Body Modification in East Asia: An Introduction

ABSTRACT

This short article introduces the special issue “Chasing Beauty: Cosmetic Surgery and Skin Lightening in East Asia”. It highlights the scale of and interest in the current boom in these procedures across Northeast and Southeast Asia, and outlines some questions of causality and interpretation arising from that boom. It then summarises the contents of the other five contributions to the collection, and identifies a number of common themes and conclusions arising from them. These are: (1) the ongoing eclipse of Western by Northeast Asian beauty ideals; (2) the continuing prevalence of uncritically inegalitarian assumptions about the relationship between physical appearance (especially skin colour) and social status; (3) the widespread framing of physical self-improvement as an ethically as well as economically desirable pursuit; (4) the weakness of cultural impediments to body modification in most countries of East Asia; and (5) the persistence, despite permissive attitudes to body modification as such, of a concern with authenticity and naturalness in ultimate appearance.

KEYWORDS:

• Cosmetic surgery
• skin lightening
• East Asia
• Southeast Asia
• Japan
• Korea
• China
• Thailand
• beauty
• race
• class
• ethics

It amused him to toss questions at me […]: Hey, Sonmi, is it worth azuring my teeth, d’you reckon, or is sapphire just a passing fad? He didn’t expect cogent answers […] Boom-Sook Kim’s only regular visitors were Min-Sic and Fang. […] They bragged about their new fords and suzukis and played poker. There is no point describing their features: they underwent facescaping monthly.

–From “An Orison of Sonmi~451”, David Mitchell’s dark fable of 22^nd century Korea, in Cloud Atlas (2004, p. 218)

Schoolgirl Kang NaYeon is still unsure about having surgery […]. “A small face is pretty,” she says. “But creating a V-line is so dangerous […]”. NaYeon shudders. She has some hope for change in Korean beauty – but it’s not what you might think. “I think if technology gets more advanced, maybe in the future everyone will get surgery, and then everyone will be beautiful!”

–Zara Stone, “The K-Pop Plastic Surgery Obsession”, The Atlantic (24 May 2013)

In the early 21^st century, East Asia’s boom in cosmetic surgery has captured the world’s imagination. Its association with frenetic K-Pop youth culture and hi-tech Asian capitalism, its apparent lack of restraint, modesty or secrecy, and its sheer speed and scale – inevitably provoking the question, “Where will this end?” – fascinate popular and academic writers alike. Not a few are at the same time repelled, openly or otherwise, by the queasy combination of cutesy aesthetics, cynical materialism and surgical gore that the industry embodies. For some commentators its blossoming in East Asia signifies the ultimate triumph, via globalisation, of Western consumer culture and Western beauty ideals:

Asia’s recent obsession with cosmetic surgical culture has been inaugurated by the tidal waves of globalization, the new economy and advances in information technology and the media. […] Seduced, captivated and sometimes addicted to Western images of cosmetic surgical culture, more and more Asians desire to remake themselves in the Caucasian mould (Elliot, 2008, pp. 25–26).

Others, however, note that Asian cosmetic surgery patients themselves rarely express their beauty aspirations in terms of any “Caucasian mould”. Indeed, some of their most sought-after “looks”, notably the narrow “V-line face” beloved of Korean pop stars and their fans, seem to stand out against, rather than conforming to, Western beauty standards. And while capitalism and consumerism are clearly central to the rise of the cosmetic surgery industry everywhere, close observers note that the cultural contexts in which these forces operate in East Asia are different from those shaping the same industry elsewhere in the world, leading to subtly different outcomes. In South Korea, for instance, there is a uniformity about the behaviour of cosmetic surgery customers that some believe reflects a “Neo-Confucian” collectivism rather than a “Western” sense of fashion as an individual choice.

The pressure under Neo-Confucianism to follow closely the rules of propriety concerning the body translates in consumer society into a rigorous demand to follow the new rules of fashion. […] The result is that the female bodies seen in the streets of Korea are nearly identical to the bodies depicted in media portrayals. […] Beauty in Korea has become a requirement of decorum for women rather than a vanity. The cultural pressure to harmonize as one […] means that fashion tends to compel conformity rather than individuality (Kim, 2003, pp. 106–107; emphasis in original).

