Changing Faces-Skin Whitening and Cosmetic Surgery Sweep Taiwan

In his book The Quest for Human Beauty, author Julian Robinson notes that standards of beauty are cultural, and are passed down from generation to generation. Beauty, he says, is in the cultural eye of the beholder.

Liberated but still enslaved

The quest for beauty has been universal and eternal.

"Women have always faced a critical problem: dissatisfaction with what they see in the mirror," avers writer Ping Lu. Women have been enslaved by this problem since time-or at least mirrors-began.

In a lecture entitled "Sexual openness is here, but are women really liberated?" Ping Lu noted that a survey in the US showed that over 90% of female university students were dissatisfied with their bodies, feeling that their faces or their figures were not beautiful enough. Most of the women also expressed a willingness to try anything that promised to improve their looks.

According to a survey conducted on behalf of the weekly periodical published by the Department of Journalism at Chinese Culture University, 8.7% of respondents (men and women) had had some kind of cosmetic surgery. More than half did so simply to upgrade their appearance or to increase self-confidence. Male students said they wanted to look more like Kaneshiro Takeshi or Brad Pitt; the most popular ideals for women were Vivian Hsu and Vicki Zhao.

Time off, face off

You can change your figure with diet and exercise. But to change your face, you need outside help.

According to newspaper reports, in recent years a growing number of Chinese from abroad-overseas students, new emigrants, or the foreign-born children of emigrants-have been coming back to Taiwan during vacations for cosmetic surgery.

Why? Besides the fact that cosmetic surgery is more expensive in the West, another major factor is that Asians have different standards of beauty and seek different things in cosmetic surgery in comparison to Westerners. A young person who came back from the States to have her single-fold eyelids changed to double-fold declares that, since most Americans have double-fold eyes by nature, it's impossible to find a surgeon who can be trusted to do a good job on this type of operation.

There are also different preferences when it comes to skin tone.

Tsai Yen-ping, whose Natural Beauty International Group not only has more than 1000 beauty centers in Taiwan but also more than 1000 outlets in mainland China, North America, and the Malay peninsula (including Singapore), says: "Caucasians like tan-colored skin, whereas Asians admire snow-white skin." Few people of European descent do anything to lighten their skin tone, but even many Asians who have emigrated to the West still want that ultra-pale look.

Many products that promise whiter skin-called lighteners or whiteners, and coming in serums, lotions, creams, masks, and so on-find that their only markets are in Asia. Even though in recent years some European and American makers of cosmetics have begun manufacturing skin lighteners, these too are mainly for the Asian market.

Of course, even in the West pale skin has been admired, and the popularity of the tanned look is a recent phenomenon. In the 18th and 19th centuries, the European aristocracy not only differentiated themselves from the working masses in their attire but also expressed their status with the paleness of their skin. It has only been in the last 100 years or so, as outdoor leisure has become popular, that ivory skin has ceased being a symbol of higher status. Instead, many Caucasians now seek a bronze hue.

Cultural critic Nan Fang Shuo says that in Japan, where people have also traditionally found snow-white skin to be elegant, a new "aesthetic of the exotic" has taken hold from abroad, and bronze skin tone is increasingly popular. But in Taiwan, where many Japanese trends have caught on with young people, the snow-white look is still deeply entrenched. As one young girl declaims: "Who wants to turn into an old 'mountain mama'?! People who prefer to get sun tans usually have lamentable looks to start with."

Whitewashing history

In recent years, as Taiwan has become a wealthy society, people of all ages and social strata have joined in the pursuit of what Chinese call meibai (beauty-whiteness); it is now a national preoccupation.

Besides the large number of skin care centers now open, dermatologists are also getting more customers. Lan Shu-hsiang, director of the Department of Dermatology at Taipei Municipal Chung Hsing Hospital, says that in recent years one-third of the patients seeking help have done so purely for reasons of appearance, with the main problems being acne, blotches (black spots), and wrinkles. In the past most of these patients were financially well-off young and middle-aged women. Today, doctors are seeing women of all ages and social strata. At the same time, there is now a bewildering variety of treatments available to get the meibai look.

