In the early 2000s,
a new phrase entered the Chinese vernacular,
renzao meinü.
It means artificial beauty
and it laid the foundation for what's become
a cultural phenomenon in China:
cosmetic treatments.
The Miss Plastic Surgery Pageant in 2004
marked the country's growing acceptance
towards going under the knife.
All part of the cosmetic surgery boom
fueled by the country's burgeoning middle class
who have more disposable income
than any generation before them.
If you look historically,
sociologically and philosophically,
beauty has always been a commodity, for centuries.
You go back to the ancient Egyptians,
or the ancient Chinese,
they always placed a very high regard
on people who were beautiful.
What's changed nowadays is that
you can buy a bit of that beauty.
But as they say, beauty is in the eye of the beholder.
In China, however, beauty is increasingly
becoming in the hands of plastic surgeons.
The country's facial
and body enhancement industry is booming.
The market in China
is now worth over $30 billion,
making up 17% of the global industry.
Innovations in nonsurgical and surgical procedures
have brought prices down to a cost accessible to everyone.
With the advent of dissolvable fillers, botox,
we have realized that we can achieve some form of beauty
without actually having to undergo the knife.
The arrival of dedicated cosmetic apps
have made booking surgery as simple as ordering a takeout.
But breakout growth has left regulators playing catch-up.
And as the Chinese government looks to crack down
on the cosmetic surgery industry,
the days of paying for perfection might be numbered.
So I've been in China, operating, working, teaching,
and observing the changing trends for the last 17 years
and I will say that people have gotten a lot more bold
in what they want to see for themselves.
Dr. Woffles Wu,
who currently operates out of Singapore,
has been a plastic surgeon for over 30 years.
In 2006 he was appointed the Honorary Head
of Plastic Surgery at a hospital in Hangzhou,
where he trains surgeons.
Over the years, he's seen China's industry
grow not only in size, but also ambition.
20 years ago,
it would have been the usual kind of double eyelid,
or maybe a little bit of a higher nasal bridge,
and that would be it, they'd be happy with that.
But with a lot of products and a lot of new techniques
being available to the Chinese,
they've gone into it full force.
And so now they're into contouring the face,
shaving the cheekbones, shaving the jawbones,
doing their nose, their eyes, their breasts,
and fixing their skin.
China's medical aesthetics industry,
which includes surgery, injections, and skin treatments,
has been growing at an unmatched rate.
Its cosmetic surgery market,
which was virtually non-existent a few decades ago,
is now the second largest in the world after the U.S.
With an annual expansion that's more than
three times faster than anywhere else,
it's poised to become the biggest this year.
In 2020, sales revenues were an estimated $51 billion.
Like many industries in China,
technology and innovation over the last two decades
have played a central role.
In early 2000, majority of the marketing was done offline,
just traditional advertising on the streets.
But then it sort of gradually evolved on to Baidu,
so more sort of on the internet browser searches based.
But then in the recent past few years,
we've seen lots of vertical integrated mobile phone apps
being advanced in the market.
Woo. Look's fancy.
Be kind.
Lengths of my two eyes are different, it says.
GengMei, which means more beautiful in Chinese,
and So-Young, are just two of the many
social networking platforms in China
dedicated to cosmetic surgery.
I can't read this, but it's obviously saying it's perfect.
From connecting prospective patients,
to recommending nearby surgeons,
and even offering micro loans to pay for the treatments,
these apps are a one-stop shop for all things beauty.
Cute face.
Great.
Within minutes of logging on,
a user can book and pay for pretty much
any treatment on the market.
And if you can't decide what you want done,
it can help with that too.
Aloof girl's face, who needs filler?
So I think this is now a lot more
first hand and interactive.
Consumers can now quite easily get their hands on
to really understand some of
the treatment they want to receive.
For many consumers,
the apps offer more transparency around procedures
than previous forms of advertising.
And the sheer volume of information available
has made the decision to go under the knife much easier.
So-Young has already been downloaded more than
400 million times in China since its launch in 2014.
Because of the internet and the way they advertise,
of course, that knowledge becomes instantly available
to anybody looking for plastic surgery.
So it has really grown.
But public awareness around
unhealthy beauty standards are growing.
In August, China's market regulator
drafted guidelines to reform advertising practices,
saying that they were prompting societal anxiety
over people's looks.
They try to appeal to their potential consumers.
And with the message that, you know,
your body is something that you can improve,
so meaning that even your identity is not pinned down.
So then that's one of the strategy.
And then what we call in academia, interpolation.
So meaning that, you position the consumer
in a place where they feel that
they are summoned to consume these products.
Then they also have diverse procedures.
So they made it so at different price range.
Whether you have lots of money,
and then you can have something more expensive.
But if you even have not so much money,
but you can still save money,
and to have a simple procedure.
Cost is always a factor when it comes to cosmetic surgery
because that's disposable income, right?
Millennials in China,
many of whom have grown up as part of the One-Child Policy,
have more disposable income than ever before.
The country will more than double the number of millionaires
in the next five years, and boost the size
of its middle class by almost half.
Cosmetic surgery is a conspicuous consumption.
So in a sense, it was almost like a luxury item, right?
And when people have more money,
they have more disposable income.
So they feel that it's all right
to use that money as kind of investing
to show that they can consume something
that was not available to the previous generation.
But even for those with a little less cash
to spend, there are options.
Traditional surgery to give you a nasal bridge
with a piece of silicone, or a piece of Gore-Tex,
would cost upwards of $10,000.