In the same period, parallel discussions have emerged in relation to another form of body modification of which the international public is increasingly aware: artificial lightening of the skin tone, cosmetics designed to achieve which are big business across Asia, as well as in Africa and Latin America. To the extent that international beauty ideals are driving this trend, they appear to be racially ambiguous “cosmopolitan” ideals, and in Southeast Asia also explicitly Northeast Asian (Japanese and Korean) ideals, rather than Western or “white” (Caucasian) ones. In addition, some commentators argue, old and indigenous cultural associations between light skin colour and beauty, cleanliness, virtue and social status also seem to be playing important roles (Nakano Glenn, 2009; Li et al., 2008).

In the last decade, anthropological and other research into how body modification is practised, experienced and understood in East Asia has built on the insights sketched above to produce an increasingly nuanced and complete picture of what continues to be an important and controversial cultural development, particularly given the now dramatic growth of the cosmetic surgery industry in China. The purpose of the present special issue is to provide an authoritative taster of this research and the results it is yielding. Our collection includes articles on South Korea, China, Japan and Thailand, and covers topics such as male beauty, gay subcultures, and the aesthetics of the ageing body which have only recently begun to receive academic attention in this context. All contributors are attentive to both local and cosmopolitan influences on body modification practices, to history and innovation, and to debates regarding the relative importance of the two. But they strive above all to describe with anthropological accuracy and cultural sensitivity how those practices are motivated, justified and experienced by practitioners, patients, and the societies around them.

It is worth being clear at the outset that this is not a collection about Western cosmetic surgery tourism in Asia. Much academic attention been paid elsewhere to the pursuit by citizens of rich countries of cheap medical and cosmetic services in the developing world – notably in Thailand, which emerged in the late 20^th century as one of the world’s leading destinations for medical tourism (Wilson, 2011), with a unique international reputation for gender reassignment surgery in particular (Aizura, 2010; Enteen, 2014). Our contributors, however, are interested in the experiences and motivations of Asian body modification subjects, not Western tourists. More generally, they are wary of Eurocentric perspectives and “postcolonial” discourses that are not necessarily relevant to the question of how and why body modification practices and industries have actually developed in Asia.

This is not to suggest that cosmetic surgery tourism is not significant in Asia. In both Thailand and South Korea, it has been estimated that foreign visitors account for as much as one-third of all cosmetic surgery business (ISAPS, 2018; Marx, 2015). But in both cases the international part of the industry has its foundations in a thriving domestic market, not vice versa. Moreover, cosmetic surgery tourism in Asia is increasingly, and in Northeast Asia overwhelmingly, an intra-Asian phenomenon. In 2016, close to 60 per cent of all visitors to South Korea for the purpose of plastic surgery came from China, compared to just 5 per cent from the US. Japan, Thailand, Singapore and Vietnam accounted between them for another 15 per cent (Nam, 2017). In sum, then, less than a quarter of South Korea’s cosmetic surgery tourism, and less than 10 per cent of its cosmetic surgery industry as a whole, involves non-Asian foreigners. It is in the spirit of this very Asian globalisation that our writers try to do justice to Asian body modification trends as objects of inquiry in their own right, and not only as mirrors of, or reactions to, global developments.

Our special issue consists, including the present Introduction, of six contributions. The second and immediately following article is entitled “Body Modification in East Asia: History and Debates” (Henley & Porath, 2021). It sets the scene by sketching the long-term historical development of body modification practices in East Asia, from prehistoric times to the present, and by providing global context, notably in the form of comparative statistics on the current scale and characteristics of the cosmetic surgery industry in our region relative to other parts of the world. The historical and statistical sections are complemented by a series of concise introductory discussions on the themes of modernisation, cultural specificity, and globalisation. These discussions highlight some salient controversies and differences of interpretation among academic writers in the field with respect to the relative importance of local tradition, in situ modernisation, and international cultural influences as factors shaping body modification practices in East Asia.

If the second contribution has a historical flavour, the four remaining articles all consist of up-to-date accounts and analyses of contemporary body modification practices. Each deals with a different East or Southeast Asian country and focusses on a different demographic group. Laura Miller’s (2021) “Deracialization or Body Fashion? Cosmetic Surgery and Body Modification in Japan” discusses eye surgery, together with eye, skin and hair colour modifications, among young Japanese women. Joanna Elfving-Hwang’s (2021) “Media, Cosmetic Surgery and Aspirational Beauty Aesthetics of the Ageing Body in South Korea” deals with beauty ideals and practices, including cosmetic surgery and Botox treatments, among older Korean women. The third and fourth contributions, somewhat unusually, deal with the expanding world of male body modification in East Asia. “Gentle yet Manly: Xiao xian rou, Male Cosmetic Surgery and Neoliberal Consumer Culture in China”, by Hua Wen (2021), focusses on heterosexual Chinese men, while Dredge Byung’chu Kang’s (2021) “The Duty to Transform: Properly Refining the Body and Re(de)fining Onself in Thailand” discusses cosmetic surgery and skin colour lightening among young Thai gay men and transgender women. In both of these male studies the focus is on cosmopolitan, relatively prosperous men living in big cities.

