Plastic surgery, a term referring to surgery that focuses on repairing what is amiss, was an act of selfless beauty when it first reached the shores of the Korean peninsula through an American doctor, Ralph Millard by name, who developed a method of repairing cleft mouths for local children who had neither the means nor the money for proper treatment. The practice began to thrive after the founding of the Korean Society of Plastic and Reconstructive Surgeons (KSPRS), and the rapid growth of Korea’s economy in the 1970s. People began to take an interest in improving their appearance a bit more thoroughly, and the Korean Society for Aesthetic Plastic Surgery (KSAPS) was born. Aesthetic plastic surgery, commonly known as cosmetic surgery, soon took root within Korean society and flourished quickly. Thus began the age of sculpted beauty, of face-lifts and fillers, which continues up to this day. 

Cosmetic surgery does not refer to surgical procedures only—that is, treatment that requires incisions to be made. Almost any medical treatment that intends to enhance the appearance rather than repair it can be considered cosmetic surgery. The International Society of Aesthetic Plastic Surgery (ISAPS) divides such procedures into two categories as follows: Surgical Procedures and Non-Surgical Procedures. Surgical Procedures consist of the categories Face and Head, Breast, and Body and Extremities; many of these processes have to do with sculpting bone or handling fat. Non-surgical treatments mostly belong in the Injectibles sub-category, which includes botulinum toxin—commonly known as botox. The ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2015 shows that the most popular surgical procedure in Korea was eyelid surgery, with 101,985 cases. Rhinoplasty, or nose surgery, was next with 72,562 cases. Botox procedures topped non-surgical procedures with 279,019 cases performed that year. 

It has been revealed through surveys conducted every decade by Gallup Korea that the prime targets and consumers of cosmetic surgery are women. In all three surveys conducted by Gallup Korea prior to 2014, when inquired whether the respondent had ever received cosmetic surgery, the percentage of women who answered positively was higher than that of men. The presence and dominance of breast-related surgeries also attest to this. Recently, however, the spectrum and number of patients have grown. 

According to the same surveys, the percentage of women who had cosmetic surgery increased over the three decades— four percent in 1994, nine percent in 2004, and 14 percent in 2014. The percentage of men who received cosmetic surgery also rose between 1994 and 2004, from 0.1 percent to one percent. Young Koreans have also entered the market; a survey conducted by Seoul in 2009 revealed that more than half of female and a little more than 40 percent of male middle and high school students in Seoul expressed a willingness to undergo cosmetic surgery. 

 

Professor Park Sun Woong (Department of Psychology) attributed the rise in cosmetic surgery to Korea’s culture and the sudden social changes that occurred here. “Koreans have a group-oriented culture, which forces them to constantly worry about how they appear to other people within the community— people who are uncomfortable with their appearance would naturally be under great stress.” There are more explanations for Koreans’ cravings over a good appearance. Professor Park explained that the devastating status of Korea in 1997 after the IMF crisis, which decreased the chances of employment and promotion while increasing difficulties in creating one’s own family, happened to prompt a change in perceptions of appearance—an attractive appearance became a factor that mattered as much as any other factor if one wished to get ahead. 

Narcissism and individualism are also the factor; although people are still self-conscious of how others within their community think of them, they have learned to tune them out and focus on their own desires. “More and more Koreans have come to believe they should live life as they want and actively take measures to ensure that they can. Fortunately, medicine in Korea was advanced enough to make things work when it came to improving one’s looks,” Professor Park stated. 

Pop culture has played a large part in lessening the stigma attached to cosmetic surgery. The immensely popular television show Let Me In (2015) is a good example. The show presents contestants who are unhappy with their appearance—for medical or psychological reasons—but could not afford financially burdensome surgeries. Medical professionals then select one contestant who is thought to be the most desperate, and the selected contestant goes under the knife completely free of charge. Daesenam (2016) is another popular TV program that has to do with cosmetic surgery; this program, however, exclusively targets males. Although Let Me In in particular sparked much controversy over its aggressive promotion of cosmetic surgery, both shows have effectively changed the attitudes of many toward surgical enhancement of their appearance. 

