t think Asians are trying to look Caucasian by getting these surgical procedures done.”

Though it’s easy to make quick judgments and generalizations about standards of beauty, cosmetic surgery is very much a complicated, personal topic, as there are varying opinions about exactly which plastic surgery procedures are more acceptable than others.

For some girls, such as Tammy, a 24-year-old Chinese American who underwent jaw surgery for a serious under bite, getting plastic surgery was a decision made mainly for functional purposes. Then there’s Korean American Stephanie, who underwent double eyelid surgery because her ophthalmologist noticed her eyelashes were scratching her cornea and could cause problems later on. “If I didn’t have a medical reason for the surgery, I don’t think I would have gone through with the procedure,” she said.

Debates about the necessity of cosmetic surgery is therefore one of the biggest differences between Asian and American culture.

In America, cosmetic surgery is mostly associated with the culture of Beverly Hills and Hollywood, rather than the average middle class American family. In Asia, the cost for getting cosmetic surgery is seen as an acceptable amount for middle class families, not just for high-income households or celebrities. According to Dr. Liu, a rhinoplasty costs around $1000-2000 USD, while double eyelid surgery costs around $800 – $1200 USD. Just as Americans are willing to dish out a couple thousand dollars for braces, middle class families in Asia also see cosmetic surgery as a necessary investment, where some mothers even pay for the surgery costs as a “graduation gift” for their daughters.

Stephanie’s parents offered to pay for the surgery twice. “Double eyelid surgery is something I’ve heard about my whole life,” she said. “I can even recall being four years old and my parents compared me to my brother who had double eyelids.” (Stephanie’s mom has natural double eyelids, and though her dad did not, he ended up getting the double eyelid surgery when he went back to Korea as well).

Though pressures from parents and pop culture play a large role in influencing girls into thinking they need cosmetic surgery, the overall consensus I got from speaking with these Asian American girls is that in the end, personality counts the most. It sounds cliché, but a major part of American culture is that yes, you have the choice to do whatever you’d like to your body, while it’s equally stressed that confidence and self-contentment comes from within.

As Dr. Liu blatantly puts it, “Plastic surgery can improve one’s appearance or image, but is poor in saving a marriage or getting a promotion. Lists of operations can help you look younger or prettier, but none can promise you a better life.”

After speaking to a few Asian American guys to get their take, it seems they’re on the same boat about stressing the importance of personality over looks.

“I think plastic surgery in itself is perfectly fine—it’s the motive that taint[s] it,” said Korean American Minnow. “I think the prettiest women are those who don’t need make up on or a flattering dress.  But more than what’s appealing to my eyes, the deeper reasons that make up their personality and character [make] them more or less attractive to me.”

When asked if plastic surgery would affect his decision to date a girl, Corey, a Chinese American from New York, says, “It doesn’t bother me, but it shows no originality and I feel these women have insecurity issues…I’d rather have her personality traits change for the better than her nose, eyelids and boobs going for surgery. Have some confidence in yourself, woman! A woman that is confident is a plus.”

So there you go. At the end of the day, the main issue comes down to the motives behind getting cosmetic surgery, not the actual procedure itself. If you’re impelled to get cosmetic surgery, the best advice is to have realistic goals about the outcome.

For more, check out our plastic surgery Q & A with Dr. Liu.

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Q. What are your criteria for accepting patient requests for cosmetic surgery?
A. One must keep in mind that not all plastic surgeries are positive or beneficial to the patients, no matter if the results are successful or not (objectively). Some patients, for example, don’t appreciate changing too much, while the others don’t appreciate changing too little. Before the operation, plastic surgeons have to figure out precisely what and how much the patient wants, and rule out those patients who have unrealistic expectations from surgery or treatment. Thorough communication is a very important step to a positive aesthetic surgery. Fortunately, during my career as a plastic surgeon the positive feedback I got from the aesthetic patients were as many as those from my reconstructive patients from before. It doesn’t mean that every surgery I performed was perfect; it rather means every surgery I performed was needed (by the patient).

Q. What are the most popular cosmetic procedures performed for young Asian American girls?
A. They came mainly for blepharoplasty (usually double eyelid surgery), hair removal, or skin problems, such as nevus excision or IPL+RF treatment (a kind of non-invasive treatment which utilizes combined energy of intensified pulsed light and radiofrequency.) As the countries they come from (U.S., Canada, New Zealand, Australia) are dominantly Caucasian, eyelid and nose surgeries are most commonly asked for and performed. Other common treatment/surgeries include augmentation mammoplasty, square face (mandibule osteotomy, or more acceptable treatment—botox injection for masseter muscle), liposuction (face or body contour sculpturing), acne scar, etc.

Q. What are the limitations for getting some of these surgeries?
A. Any operation will be refused or deferred for patients under 18 years old unless her parents give consent. This is under the prerequisite that the patient makes the decision by herself (and that she’s not under the influence or pressure of anyone, including her parents), and after a full discussion with her parents and doctor. Operations not aimed at treatment purpose (e.g. restoring function) are not suggested for younger girls even if her parents agree. Certain operations, e.g. rhinoplasty (nose job) and mammoplasty (breast reduction or enlargement) should be deferred until the nasal bone/thoracic cage/pectoralis muscles are completely developed, which differs by age for each individual.

Q. Can you describe the general cosmetic procedures?
Double eyelid surgery—is only performed on (and usually, by) Asian people because of their different anatomical structure from Caucasians. I usually remove some skin, fat and muscular tissue to improve the “puffy” look of most Asian women, and in addition to create a double fold. Local anesthesia and operation time takes about 30 to 60 minutes, marked swelling lasts 2 to 4 days, stitches come out in 5 to 7 days, and the total recovery time takes around 6 to 12 wks. The approximate cost for this surgery is NT$ 25000-40000.

Nose surgery (rhinoplasty) — Asians mostly get the “augmentation rhinoplasty” procedure which involves local anesthesia, concealed incision in nostril, and a silastic implant. Operation time takes 15 to 20 minutes and recovery takes 2 weeks. The implant rejection rate is less than 2 to 5 percent, where sometimes you may need to have a cartilage graft from auricle for nose tip sculpturing. The approximate cost this surgery is NT$35000 to 60000.

Q. What are the circumstances where you don’t approve of a patient’s wish to get surgery?
1. When the patient has unrealistic expectations about the result of the surgery.
2. When the patient has uncertainty about the operation site or the extent of change.
3. If the patient has insufficient recovery time (because of a short stay, tight flight schedule, etc.)
4. If the patient has diabetes, cardiovascular disease, or is psychologically immature or impaired.
5. If the patient is under 18 years old, they’ll need parent or guardian approval.
6. Some operations could only be performed on physiologically developed patients (mammoplasty, rhinoplasty, bone shaving surgery, chin/nasal implantation, etc.)

For more information and viewpoints on plastic surgery, read our survey results.

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