These four contemporary research articles, all by acknowledged experts in their respective areas, speak for themselves and are appropriately diverse, reflecting the wide geographical and cultural scope they span. Yet they are hardly worlds apart. There is a unity about the contemporary body cultures of East Asia, one that reflects what Kimberley Hoang (2014, p. 513) has described as “a new pan-Asian modernity highlighting emergent Asian ideals of beauty in a project of progress that signals the rise of Asia”. Some important common themes, accordingly, do emerge from the contributions by Miller, Elfving-Hwang, Kang and Wen, and these are worth highlighting in brief.

The first such common theme is what might be described as “non-Westernisation”. If body modification in East Asia was once inspired and motivated largely by Western beauty ideals, that time has now passed. While some of Elfving-Hwang’s older Korean informants recalled being influenced by American film stars in the 1970s and 80s, “none […] considered Hollywood beauty important or relevant for their current aspirational standard of beauty” (Elfving-Hwang, 2021, p. 249). Although the kaleidoscopic Japanese youth subcultures described by Miller incorporate features ultimately derived from Western sources into their various “looks”, they do so very partially and selectively, and often more by way of parody than of mimicry. Their devotees’ hair is blue, purple, red and pink as well as blond and brown, their contact lenses more often variegated brown, pink, silver and gold, with cartoon-like enlargement of the iris, than blue, green or hazel. Their direct sources of inspiration are mainly Japanese: “manga and anime characters and Japanese pop stars” (Miller, 2021, p. 232). Other indigenous influences on contemporary Asian body styles are much older. Hua Wen argues that the delicate, fair-skinned appearance aspired to by China’s new “metrosexuals” partly reflects the resurgence of a traditional elitist model of “soft” or wen masculinity, emphasising civilisation, sophistication and cultural attainment, as opposed to the “hard” or wu masculinity favoured in the Maoist period.

If Western aesthetic hegemony in East Asia seems increasingly a thing of the past, active intra-Asian influences are very much evident in our contributions. Hua Wen describes how a Japanese manga comic and TV series Hana yori dango (“Boys over Flowers”) inspired a South Korean imitation which in turn has shaped the emerging culture of androgynous male beauty in China, where the influence of Korean pop culture is strong. China’s “little fresh meat” (xiao xian rou) aesthetic is in fact just one manifestation of a new “Pan-East Asian soft masculinity” (Jung, 2009), the influence of which on body modification practices has not been trivial. According to Hua Wen even the most drastic of the Korean cosmetic surgery styles, the V-line jaw operation, is already commonplace among Chinese metropolitan men. The same is true, at least in gay circles, in Thailand, where beautification practices have become “strongly keyed to newly imagined Korean and Japanese ideals”, giving rise to “new style hierarchies” that reflect “the growing Asianisation of Thailand” (Kang, 2021, p. 285). One of Kang’s informants, tellingly, expressed an interest in “making his eyes smaller (ta-lek), like Northeast Asian eyes, as he believed that Thais already have large eyes (ta-to) like Caucasians” (Kang, 2021, p. 282; emphasis added).

A concomitant of “non-Westernisation” concerns the frequently expressed critique of Asian cosmetic surgery as an exercise in “de-racialisation”, a humiliating denial or erasure of racial or ethnic identity. Insofar as it refers to imitation of “Caucasian” features, that critique, whatever its merits in relation to Asian diasporas in Western countries, is fast becoming more or less irrelevant to Asia itself. Yet this does not mean that race, in the sense of inherited differences in physical features between geographically distinct populations, has no further bearing on Asian body modification practices. East Asia’s new and increasingly standardised beauty ideal is not just a hybrid product of the cosmopolitan imagination: it clearly elevates (fair-skinned) Northeast Asian over Southeast Asian phenotypes. Kang, writing from a Southeast Asian vantage point, goes so far as to refer in his contribution to our collection to “a newly regionalised and racialised […] East Asia” in which Thais seek “to mould the self and the Thai nation” according to a “white Asian” ideal (2021, p. 272). This Asian whiteness is one that is defined specifically by Korean and Japanese imagery, and its desirability is underpinned by the prestige of Northeast Asian (pop) culture, wealth and modernity.

