# Cosmetic surgery in South Korea

Cosmetic surgery is voluntary or elective surgery for beauty enhancement. The motivation for plastic surgery has been debated throughout Korean society. Holliday and Elfving-Hwang suggest that the pressure of success in work and marriage is deeply rooted in one's ability to manage their body which is influenced by beauty. As companies helping with matchmaking for marriage and even job applications require a photo of the individual, Korean population inevitably feels pressure to undergo plastic surgery to achieve the "natural beauty".
South Korea has emerged as a major destination for medical tourism. Over the past four years, the number of foreign patients who visited plastic surgery clinics was 190,000, with Thailand and China accounting for the largest number.
According to ISAPS data as of 2021, South Korea has estimated the highest number of plastic surgery cases per capita in the world.

## History

The modern Korean interest in appearance dates back to the 7th century, finding its roots in physiognomy (gwansang). The concept of connecting identity and appearance became stronger during the Japanese colonial period in Korea, as Japanese rulers believed that certain facial features displayed greater intelligence and nobility. After that, plastic surgery technique brought by American doctors during the Korean War and accepted the Western notion that changing one's face would change one's destiny.
Due to the 1997 Asian financial crisis, South Korea deregulated the labor market; Korean citizens tried all they could to get an edge over competitors for a job position, including cosmetic surgery. This still happens in the current day, as companies require a photo, height, and sometimes the family background of applicants as a part of the hiring process.

## Statistics

Over the past few decades, plastic surgery has become more accepted in Korea. For example, 66% of respondents in 2015 expressed that a woman can get plastic surgery for marriage, compared to 38% in 1994. The proportion of women who reported that they had undergone plastic surgery also climbed from 5% in 1994 to 31% in 2015. Women consistently score higher and are more supportive about the procedures than men. According to a Statista survey in 2020 which interviewed a total of 1,500 people, plastic surgery is prevalent among young women in South Korea. Nearly 25% of women aged 19–29 have undergone plastic surgery, while men have only undergone surgery 2% of the time. This number increases to 31% of women and 4% of men among 30–39-year-olds. A case study by Allure Magazine noted that in recent years, the percentage rate of males who underwent plastic surgery increased and consisted as much as 30% of cases of those who underwent the procedure. The expectation of undergoing cosmetic surgery is not restricted to urban areas and has spread to rural towns, in part due to the popularity of K-pop idols such as Wonder Girls and Girls' Generation.
South Korea is frequently called the "plastic surgery capital of the world". Cosmetic surgery in South Korea is commonplace, if not a common graduation gift. South Korea's cosmetic surgery is a market leader, with South Korea taking a 25% share in the global market. One in five Korean women have undergone plastic surgery, compared to just one in twenty in the United States. In 2018, a total of 464,452 patients visited South Korea for cosmetic surgery, a 16.7 percent increase from 2017.

## Market

In the Korean surgery market, there are two providers: Hospitals and Specialty Clinics and Spas and Cosmetic Surgery Centers. In 2021, the market was valued to 1.95 billion US dollars.

### Forms of cosmetic surgery
#### Blepharoplasty

This form of cosmetic surgery is also known as the "double eyelid surgery". It is a surgery that reshapes the skin around the eye, resulting in a crease on the upper eyelid. The procedure is popular not just in South Korea but also other Asian countries like Taiwan and India.
The double eyelid surgery can be done in several ways, with the main difference being the form of incision. The full incision is often done to patients with excess fat and skin in the upper eyelid, a partial incision is done when there is only excess fat in the eyelid, while there is no incision used when there is no excess fat and skin. The surgery is not considered painful and it can take up to 4 weeks to fully recover.

#### Facial contouring

Asian facial skeletal contouring surgeries, also known as V-Line surgeries, are often done to reduce the dimension or angularity of the cheekbones or the jaw in order to create a V shape. They are commonly found among young Korean pop stars and can give the face an elf- or childlike appeal. K-pop groups like created a trend for the V-shaped face among young girls, as it is seen as an attractive feature.
A surgery can involve several related procedures: zygomatic reduction, V-Line surgery, mandibular contouring, and sagittal osteotomy of mandible. Zygomatic reduction involves fracturing the zygomatic arch, reshaping and re-orienting the bone so that it protrudes less to the side. During a V-Line surgery, incisions are made through the mouth. The chin is then fractured and reduced, and the jaw bone is shaved. Mandibular contouring is similar but does not involve the chin. Sagittal osteotomy reduces the width of the jaw bone.
The pain following surgery ranges from mild to extreme. The jaws may be wired together for weeks, and it can take six months for the swelling to completely disappear, although it is most significant during the first 72 hours. A maxillofacial surgeon and former professor at Columbia University said the V-Line surgery is complex and carries risks of permanent numbness and death.

