Changing Faces

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At 18, Saeko Kimura was a shy, sleepy-eyed university student. Until she discovered a secret weapon: if she applied a strip of glue to her eyelids, her eyes became wider, rounder, prettier. "Men noticed me," she says. "I became outgoing. Suddenly, I had a life." Her new looks also landed her part-time work as a hostess in an upmarket bar, where she gets top dollar on a pay scale determined by beauty.

But Kimura lived in fear of discovery, rushing off to the bathroom several times a day to reapply the glue and never daring to visit the beach. And so, at 21, she finds herself in a doctor's office in a Tokyo high-rise, lying on an operating table with her fists nervously clenched. Plastic surgeon Katsuya Takasu breezes in wielding a cartoonishly enormous needle. "This will hurt a little," he says cheerfully. Once the anesthetic is administered, Takasu brandishes another, hooked needle and threads it through Kimura's upper eyelids, creating a permanent crease. He then injects a filler fluid called hyaluronic acid into her nose and chin and pinches them into shape. Takasu inspects his handiwork. "The swelling will go down in a few days," he says. "But even if you went out tonight in Roppongi, you'd be a hit." A nurse hands Kimura a mirror. Though red and puffy, she now has the face she's always dreamed of: big, round eyes, a tall nose, a defined chin. The entire procedure took less than 10 minutes. But Kimura collapses with an ice pack on her face and moans, "Oh, the pain."

What we won't do for beauty. Around Asia, womenand increasingly, menare nipping and tucking, sucking and suturing, injecting and implanting, all in the quest for better looks. In the past, Asia had lagged behind the West in catching the plastic surgery wave, held back by cultural hang-ups, arrested medical skills and a poorer consumer base. But cosmetic surgery is now booming throughout Asia like never before. In Taiwan, a million procedures were performed last year, double the number from five years ago. In Korea, surgeons estimate that at least one in 10 adults have received some form of surgical upgrade and even tots have their eyelids done. The government of Thailand has taken to hawking plastic surgery tours. In Japan, noninvasive procedures dubbed "petite surgery" have set off such a rage that top clinics are raking in $100 million a year.

Elsewhere in Asia, this explosion of personal re-engineering is harder to document, because for every skilled and legitimate surgeon there seethes a swarm of shady pretenders. Indonesia, for instance, boasts only 43 licensed plastic surgeons for a population of about 230 million; yet an estimated 400 illicit procedures are performed each week in the capital alone. In Shenzhen, the Chinese boomtown, thousands of unlicensed "beauty-science centers" lure hordes of upwardly mobile patients, looking to buy a new pair of eyes or a new nose as the perfect accessory to their new cars and new clothes.

The results are often disastrous. In China alone, over 200,000 lawsuits were filed in the past decade against cosmetic surgery practitioners, according to the China Quality Daily, an official consumer protection newspaper. The dangers are greatest in places like Shenzhen that specialize in cut-price procedures. "Any Tom, Dick or Harry with a piece of papergenuine or notcan practice over there," says Dr. Philip Hsieh, a Hong Kong-based plastic surgeon. "They use things that have not been approved, just for a quick buck. And people in China don't know that they're subjecting themselves to this kind of risk."

Of course, Asians have always suffered for beauty. Consider the ancient practice of foot binding in China, or the stacked, brass coils used to distend the necks of Karen women. In fact, some of the earliest records of reconstructive plastic surgery come from sixth century India: the Hindu medical chronicle Susruta Samhita describes how noses were recreated after being chopped off as punishment for adultery.

