Body Modification in East Asia: History and Debates

ABSTRACT

This article outlines the long-term historical development of body modification in East (Northeast and Southeast) Asia, from the intentionally transformative practices of prehistory, such as tattooing and tooth blackening, to the “naturalistic” practices of the 20^th century, such as cosmetic surgery, which aim to leave no visible evidence of change. Attention is also paid to the recent postmodern revival of transformative body fashions. Asian developments are discussed in global context, and comparative international statistics are provided on cosmetic surgery prevalence. The remainder of the article addresses important questions of interpretation. To what extent does Asia’s current cosmetic surgery boom reflect universal processes and experiences of modernity, and to what extent culturally specific desires and developments? To what extent are current Asian beauty ideals and practices, notably the almost universal desire for fair skin, variations on indigenous traditions, legacies of colonialism, products of Western cultural hegemony, or consequences of a broader, cosmopolitan globalisation? A final section asks whether the recent expansionary trend in cosmetic body modification is likely to continue undiminished, or encounter effective forces of opposition in Asian societies.

KEYWORDS:

• Cosmetic surgery
• skin lightening
• East Asia; Southeast Asia
• tradition
• modernity
• Westernisation
• globalisation
• cosmopolitanism

This essay sketches the long-term historical development of body modification practices in East Asia, from prehistoric times up to the present. It also provides global context, including statistics on the current scale of the cosmetic surgery industry in this region relative to other parts of the world. The comparative material is followed by a series of introductory discussions highlighting key topics, controversies, and differences of interpretation regarding the relative importance of local tradition, in situ modernisation, and international cultural influences as factors shaping body modification practices in East Asia.

From Prehistory to the Early 20^th Century: Transformative Body Modification

Human bodies have always been objects of transformation, intentionally marked and modified in various ways and to various ends (Brain, 1979; Caplan, 2000). Throughout most of history such interventions were practised not to create an illusion of “natural” beauty, as is usually the case with modern cosmetic surgery, but rather to differentiate the modified from the natural body in visible and tangible ways. Sometimes such modifications were inflicted on unwilling subjects by way of revenge, punishment, or stigmatisation. More often they were consensual procedures intended to serve talismanic or medical purposes, protecting their bearer from harm of various kinds, or to mark rites of passage separating phases in an individual’s life, or to differentiate people of rank and renown. Especially in the case of tattooing, these traditional body modifications often also seem to have reflected an artistic impulse. Whatever their purpose, their hallmark was transparent artifice, the creation and representation of a clear break with a person’s unmarked and unmodified past. They also symbolised a boundary between humanity and the animal world: the Burmese, noted a 16^th-century English visitor, “say a dog hath his teeth white, and so they will blacken theirs” (cited in Reid, 1988, p. 75).

The inhabitants of East Asia originally possessed a rich repertoire of such transformative body practices. In parts of Southeast Asia these survived into recent or historical times to be documented by travellers, missionaries and ethnographers. Tooth blackening, accomplished by dyeing (Zumbroich, 2009), was just one common example. Others included tooth filing of various kinds, some of them very invasive, and the insertion of gold pins into the teeth (Jones, 2001; Zumbroich & Salvador-Amores, 2009). The practice of piercing and distending the earlobes was also widespread (Reid, 1988, p. 76), and in some areas the skulls of infants were deliberately deformed by binding to produce a desired head shape (Scott, 1994, p. 22). Tattooing, as a talismanic device and status-marker, was probably almost universal (Reid, 1988, pp. 77–79; Terwiel, 1979). Also characteristic for the region was the insertion of implants of various kinds into the penis (Brown et al., 1988; Hull & Budiharsana, 2001).

While these practices are best known from Southeast Asia where they survived longest, it is likely that in prehistoric times they also extended much further north. Recently the term “Greater Southeast Asia“ has been used to refer to a huge region, including Japan, Korea and a large part of China, which emerged as a “human unit” following the domestication of rice in central China around 7000 BCE (Abalahin, 2011). Modern populations throughout East Asia and the Pacific probably originate from migrations triggered, directly or indirectly, by this agricultural revolution. That they once shared a common heritage beyond agriculture is suggested by the occurrence of similar architectural forms in traditional Southeast Asian houses, Japanese shrines and Chinese archaeological sites, and by a number of specific cultural parallels, albeit of disputed strength and origin, between Java and Japan (Kumar, 2009). A shared set of body modification practices was probably also part of this ancient Greater Southeast Asian culture complex. Chinese records show that in the first millennium CE and earlier, tattooing was common among non-Han “barbarian” peoples as far north as the Yangzi River (Reed, 2000, pp. 361–364) and as far east as Japan (Van Gulik, 1982, pp. 246–251). It is likely no coincidence that cosmetic dentistry and tooth blackening were both practised (the latter until as late as the beginning of the 20^th century) in Japan as well as in Southeast Asia (Blomberg, 1990), and that a tradition of penile bead implantation exists in the modern Japanese underworld (Tsunenari et al., 1981).

If transformative body practices were once common throughout East Asia, over the centuries they came under pressure from the rise of several different “great traditions” that were hostile to them. Classical Chinese civilisation, like both Greek and Roman civilisations in classical Europe (Jones, 2000), disapproved strongly of body modification, including tattooing, which it condoned only as a degrading punishment for criminals (Reed, 2000). As the Chinese empire expanded, tattooing became restricted to socially marginal groups, both within China and in countries under Chinese cultural influence. In Sinicised Vietnam, it was officially prohibited as barbarous in the 14^th century (Reid, 1988, p. 77). In Japan, traditional tattooing disappeared as early as the 6^th century CE (Van Gulik, 1982, p. 270), except among the non-Sinicised Ainu people of Hokkaido. Today’s renowned Japanese tattoo art is a separate and later tradition, of which more below.

