“This [Korea] is indeed a plastic surgeon’s paradise.” – Dr. David Ralph Millard quoted from the book Reconstructing Bodies: Biomedicine, Health, and Nation-Building in South Korea Since 1945 by John Dimoia
Commonly referred to as the “Republic of Plastic Surgery,” South Korea is home to the largest number of cosmetic plastic surgery procedures performed and the largest number of cosmetic plastic surgeons per capita in the world. Most South Korean plastic surgery patients are female, which reflects a strict cultural expectation that women maintain a youthful appearance when in public life. Possibly because of this cultural expectation, South Koreans begin undergoing cosmetic plastic surgery at a relatively young age. A Gallup Korea poll from 2015 found that one-third of women ages 19 to 29 have undergone plastic surgery in South Korea. According to the NPR reporter Elise Hu in her book Flawless: Lessons in Looks and Culture from the K-Beauty Capital, high school graduates are commonly given gift certificates for cosmetic surgery by their parents and grandparents. The three most common procedures chosen by patients are double eyelid (blepharoplasty) surgery followed by rhinoplasty then jaw contouring surgery, otherwise known as V-line surgery. More specifically, the New Yorker reporter Patricia Marx describes the Bagel Girl look, short for “baby-faced and glamorous,” as being popular among South Koreans as of 2015. In addition to V-line surgery, double eyelid surgery with epicanthoplasty (will be discussed below), and rhinoplasty, fat grafting to the lower eyelids is considered to contribute to this look. Regardless of the name given to this look, the history of cosmetic plastic surgery in South Korea and possibly the future of cosmetic plastic surgery worldwide can be found in the three most common cosmetic plastic surgery procedures pursued.
The origin story of cosmetic plastic surgery in South Korean, according to most Western authors, begins with an American named David Ralph Millard. Dr. Millard was the plastic surgeon for the United States Marines in South Korea. He trained with the famous plastic surgeon Dr. Harold Gillies during World War II. He remained in South Korea after the armistice in 1953 and continued to practice as a plastic surgeon, performing both cosmetic and reconstructive surgery on American troops and South Koreans. The two procedures he performed most frequently on South Korean patients were double eyelid surgery – which created an extra fold in the upper eyelids – and rhinoplasty meant to increase the projection of the nose. Patients included South Korean sex workers trying to better attract American troops and South Korean women who married Americans and felt plastic surgery would ease their transition to life in the United States. Like Ivo Pitanguy, Dr. Millard believed he was empowering those he treated by transforming their character. He also believed he was a pioneer in the techniques he utilized.
The professor John P. DiMoia argues against this origin story in his book Reconstructing Bodies: Biomedicine, Health, and Nation-Building in South Korea Since 1945. Mr. Dimoia writes that the story of Dr. Millard, while important, is incomplete. For example, the technique Dr. Millard employed for double eyelid surgery was only one of over thirty techniques developed since the late 1800s. In fact, according to Elise Hu, the first reported double eyelid surgery in the literature was published by the Japanese ophthalmologist and surgeon Kotaro Mikamo in 1896. South Korean surgeons more often cited the techniques of Japanese plastic surgeons from the late 1800s to the 1920s in their publications and teaching, because Japan was a regional center for plastic surgery at the time.
The professionalization of the field of plastic surgery started with the foundation of the Department of Plastic Surgery at Yonsei University in 1961. Residents were taught starting in 1964. However, it was not until 1973 that plastic surgery was officially recognized as a subspeciality in South Korea. Private plastic surgery clinics providing cosmetic services would start to predominate reconstructive surgery programs in the 1980s and 1990s after healthcare reforms largely nationalized the healthcare system. Physician-reported difficulties getting paid by the South Korean government for medical services pushed plastic surgeons to break from large hospitals and establish their own private cosmetic plastic surgery clinics in the Gagnam district in Seoul.
