Press Room

Data shows that an increasing number of people are beginning to understand and try cosmetic procedures. According to the ‘2024 China Lifestyle, Beauty and Light Medical Aesthetics Market Research Report’ by iiMedia Research(CAMIR member units), China’s medical aesthetics industry reached a market size of 280.4 billion yuan in 2023, and this figure is expected to grow to 381.6 billion yuan by 2025.

Ashley Mills, a sociologist who studies the beauty economy, once said: “Beauty has become everyone’s obligation – and for powerful and successful women, this obligation may be even more demanding.” I used to think that, once I had social status and material resources, I could gracefully withdraw from the pursuit of beauty, but the truth is that the more resources I have, the more expensive beauty treatments I can access.

Having been immersed in the medical aesthetics industry for nearly a decade, Dr. Guo has witnessed its transformation from a unique perspective. While he has seen the industry gradually grow from a relatively marginal sector, he is also keenly aware that it is still in a state of flux and that inadequate regulation is one of the reasons for this. In this article, we will speak to Dr Guo, a senior plastic surgeon employed at a Grade III Class A hospital in China, to hear his thoughts.

Part 01.Hospitals and “Institutions”

The medical aesthetics that we often discuss fall under the category of plastic and cosmetic surgery within the medical industry. Many of these ‘patients’ are not actually patients in the traditional sense. They seek treatment not because their health is at risk, but because they want to “look better” or “put the icing on the cake”. These patients usually consult several doctors before making a final decision. For them, doctors are “selected”, not lifelines. Therefore, a doctor’s success in securing a patient often depends on their overall competence, including their communication style, their ability to explain treatment plans, their aesthetic judgement, their compatibility with the patient, and the adequacy of post-operative follow-up.

It is worth mentioning that the development of plastic surgery departments in public hospitals in East Asia is now approaching saturation point, with fierce competition. It is precisely because of the unique nature of aesthetic surgery that a number of private clinics, referred to as “institutions” in this article, have emerged in East Asia and worldwide.

Private medical institutions prioritise revenue. Patients often first interact with consultants in these institutions, who may not necessarily have medical expertise and are essentially salespeople. The consultant usually determines the patient’s treatment plan, leaving the doctor relatively passive. Consequently, doctor turnover in private hospitals is very high, with some changing hospitals several times a year. Career advancement is driven more by building personal networks and reputations, with many doctors cultivating their personal brands through social media and commercial activities. In contrast, plastic surgeons in public hospitals tend to be more stable in their employment and rarely change jobs.

“A responsible doctor will not perform any aesthetic procedures outside of a hospital because all aesthetic procedures are medical procedures that carry risks, regardless of size. In severe cases, these risks can even be life-threatening,” said Dr Guo.

For example, common risks associated with hyaluronic acid injections include allergies and inflammatory granulomas caused by inadequate sterilisation. However, these risks are often deliberately downplayed or omitted entirely in advertisements. So-called “home injections” or “at-home procedures” pose an even greater risk: the home environment is far from meeting the sterile standards of a hospital, and self-injection or having it performed by unqualified personnel significantly increases the risk. Frankly, most cosmetic surgery adverts you see online are exaggerated — otherwise, they wouldn’t be adverts. It’s like the piece of meat on a packet of ramen noodles — you’re almost never going to eat such a large piece of meat in real life.

Besides, When patients come for consultations, I often tell them that expecting cosmetic procedures to solve all appearance problems “once and for all” is putting the cart before the horse. A common misconception is that people have overly high expectations of what cosmetic procedures can achieve. In reality, the skin on our faces only accounts for 3% to 5% of our total body skin area, yet we often invest most of our energy and money in it, neglecting the remaining 97%.

Part 02. Changes in aesthetics

When discussing changes in plastic and cosmetic surgery over the years, Dr Guo described the state of the field in previous eras. He said that his father was also a plastic and cosmetic surgeon. In the early 1990s, the focus was on “repair”, such as treating injuries from car accidents and burns, and helping patients “restore their original appearance”. However, by the late 1990s and early 2000s, demand had shifted towards “transformation”. At that time, East Asian aesthetics were heavily influenced by the West, with large double eyelids and high nose bridges becoming popular features. Many people even felt inferior and hoped to “completely transform” their appearance through plastic surgery. Around 2005, however, the trend changed again, with people beginning to accept Eastern beauty and pursue “improvement” rather than “transformation”. Surgical procedures still dominated during this period, which was also a time of rapid development for plastic surgery institutions.

Around 2015 and 2016, the concept of “light medical aesthetics” emerged. Injectable products and phototherapy devices flooded the market as people favoured these quick, non-surgical procedures with a short recovery time. Skin aesthetics (including injections and lasers) became the highest-revenue department in hospitals and clinics. This shift is closely related to the changing consumption habits of a new generation of young people. Many young people are willing to spend money on ‘self-improvement’, pursuing not just designer bags or luxury cars, but also a strong sense of self, with more clearly defined needs when communicating with doctors. Howev

er, in the past few years, the medical aesthetics industry as a whole has experienced a significant “consumption downgrade” due to the global economic downturn.

