Across Japan, the most common surgical procedure isn’t liposuction or breast augmentation — the two most popular plastic surgeries worldwide — but eyelid surgery.
According to new data from the International Society of Aesthetic Plastic Surgery, Japan and other Asian countries accounted for more than a fifth of the 1.3 million eyelid procedures performed worldwide.
The trend has grown steadily over the past decade, and it’s led some experts to claim that Asian patients are using the procedure, known formally as blepharoplasty, as a way to turn the Asian “monolid” into the double eyelid of Europeans.
“They want a Caucasian-looking eyelid with a fold or a crease of the upper eyelid, as opposed to the classic Asian lid which doesn’t have what we call a tarsal crease,” Dr. Daniel Maman, a plastic surgeon in New York City, told Business Insider.
Dr. Maman said that roughly 2 to 3% of his patients getting eyelid surgeries are Asian clients looking for the procedure, so it is still rare overall. But every single one that he has referred to a specialist trained in the procedure — he doesn’t perform that specific procedure himself — has cited the desire to look more white as their reason for wanting it done.
Other surgeons have pushed back at this claim, saying it’s mostly a stereotype. They say the majority of patients just want to look more beautiful by enlarging their eyes and creating an eye shape that fits their particular face. A desire to look more European may not be a prevailing factor.
“I would get serious complaints if I performed the procedure and the Korean patient gets a crease like the one of a Caucasian person,” plastic surgeon Minhwa Na told the Korea Herald in 2015. “What people want is a natural crease that is suited to Asian faces. The whole idea that undergoing this surgery is an attempt to look white is absurd.”
Dr. Laura Phan, a US-based plastic surgeon, told NPR something similar a year prior about her Asian-American patients.
“People are not saying that, ‘I want eyes that big, that high,'” Phan said. “They’re saying, I want it a little higher, but I want you to preserve my contour, or the fold, or the things that define me as an Asian woman.”
People in South Korea and Japan also look to pop stars as plastic-surgery role models. Eyelid surgery, nose jobs, and botox injections have become widespread in the countries’ booming music industries, and fans have come to emulate those behaviors.
The latest ISAPS data indicate that eyelid surgeries are the most common procedures in Japan, Thailand, Russia, and Chinese Taipei. (Reports from past years have included South Korea as well, but the most recent data leave the country off the list.) In most other countries, breast augmentation and liposuction ranked as the most common.
The US still ranks as the country most obsessed with cosmetic surgery. In 2016, US surgeons performed a total of 4.2 million procedures meant to enhance a person’s beauty, through surgical means or otherwise. Surgeons in Brazil, the second-place country, performed 2.5 million procedures.
And while Japan had only 1.1 million procedures, a full 10% of those were eyelid surgeries. In the US, only 3% were.
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