In Southeast Asia it was from Indic, Islamic and Western quarters that tattooing and similar traditions came under pressure. The fact that there is no direct evidence from any period of tattooing on Java seems to reflect the early and deep influence there of Hindu civilisation, in which the tattoo is associated with low social status. “The higher the caste,” notes Clare Anderson (2000, p. 104) of India, “the fewer the designs”. Elsewhere in archipelagic Southeast Asia, tattooing was under sustained attack from the 16^th century onward in connection with mass conversions to Islam and (in the Philippines) Christianity (Reid, 1988, pp. 76–77). Proselytists of both religions had doctrinal reasons to deplore what they saw as superstitious, if not diabolical, practices involving mutilation of the God-given body. In Indonesia, Malaysia and the Philippines, as in China and Japan, the tattoo ultimately became almost synonymous with criminality. During a wave of extrajudicial killings of suspected gangsters by Indonesia’s Suharto regime in the 1980s, anybody sporting one risked joining a long series of tattooed corpses discovered in sacks by the roadside (Siegel, 1998, p. 111).

In the Buddhist states of mainland Southeast Asia, tattooing and other traditional forms of body modification persisted for longer. In Burma at the end of the 19^th century there was still said to be “not a single up-country man” who was not tattooed, and ear-boring was still universal for women (Shway Yoe, 1910, p. 39, p. 51). In Thailand, tattoos were applied for administrative purposes, and to mark noble as well as servile status, until Westernising reforms put an end to these practices at the beginning of the 20^th century (Reid, 1988, pp. 77–78; Terwiel, 1979, pp. 156–160). Today, Thai, Burmese, Lao and Khmer Buddhism continues to support or tolerate traditions of sacred or magical tattooing, in which religious texts and symbols are incorporated into charms inscribed on the body to protect its owner against misfortune (Cummings & White, 2012). Many living inhabitants of the Burmese, Thai and Laotian borderlands still have deliberately blackened or otherwise modified teeth. Many young Thai men, at least among marginal social groups, still practise penile modification (Thomson et al., 2008).

In these countries too, however, such practices have been in sharp retreat in the last hundred years. In general it can be said that from late prehistoric times until the mid-20^th century, body modification of most kinds was in decline throughout East Asia. But there were some exceptions to this trend, most strikingly the rise and millennium-long persistence in China of foot-binding, popular from the Song dynasty (960–1279) until the 20^th century (D. Ko, 2005; Wang, 2000). Another exception was the late reinvention of Japanese tattooing, in the cities of the Tokugawa shogunate between the 17^th and 19^th centuries (Richie & Buruma, 1980). In its early stages this appears to have been a countercultural development of official penal tattooing; in its mature form it was inspired by the Chinese “Robin Hood” novel Shui-Hu Zhuan (often known in English as The Water Margin), in which a number of the outlaw heroes are tattooed. Illustrated translations of this novel were popular in Japan from 1750 onward, and illustrations published in best-selling editions of the early 19^th century set the style, and much of the iconography, of subsequent Japanese tattoo art.

Innovations and countercurrents aside, body modification practices with their origins in prehistory ultimately died out almost everywhere. Associated from the outset with the magical beliefs and rites of passage of small communities, they became less important as tribal peoples lost their autonomy, were absorbed into larger societies and centralised states, and began to take for granted their separateness from nature, rather than continually seeking to underline it using body art (Reid, 1988, p. 83). As noted, parallel tendencies in this direction are evident in Confucian, classical European and Indic civilisations as well as in the Christian and Muslim worlds. The world religions, interestingly, can be said to have run against this historical grain insofar as they did promote one particular type of body modification on an unprecedented scale: genital circumcision, required by Islam for men, and in Southeast Asia also promoted by Muslims for women to an extent that is not always fully recognised (Clarence-Smith, 2012; Feillard & Marcoes, 1998).

The Rise of Naturalistic Body Modification

Just as the last remnants of traditional body modification customs, with their transparent forms and transformative intent, appeared to be dying out across East Asia in the mid-20^th century, new practices, aimed at creating naturalistic beauty by artificial but ultimately invisible means, began a steady rise to popularity. The first country to be affected was Japan, where in the early decades of the 20^th century surgeons experimented with “augmentation rhinoplasty”, and with various forms of what later became known as “East Asian blepharoplasty” or the “double-eyelid operation” (Shirakabe, 1990). The former creates a more prominent nose, the latter an extra eyelid fold, the “superior palpebral fold”, which in most East Asians is not naturally present. The much-debated significance of these procedures in relation to questions of race, culture and cosmopolitanism will be addressed further on. In the 1930s and 40s they and other new cosmetic practices, including breast enlargement, also became available on a small scale in the major cities of China, although the revolution of 1949 put an end to them for several decades (Wen, 2013, pp. 30–40). In Japan, rhinoplasty and blepharoplasty grew increasingly routine during the 1950s and 60s (Brandt, 2016; Shirakabe et al., 1985).