The culturally loaded issue today is the number of Asians looking to remake themselves to look more Caucasian. It's a charge many deny, although few would argue that under the relentless bombardment of Hollywood, satellite TV, and Madison Avenue, Asia's aesthetic ideal has changed drastically. "Beauty, after all, is evolutionary," says Harvard psychology professor Nancy Etcoff, who is the author of Survival of the Prettiest: The Science of Beautynot coincidentally a best seller in Japan, Korea, Hong Kong and China. Asians are increasingly asking their surgeons for wider eyes, longer noses and fuller breastsfeatures not typical of the race. To accommodate such demands, surgeons in the region have had to invent unique techniques. The No. 1 procedure by far in Asia is a form of blepharoplasty, in which a crease is created above the eye by scalpel or by needle and thread; in the U.S., blepharoplasty also ranks near the top, but involves removing bags and fat around the eyes. Likewise, Westerners use botox, or botulinum toxin, to diminish wrinkleswhile in Korea, Japan and Taiwan, botox is injected into wide cheeks so the muscle will atrophy and the cheeks will shrink.

Just as Asian faces require unique procedures, their bodies demand innovative operations to achieve the leggy, skinny, busty Western ideal that has become increasingly universal. Dr. Suh In Seock, a surgeon in Seoul, has struggled to find the best way to fix an affliction the Koreans call muu-dari and the Japanese call daikon-ashi: radish-shaped calves. Liposuction, so effective on the legs of plump Westerners, doesn't work on Asians since muscle, not fat, accounts for the bulk. Suh says earlier attempts to carve the muscle were painful and made walking difficult. "Finally, I discovered that by severing a nerve behind the knee, the muscle would atrophy," says Suh, "thereby reducing its size up to 40%." Suh has performed over 600 of the operations since 1996. He disappears for a minute and returns with a bottle of fluid containing what looks like chopped up bits of ramen noodles. He has preserved his patients' excised nerves in alcohol. "And that's just since November," he says proudly.

The cultural quirks of the plastic surgery business in Asia also extend to sexuality. In China, Korea and Indonesia, where virginity is highly prized, young women go in for hymen reconstruction in time for their wedding night. In Japan, Indonesia and Korea, men ask for penis-enlargement procedures, in part to avoid shame when bathing en masse. In Thailand, with its sizable population of so-called "lady boys," a thriving industry has sprung up to provide male-to-female sex-change operations.

Traditionally, most Asians going under the scalpel were women. But a mutant strain of male vanity has turned into a virtual epidemic. "Men are uptight about seeming too vain," says Dr. Takasu after completing the procedure on Kimura. "But it's true that when you look old, you're treated that way." He clicks his computer mouse and a close-up of a saggy-faced, dour man appears on a flat, wall-mounted monitor. "That's me four years ago," he says with a satisfied chortle. "Lifts," he explains, batting his eyes and stroking his jaw. "Chemical peel," he says, sweeping a hand across his face. "Plugs," he adds, tilting his brown-dyed hair forward. "I had a colleague insert a golden wire in my chin to prevent sagging." Takasu, who looks a decade younger than his 57 years, uses his own face as an advertisement prop for his trade, and it glows like a large peach.

Today, all beauty requires is cashand Asians are blowing it on surgery at an unprecedented rate. "People want to look more beautiful as a way to show off their newfound wealth," explains Dr. He Xiaoming of the Peking Medical Union College's Plastic Surgery Hospital. Dr. Jean Lin, a plastic surgeon in Taipei, adds: "When the market goes up, I get more patients. When it drops, so do my appointments." On the other hand, a tight labor market also forces workers to compete by trying to look more attractive. In Japan, salarymen buzz about "recruit seikei"cosmetic surgery for the sake of landing a job. The owner of a "beauty center" in Shenzen's Jiulong City Mall observes, "China has too many people. How do you make yourself stand out from 1.3 billion? Imagine your boss sees two people of similar ability. He will definitely pick the person with the better appearance."

In China, surgically enhanced beauty is both a way to display wealth and a tool with which to attain it. Audis of the rich and well connected cram the parking lot of the high-tech Shenzhen Fuhua Plastic & Aesthetic Hospital, where the operating rooms look like a Star Trek set. The surgery center at Northwest University in Xi'an, a city in western China, targets a different demographic, handing out promotional flyers that offer procedures including hymen reconstruction at a 50% discount for students"in order to make you tops in both your academic achievements and your looks!"

