[WHY] What makes Korea the plastic surgery capital of the world? Signs for hospitals performing plastic surgery are seen on a street in Gangnam District, southern Seoul, on May 14, 2020. Gangnam is known as the mecca for plastic surgery hospitals in Seoul. [NEWS1] Walk into just about any subway station in Seoul, and you can find billboard-sized advertisements on plastic surgery. Before and after pictures of women who have had a literal face-lift boast phrases like, “You too can be pretty,” and when you walk out of that subway station, there are likely rows and rows of signs for hospitals where you could also get a nose job or eyelid surgery. According to the International Society of Aesthetic Plastic Surgeons and the World Population Review, Korea is the number one country for plastic surgery, with the highest number of surgeries per population. The absolute number of plastic surgeries yearly is the highest in the United States, followed by Brazil and Mexico. Still, per capita, nearly one in every four Koreans gets plastic surgery annually. There is even a common saying that the best time to get double-eyelid surgery — one of Korea’s most popular plastic surgeries — is before you enter middle or high school. Parents let their children get these surgeries as a graduation gift so teens can start afresh when they go to a new school. Why has Korea become the number one country for plastic surgery? When did this super-fad start? And what is the meaning behind the phenomenon? A medical professional looks over screens showing a plastic surgery procedure at a hospital in Suwon, Gyeonggi, on Sept. 25, 2023. [NEWS1] Korea: plastic surgery nation The most popular types of plastic surgery in Korea are rhinoplasty (nose job), liposuction and blepharoplasty (eyelid surgery), according to a 2022 report on plastic surgery from the World Population Review. These surgeries focus more on the face than the body, in contrast to Brazil, Greece and the United States, where breast and buttock enhancements are more popular. What is even more distinct about plastic surgeries in Korea is the onset of straightforward and quick procedures, often referred to as “one shot” or “lunch” surgeries — named so because you need only one shot of fillers injected into your face or a simple procedure completed during your lunch break. “Surgeries that we nickname ‘petit’ procedures have become the trend in recent years,” said Heo Chan-yeong, a plastic surgery doctor at Seoul National University Hospital and a representative of the Korean Association of Plastic Surgeons. “Noninvasive surgeries, where you don’t have to get a knife put to your face and the healing time after the procedure is very short, are rising as the preferred option in Korea.” Another statistic that shows just how prevalent plastic surgery has become is that there were over 200 doctor-patient disputes regarding plastic surgery last year, according to the Korea Medical Dispute Mediation and Arbitration Agency. The global plastic surgery market was 45.55 billion dollars in 2022 and is projected to become as large as 59.45 billion by 2030, according to a report by Vantage Market Research. That is a 3.4 percent yearly growth rate, considerably higher than most other industries. For Korea, the plastic surgery market is valued at 5 trillion won ($3.7 billion). Signs for hospitals performing plastic surgery are seen on a street in Gangnam District, southern Seoul, on May 14, 2020. Gangnam is known as the mecca for plastic surgery hospitals in Seoul. [NEWS1] When did plastic surgery first begin in Korea? An unidentified American doctor performed the first plastic surgery in Korea during the Korean War. At first, plastic surgeries were introduced to reconstruct the faces of people wounded during the war, but they soon became a way to beautify oneself. A U.S. surgeon named D.H. Millard popularized what Millard himself called “deorientalizing” surgeries, which meant that the first plastic surgeries were mainly aimed at making patients look more Western, according to research by Stanford University professor Lee So-Rim. “Until the 1980s and 90s, the goal of plastic surgery was to make people look more Caucasian, but that changed after the 1997 Asian financial crisis,” said Leem So-yeon, a professor of classics at Dong-A University who wrote her dissertation on plastic surgery. Leem went in-depth into the heart of plastic surgery and worked as a coordinator at a hospital, meeting with hundreds of patients and eventually going under the knife herself. “The history of plastic surgery in Korea certainly started that way, but it is hard to say that people are getting procedures to look Western nowadays.” Cover of ″How I Became a Plastic Surgery Beauty″ (translated), by Leem So-yeon, professor of classics at Dong-A University. [SCREEN CAPTURE] Neoliberal reforms and changes in the labor market following the Asian financial crisis also led to a surge in plastic surgery, according to Stanford professor Lee’s research and a report from U.S.-based think tank the Brookings Institution. Because it became so hard to get a job after the crisis, younger people took to getting plastic surgery to heighten their appearance for a competitive edge, writes Lee. “Your appearance became the competitive factor that could land you a job — lookism became widespread” after the crisis, said Heo. “Another factor behind the rise of plastic surgeries after 1997 is the atypical structure of the medical business, where doctors cannot earn much from insured procedures and treatments.” A patient receives double-eyelid surgery at a hospital in Seoul on Sept. 10, 2020. [JOONGANG PHOTO] Perceptions, technology and social media However, this historical and economic legacy is not the only reason behind Korea’s status as the world’s per capita plastic surgery capital. Experts point to three factors: changing perceptions of plastic surgery, the development of surgery technology and the popularization and spread of social media. “Before, you had to muster a lot of courage to get plastic surgery, but social awareness and recognition of the subject have changed a lot — so much that plastic surgery is not seen as