 

 

 

Another factor for changing views on cosmetic surgery is its undeniably positive effects. “Barring the few who have deep issues related to their self-image, most patients have much to benefit from cosmetic surgery,” explained Professor Han Seung-kyu (Korea University College of Medicine, Department of Plastic Surgery). He compared the psychological effects of cosmetic surgery to the jubilation one would feel upon looking in the mirror and seeing themselves, not a strand of hair out of place and clad in a perfectly coordinated outfit. “Cosmetic surgery significantly boosts a person’s selfesteem; this can motivate them to be much more active, socially or otherwise.” It must be noted that cosmetic surgery does not automatically grant such effects. Professor Han warned that patients need to make sure they are making the right choice— that is, check thoroughly whether the procedure is affordable and compatible with their body type. “If all these conditions are met, then there is no reason for anyone who wants cosmetic surgery to feel unhappy about their choice.” 

The view on cosmetic surgery thus stands divided. Some see it as unhealthy both physically and emotionally, while some see it as a ticket to happiness. As it happens, plastic surgery may even buy one a seat at the executive’s table. One group of people—job seekers, to be precise—have come to see plastic surgery as necessary as a college degree or a well-written resume. Saramin, a job portal site, found that well over half of human resources managers consider an applicant’s appearance when recruiting. This trend, ironically enough, led to a surge in reverse plastic surgery. People who undergo cosmetic surgery tend to have specific requests, such as wide, double-lidded eyes and high-bridged noses. As a result, patients end up looking unnervingly similar to one another. With the number of Gangnam sisters, a term for women who have such altered faces, rising higher and higher, people began favoring a natural and unique appearance over mass-produced perfection. Some could say this proves cosmetic surgery is a self-negating action, though whether it truly is one is still disputed.

Crossing the Line with Advertisements

One clear negative about cosmetic surgery in Korea is how it is marketed. Ads for plastic surgery clinics are as pervasive as weeds. They’re in pop-up windows on apps or websites, on the sides of buses, and on the walls of subway cars and stations. This is not just a source of annoyance for commuters—ads like these potentially spell danger for the children and teenagers who may stumble across them. Professor Han mentioned that cosmetic surgery may be unsafe for individuals whose bodies have not yet fully matured. 

 

Immature and impressionable teenagers are not all that is threatened by cosmetic surgery ads; some of the ads play on the fears and insecurities women may have about their appearances. For example, some ads make it seem as if women who do not surgically enhance their appearance are inevitably doomed to a miserable single life. Due to concerns that people, especially young children, may develop a warped perception of themselves and society through overexposure to such ads, Kim Gwan Young, a member of the National Assembly, proposed an amendment to medical laws that would strengthen regulation of advertisements for cosmetic surgery. 

Equally serious is the flood of illegal advertisements. The Ministry of Health and Welfare, with the assistance of the Korean Internet Advertising Foundation (KIAF), discovered that 174 of 657 plastic surgery clinics were violating the law, which states that information about the patients is not to be exposed to the public without a justifiable reason. The clinics in question posted cosmetic surgery cases online as part of their advertising; medical law requires that such information only be made accessible to potential clients after logging in, yet none of the offending clinics took measures to protect their patients’ identities. 

Another example of how such clinics advertise is the case of the actress Chun Isul. The clinic where she received her treatment posted an interview about the procedure she went through, without obtaining her consent. Chun went to court to have them take down the ad. Celebrities are not the only ones whose right to privacy is infringed upon—numerous unnamed patients are going through the same, and more could have it happen in the future. 

