Shownotes Transcript
In China, looking good is seen as essential to success in your career, your relationships and your social status.
Online, you can be bombarded by filtered faces, extreme weight loss hacks, and there are apps that scan your face and let you book cosmetic surgery as easily as ordering a taxi. That's Abby. She's one of China's biggest plastic surgery influencers. And she's saying she's had six nose jobs, four fat grafts, two body liposuctions and three double eyelid surgeries.
In fact, in the past 20 years, she's had more than 100 cosmetic procedures and she says she'll never stop trying to become more beautiful.
And behind the flawless selfies, there's a real shortage of qualified practitioners and licensed clinics. Every day in China, hundreds of women walk into unregulated clinics and come out with permanent damage. I'm Hannah Gelbart, and today on What in the World from the BBC World Service, we're going to go beneath the surface of China's cosmetic surgery industry.
To find out more, I'm speaking to Natalia Zhou, a BBC journalist who made a documentary about this. Hello, welcome to the podcast. Thank you so much. Great to be here. Can you start by outlining how big China's cosmetic surgery industry is? Yeah, so China's cosmetic surgery industry really has grown exponentially in the past two decades. It used to be quite a taboo. So people of my mother's generation, if they had ever gone and done plastic surgery, they'd come back hiding behind masks.
But social attitude has changed a lot because of the rise in disposable income. And obviously, social media has really helped normalizing plastic surgery. You have loads of influencers who were made famous because of the amount of plastic surgery they've had and how open they are sharing those. In terms of figures, there are quite a few different stats. Research from Deloitte that says in 2023, the market value would hit $1.
200 billion Chinese yuan, which is 27 billion US dollars. And another research report from iResearch estimate the market value to hit
400 billion Chinese yuan in 2025, which is the equivalent of 55 billion US dollars. So it's very difficult to pin down a specific number. But what we do know is, and we can confidently say that in the past decade, the market has grown by fivefold, at least, and it's one of the biggest in the world. And what's really interesting is,
When we were interviewing Dr. Yang Lu, who is this experienced surgeon with 20 years working in the field, seeing the development of this whole industry, she said these figures are from licensed clinics.
lawful venues. If you look into these shady venues, underground clinics, beauty salons that offer cosmetic surgery, double eyelid, everything, the figures would be way bigger than that. In the past few years, I've noticed the number of patients coming for repairs is growing year by year.
I've seen many patients whose first surgery was botched. Can you expand on the types of procedures that people are getting and also who is it that is getting these things done?
Yeah, so in terms of procedures, there's a few types of cosmetic surgery that's really popular and it's been popular for ever since people started doing surgery. So that's double eyelid surgery, rhinoplasty, of course, jawline reduction. And when I spoke with a beauty influencer, Abby Wu, who in the past 20 years spent over half a million US dollars on over 100 procedures, and she's made a name for herself for doing that.
And she said herself, she's helped normalizing the attitude towards plastic surgeries. And quite a few of people like her in Chinese social media for the past decade or so. And she's described how jawline reduction is done. So she says you need to cut
your skin layer, your tissue layer, muscle layer, and then it goes to the bone. Well, I have to obviously cut the nerve and then you have to remove some of the bone and then stitch them all back. And she had done that three times. And the whole point is to create a diamond shape, small, more feminine looking face that's very anime-like.
So I would say a lot of these popular procedures are inspired by the sort of Western look, you know, big eyes, you know, more prominent nose. And some of it also affected by Korean pop culture and anime. Some of the procedures is really difficult to understand. And some of them have been criticized for being
being unhealthy and unsafe for example a popular trend a few years ago which I think the surgery has been largely banned and stopped by a lot of clinics is to remove some of the nerve between your calf because that is believed to make your legs thinner because very skinny legs are very very popular in China. Is it mostly women young women getting these things done?
Yes, most of the cosmetic surgery consumers are women in China. And research shows 80% of people who pay for cosmetic surgeries are women. And there is an increasing number of male customers because it is becoming more common. In terms of the age of the demographic in China, vast majority...
of people who opt for cosmetic procedures are young women. Over 60% are under the age of 30. Why is this? Why are so many more young people, young women, people in general in China, getting these procedures done? Well, you know, in a cliche way, this is like the rest of the world. Social media plays a big role. But in China, the use of filter apps is so much more extreme compared with the rest of the world.
photos are so heavily altered and it's really, really rare. If you are a social media user in China, you're a young woman and you look around your friend circle, it's very rare to find someone who would upload a photo without it being altered. So if you have seen yourself looking that way for a long time, when you look at yourself...
You don't really look exactly the way you are in the photos. It does motivate people in another way. And obviously the rise of influencers, people openly talk about plastic surgery, it's no longer a taboo and actually it's becoming a trend. So that motivates people to get plastic surgery as well.