In recession-plagued Thailand, even the government has recognized the money-making potential of plastic surgery. The Tourism Authority of Thailand helps promote institutions like the Bumrungrad Hospital to foreigners, who make up one-third of its patients. "We're a hot commodity," says Ruben Toral, the hospital's director of international programs. Located on a traffic-clogged street in Bangkok, the 12-story, $90 million hospital is like a five-star, round-the-clock plastic surgery factory. There's a Starbucks in the lobby, high-speed Internet connection for the patients and room service offering halal and kosher meals.

In the mid-'70s, Thailand had only 10 plastic surgeons, so locals tended to go abroad to Japan or Singapore for cosmetic help. Today, the tide has reversed, and Thailand has become a surgical hub. "No country can compete with Thailand," says Dr. Preecha Tiewtranon, a surgeon specializing in sex reassignment at Bangkok's Preecha Aesthetic Institute, where 80% of the clientele is foreign. Much of the appeal is price: Preecha, who performed 300 operations last year, charges only $6,000 for a sex change, compared to $25,000 in the West.

Price, too, is what attracts foreign patientsmainly from Japan, Taiwan and Hong Kongto Apkujong, a section of Seoul with over 400 surgery clinics. Here, on a busy avenue nicknamed "Plastic Surgery Street," Park Chan Hoon pulls up in his sedan and leads three female passengers into a softly lit lobby decked out in black leather and chrome. A few years ago, the 38-year-old engineering Ph.D. quit a research job to start a travel agency offering plastic surgery tours for the Japanese. Packages include airfare, hotel, sightseeing and, say, a boob joball for the cost of the procedure alone back home.

Park jokes in fluent Japanese with Satsuki Takemoto, who has traveled to Seoul for shopping and liposuction. The 34-year-old homemaker from Hiroshima pulls out a snapshot of a stunning woman in a red kimono. "That's me 10 years ago," she says. She once weighed 40 kilos; today, after having two children, she's 75 kilos. "My husband says he doesn't care," rasps Takemoto, exhaling cigarette smoke, "but when the kids are mad at me they'll sometimes yell, 'buta'"pig. Over the years, Takemoto has tried prescription diets, spa treatments, specially-designed slimming underwearall of which were expensive and none of which worked. Surgery, especially at a decent price, seemed the smart solution. "We told the kids, 'Mommy's in Korea getting her fat sucked out because we don't want her to drop dead from heart failure,'" she says. She takes another drag on her cigarette. "Yeah, they're a little scared."

Kawinna Suwanpradeep, an actress known throughout Thailand for her roles in TV soap operas, wasn't scared. Plastic surgery is no big deal in her line of work, and Suwanpradeep, 32, was less concerned about medical risks than the risk of losing work due to her hefty thighs. When Yanhee Hospital, a Bangkok plastic surgery center, offered her free liposuction in return for a public endorsement, she jumped at the chance. "I figured the doctors were internationally trained, and a lot of stars went there," she says. "I hadn't heard that a lot of things had gone wrong."

She was told she would be able to go home the same day as the operation, "but I had to stay three days," says Suwanpradeep. "I couldn't walk because of the pain and weakness." After the bandages were removed, she noticed wavy patches and scars. The doctor told her they would disappear in a few months, but when they still hadn't healed a year later, she demanded an explanation. "Then his whole tone changed and he said it wouldn't healthat I would have to have another operation."

Instead, Suwanpradeep went to court: "I can't wear swimsuits. I can't do fashion shoots. And I can't play any sexy characters on television, because at some point they might have to show their legs." The hospital denies responsibility (and declined to comment for this article, citing the pending court case). Disgusted with her courthouse experience, Suwanpradeep is studying for a law degree. "Now," she says, "I'm the poster girl for plastic surgery disaster."