Koreans’ such excessive interest on cosmetic surgery over the past couple decades has naturally led even foreigners to turn their eyes towards this emerging mecca of beauty industry. Partly thanks to the K-pop and K-drama boom that swept the Asian Pacific region by storm, Korea has earned itself a glowing reputation as one of the finest medical tourism destinations around the world. Subsequently, Korean plastic surgeons and private clinics have been milking foreign tourists for years, mostly Chinese, who have been rushing to the country with high hopes to emulate the stunning beauty of Korean celebrities. 

The trend in the rise of Chinese tourists seeking for Korean cosmetic surgery started to gain momentum around 2010, and peaked in 2014 with approximately 79,000 patient visitors. Commonly referred to as medical tourism, it was clearly more lucrative than regular tourism in that these clinics were selling costly medical procedures, and providing food and lodging to recuperating patients. However, while the numbers of patients rose in tandem with the profit margins of plastic surgeons, a number of critical issues began to bubble up to the surface that altogether dealt a serious blow to this thriving industry. By all appearances, the hype surrounding Korea’s cosmetic surgery tourism now seems to have fizzled off, with its heyday coming to an abrupt end. 

Some feel the primary reason why the industry has seen a decline in its fortunes is the outrageous amount of commission fees pocketed by brokers. Most Korean cosmetic surgery clinics employ individual or small-scale agencies, which act as intermediaries, to lure in Chinese customers. These agencies often demand hefty commission fees that can take up to 90 percent of the bill. As a result, Chinese patients end up paying several times more than their Korean counterparts. Even the doctors who actually perform the surgeries get paid only a fraction of commission fees in some cases. 

In the meantime, a number of former patients who are suffering from serious side effects have come forward to accuse unscrupulous clinics of hiring unqualified surgeons and interns to operate. One group of Chinese women took to the streets in Myungdong last October to expose the ugly truth about Korean cosmetic surgery boom. The most infamous case is that of the Chinese tourist who was announced brain-dead in the middle of an operation last year, which led to the government saying it would more strictly regulate the industry. 

This debacle has reached a point where even Chinese media started to take notice of the issue. Earlier this year, China Central Television (CCTV) shed light on the rampant exploitation of a Chinese patient who was overcharged at a clinic in Gangnam. Coupled with these news reports, the negative words-of-mouth rapidly spreading across Chinese Social Networking Services (SNS), such as Weibo, continues to reinforce the antagonism towards this once highly coveted tourism destination. 

The signs of its decline are everywhere. A substantial portion of youkes, meaning Chinese tourist, that used to flood the country in pursuit of cosmetic surgery is now veering off to other destinations, namely Japan and Taiwan. Perhaps the most telltale indication is the fact that the streets of Apgujeong, which is collectively known as the “Beauty Belt” of Gangnam, are no longer bustling with Chinese tourists wearing white surgical masks and sunglasses. In fact, Ministry of Health and Welfare (MoHW) recently released a survey that showed a roughly 40 percent decline in the number of Chinese tourists who visited clinics in Gangnam alone.

 

The root of the problem lies in a lack of accountability. Many private clinics and brokers simply take advantage of foreign tourists, who are uninformed as to the credibility of the surgeons and the procedures. Although the risk of side effects and unseen complications resulting from plastic surgery has always existed, they seem to have been ignored in the drive for profits. 

The negative publicity associated with such irresponsible mentality is hurting the entire medical tourism industry, which has been heralded as one of new growth engines for the South Korean economy. According to the statistics provided by MoHW, 26,000 patients out of 100,000 Chinese tourists who visited South Korea for medical purposes sought cosmetic surgery procedures. 

Against such a backdrop, the government has announced plans to turn around the slowing tide of Chinese tourists by launching a tax refund program for tourists who undergo cosmetic surgery in Korea. More specifically, the tax reimbursements are granted on a wide range of procedures, from the all-too-familiar double eyelid surgery and rhinoplasty to facial bone contouring and teeth whitening. 