Except perhaps within the tanning subcultures of Japan, skin colour prejudice or colourism, whether or not it is framed in racial or genetic terms, appears to be universal across the region. “What is consistent in these contexts,” as Yip, Ainsworth and Hugh (2019, p. 81) observe in a recent essay on “the rise of the Pan-Asian beauty ideal” in both Northeast and Southeast Asia, “is the centralization and idolatry of white skin”. The ubiquity and unquestioned status of this prejudice, moreover, reflect in turn a broader and deeper set of inegalitarian assumptions about physical appearance and social hierarchy.

As we note in our separate historical overview article (Henley & Porath, 2021), in recent years a reaction against colourism and “beauty bias” has in fact begun in several parts of Asia. However, there is no sign of it yet in any of the other pieces in our collection. The contemporary Asians described and quoted in these all appear to endorse without reservation the idea that an attractive appearance, as defined by existing social convention, is simply intrinsically valuable: “beautiful is beautiful”, as an insightful “culture shock” handbook for visitors to the Philippines once pithily put it (Roces & Roces, 1985, p. 19). The role of beauty in the acquisition of social and economic status is treated as legitimate – or at least, as so inevitable and self-explanatory as to be beyond critical discussion. Even in personal reflections by informants, there are no apologetic asides here to the effect that “appearances are not everything”, no relativising comments in the vein of “beauty is in the eye of the beholder”, and no musings on the injustice of society’s biases in favour of the accidentally beautiful – still less any hint of critique of social or gender hierarchy and inequality itself.

This lack of critical societal introspection seems both striking and characteristic. Even in Japan, where some body subcultures do have subversive overtones, the “playful critique” (Miller, 2021, p. 218) that they imply appears to be directed at expectations of conformity and homogeneity, not at power, inequality or the cult of appearances. Gay Thais, meanwhile, seem happy to approve cosmetic surgery as “a consumption practice that demonstrates class distinction” (Kang, 2021, p. 284). Chinese cosmopolitans, for their part, eagerly consume media narratives of “self-improvement, successful transformations, and dramatic life changes for the better” through surgery and the resulting career enhancement (Wen, 2021, p. 266). Terms such as “face value” (yanzhi) are used without irony or distaste in contemporary China to convey the idea of artificial beauty as a prudent form of capital investment en route to wealth, success and happiness. Ageing Korean women regard cosmetic surgery as a valid and desirable route, for those who can afford it, to the kind of “elegance” (pumwi) that is appropriate to their station in life (Elfving-Hwang, 2021, p. 247).

This is not to say that body modification practices in these countries are devoid of any ethical content. Kang is at pains to stress that his Thai informants perceive body modification not only as a way of advancing their own interests and self-esteem, but also as part of a “duty” to be “socially presentable”, failure to discharge which would indicate a lack of moral virtue.

Anyone who has the financial means to transform is expected to engage in the labour of self-care, to improve onself. Transformation is not […] a choice but an expectation, like proper daily grooming before presenting oneself in public. […] Not following through [is] akin to laziness or misbehaviour. […] [B]eautification […] points to one’s wealth in the ability to afford beauty and demonstrates a morally upright commitment to ongoing self-improvement (Kang, 2021, pp. 278–284).

Even in the more intensely competitive context of urban China, according to Hua Wen (2021), “self-improvement”, not career promotion as such, is the most regularly self-reported motivation for men to undergo cosmetic procedures. Elfving-Hwang, comparably, argues that in South Korea the pursuit of beauty is “a way of displaying appropriate social etiquette (yewi) toward others” (2021, p. 243). The kind of morality involved here, however, is one that is explicitly status-referential, and that systematically reinforces the existing social hierarchy. It is also one that depends on a well-nigh stereotypically Asian concern for “face” and the avoidance of public shame.

All our contributions testify to the pervasiveness of body modification in East Asia, and to its dynamic expansion there into new sections of the population. They also testify to the relative lack of cultural barriers to this process in the region. Elfving-Hwang observes that in Korea “the border between the perceived ‘natural’ (unmodified) self and the modified self is not vigorously policed or stigmatised” and “there is thus greater flexibility toward altering one’s appearance […] than in countries such as Australia, the Netherlands, the UK or the US” (2021, p. 243). With the significant exception of two very doctrinaire (and elderly) Christians, accordingly, her older female informants displayed positive attitudes to cosmetic surgery, with no inclination to keep their bodies in their natural state on moral grounds. The views of younger people are more permissive still: Miller writes that for many young Japanese, the body is “simply an extension of fashion […] a pliable surface that one may play with by painting and sculpting” (2021, p. 220).