That's a poster that should be plastered around countless back lanes offering cut-rate beautyespecially in Thailand, Indonesia and China, where outdated laws offer scant protection against crooks and incompetents. In Indonesia, a thriving underground of beauty parlors and door-to-door salesmen cash in on perhaps the most rampant and dangerous procedure available in Asia: silicone injections, which are strictly regulated in the U.S. In Asia, silicone is still hawked to plump up noses, breasts and even sex organs like the labia or penis. It works at first, but liquid silicone can't escape the laws of gravity, resulting eventually in an unsightly droop. It can also cause swelling, tissue decay, andif it enters the bloodstreamdeath. Transsexuals are often both perpetrators and victims. Two years ago, a transsexual in East Java died after injecting silicone into her breasts. What's more, the injectable silicone typically used among transsexuals is industrial grademuch cheaper and more toxic than medical-grade silicone. "To make even more money," adds Dede Oetomo, a Surabaya-based anthropologist and gay activist, "they heat the substance and mix it with cod-liver oil, lard or frying oil."

Saleha, now 33, received her first silicone injection in 1995 from a fellow transsexual who owned a beauty parlor in Surabaya. Tall, slender and dressed in a tight, white top and matching miniskirt, Saleha would be attractive if not for her ruined nose and chin. After her first cosmetic injection, she wound up with a nose "like Bozo the clown's," she says. So she visited another beautician who pinched and tweaked her nose into shape, then treated her with more injections than Saleha can now count. "I was totally broke after a while," says Saleha, who at the time sold noodles and moonlighted as a prostitute. Gradually, as the silicone shifted, her whole face began to sag and her chin withered. When she speaks, her large hands flutter constantly to her face to perform a furtive, futile massage.

Part of the problem is that it's much harder to exact legal retribution in Asia than in the West, where medical malpractice suits often yield enormous settlements. Most Asian lawyers avoid malpractice cases, since so few result in victory and financial payoff. Above all, though, it's the bargain-hunting instinct that leads patients astray, tempting them to use unqualified cosmetic practitioners. "At the end of the day, the government will have to make a decision on whether to restrict surgery to specialists," says Dr. Woffles Wu, a plastic surgeon at the Camden Medical Center in Singapore. "This is a time bomb waiting to go off."

It may seem reckless to undergo medically unnecessary operations that could disfigure or even kill you. But who's to say that good looks aren't worth the risk? "The Japanese have a saying: 'It's not the face, it's the heart,'" says television producer Koji Kaneda. "But when I asked around, everyone acknowledged appearances countoften more than anything." With that in mind, Kaneda dreamed up a show called Beauty Colosseum that launched last fall. Each week, women pour forth tales of woe, and a panel of beauty experts offers makeover advice. The most desperate cases are referred to the show's "miracle doctor of beauty," Toshiya Handa, a surgeon at the Otsuka Academy of Cosmetic & Plastic Surgery, a chain of 13 clinics across Japan. The regular appearance of tanned, telegenic Handa on Beauty Colosseum has inspired a flood of young TV viewers to sign up for surgery at Otsuka. In 2001, 64% of the patients there were in their teens or 20s.

One of the program's most memorable guests was Yumi Sakaguchi, a 26-year-old from Osaka. Even today, her lips tremble as she recounts her life. Born with droopy eyes, a receding chin and prominent buckteeth, Sakaguchi endured merciless teasing in her youth. Classmates even drew caricatures of her on the chalkboard. "I always walked with my face to the ground," she says. After high school, when her diabetic father racked up big medical bills, Sakaguchi sought work as a bar hostess to pay off the family debt. "They turned me away flat, saying, 'You'd make the customers sick,'" she recalls. "It was then I realized I had only my body to sell." Sakaguchi found work at a brothel, but many customers rejected her because of her looks. "I was at rock bottom," she says, softly. "I kept thinking, something will work out, somehow. My life depended on it."