#### Rhinoplasty

Examples of Korean celebrities that have undergone a "nose job" include Kim Hee-chul, Jessi, and Soyou. A popular member from Apink Hyoyeon has undergone rhinoplasty and other procedures during her time as an idol.
The surgery can be performed open and closed. The open procedure is the most popular as it gives the surgeon more visual context. It requires an incision in the columella, which often heals without any issues and leaves a minor scar that should be difficult to spot. Once the procedure is done, it takes a few weeks to heal completely. In a closed surgery, all the incisions are made inside of the nose.
In South Korea, rhinoplasty is the second least common surgery among ethnic Koreans. The procedure is sometimes be performed in a health context as well, as restructuring the nose can also make it easier to breathe.

#### Face whitening

Face-whitening injections have also started becoming more popular as a pale skin fits within the Korean beauty standards. The active ingredients in these injections is glutathione. The procedure last 20 minutes. Some negative effects from the procedure are as following: low blood pressure, rash all over the body, and problems with the digestive system such as nausea or vomiting.

### Medical tourism

Medical tourism is the act of attracting foreigners to undergo surgeries. With the rise of popularity of K-drama and K-pop around the world, numerous people opted South Korea to undergo cosmetic surgeries. "South Korea's plastic surgery business is gaining popularity because of the country's quick, affordable, efficient, safe, and high-quality healthcare system." In 2019, a total of 211,218 tourists visited South Korea for plastic surgery.

## Controversy
### Ghost surgeries

A ghost surgery is a surgery in which the person who performs the operation, the "ghost doctor," is not the surgeon that was hired for and is credited with the operation. The ghost doctor substitutes the hired surgeon while the patient is unconscious from anesthesia.
Ghost surgeries are "rampant" in the South Korean cosmetic surgery industry. Ghost doctors are often unlicensed and unqualified to perform the operations they are hired for, with some plastic surgeries being performed by dentists, nurses, or salespeople; one former ghost doctor reported that most substitutes were dentists. The Korean Society of Plastic Surgeons estimated that there were about 100,000 victims of ghost surgery in South Korea between 2008 and 2014. About five patients died during ghost surgeries between 2014 and 2022.
Ghost surgery is illegal in South Korea, but as there is often no evidence a surgery was performed by a ghost doctor, it is rarely punished in court. Public backlash to ghost surgery has led to the mandating of security cameras in operating rooms in South Korea.

### Beauty standards

Korea is often criticised for having unrealistic beauty standards, often expecting women to be very thin to the point where their weight can become unhealthy. The "escape the corset" movement goes directly against the country's beauty standards and active promotion of beauty products and surgery. The movement is intended to create body positivity and reduce the strict standards that women have to live up to in the country.
Another study made by Young A. Kim, Duckhee Chae and Hyunlye Kim about "Factors Affecting Acceptance of Cosmetic Surgery Among Undergraduate Students" affirms that the rise of the beauty standards conveyed by television, internet, actors and stars of K-pop affect people's mental health by decreasing their self-esteem and increasing their anxiety. The socio-cultural message transmitted by peers reflects the high beauty standards are became the norms.
Let Me In was a controversial South Korean television show that is focused on doing complete make-overs, including plastic surgery. Participants have to convince a panel that their appearance makes their life difficult, it even goes as far as making their parents apologise for appearance and lack of plastic surgery. Participants are presented to the audience after their make-over. The show was shut down in 2015 in a response to the amount of controversy and criticism, as the show was blamed for making plastic surgery more attractive to its viewers.
A 2021 study found correlation between negative body image or evaluation and acceptance of plastic surgery among South Korean college students.

### Employment surgery

Employment surgery is a common occurrence in South Korea. Due to a lot of competition in the job market, appearance is considered an important factor when hiring, which pressures people into undergoing surgery to get an edge over their competitors. People who are considered more appealing have statistically more chances to "have" the job than people who do not fit the beauty standards. This is well known by Koreans and can affect also the mental health of person who are looking for a job with the required qualification but not does not satisfy the beauty qualification. According to a 2006 survey, 92.2% of women in South Korea expect to be discriminated based on appearance during a job interview.
In 2021, a bill was proposed that take action against this culture, banning companies from asking for photos at a résumé. A survey in 2006 showed that 80% of public companies require personal information like photos.