Despite such government initiatives in the form of tourism policies, the question still remains whether the mere gesture of offering tax breaks, without tackling the fundamental problem, could restore the tarnished reputation of Korea’s cosmetic surgery kingdom. Without a doubt, a comprehensive set of enforceable regulations is sorely needed in order to ensure safe practices by certified doctors, while curbing illegal exploitation by the brokers. However, this seems to be much easier said than done. For one, the nature of cosmetic surgery—beauty—is what stands in the way of restricting its practice to licensed doctors only. Professor Han, said that “Because the purpose is to simply enhance one’s appearance, rather than save one’s life from a deadly disease, the level of entry into this area is relatively low.” 

 

He then elaborated on why that is the case. “Strictly speaking, the technical difficulty involved in performing cosmetic surgery is often simpler than operating on your eyes, to give an example. When it comes to sensitive areas like one’s eyes, only professionals are equipped with the knowledge and skill to operate on a patient. On the other hand, a quick nip and tuck like making a double-eyelid seems much easier in comparison. This is why laymen without any professional training jump into cosmetic surgery, thinking they could do it too.” 

In addition, Professor Han added that the idea of limiting the legal rights to only cosmetic surgeons is not welcomed with open arms by many medical professionals in other fields. As beauty-enhancing procedures tend to yield higher profitability, even doctors with different specialties dabble in cosmetic surgery nowadays. For instance, the Supreme Court recently ruled in August that dentists can operate on patients’ faces using lasers to treat wrinkles and rejuvenate their skin. The list goes on, as even gynecologists promote pricey fillers that are injected into the genital areas, along with regular fillers for facial areas. Thus, it is understandable that the government is rather hard-pressed to set any legal boundaries that effectively prohibit uncertified laymen from fiddling with cosmetic surgery. 

 

Having said that, there is surely something that can still be done to control the damage. Park Young Jin from KRPRS suggested a “real-name system” that clearly informs patients exactly who is performing their surgery. He underscored that transparency must be prioritized to revive the medical tourism that is increasingly losing steam, which is an advice that the government should heed to stay competitive in the global market. 

 

For all its problems, Korean cosmetic surgery industry is still going strong and is most likely to stay that way for the foreseeable future. One indicator that points to such promising future is the obsession with beauty and anti-aging that is rapidly intensifying on a global scale. This trend is accompanied by the rise of underdeveloped economies—more customers with more money to spend. South Korea is ranked third in the global beauty and cosmetic surgery scene, with a market share of 5.3 percent, trailing after the United States (U.S.) and Brazil. 

To dig a little deeper, South Korea has recorded an annual growth rate of 10.2 percent from 2011 to 2015. The area growing fastest is the Non-Surgical procedures, with botox and fillers alone having grown by 17.6 percent and 21.8 percent, respectively. What is even more encouraging is that experts anticipate the non-surgical procedures to lead the way into the future. More commonly known as “petit surgery,” meaning “small” in French, this type of procedure is generally preferred for its speedy recovery and affordable price tags. 

Though the size of Brazil’s cosmetic surgery market is bigger than that of South Korea, Korean pharmaceutical companies’ technical superiority is overshadowing their global competitors even in the Brazilian market. Not only did Meditox, a domestic company, witness a 50 percent increase in sales compared to the year earlier, but it also expanded into four more South American countries, including Mexico, Chile, the Dominican Republic, as well as Guatemala. Meanwhile, Hugel, which is another Korean pharmaceutical giant, is currently taking steps to venture into the Brazilian and the Russian markets. 

Cosmetic surgery is a double-edged sword that has varying degrees of positive and negative implications both on individual and societal level. While more and more people are finding confidence and self-esteem at the hands of plastic surgeons, some are still suffering from complications and side effects in silence. Still, what has been made clear by the recent developments involving Chinese tourists is that despite the robust demand for cosmetic surgery both in and out of this country, repeating the same mistake will prove costly. Hence, adequate safety mechanisms by the government are called for to ensure a sustainable growth of this cash cow industry.