In Korea, the popularisation of similar surgery is often attributed to US military doctors stationed there during and after the Korean War of 1950–1953, and in particular to one specific American, the renowned plastic surgeon Ralph Millard (Kurek, 2015; Lee, 2012). Millard’s work, however, was independently paralleled in the same period by that of many indigenous surgeons, in Korea itself and in other Asian countries, including Malaya and the Philippines (DiMoia, 2013, pp. 185–189; Millard, 1964, p. 646). Thailand, despite its subsequent role as a centre of international cosmetic surgery tourism (Wilson, 2011), particularly in the specialised field of gender reassignment (Aizura, 2010), was a relative latecomer to the field. The industry was reportedly pioneered there only in 1969, by Thai doctors trained in Britain and the USA (Boonbongkarn, 2001, p. 13). In China, the cosmetic surgery industry revived steadily in the 1980s and 90s following the economic and other reforms of the late 1970s, and its growth accelerated dramatically from 2003 onward (Wen, 2013, pp. 40–50, p. 85).

The recent growth of aesthetic cosmetic surgery in East Asia has been exceptionally rapid, particularly in the catch-up case of China. But it forms part of a global trend, the dimensions of which vary more by country than by region. South Korea, with its uniquely public plastic surgery culture, epitomised by the famous rows of posters advertising cosmetic clinics on the Seoul Metro, has the reputation of being the world centre of cosmetic surgery. In terms of strictly surgical, invasive procedures, this is indeed the case, but only narrowly so. The most cited data on the subject are those collected by the International Society of Aesthetic Plastic Surgery (ISAPS). In 2016, according to ISAPS, 8.7 surgical cosmetic procedures were performed in South Korea per thousand inhabitants, ahead of 7.8 per thousand in Belgium, 7.0 in Brazil, and 6.3 in Greece. When reported numbers of non-surgical procedures, such as Botox injections and chemical or abrasive skin treatments, are included, the leading country is no longer South Korea, but Greece (Table 1).

Table 1. Selected National Data on Cosmetic Procedures, Various Countries, 2016

	1 Countries in order of total number of procedures relative to population, 2016 (from ISAPS, n = 25)	2 Total number of cosmetic procedures performed per 1,000 inhabitants in 2016	3 Number of surgical cosmetic procedures performed per 1,000 inhabitants in 2016	4 Total number of procedures per billion US dollars of GDP in 2016
1	Greece	26.7	6.3	1494
2	South Korea (2015)	22.7	8.7	836
3	Belgium	17.3	7.8	418
4	Taiwan	16.5	5.3	732
5	Italy	15.8	5.4	515
6	Lebanon	13.3	5.8	1608
7	USA	13.0	4.6	226
8	Brazil	12.2	7.0	1407
11	Turkey	9.9	3.8	914
13	Japan	9.0	1.7	230
22	Iran	1.9	1.2	362
23	Thailand	1.6	1.2	281
25	India	0.7	0.4	386

Sources: ISAPS (2016); World Bank (2016); ROC (Taiwan) (2017). Statistics for South Korea in 2016 being unavailable, for that country the 2015 data are shown instead.

The reliability and comparability of these statistics is no doubt low, especially for poorer countries such as Thailand, but also for South Korea, where many cosmetic surgeons are not accredited (Elfving-Hwang, 2013, p. 1). Nevertheless, the general picture is instructive. One striking feature is the wide variation among countries of East Asia. South Korea and Taiwan may be among the world leaders in cosmetic procedures, but Japan, at a modest number 13 (in procedures relative to population), is not, and especially not when it comes to invasive surgery: “aesthetic salons” concentrating on skin treatments are the mainstay of the industry in Japan (Miller, 2006, pp. 40–70). Thailand, at number 23, has only a fraction of South Korea’s reported frequencies, although the Thai figures may well be severely understated. Japan and Thailand are outdone in the league table not only by Brazil and the USA, well-known centres of cosmetic surgery in the New World, but within Asia also by Lebanon, Turkey and Iran. It is worth noting that in these three countries the dominant religion is Islam, of all major faiths the most clearly hostile in principle to cosmetic body modification. This must give pause for thought regarding the significance of religious factors to cosmetic surgery practice and prevalence (see further below).

When we look at the number of cosmetic procedures in relation to national income (column 4), rather than population, finally, the countries that stand out are not South Korea and Taiwan but Greece, Lebanon and Brazil. By this measure, it is also interesting to note, Thailand moves into the big league after all, with more procedures (especially invasive procedures) per dollar of GDP than the USA – although still fewer than Taiwan or South Korea, and fewer too than India, a much poorer country.

Shared Trajectories: Modernity, Capitalism, and Consumerism

Cosmetic surgery of the kind just discussed is a modern phenomenon which in many ways reflects universal experiences of modernity. In the first place it involves – albeit perhaps in a uniquely superficial way – a modern aesthetic, one that values simplicity over ornamentation. A general movement away from decorative body modifications such as tattooing, we have seen, has been evident in Asia, and across the world, for centuries if not millennia. The high modernism of the 20^th century nevertheless marked the apogee of that trend. In a well-known modernist manifesto of 1908 entitled Ornament and Crime, architect Adolf Loos used Southeast Asian or Pacific (“Papuan”) tattooing – “the urge to ornament one’s face” – to exemplify the decorative instinct that he saw as the antithesis of modernity: “what is natural to the Papuan […] is a symptom of degeneracy in the modern adult” (Loos, 1998, p. 167). Most cosmetic interventions in contemporary Asia, as elsewhere in the world, are in line with this polemic insofar as they aim not to decorate artificially, but to enhance – albeit, ironically, by artificial means – natural beauty.