Also, the other thing is looking good is associated with career success. For a long time, young women in China have been subjected to physical requirement when they apply for a job or those job requirements.
doesn't really have anything to do with looking a certain way. I did a rough search on one of the popular recruitment apps and I found a reception job and an office admin job requiring the applicant to be at least 160 centimetres tall, to look physically appealing and one of the other ones says to have a graceful presence.
Abby's had loads of surgeries. Her first one was when she was 14, she had liposuction. Why did she continue to get more after that? We did ask because the liposuction seemed quite crucial to Abby's career back then. So after the liposuction, Abby said she had become more confident and happier and then she found her eyes a bit smaller. So she had double eyelid surgery. She had rhinoplasty and eventually she realised that
A lot of people like her were really struggling to find reliable places to have surgery. So she wanted to share that experience. So she started telling people around her where she got surgery and realised people were really interested. Then she started posting on social media. And then 20 years down the line, she's had 100 procedures and she's one of the most famous faces of China's cosmetic surgery boom. Did any of those procedures go wrong? Yeah, horribly, some of those. She told me one of the procedures she had, she had travelled to Korea to have it,
And it was facial reframing surgery, which requires moving cheekbone and jawline. And it's really quite a dangerous procedure. And she said she was recovering with her face bandaged up, walking on the streets of Seoul, and she coughed blood. So...
Some of them have gone really wrong. And then she had said that the reason she also wanted to share it is she doesn't really want other women to go through what she had gone through to really choose reliable clinics. However, a lot of people have argued, has she normalized cosmetic surgery to people who
don't really need it in the first place. You also mentioned that there is an issue in China with unlicensed, unregulated clinics. And I think you've spoken to some people who've had procedures done there, botched jobs. How big of a problem is it?
The problem of unlicensed cosmetic surgery clinics and unqualified practitioners is big. And there is a report by iResearch, a marketing research firm, says that in 2019, 80,000 venues in China were providing cosmetic procedures without a license and 100,000 cosmetic practitioners were working without the right qualifications.
That has been a big problem for a long time because the demand is so high while the number of licensed clinics and qualified surgeons are much lower. And the government has tried to regulate it in the past few years as local media has also reported a
a lot of really tragic botched surgeries. Some led to death and some led to people being disfigured and going into depression. People wonder why I wear a mask and a hat even in summer. My face felt as if I had cement under my skin. It was really hard. I also read about these cosmetic surgery apps that make it easier than ever to book a procedure. Like you can do it like ordering a takeaway or a taxi.
Yeah, so it's kind of dystopian, actually. You can literally take a picture, let the app run an AI-driven analysis. So in a few minutes, you were given a full report pointing out the so-called imperfections and what needs to be done in order to be more successful, more attractive. They categorize your face in different sort of ways.
jargons. So some of them are called posh lady face and you want to do a few tweaks to have the child looking face. And there's also another one that's really odd called marriage material face. You can opt in for multiple procedures it recommends based on where you are, the clinics close to you. You can see people's reviews. You can see how someone goes through the procedure and I think it does make you feel a lot less scary. That's the thing.
As we said, a lot of this comes down to self-esteem and mental health. Is there support for people so they don't feel they have to turn to surgery? There are discussions about appearance anxiety and there have been criticisms towards cosmetic surgery industry, the influencers pushing for surgeries and also the celebrities that help normalise them.
I think a lot of young women these days in China have started to realize that some of these standards are not healthy. And in the past few years, people have said we shouldn't really subject ourselves to the so-called
which in Chinese that means fair-skinned, childlike and skinny. There is some awareness to it, but the social media trend is so overwhelming. However, the pressure is so big and social media is so far advanced, it's just very difficult to then say, let's stop. You mentioned that the government is trying to crack down on the unregulated clinics. What else has the government said about all of this?
The Central Health Commission, which is in charge, manages the local health commission in China and these ones that manage clinics and practitioners regionally. So they've established a few rules. For example, beauty loans, which is the loans that people take to pay for cosmetic surgery. They've stopped adverts for beauty loans to run on television because they think that encourages people to get into debt to pay for something they can't afford or maybe they don't need in the first place.
Certain places have become more strict with these things as well. In Shanghai, local government has said practitioners and clinics shouldn't really offer these loans without being asked by the customers first. And regulations around qualifications have become tougher. So, you know, it's a huge industry. Let's not forget, it's a huge industry. China is a massive country. There are hundreds of thousands of cosmetic surgery clinics everywhere.
And there will still be problems, even these regulations are imposed because the demand is so huge. And the root of the problem is where people felt like they have to go under the knife to look a certain way. And as long as they felt that, there would be people exploiting it. Natalia, thank you. Thank you very much.
If you want to watch Natalia's documentary, it's on YouTube and it's called Make Me Perfect, Manufacturing Beauty in China. That's it for today. Thank you so much for joining us. I'm Hannah Gelbart. This is What In The World from the BBC World Service. We'll see you next time.