Nowadays, most young women opt for minor procedures such as hyaluronic acid injections, Botox or IPL skin rejuvenation, rather than major surgeries like jaw reduction or rhinoplasty. The mindset is no longer one of “denying oneself and undergoing a complete change”, but rather “I’m fine, but I could be better”. It’s the ease of access to minimally invasive cosmetic procedures

Another factor is: the social aspect of cosmetic medicine. If one woman tries a procedure and finds it effective, for example, she may influence her friends. In the past, people were reluctant to talk about their cosmetic surgeries, but now it has become a popular conversation topic. Many people also post about their experiences on social media, using phrases such as “personally tested and effective” to encourage others. The desire to improve oneself is universal, and cosmetic procedures can be addictive.

As a plastic surgeon, I’ve had hyaluronic acid injected into my chin and I occasionally have IPL skin rejuvenation treatments. When I was younger, I wanted to look more mature. Now that I am more mature, I want to look younger. I like wearing hats and masks because I feel that my hair isn’t thick enough and that my mouth protrudes slightly. Being surrounded by young, appearance-conscious patients and colleagues in my work environment naturally makes me more conscious of my image. Like fitness, a moderate level of appearance anxiety can be a motivator — applying a certain amount of pressure to the body causes micro-damage and allows it to repair and become stronger. People are the same, they need a suitable amount of tension and dissatisfaction to motivate themselves.

Part 03. The risks of cross-border cosmetic surgery

East Asia has a unique approach to cosmetic medicine that differs from that in Europe and America. Due to its proximity to South Korea, cross-border cosmetic procedures are very popular. As everyone knows, South Korea’s position in the medical aesthetics industry is akin to Michael Jordan’s position in basketball.

Dr Guo said “i studied in South Korea, and many people like to go there mainly because it’s cheaper”. For example, due to tariffs, distribution costs and other factors, one dose of Juvederm (hyaluronic acid) costs about three to four thousand yuan in a Chinese, whereas in public hospitals in Hong Kong or South Korea, the same brand of hyaluronic acid costs about one thousand yuan. Therefore, many people who require multiple injections tend to travel to Hong Kong or South Korea to save money. However, I should warn that unless you have a close friend in Korea who can recommend a reputable medical institution, there are significant risks. Renowned Korean doctors are already overwhelmed with local patients. Many doctors who treat Chinese patients may not have much experience, and some may be there simply to “gain experience”. There’s also the risk of middlemen taking a cut.

Above all, patients have virtually no effective channels through which to seek redress if accidents or complications occur overseas. Suing for compensation in South Korea is extremely difficult due to language barriers, visa requirements and time constraints. Realistically, many people only discover problems such as hyaluronic acid lumps or facial asymmetry after returning home, by which time they may no longer be able to contact their original doctors.

When discussing South Korea’s attitude towards plastic surgery, he used thread lifting as an example of a product that was once very popular in South Korea but is now rarely used.

Thread lifting originated in South Korea and was once extremely popular. However, it is no longer as popular, primarily because people feel that the lifting effect looks stiff and unnatural and restricts facial expressions. Sometimes the threads are even visible, which Koreans particularly dislike as they dislike “unnatural facial appearances”. Furthermore, South Korea has very lax regulations on plastic surgery, allowing surgeons to develop and implement their own procedures without lengthy approval processes. Consequently, the South Korean plastic surgery industry is highly diverse, with various small incision techniques, minimally invasive facelifts and unique technologies emerging. Doctors can use “minor surgeries” as an alternative to thread lifting, so they don’t favour the “stiffness after being pulled up” method.

South Korea actually entered a state of “confidence” earlier on and has a greater appreciation of Eastern aesthetics. When I was a resident physician there in 2016, Koreans generally pursued very natural-looking results. Those undergoing double eyelid surgery or rhinoplasty would only request “slight improvement”, and the resulting double eyelids were often inner double eyelids with a very narrow width. I went back to China with the Korean professor, thinking he would be very popular — after all, he was a top-tier doctor. However, at that stage, many Chinese patients couldn’t accept the “natural, as if nothing had been done” effect. They would say: “I spent so much money — how come it looks like nothing was done? The rhinoplasty only raised it a little, it’s not worth it.” The professor was also very uncomfortable with this difference in aesthetic standards at the time.

Our attitudes are changing, and we’re moving towards a stage where ‘minor adjustments are enough’. South Korean society developed this mindset earlier, and cosmetic procedures became commonplace sooner. Almost every woman is a consumer of cosmetic procedures, and it’s common to have a treatment during your lunch break.