Another way in which naturalistic cosmetic surgery reflects universal modernity is in its dependence on technology: surgical and anaesthetic procedures developed by scientific medicine in the 19^th century, and perfected as a result of industrialised warfare in the 20^th. Cosmetic surgery patients must have access to, and faith in, these technologies. Hao Lulu, dubbed China’s first “artificial beauty” after a long series of operations sponsored for publicity purposes by a private Beijing hospital in 2003, wrote that she had too much confidence in technical progress to be worried about the dangers of surgery: “Even if there might be something wrong […] I believe that with the development of the technology, there must be some ways to fix it” (cited in Wen, 2013, p. 61). Other technological aspects of modernity conducive to cosmetic body modification include photography, mass print reproduction and digital media, which in conjunction with capital and markets (of which more below) expose people with unprecedented frequency to images of themselves and others.

Faith in the transformative power of technology is related in turn to another central precept of modernity, the principle that people’s status and identity should not be predetermined by society, but achieved and constructed by their own deliberate efforts: “We are, not what we are, but what we make of ourselves” (Giddens, 1991, p. 75). Since the demise of state socialism as an economic model, the criteria of achievement in modern society are almost everywhere set by market economies (including those of post-socialist Asian countries such as China and Vietnam) in which people compete relatively freely with each other for jobs, income and status. Beauty is an important asset in this kind of contest – particularly for women, whose employability, as well as marriageability, tends to depend heavily on their appearance (Rhode, 2010, pp. 23–32).

The freer and tougher the social and economic competition, the greater the importance of what in the literature is sometimes referred to as “beauty capital” (Wen, 2009). The growth in South Korean cosmetic surgery over the last 20 years has been linked by some with the Asian financial crisis of 1997–1998, which sharply intensified competition for jobs (Lee, 2012, p. 9). In the longer term, however, the cosmetic surgery industry also depends on structural prosperity, which enables consumers to afford its products. And like the competitive job and marriage markets on which it feeds, it is itself a creature of capitalism and consumer society, which enables it to invest, sell and profit from its activities, and which supports mass media that disseminate and popularise the beauty ideals to which it caters.

These then are some of the reasons why East Asian trends in body modification over the last century have broadly paralleled developments elsewhere in the world, and reflect what can be regarded as near-universal modernising forces in economy and society. Shared trajectories and experiences, nevertheless, are not the whole story. There also seem to be important intercultural differences in the ways in which “beauty capital” is perceived and used.

Worlds Apart? Body Modification as Discipline, Gift, and Mask

Anthony Giddens has illuminated the relationship between sociocultural modernity and body modification (together with other “body regimes” such as dieting and exercise) by pointing to the “reflexivity“ that distinguishes the fluid, aspirational self-identities of individuals in modern societies from the premodern determination of identity by fixed attributes such as lineage, gender and social status. “The reflexivity of the self extends to the body, where the body […] is part of an action system rather than merely a passive object” (Giddens, 1991, p. 77). Broadly speaking, this is as true in South Korea as it is in the West. Yet there is one aspect of Giddens’ account that seems out of line with descriptions of modern body modification in Asia. Modernity, for Giddens (1991, p. 102), is a condition in which individuals construct their bodies and identities as a matter of individual choice between multiple possibilities, or “lifestyles”. In this formulation, individuals experience decisions regarding whether or not to spend their money on particular cosmetic procedures as matters of personal freedom.

In Asia as well as in the West, body modification is indeed perceived by some as an act of individual empowerment and liberation (Luo, 2013, pp. 6–7; Wen, 2021). On occasion it has even given rise to a libertarian defence of individual rights: when Chinese “artificial beauty” Hao Lulu was debarred from a Beijing beauty contest in 2004, she attempted to sue the organisers for “infringements upon her rights and dignity” (Wen, 2013, p. 3). But as the seriousness of Hao’s formulation perhaps already suggests, the circumstances under which people in China (and Korea) typically decide to undergo plastic surgery are not such that their decision can adequately be understood in terms of a “lifestyle choice”. The forces acting on cosmetic surgery consumers are often too powerful for that, and their choices too constrained.

A distinctive feature of the cosmetic surgery industry in Northeast Asia is that many of the patients are very young women undergoing treatment at the expense of their parents, who see eyelid surgery in particular as a wise gift and intergenerational investment (Zhou, 2017). In the words of one Chinese mother interviewed by Hua Wen:

The competition for jobs and every kind of resource is so fierce. Especially it’s brutal for girls […]. I know that appearance is absolutely an important element in the keen job market today. […] [A] pretty face is a worthwhile long-term investment for my daughter’s future (cited in Wen, 2009, p. 93).

In South Korea, with its longer history of capitalist economic development, the normalisation of cosmetic surgery has proceeded further still. Here the eyelid operation has reportedly become not just a common intergenerational strategy for social and economic success, but a standard rite of passage for young adults, approved and encouraged by friends and family in their own and older generations alike (Karupiah, 2013, p. 12). This intergenerational socialisation, or traditionalisation, of cosmetic surgery is consistent with Taeyon Kim’s argument (2003) that beauty ideals and practices in South Korea are better understood in terms of a “Neo-Confucian” conformism than in terms of a Western, or indeed modern, individualism. Kim links the rigours of contemporary Korean fashion directly with the emphasis on “self-cultivation” that characterised premodern Korean culture:

The Neo-Confucian techniques of body management that compelled women to adhere to strict body rules continue today […]. The current emphasis on appearance over abilities means that women who fit the beauty norm are more apt to succeed in work and marriage. […] In such an environment, choosing to alter one’s body is a necessity rather than an option (Kim, 2003, pp. 107–108).