such a daunting thing anymore,” said Heo. “It used to be that people who had gotten plastic surgery would hide the fact that they had received surgery. But now people actively talk about their experiences of going under the knife, sharing reviews of hospitals and doctors, and discussing the better choices.” “The aim of plastic surgery has also changed, like I said, from imitating the Western standard of beauty to having developed a distinct image that Korean women want,” said Leem. “Each race — whether Asian, Caucasian or African — has their distinct ideal image and face, and the idea of a global beauty has changed.” According to Heo, another factor behind the surge of plastic surgeries in Korea is the development of more simple and quickly performed ‘petit’ surgeries. Visitors examine medical equipment used in plastic surgeries at a technology fair hosted by the Korean Aesthetic Surgery & Laser Society at the aT Center in Seocho District, southern Seoul, on Feb. 26, 2023. [NEWS1] “Non-evasive surgeries [surgeries and procedures which do not require opening the skin or bone structures] and the growth of energy-based device (EBD) technologies have developed very well in Korea,” said Heo. “Because the procedures have become so simple, plastic surgeries have become more approachable to people.” The onset of social media has also contributed to the ever-growing rise of plastic surgery, according to numerous reports, academic articles and experts. According to a survey by Dream Medical Group, which owns the plastic surgery chain Dream Plastic Surgery, nearly nine in 10 people who use social media daily have felt the desire to get plastic surgery done. More than half of the respondents — 53.3 percent — responded that they think this desire is because they “compare themselves to others” when looking at photos of people they believe to be aesthetically pleasing. “Social media has played a big part in more people wanting to enhance their looks,” said Heo. “Exchanging information on plastic surgery through social media is also rampant.” Cho Yong-kee, head doctor at the Lavian Plastic Surgery Clinic in Gangnam District, southern Seoul, explains plastic surgery procedure to a patient on Aug. 12, 2021. [JOONGANG PHOTO] Are Korean beauty standards really so harsh? Beauty standards are very high in Korea, so much so that endless articles in foreign media have also covered the subject. The pressure to look perfect, fair-skinned and thin comes from feelings of inferiority if people think they are less attractive, according to a study by Kathy Lin and Vaishali Raval at Miami University. “Sociocultural factors including media, social group factors (e.g., respect for others), societal advantages in career and marriage, and general acceptance of plastic surgery seemingly play a role in the importance of achieving ideal beauty standards in South Korean adult women,” writes Lin and Raval. This means that the factors mentioned above all play into the more extensive subject of beauty standards in Korea. “I think there is much pressure for people around my age to ‘catch up’ to these beauty standards and fit into the ideal image of girls,” said Choi Ha-mi, a middle school student from Daecheon. “I find my friends and me talking all the time about how to look prettier and thinner, and just talking about those things every day makes me feel pressured and unsatisfied with my face and body.” But in recent years, a social movement has been rising in Korea to reject these beauty standards. Also referred to as the “escape the corset” movement, this wave of fighting against the harsh beauty standards in Korea began around 2016 or 2017, when feminism became a buzzword in Korea. “The ‘escape the corset’ movement has elements of rejecting the existing standardized femininity and the myth of the beauty,” writes Lee Na-young, a professor of sociology at Chung-Ang University, in an academic article titled “‘Post/Gangnam Station’: Collective Resistance against Gender Discrimination and Re/Construction of Feminist Subjects.” Doctors perform plastic surgery on a patient at a hospital in Seoul on June 16, 2022. [JOONGANG PHOTO] What do people who have had plastic surgeries say? There are two types of people who set foot in a hospital to get plastic surgery, says Leem. She met hundreds of patients who visited the hospital where she worked and has watched surgeries from beginning to end. “The first type is people who are going through plastic surgery for the first time, and the second is those who are already objectively pretty but are not ever satisfied with how they look,” said Leem. “The second type keeps coming to the hospitals to maintain their beauty or enhance their looks.” A university student in her second year student year who recently got a nose job said that she was delighted with the results of her operation — this was her second time getting plastic surgery after getting double-eyelid surgery after her middle school graduation. “I am thrilled with the surgeries I have had — my confidence has gone up after getting these surgeries done,” said the student, who requested anonymity. “I used to think people ignored me because of my low-set nose, but I don’t think about that anymore. People around me also compliment me. But I don’t think I will get more surgeries done because I don’t want to look too much like a plastic surgery beauty.” Another patient who received five surgeries and procedures, including orthognathic surgery (aligning the upper and lower jaws), also expressed satisfaction with the results and said that her choice to do so was just an everyday option, something not to be taken too seriously. “I wanted to be satisfied with how I look, and that is why I received the surgeries,” said the woman, who also requested not to be named. “I don’t want to think about it too much. I dislike being labeled a ‘plastic surgery beauty’ or a ‘victim’ of beauty standards here. I think that plastic surgery is just one of those things you purchase with the means you have, and it is every individual’s choice to do as they like.” BY LIM JEONG-WON [lim.jeongwon@joongang.co.kr]

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