But with a syringe of filler,
which you can just inject in the clinic,
you can get a semblance of that improved projection,
and contouring of the nose
and that costs about one tenth,
if not less, than the surgery itself.
So for somebody who's a little tight on budget,
they would tend to do the non-surgical procedures,
which are infinitely cheaper than the surgical procedures,
and with fewer complications.
So that has been a burgeoning market
and it's always what we call the entry point
for these young people who wish to dabble in plastic surgery
as they would dabble with new makeup.
The average age for those going under the knife
in China is 24 years old, with over 80% being female.
And the number of under '20s
opting for treatments is increasing.
One of the most popular procedures
among the younger clientele is double eyelid surgery.
I did a double eyelid surgery in July, 2016,
after the university entrance examination.
I did it mainly for two reasons.
The first is, I don't like my single eyelid.
It is very difficult to make up.
Another reason is my mom,
she thinks my eyes are too small.
So a surgery is very necessary.
Eyelid surgery was one of the popular procedures.
For one thing, it was quite affordable
in comparison to a nose job.
So it might cost just a couple hundred US dollars,
say about 1000 Chinese yuan.
This one child policy, I mean,
parents are quite willing to
help their children to get started
in a very competitive society.
I heard about, numerous stories actually, about parents
paying for this kind of simple surgery
as a gift for graduation, for example.
Beyond just aesthetics,
some consumers hope that changing their face
may change their fate in the country's
highly competitive job market.
Today, you have to be beautiful to succeed.
The competition to find a job is so fierce,
many believe being operated on helps you stand out.
A new report is drawing attention to widespread gender
discrimination in job ads for Chinese companies.
In 2018, a human rights watch report
pointed to several job postings
that openly specified requirements in gender and appearance.
Changing their aesthetic beauty,
they can somehow enjoy some social advantages.
Several people tell me that they can find a better job,
for example, at a job market.
Or they feel that it's a investment in a sense that,
in the long term, they can get some kind of a return.
It's not so much about whether or not
they like to have cosmetic surgery,
but rather they feel that that's an opportunity
that they cannot miss out.
So if they can actually invest a little bit money,
and then undergo a painful procedure,
but however, there is a reward at the end.
So they will try their best to do it, if they can afford it.
Like many parts of the world,
beauty standards are being set and exacerbated by
the presence of influencer and celebrity culture.
They're constantly bombarding the internet space
with images of what they think a beautiful face should be
and people therefore follow that
and feel that that's what we should look like
because everybody else is doing it
and all the influencers that have
a certain kind of facial look.
So this does rub off on the younger people
and it's exactly the same in China as it is in Singapore,
or any other part of Asia.
In the Chinese culture, that kind of peer pressure
and emulation can become a norm that people internalized,
and then they try and kind of spread around.
You will see something in the celebrities,
sometimes they might have a doctor that's special,
and they would really sort of speak quite openly
and in-depth about some of the treatments.
But the same influencers
that help build the buzz
have also fallen victim to its darker side.
During the industry's explosive growth,
demand for surgery massively outgrew
the number of qualified practitioners able to supply it.
Unlicensed clinics began performing illegal surgeries,
which led to some fatalities.
About 40,000 medical accidents
occur in these unlicensed clinics every year;
an average of about 110 per day.
China had over 80,000 unlicensed institutions in 2019,
accounting for about 84% of the market.
With uncertified physicians
making up 72% of all practitioners.
But change could be coming.
We will make more notable and substantial progress
toward achieving well-rounded human development
and common prosperity for all.
President Xi Jinping's Common Prosperity Plan
has seen entire sectors ordered to change
the way they do business.
The government really is pushing through
some house cleaning when it comes to China's economy.
They are talking about enforcing laws and regulations
on so many corners of the economy, at the moment.
Industries that ballooned over recent decades
have faced particular scrutiny.
Leading analysts to question
how long it will be before the cosmetic sector gets hit.
Since the start of July,
the market value of the country's three biggest
publicly traded medical aesthetics companies
has fallen by a third,
representing a collective loss of more than $17 billion,
as the industry plays a waiting game.
So I think naturally there will be
some reform in the market,
both in terms of crackdowns on malpractice.
By that I mean companies that do not have
the business license and the right accreditation
to operate or give surgery in the market.
And I think second is also regarding the reform
on how authority can better regulate
some of the advertising of these institutes.
I can understand if there are changes
that could truncate, or curtail part of the industry,
or make it less profit driven.
So that would probably be the trend
because industry's like that,
at least in the Chinese case,
always serve the ideology of the ruling government.
But there are signs that the market
could survive under a more watchful eye from Beijing.
Medical tourism could even become a driver for the economy,
if the government can ease widespread safety concerns.
They've made these special medical tourism zones
where foreign companies can go and set up much more easily.
Foreign doctors can go
and get their license much more easily as well.
There are certain tax breaks
that I think are afforded to them.
And so a number of American, European companies
have moved into these areas to set up shop
so that they can open up manufacturing plants,
and provide China with a constant stream
of these, essentially, foreign-made products
and I think the Chinese authorities have done this
because they realized that
medical tourism is a very big item
and can bring in a lot of tourist dollars.
Plastic surgery is a very normal thing in China.
Many young people will change something
they're not very satisfied with.
But I don't think beauty is everything,
but the confidence maybe can really take you
some more, better opportunities.
But I think if you are not beautiful,
but you are very confident and talented,
the opportunity is also there for you.
So I don't think it's just the benefits of the beauty.