Tsai Yen-ping says that in the 1950s and 1960s, skin-sanding was very common. Soft sandpaper was used to gently scrape the face of the client to rub out blotches or freckles. The skin was then treated with disinfectant and medicated cream. When the skin healed, it would have (at least for a time) a fresh and delicate appearance. Tsai notes that there was no scientific foundation for this method, and that it increased health risks by lowering the skin's resistance to infection. Another method involved using powerful creams with mercury to lighten the skin, which had many side-effects.

Today, TV advertisements hype all kinds of new products to remove blotches and whiten the skin. Some operate by reconstruction of skin cells, others favor "inner cleanliness" and removal of toxins from the body. "Satisfied customers" declare: "After using Product Z, even in my dreams I can't stop smiling!"

Pale face, how

What after all is the best way to get whiter skin? Is there any shortcut method?

If you want a shortcut, "you have to pay the price!" declares dermatologist Chiang Hsing-chih. For example, p-hydroxybenzene (hydroquinone), which is now banned, can bleach skin temporarily. But it also leads to irreversible hyperpigmentation (extreme darkening of the skin).

Tsai Yen-ping notes that in fact "meibai does not mean bleaching. It means only to lighten the skin color of the face to the same tone as that of skin on parts of the body less exposed to the sun." The amount of pigmentation secreted by the basal metrocytes (base layer cells) plays the main role in determining a person's skin color. Skin color is determined by innate factors like race and heredity. Asians cannot expect to have skin with a permanent alabaster hue.

Currently a number of ingredients are recognized to be effective whiteners, including matteucinin, sinistrogyric vitamin C, and vitamin A acid. The problem is how such ingredients can be absorbed by the skin.

Probably everyone has seen a woman putting slices of cucumber or lemon on her face. Many people have tried it, in hopes that their skin will absorb the vitamin C in the cucumber or lemon, and thereby get a whitening effect. Alas, though cucumber or lemon slices may feel good, they do nothing for your skin, because the vitamin C cannot penetrate the epidermis.

"That's the real bottleneck," says Chiang Hsing-shih. Humans have obstructing walls between the layers of the skin. These keep out viruses or bacteria, and it is all the more difficult for skin care products and make-up to be absorbed. Since common skin care products cannot penetrate the skin, concludes Chiang, "at most they have a psychological effect."

Even if vitamin C is taken orally or by injection, the skin can only absorb seven to nine percent. Anything applied to the surface of the skin can only block out ultraviolet rays or keep the skin moist. For real meibai, you have to get through to the dermis layer, and for that you need the right techniques and tools.

In recent years, new methods have been developed to overcome the skin's natural obstacles which use ultrasound and "pulse ion" introduction techniques. Lan says that with ultrasound introduction, absorption through the skin is multiplied by ten. With this technique, that ivory look is no longer just a dream. However, as Lan reminds us, there are limits to meibai. Someone 50% of the way to snow-white skin can get to 70%, while someone 40% of the way there can only make it to 60%; it is impossible to completely redo a person's skin color.

Sunbeams, no; laser beams, yes!

In fact, you don't necessarily need expensive beauty salons or skin care products to redo your hue. If you just take precautions against exposure to sunlight, then you don't have to spend a lot of time or money to get sun-darkened skin back to its original state.

For dermatologists, the sun is the main enemy of an opalescent epidermis. Long-term exposure to ultraviolet rays causes blotches and age spots. More ominously, it can even cause skin cancer.

Chiang says, "The new conventional wisdom is to reduce exposure to the sun right from birth." Even a single episode of sunburn can greatly increase the likelihood of skin cancer.

To block out sunlight, some people carry parasols or wear hats, not making exceptions even on cloudy days. Some people cover themselves in sunscreen from head to foot. And there has even been a suggestion posted on the Internet for young women who ride scooters: If you wear your raincoat all the time, you can block out ultraviolet rays and steam off excess fat at the same time.