Other writers note a proclivity among Koreans to see virtue in the pain that, despite all efforts of medical science to minimise it, cosmetic surgery patients must suffer to some degree if they are to realise their goals of physical self-improvement (Lee, 2012, pp. 151–152; Park, 2007, pp. 46–47, pp. 63–64). Through the pain of surgery and the discipline of dieting and exercise, modern Korean body regimes acquire an echo of the virtue ascribed in traditional Confucian thought to older forms of civilised self-mastery. There is an analogy here with the recently-vanished Chinese practice of foot-binding, which, although not directly underpinned by Confucian doctrine, appealed to the Confucian ethic of self-discipline and self-cultivation (Blake, 1994).

This kind of “traditionalist” interpretation of modern Korean body culture has been criticised by Holliday and Elfving-Hwang (2012, p. 68, p. 72) for overstating the extent to which contemporary practices are inspired by Confucian principles. In the conventional Korean view, Elfving-Hwang (2013, p. 5) points out, Confucian or Neo-Confucian tradition was actually hostile to body modification: “the principle of sinch’ebalbu (body, hair and skin) prohibited any alteration of the body”, since “care-of-self and preserving the body were seen as important expressions of filial piety”. Much has changed, moreover, since the turn of the millennium when Taeyon Kim formulated her analysis, and for young South Koreans the distinctly un-Confucian world of K-pop celebrity culture is now the proximate source of inspiration for cosmetic body practices (Elfving-Hwang, 2018).

Although rejecting the idea of an ongoing influence from Confucianism, Elfving-Hwang echoes Kim in emphasising other culturally specific aspects of South Korean cosmetic practice: the “extremely limited range of beauty ideals promoted in the media” (Holliday & Elfving-Hwang, 2012, p. 75), and the extent to which consumer choices are governed by conformism rather than individualism.

[A]n analysis of Korean popular media discourse reveals that ideas of self-improvement are not simply grounded in Western individualism. Quite the contrary, they are also necessitated by the affective, intersubjective gaze of a social group (whether it be the family or other group that the subject identifies with) which promotes a view that the individual subject’s body is also representative of the collective body of that group (Elfving-Hwang, 2013, pp. 5–6).

In her account of a popular Korean “makeover” TV series, Elfving-Hwang notes that the programme-makers present the willingness of contestants to undergo cosmetic surgery partly as “an expression of filial piety or parental duty” (2013, p. 2). Despite the dramatic changes associated with economic growth and transformation, then, it is clear that family and society, not an individual quest to make “inner beauty” visible, continue to dominate Korean body culture.

Another culturally specific influence on the way in which cosmetic surgery is perceived and understood may be the cultural psychology of “face”. Unlike Confucian self-cultivation, this is characteristic of Southeast as well as Northeast Asia. It involves an ethically approved disconnect between outward appearance and inner feelings, whereby impassivity is valued over the expression of emotion, and stress is laid on the maintenance of a wide space between facial expression and mental attitude. There is a link here with the cultural fascination with masks that is pronounced in Japan (McCormick, 1956) and in Southeast Asia, especially Java (Coldiron, 2016) where Benedict Anderson (1990, p. 129) observed a “sense of the face as a kind of built-in-mask”. Thailand, too, has both a tradition of masked performative art and a complex system of what Goffman (1967) called “face-work” (Mulder, 1985, pp. 64–65, p. 68, pp. 73–74). Thai children are brought up with an understanding that just as a mask may be more than merely a disguise, face, appearance and beauty may be necessary, pleasing, even admirable things in themselves. And from the highly prized inauthenticity of accomplished face-work – of the smile-as-mask – it is, perhaps, a relatively small cultural step to the surgical alteration of the physical face.

It is not hard to think of further aspects of Asian cultural traditions that might favour permissive attitudes to cosmetic surgery. Examples come to mind particularly in the domain of religion: Buddhist notions of the impermanence of nature and the ephemerality of the body, for instance, or, more broadly, the absence in both Buddhist and Confucian thought of the Christian idea of the human body as a divine gift, created by God “in his own image”. However, it bears repeating that the available international statistics offer little support for any strong causal association between religious tradition, as such, and the prevalence of cosmetic body modification. Particularly telling here are the high rates of cosmetic surgery in some Muslim countries, where such a practice is in principle hard to reconcile with religious doctrine (Atiyeh et al., 2008).

Globalisation, Cosmopolitanism, and Convergence

To characterise the mainstream of modern cosmetic surgery as “naturalistic” is not yet to consider which specific natural features, within the rather wide range of human biological variation, it aims to simulate. In our context an important issue here is what anthropologist Eugenia Kaw, in a much-cited 1993 article on cosmetic surgery among US women of Asian descent, called the “medicalization of racial features”. The popularity of eyelid and nose surgery among Asian Americans, Kaw argued, reflected a pathological internalisation of racial stereotypes according to which Asian facial features were associated with “dullness” and “passivity” (Kaw, 1993, pp. 78–84).

