Seeking an injection of beauty
2016-03-18, YU RAN in Shanghai

There used to be a stereotype in China that only ugly people had cosmetic surgery. But times are changing, and fast.

Zhou Jianjing, who is in her 30s, has a wish list of cosmetic procedures and she fully intends to attempt to check every item off, citing fears that she might one day look worse than her peers.

“Some of my friends have gotten certain injections to get a face-lift and a narrower chin. I need to deal with the minor changes to my face to keep up as well,” said Zhou, who is thinking of getting a botulinum toxin injection, commonly known by the brand name Botox, for a slimmer face. 

In the West, Botox is mostly associated with reducing wrinkles. However, it can also used on muscles in the jawline in an attempt to create a slimmer face. Zhou is also considering hyaluronic acid injections for a firmer nose.

Micro cosmetic procedures, such as the two Zhou is mulling over, have experienced a surge in popularity in recent years. Unlike plastic surgeries that often come with long-term effects, these injections produce effects that last from three months to two years.

Even though they are not devoid of risk, many women in China have adopted positive attitudes toward such injections, mainly due to demands in their career and personal life, as well as social perceptions.

“I believe that more Chinese women across different ages will be urged to take action and accept micro cosmetic surgeries as the norm,” said Zhou. “Pursuing beauty is a lifetime mission for us women.”

According to statistics released by the Chinese Association of Plastics and Aesthetics in November, China’s plastic surgery industry has seen a yearly growth rate of 30 percent over the past three to five years. It is expected to become an 800 billion yuan ($120 billion) market by 2019 to become the third largest source of cosmetic surgery clients after the United States and Brazil.

“The definition of plastic surgery has changed. It is no longer just ugly people who want to undergo changes to their face,” said Zhang Xiaofei, a doctor at Shanghai Ximei Medical Cosmetic Clinic. “Now, it is more like getting the icing on the cake for already attractive people.”

Zhang has worked as a cosmetic doctor for more than 10 years and he has witnessed a major change in his clientele. There are now more young people looking to enhance their facial features and they see plastic surgery as an acceptable and quick method to do so.

“The total sales revenue earned by non-surgical procedures grew from 10 to 40 percent in the past five years. Such procedures are the preferred option for consumers who are only in their 20s,” said Zhang, who performs cosmetic treatments for about five clients every day.

Zhang added that Botox injections have been very popular among young people, especially women who have just graduated from university, as they believe that changing their looks can give them an edge in applying for jobs and finding boyfriends.

“As one of the hottest choices among young women, the domestic brand of botulinum toxin costs about 2,000 to 3,000 yuan per injection, which requires the person to continue application every half a year if she wants to retain the firmness of her face,” said Zhang.

Yang Xi is a regular patient, spending about 4,000 yuan quarterly on Botox injections. To 24-year-old Yang, this is a necessary investment to continue looking young.

“I don’t feel ashamed that I have undergone micro cosmetic procedures as I wasn’t born with a slim face. I know I have the choice to change it to become more beautiful through injections or wearing makeup,” said Yang, who is planning to get injections for her nose as well as undergo double eyelid surgery this year.

“There is no turning back when it comes to cosmetic surgery, but I don’t regret it at all.” 

From the perspective of professional cosmetic experts, Chinese beauty standards have been increasingly influenced by their Western counterparts.

“Wide and round eyes, white skin and high nose bridges are seen as ideal for Chinese consumers, who tend to be wiser with their decisions on cosmetic surgery — from seeking long-term effects to accepting temporary and safer products,” said Wang Tso-hsuan, the chairman of Taiwan Nice Clinic, who has been attending consulting events in the Chinese mainland since 2010.

As Wang recalled, the first time he was invited to give a speech in the Chinese mainland, there were only two imported products (Botox and Restylane, a brand of filler). Today, there is a considerable range of imported cosmetic surgery products.

“The rise in popularity of non-surgical treatments here in China is a natural movement of the cosmetic surgery industry. Soon, such treatments will fall under the daily beauty care category, similar to hair and skin care treatments,” said Wang.

However, not everyone agrees that the growth in injected treatments is a positive development. 

“More and more students are seeking plastic surgery as they believe changing their looks can boost their self-confidence and bring them more opportunities in life,” said Tian Hong, a researcher at the Shanghai Academy of Social Sciences. “But this isn’t the only way to attain beauty. Young people shouldn’t pin their hopes on cosmetic surgery.”

The growing trend in China can be traced back to the mecca of plastic surgery — South Korea. With 20 percent of women aged 20 to 49 in Seoul saying they have gone under the knife in order to look good, the country is home to the largest number of people in the world who have undergone plastic surgeries. The revenue of this industry in South Korea in 2013 exceeded $60 billion, accounting for 4 percent of the country’s GDP.

Such is its reputation that South Korea has become the top destination for Chinese consumers seeking the latest procedures. Statistics from South Korea’s Ministry for Health, Welfare and Family Affairs showed that the number of Chinese people entering the country for cosmetic surgery jumped from 791 in 2009 to 56,000 in 2014.

“In China, consumption in plastic surgery and beauty care has become the fourth largest growth engine following real estate, automobiles and tourism … it is a promising market to explore,” said Lee Kil Sung, chief operating officer of Yestar International Medical Beauty Group, a South Korean brand that entered the China market in 2005.

Another popular cosmetic surgery destination where consumers pay relatively lower costs is Taiwan. In fact, competition has been so stiff in Taiwan that 160 clinics have closed or gone bankrupt in the past two years, said Wang from the Taiwan Nice Clinic.

“More consumers are flying to Taipei to get plastic surgery and non-surgical procedures as they cost half of those in South Korea,” said Wang, whose clinic faces extremely stiff competition from 400 other cosmetic establishments located on a 4-kilometer-long road in downtown Taipei.

The increase in interest in such procedures has also led to some customers seeking cut-price options, with predictably unhappy results.

Statistics from the Chinese Association of Plastics and Aesthetics show that the percentage of accidents and disputes caused by cosmetic surgeries undergone by Chinese consumers in South Korea have increased from 10 to 15 percent yearly. 

The association also revealed that up to 80 percent of derma fillers are illegally injected in hotel rooms by people recommended from online social platforms.

Cui Shuang, deputy director and dermatologist at Shanghai Major Young Plastic Surgery Hospital, has also noticed the rise in unlawful procedures.

“I’ve seen too many victims of illegal medical surgeries or injections which haven’t been performed by licensed physicians at licensed medical institutions with products that have been approved by the Chinese Food and Drug Administration (CFDA),” said Cui.

“It is essential for the media and government to educate consumers about the correct way to consume such products and services. The more expensive and legally imported products operated by experienced licensed doctors have better effects and fewer side effects.”

Working at one of the only two specialized plastic surgery hospitals in Shanghai, Cui believes that the industry should be more regulated to prevent the occurrences of medical accidents. Her major clients are still middle-class and upper-class women aged from 30 to 50, though she has noticed that more young graduates are seeking her out these days.

“The lower-risk face-lifting and non-surgical procedures have attracted younger people in their 20s to change their facial features, while older consumers mainly go for cosmetic products that can result in firmer skin and reduce wrinkles,” said Cui.

With regard to the future trends in the cosmetic surgery industry in China, Cui expects to see more experienced doctors open clinics to provide more specific treatments. She also foresees that new information about cosmetic procedures will be more openly shared among Chinese and international experts in conferences.

“Although we are still lagging behind a little with certain new products that are still awaiting approvals from CFDA, I believe that Chinese doctors will be able to catch up by using upgrades to current products,” said Cui.

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