Another impetus for the movement of plastic surgeons to cosmetic procedures was the fact that the government supported the development of the industry (like Brazil), starting by temporarily subsidizing cosmetic surgery after the financial crisis of the late 1990s. According to Elise Hu, in addition to creating tax breaks for cosmetic plastic surgery domestically, the South Korean government started the Korea Culture and Content Agency to promote popular Korean culture worldwide, referred to as Hallyu, which includes cosmetic plastic surgery. As a result of the government’s effort, the number of medical tourism patients increased almost tenfold, from 60,000 in 2009 to almost 500,000 in 2019. Most tourists come from China, which accounts for 40% of all plastic surgery procedures in South Korea. Japan, the United States, Thailand, and Vietnam round out the top visitor countries. This medical tourism has spread the influence of South Korean aesthetic plastic surgery procedures and aesthetics around the world, including the United States. For example, I once met a Caucasian patient from the United States who had travelled to South Korea for V-line surgery. This individual explained that they desired a narrower, more refined jawline. They were very satisfied with their results. However, they were told by the South Korean surgeon that they would likely require a facelift earlier than normal due to the procedure. This individual returned to the United States and sought a facelift within a few years of undergoing V-line surgery.
The geographic center of plastic surgery in South Korea, called the Improvement Quarter/Beauty Belt/Plastic Surgery Street in the Apgujeong and Sinsa wards of the Gagnam district, is significantly smaller than that of Brazil. The “Beverly Hills of Seoul” got its start as a “new money” neighborhood on the outskirts of Seoul in the 1980s where land was less expensive than in the city center. It is home to over four hundred plastic surgery clinics per square mile and over seven hundred clinics total as of 2007.
This concentration of surgeons and the number of cosmetic plastic surgery procedures performed in South Korea has resulted in a great deal of innovation in the field, which patients around the world are only just starting to benefit from. For example, an additional focus of South Korean surgical innovation from the 1960s to the present has involved not simply the creation of double eyelids but also the removal of an extra fold of skin in the medial eye near the nose that is present in some South Koreans, called the epicanthal fold. Mr. Dimoia and Ms. Hu argue that there is a misconception that double eyelid surgery and epicanthoplasty surgery were meant to make South Koreans look more Western. In fact, double eyelid surgery and the epicanthoplasty reflect an independently developed, regional Asian aesthetic norm. Moreover, innovations in scar concealment reflect a greater desire on the part of South Koreans to minimize the appearance of scars compared with Americans. As a result, the overall trend in eyelid surgery has shifted from what Dr. Millard described as a desire for “round eyes” to “big eyes,” which encompasses a wider variety of procedures, including epicanthoplasty. In contrast, there is also a concern about having a “big face,” which is why V-line surgery – an invasive surgery that involves a reduction in the width of the jawline – has become so popular in South Korea. And while South Korean aesthetic norms may have been influenced by American surgeons like Dr. Millard, additional influences range from regional colleagues in countries such as Japan and local South Korean culture, similar in process to the unique aesthetic norms that have developed in Brazil. In fact, the V-line surgery is a distinctly Korean creation that reflects a focus on facial proportions such that men and women seek a narrowing jawline that forms a V shape. According to Ms. Hu, an “ideal” face in Korea has big eyes (see above), a pointy nose with a raised nasal bridge, and a V-shaped jawline. This is consistent with the most chosen cosmetic plastic surgery procedures in South Korea. Interestingly, the more “traditional,” unaltered Korean face – more circular, with smaller eyes, round cheeks, and wider noses – is now associated with the standard look of North Koreans.
The differences in aesthetic norms between South Korea and the United States have led to confusion as highlighted by the author S. Heijin Lee in the essay “Beauty Between Empires” in the book Fashion and Beauty in the Time of Asia. A GIF was widely circulated in the United States of what was believed to be a fast scroll of all the candidates for the 2013 Miss South Korea competition. What was striking to people was how similar the faces of the contestants looked. Online commenters considered this a reflection of the sameness of the appearance of South Koreans and heaped scorn on the country for promoting this. The GIF was a photoshopped fake. That people, specifically Americans, would not immediately assume the GIF to be a fake was thought to be indicative of a misunderstanding of Asian diversity and conceptions of beauty.
Like in Brazil, the increasing popularity of plastic surgery reflects the increased wealth and democratization of the country, which accelerated in the 1980s. The body was considered a way to elevate one’s status in society to gain economic and social advantages. Patricia Marx traveled to South Korea in 2015 to learn about why South Korea has become a capital of plastic surgery. She reports that there is a great deal of competition for jobs in South Korea, especially since the Asian financial crisis of the late 1990s. Many men and women in South Korea feel plastic surgery can improve their competitiveness for jobs. This sentiment is reflected in common terms used in South Korean ads for plastic surgery such as “self-management,” “self-development,” and “self-investment.” Competition for jobs is so intense, in fact, that an industry of “face readers” has sprouted in South Korean where one can pay for a non-physician to examine your face and make recommendations for changes with plastic surgery.