In Asia itself, it is common today for blepharoplasty patients to deny that their aim is to look more like Westerners (Holliday & Elfving-Hwang, 2012, pp. 71–72; Miller, 2006, pp. 119–121). Round-eyed Asian celebrities, and intuitive aesthetics, are instead cited as the real sources of inspiration. But although many people in the region (especially in Southeast Asia and Japan) do possess “Caucasian” double eyelid folds from birth, there is no doubt that the development of double-eyelid surgery in Asia took place under Western influence. Reviewing the history of the operation in Japan up to the 1980s, practising cosmetic surgeon Yukio Shirakabe did not hesitate to describe that history as one of successive “attempts to westernize the eyes of Japanese women” in a context of powerful American cultural influence (Shirakabe et al., 1985, p. 224). It is significant that unlike the apparently timeless appeal of pale skin, to be discussed later, the idealisation of wide, round eyes and sharp noses represented a clear break with the East Asian past. Traditional ideals of feminine beauty in Japan (Shirakabe, 1990, pp. 215–217), as in Korea (Holliday & Elfving-Hwang, 2012, p. 71) and China (Wen, 2013, pp. 168–169), had typically included small, slanted eyes and rounded facial features – virtually the opposite of today’s dominant beauty paradigm.

The cultural Westernisation of Japanese women in the 20^th century was more than just a matter of adopting a new “Western look”. It also involved changes in social attitudes, including a new appreciation for individuality and self-expression (Brandt, 2016). The open gaze and sharp features of Western models were regarded as emblematic of these modern virtues, and inspired imitation for that reason: “the eyes and nose were the keys to enhancing the individual characteristics and expressions of the Japanese face” (Shirakabe, 1990, p. 220). In Korea, likewise, wide eyes came to signal increasingly desirable qualities of “energy and alertness”, as well as an “overt sexuality” that contrasted sharply with the modest, downcast female gaze of the patriarchal past (Holliday & Elfving-Hwang, 2012, pp. 71–72). The story is similar in China, where Caucasian features have become, in the words of Hua Wen (2013, p. 191), “a kind of embodiment of modernity in the eyes of Chinese women”. Once embodied (surgically or otherwise) in sufficient numbers of influential Asian celebrities, this kind of “cosmopolitan” look became less self-evidently Western, paving the way for its “normalisation” in Asian cultures. Caucasian physiognomy, individual character and universal modernity have thus become so closely intertwined that for many Asians the links between them are no longer consciously perceived.

Even among Asian cosmetic surgery patients who do acknowledge the influence of Western beauty ideals, there is still a widespread rejection of any imitation of Caucasian features that is so accurate as to suggest a denial of racial or ethnic identity (Luo, 2013, p. 6; Miller, 2006, pp. 120–121). For most patients the result of the intervention must always appear – perhaps at some level even be – a “natural” extension of the subject’s own person, both physical and cultural. In Korea, according to Holliday and Elfving-Hwang (2013, p. 71), the “most important aim” of cosmetic surgery is “a natural look that ‘enhances’ the body without losing the ‘Koreanness’ of the subject”. In multiracial Malaysia, where there is no single national beauty ideal, surgeons and their patients likewise avoid overt imitation of Caucasian features and aim in blepharoplasty for relatively narrow eyelid folds consistent with a “natural Asian look”. Malaysian cosmetic surgeons, according to Alka Menon (2019, pp. 6–7), have “relied upon East Asian, especially Chinese, notions of female beauty to construct what they called an Asian look […] with traces of a conservative past”.

In view of such attitudes, scholars often prefer terms such as “hybridity” (Johansson, 1998, p. 59) and “syncretic aesthetics” (Miller, 2006, p. 122) over “Westernisation” when it comes to describing how Western beauty ideals have affected East Asia. Some evidence suggests that in multicultural Western countries, a converse process is under way by which “white” beauty ideals are increasingly influenced by cosmopolitan elements (Adamson & Zavod, 2006; Sands & Adamson, 2014). If so, then the ultimate effect of the cosmetic surgery revolution may ironically be to accelerate, by artificial means, a centripetal movement toward a physiognomic “average” that some believe is a constant of human evolution (Symons, 1979, pp. 194–197; Langlois & Roggman, 1990). There is, however, one area of human appearance, skin colour, in which cultural preferences consistently seem to set a target far removed from any global average.

Skin Colour in Asian Society and History

The academic discussion on cosmetic surgery and race is in some ways paralleled by that surrounding another, less invasive but much more common, type of body modification with racial overtones: artificial lightening of the skin colour. Across Asia, Africa and Latin America, skin whitening creams and similar treatments, many of them expensive and some dangerous, are in regular use by hundreds of millions of people (Davids et al., 2016; Nakano Glenn, 2008). In Asia, almost every brand of skin care product available, regardless of region, includes a whitening range (Yip et al., 2019, p. 77). The popularity of skin lightening is often interpreted as a legacy of colonialism, or as a direct effect of contemporary Western cultural imperialism (Blay, 2011; Rondilla, 2012). But the full picture, in Asia at least, is more complex.

In Thailand there is great attentiveness to skin tone and an almost universal conviction that a light colour is desirable (Chaipraditkul, 2013; Purnell, 2013). However, this is more a matter of class than of race, and in discussions of the topic, which are frequent and frank, Thais seldom use the whiteness of Europeans as an ideal point of reference. Indeed, they sometimes distinguish explicitly between a coarse “Western whiteness” and a more desirable “Eastern whiteness”, associated with a soft, refined skin texture. Indonesians, likewise, make a distinction between Western or bule (literally, “albino”) whiteness, and that of fair-skinned Asians, which they usually regard as more attractive (Paramita & Winahjoe, 2014, p. 112; Saraswati, 2013, p. 115). In middle-class Indonesia today, according to Ayu Saraswati (2010; 2013), the operative ideal is one of “cosmopolitan whiteness”, as represented by the pale Asian or Eurasian (mixed-race) women who populate the pages of glossy Indonesian women’s magazines. The transnational glamour of these women, many of them Japanese or Korean, indulges readers’ aspiration to be cosmopolitan without implying that they want to become “Caucasian”.