It is tempting to expand this point into a neat binary contrast between the general permissiveness of societal attitudes to body modification in East Asia, and the undertone of hostility that has often characterised modern Western (and Islamic) responses, popular as well as intellectual, to the cosmetic applications of medical technologies. From the satirical horror of classic Twilight Zone science fiction TV series episodes “The Eye of the Beholder” (1960) and “Number 12 Looks Just Like You” (1964) to the horrified fascination generated by reality TV shows such as Extreme Makeover (2002–2007) and Botched (2014–2018) in the 21^st century, cosmetic body modification has always attracted a good deal of negative attention in Western media. In the face of still widespread public antipathy, many cosmetic surgery professionals in Western countries continue to be concerned to legitimate themselves by presenting what they provide as a medical service rather than a consumer product (Adams, 2012). There is a parallel here with the West’s turbulent response to the possibilities of human eugenics and genetic engineering, procedures that aim to accomplish on an inter-generational basis what cosmetic surgery purports to achieve within a single lifetime: the improvement of the human body in the perceptions of humans themselves.

On close inspection of our Asian evidence, however, the contrast with the supposed Western cultural emphasis on naturalness and authenticity turns out to be less than absolute. The same ageing Korean women who are positively inclined in principle toward cosmetic surgery nevertheless also express a concern to maintain a “natural-looking appearance”: “if it’s too obvious, then it’s not good” (Elfving-Hwang, 2021, p. 246). “Excessive” surgery, reports Elfving-Hwang, tends to be “pathologised” as “unnatural” (2021, p. 246). A concern with authenticity is also evident in the physiognomic nationalism which causes most Japanese to reject surgery that makes the eyes appear “too Western”, and which is one reason why even in the case of the “racially mixed” hybrid body fashions that emerged in Japan at the end of the 20^th century, according to Miller “the aim was never to not look Japanese” (2021, p. 232).

It is also important to remember here that the cosmetic surgery boom of our time is a global one, affecting not only Asia, but also Europe and the Americas – not to mention parts of the Muslim world and, increasingly, Sub-Saharan Africa (Parker, 2014). Whatever controversy it still generates, cosmetic surgery is far more “normalised” in Western countries today than it was a generation ago. Even explicitly feminist opinion on the subject, traditionally a bastion of hostility because it saw women’s pursuit of artificial beauty as the result of ideas and structures that ultimately functioned to subordinate them (Davis, 1995; Wolf, 1990), has tended to become more ambivalent, attentive now to the voices of women – including professed feminists – who report experiencing real benefits, psychological and otherwise, from cosmetic surgery (Pitts-Taylor, 2009; Sweeney, 2009).

One way of looking at today’s global convergence of popular opinion in favour of cosmetic body modification is to say that the whole world is in effect becoming more “Asian” in its concern with appearance and “face”. Ruth Benedict, who popularised the idea of a distinction between “shame cultures” (such as Japan) and “guilt cultures” (such as the US), suggested as early as the 1940s that guilt (internalised fear of wrongdoing) was losing ground to shame (fear of public censure or disapproval) as a principle of social life in America (Benedict, 1946, pp. 223–224). In the 1990s, Anthony Giddens (1991, p. 155) agreed that the “characteristic movement” of late modernity is away from guilt and toward shame. In the 21^st century this movement has been accelerated by the rise of electronic social media, users of which continually manage and manipulate their public image via mask-like “profiles”. In our second contribution to this collection (Henley & Porath, 2021), we argue that from the studied inauthenticity of traditional Southeast Asian “face-work” – of the smile-as-mask – it is a relatively small cultural step to the surgical alteration of the physical face. Here we may conclude our introductory essay by suggesting that cosmetic surgery is an even smaller step removed from the virtual masked ball of Facebook and Instagram, where participants routinely doctor their profile photographs by digital means (Cosslett, 2016; Solon, 2018) to make their bodies appear slimmer, their features more symmetrical, and their complexions clearer.

Additional information

Funding

This work was supported by: Leiden University; Walailak University; International Institute of Asian Studies.