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China goes under the
knife
By Fraser Newham
"In 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.
Fraser Newham is a freelance
writer based in Shanghai.
(Copyright
2005 Asia Times Online Ltd. All rights reserved.
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