The increasing importance of Northeast Asian beauty ideals is in line with the changing international dynamic of wealth and power, and with the growing visibility of Japanese, and especially South Korean, pop culture (Kang, 2017; Menon, 2019). To that extent it might be seen as part of a new wave of cultural imperialism: “South Korea has become the new France,” as one Vietnamese cosmetic surgeon bluntly put it in 2010 (cited in Hoang, 2014, p. 525). Yet once again, this is not the whole story. Western colonialism and the economic rise of Northeast Asia have both contributed to Southeast Asian “colourism”. But there is ample evidence that the desire for light skin, unlike the desire for round eyes, is indigenous throughout East Asia, and far predates the colonial experience. In China, where labourers who worked under the sun were referred to in antiquity as “the black-headed people”, there is an old saying that “a fair skin overshadows three ugly qualities”; in Japan, the white face paint of the geisha is a reminder of the traditional association of fairness with refinement (Johansson, 1998, pp. 60–61). A 9^th-century Javanese literary work likens the complexion of beautiful women to the radiance of the moon (Saraswati, 2013, pp. 26–32) and describes women using pollen “as face powder, so that they look perfectly white” (cited in Santoso, 1980, p. 697). In the pre-Hispanic Philippines, according to a 17^th-century account, the wives of chiefs were “just as fair as the Spanish women […] due to their isolation and seclusion and not seeing the sun” (Alcina, 2002, p. 97).

A similar ideal of fairness prevailed in the West until the 20^th century, when tanning became increasingly popular, first as a health treatment and later as a souvenir of seaside and international tourism (Featherstone, 1982, p. 23). Yet there may be some culturally specific aspects to the persistent Asian admiration for fair skin. In Hindu tradition the colour white symbolises not only the physical fairness and social superiority of the Brahman caste, but also the truthfulness and purity of Brahminical knowledge (Bates, 2007, p. 7). A similar symbolism exists in Buddhism. It is interesting to note that in some Southeast Asian languages, the word “white“ can also mean “clear” or “pure” – for example, “white [fresh/drinking] water” (Indonesian: air putih; Thai: nam plao). Possibly there is a connection here with Saraswati’s intriguing characterisation (2013, p. 107) of the “cosmopolitan whiteness” of the Indonesian middle-class imagination as “a virtual quality, neither real nor unreal”.

What is at any rate evident is that, in the past as in the present, it was seldom a specifically European skin colour that was admired in Asia. Two centuries ago, John Crawfurd (2013, p. 22) observed that the people of what is now Indonesia admired “fairness of complexion”, but “not the sickly hue of the European”. A general preference for fairer over darker skin, especially in women, actually appears to have been very widely shared among unrelated societies in all recorded periods (Van den Berghe & Frost, 1986). The reasons for this may include “pre-evolved sensory bias” (Aoki, 2002, p. 603) and the quasi-universal emotional and moral associations of light and darkness (Baumann, 2008), interacting with class (only the privileged could avoid the sun) and sexual selection to produce persistent skin colour hierarchies. Since aristocrats everywhere already tended to be more cosmopolitan than peasants in their experience, education and social contacts, the old ideal of aristocratic fairness has flowed more or less seamlessly into the modern ideal of urban, international and wealthy whiteness. Along the way it has been boosted in some settings by the importance in modernist thinking of hygiene, also associated with the colour white (Blay, 2011, pp. 16–19, pp. 26–29; Rondilla, 2012, pp. 21–26).

Recent Developments

Since the mid-1980s, body modification in Western countries has taken a postmodern turn, with tattooing and piercing practices spreading beyond the confines of stigmatised social groups, first into various individualistic and bohemian subcultures, and then increasingly, though still in quite diverse and eclectic forms, into mass consumer culture (Sweetman, 1999; Turner, 1999). The “new tribalism” of the Western tattoo revival drew its inspiration partly from Asia, and particularly from the spectacular Dayak tattooing traditions of Borneo. More recently, Japanese and Thai (Sak Yant) tattoo designs have also made their entry into Western popular culture. This is not the first time in history that Asian body art has been exported to the West: at the beginning of the 20^th century, it was fashionable among European visitors to Japan and Burma, including officers and aristocrats as well as rank and file soldiers and seamen, to have themselves tattooed in local styles (Sinclair, 1908, p. 368, p. 372). But the scale of the current wave of imitation is unprecedented, and ironically it began at a time when tattooing and other traditional forms of body modification had almost disappeared in Asia itself, replaced by body cultures involving pursuit of a naturalistic beauty devoid of visible artifice.

In Asia as in the West, however, things are changing. The changes started in Japan, where in the 1990s a new diversity became visible in youth body styles. The new “looks” no longer followed each other in succession like previous fashions, but coexisted with each other as parallel subcultures. Many of them featured conspicuously dyed hair; some, taking their cue partly from international surf culture or Afro-American music genres, also involved skin tanning and/or tattooing (Miller, 2006, pp. 27–35). More recently, new tattooing subcultures have also appeared in South Korea (Park, 2015) and Indonesia (Hegarty, 2017; Rokib & Sodiq, 2017). In the Philippines, where the revival of Southeast Asian tribal tattoos in the West has come full circle, indigenous tattoo designs known only from European illustrations more than four centuries old are once again providing inspiration for Filipino body art (Jaldon, 2011).