Last October, Sakaguchi appeared on Beauty Colosseum and won free dental, eye and chin surgery that would otherwise have cost over $30,000. She quit the skin trade, landed a high-paying hostess job, and plans to study psychology. But nearly a year after her surgical windfall, Sakaguchi sounds circumspect, as if the enormity of the change has come to weigh on her. Though open about her surgery and her past, she was hurt when a recent boyfriend told her he would not have dated her before her surgical alteration. "I always wanted to believe people were ultimately judged by what was inside," she muses, her gaze hesitant and sad. "But I knew from my personal experience that this wasn't true. It's always the pretty girls who win the good things in life."

Alvin Goh, a slight, impeccably dressed stylist and creative director of a soon-to-be-launched lifestyle magazine in Singapore, understands better than most our tendency to judge a book by its cover. So, a year and a half ago, Goh, now 24, decided to get an eye job. "We live in a cruel society where everything is based on first impressions," he says. "If you look in the mirror and don't feel good about what you see, it won't help you in your life, in your work or in your relationships."

Much more so than women, men cite their careers as the driving reason to go under the knife. Taiwanese comedian Tsai Tou was once known as the ugliest man in show business. While his face helped win him laughs, he felt it limited his chances of hosting a talk show: so he too had surgery two years ago, adding folds to his eyelids, getting his eye bags removed, having his nose heightened and his wrinkles flattened with botox. A face free of bags and wrinkles, Tsai explains, captures the "trustworthy" look that TV viewers prefer. Dr. Kenneth Hui, a plastic surgeon in Hong Kong, remarks: "It can be a matter of necessity, not vanity."

Necessity drove Ching Wei to plastic surgery. Desperate for work, the struggling Taiwanese entertainer took a TV role in 1997 that required him to escape chains and a wooden box as it was set on fire. Instead, he found himself trapped. Covered with third-degree burns, Ching saw his career evaporate and attempted suicide. Five years and $60,000 worth of surgery later, Ching, now 37, is an award-winning media personality and owner of his own communications company. "It's a miracle," he says. "Everything you see about me is the work of plastic surgerymy facial skin, implanted hair, and restored retina."

Some people find tragedy in the plastic surgery clinic. Others, like Sakaguchi and Ching, are reborn. Most are somehow looking to achieve that most elusive of goals: to halt the march of time. "All of Asia is ruled by a youth culture," says Hiromi Yamamoto, a Tokyo hair and makeup artist who has written extensively about plastic surgery. "We may respect the old, but it's the young who play the lead roles. So it's no surprise that the old want to look young, and the young want to look fabulous."

In a plush cabaret in the Akasaka entertainment district of Tokyo, a slender woman in a slinky, red dress croons Amazing Grace. Despite her rich voice and charming stage presence, Teri Hirayama is, at 36, pushing the upper limits of the business. So, over the course of six months, she has had her baggy eyelids lifted, her nose and chin shaped, and her wrinkles smoothed away. Now the politicians and foreign executives who frequent the joint ply Hirayama with requests.

"I'm the one who urged her to get it done," boasts cabaret owner Kirisa Matsui, herself a gorgeous specimen of 60. "I don't hire homely girls. These are difficult times, you know, and I've got a business to run."

Whether for vanity, ego or cold hard cash, we all want to look better, younger, more fabulous. Think of all the clichEs about beauty: that it is in the eye of the beholder, that it slayed the beast and, of course, that it is only skin deep. Teri Hirayama and millions more throughout the region seem to be buying into that last conceit as they go under the knife in the quest for an aesthetic beauty as malleable as silicone in a surgeon's hand.

With reporting by Robert Horn/Bangkok, Joyce Huang/Taipei, Zamira Loebis/Jakarta, Michiko Toyama/Tokyo, Bryan Walsh/Shenzhen and Genevieve Wilkinson/Singapore