Just how fundamental a cultural change these developments reflect is debatable. The Japanese body subcultures, however different from each other, seem to involve high levels of conformism among their own devotees, and the fashion for tattooing among young metropolitan Koreans has been described by Judy Park (2015, p. 89) as “perhaps another form of conformity that is disguised as individuality”. But then, similar things have always been said about the subcultures of Western postmodernity too (Maffesoli, 1988). More unique is the recent emergence in South Korea of a culture of invasive yet transparent cosmetic surgery, epitomised by dramatic jaw reconstructions, that has almost nothing to do with any historical inspiration, real or imagined (Leem, 2017, pp. 665–667). In the words of a photographic chronicler of the Korean plastic surgery boom, Ji Yeo:

[T]here are actually two main types of plastic surgery clients in Korea: They are those who go for a more natural look (which can also be very expensive), and then those who prefer a more artificial look that can’t be achieved without plastic surgery: large eyes, a large nose and a very small chin (cited in Swanson, 2015).

A concomitant of this transparent artificiality in the end result of the surgery is the abandonment of secrecy or seclusion during the recovery period, with patients reportedly “strolling around Seoul wearing their bandages and talking excitedly about the procedures they have planned next” (Kurek, 2015).

Concluding Thoughts

Part of the fascination with the current boom of cosmetic surgery in East Asia lies in the question: “Where will this end?” The embrace of artificiality represented by the V-line jaw seems to imply that the answer might be: never, or not before humans have redesigned themselves according to their own whims, and the distinction between nature and artifice is utterly erased.

Yet even in Korea, there are signs of countervailing forces that may ultimately set limits to the normalisation of body modification. In 2017 the Seoul Metro, responding to complaints from members of the public about “distorted images of how women should look”, announced that the famous cosmetic surgery advertisements in its stations would be banned by 2022 (D.-h. Ko, 2017). Feminist criticism of plastic surgery has been heard in South Korea for some time (Holliday & Elfving-Hwang, 2012, p. 62) as part of a reaction against “beauty” as “a form of labour […] that only women are expected to perform and for which they are in no way compensated” (Haas, 2018). Aesthetic resistance to surgical body modification, at least in its more extreme forms, also exists in some sections of Korean society. “Gangnam beauty,” according to So Yeon Leem (2017, p. 665), “is often criticized by the Korean public because it looks ‘unnatural’, ‘artificial’, ‘excessive’, and even ‘ridiculous’”. In other Asian countries, an underlying cultural unease about cosmetic surgery persists more strongly still. Chinese plastic surgery tourism to South Korea, despite its popularity, is still surrounded by anxieties and taboos (Wong, 2018), and in Malaysia even cosmetic surgeons themselves reportedly associate the Korean industry with “perverted excess” and “modernity run amok” (Menon, 2019, p. 8).

In Thailand, meanwhile, there have for several years now been stirrings of a movement against skin lightening, fuelled partly by concerns about the safety of whitening products (Iverson, 2016), but also, following the example of earlier activism against colourism in India (Abraham, 2017), by a growing rejection of prejudice and injustice toward dark-skinned people (BBC, 2016; Holmes, 2016). On the global stage, the issue of colour prejudice has been brought to the fore recently by the Black Lives Matter movement, leading to the discontinuation or rebranding of some international skin lightening products (Jones, 2020; Toh, 2020). What further impact these developments will have in East Asia remains to be seen. But they have already exerted considerable traction in Indonesia, where dark-skinned Papuans, long subject to everyday discrimination as well as to political repression of the independence movement to which many of them are attracted, have rallied to the slogan of Papuan Lives Matter (Fatima, 2020).

We have seen that practices of, and attitudes to, body modification vary markedly between cultures – albeit often in ways that have less to do with formal religious or ethical doctrines than with uncodified societal norms of appropriate self-presentation. But we have also seen that body cultures, like cultures in general, change over time, often in mutually parallel ways. Modernity, however defined or understood, led across the globe to a pursuit of naturalistic beauty using, paradoxically, the artificial means of modern technology. Postmodernity has led to a partial breakdown of the naturalistic body aesthetic, whether in the nostalgic direction of neo-tribalism (tattooing, piercing), or in the wholly self-referential direction represented by V-line jaw surgery.

Yet both (late) modernity and (early) postmodernity may well be unique and fleeting episodes of historical instability, shaped respectively by the unprecedented speed of scientific advance in the century 1850–1950, and by the disorientation caused by the unexpected (and still partly unacknowledged) slowdown of technological and other progress since 1950 (Graeber, 2012; Huebner, 2005). Once this double shock is finally behind us, cultural futures, in Asia as elsewhere, may well settle down into patterns that are more balanced, stable and conservative than in the recent past. Exactly what the new balance in the domain of body culture will look like, we cannot predict. But quite probably it will continue to be informed by the notions of universal human rights, foreshadowed in the world religions and systematised by modernity, that underpin today’s incipient Asian critiques of the excesses of cosmetic surgery and skin whitening culture.

Additional information

Funding

This work was supported by the International Institute for Asian Studies; Walailak University; Leiden University.