But besides staying out of the sun, the other tack to follow to get truly 100% pure-white skin is to get rid of all blemishes. In general, the skin of Asian people is easily stimulated, leading to a deepening of pigmentation, resulting in blotches. Fortunately, in recent years there have been major breakthroughs in techniques for removing blotches.

At present, the best way to "terminate" blotches is with lasers. In fact, lasers can eradicate not only blotches but also tattoos, birth marks, and scars. There are several varieties of laser, such as CO2 lasers, Nd-YAG lasers, ruby lasers, and dye lasers, which have different wavelengths and characteristics for handling different sorts of problems. For example, the double wavelength Nd-YAG laser is especially effective on freckles and tattoos, while the ruby laser eliminates deep pigmentation spots.

The theory behind the use of lasers is that they destroy and disperse pigmentation cells, like using a giant boulder to smash small rocks. Eventually, the dermis pushes the destroyed pigmentation cells to the surface, where they are carried away by megakaryocytes. However, the effectiveness of lasers is not uniform. Some deep layer spots can even become darker after being struck with a laser. Another thing to watch out for is that there is swelling for 7-10 days after laser surgery, and in this period protective measures like cold compresses and sunblock are very important.

Ego surgery?

Through modern surgical techniques, people not only can pursue their ideal of snow-white skin, but even alter their faces and bodies, giving themselves even greater confidence.

Lai Yung-lung, director of the center for cosmetic surgery at Chang Geng Memorial Hospital, says that purely cosmetic surgery is entirely driven by fads and market demand. Plastic surgeons do not operate to save lives or resolve functional problems, but are responding to the inner, psychological needs of their clients. Thus Lai considers himself a "psychological surgeon," and the patient must decide whether the surgery is "necessary."

"The most important goal of cosmetic surgery is to build confidence," adds Lin Jean-yin, founder of Jean's Clinic of Plastic Surgery, who has worked on many famous people, including the former first lady, Tseng Wen-hui. What matters is that the patient feels that he or she is inadequate in appearance in some way, even though others may not think so. This can go to amusing lengths. Lin relates that she has seen people in her clinic who may, say, have a large mole on their face, but come in for something unrelated, like double-fold eyelids or thinner lips, and they don't care at all that there is a large black mark on their face.

Besides building confidence, sometimes cosmetic surgery even has the mission of saving a marriage. Lin says that when women in Taiwan hit a rough patch with their spouse, often the first thing they do is seek out a fortune teller, after which they seek out a cosmetic surgeon. Many women believe that they can rescue their marriages with such tactics as eliminating bags from under their eyes, breast enlargement, or tightening of the vagina.

Another reason some people come for plastic surgery is that the aesthetic values that parents instill in their children have a long-lasting influence. One girl came in seeking to have the bridge of her nose raised, when in fact her nose was not all flat. It turns out that from the time she was small her mother repeatedly told her that a person with a flat nose would never have good luck, and that's why she wanted her own nose lifted.

Parents sometimes feel, in fact, that they have let down their children somehow if the kids are not naturally attractive, and they bring them for cosmetic surgery by way of making up for their "failure." Lin relates that now that the Joint University Entrance Exams have just ended, a number of children are being brought into the surgery to have work done.

An eye-opening experience

Lin Jean-yin says that there are four reasons why cosmetic surgery is such a hot field these days in Taiwan: double-fold eyelids, nose-bridge raising, liposuction, and scar removal.

The modern interpretation of the old expression "the eyes are the window on the soul" is: If you want to flirt, it's all up to the eyes. In traditional China, single-fold eyelids were favored. But modern people are inclined to want large, bright, expressive eyes. For many years now, making of double-fold eyelids has been the most common procedure among cosmetic surgeons.

Lin Jean-yin notes the eyes of most Asian people are between 0.7 and 1.2 centimeters from top to bottom. Westerners typically have large round eyes with a top-to-bottom width of 1.0 to 1.5 cm.

"Cosmetic surgery really can have the effect of 'bringing a dragon to life by drawing in the eyes.' It can cause a sleepy-eyed Cinderella to wake up and face life with a smile," declares Lin.

This is not to say that people want to look completely Western, especially now that there has been a resurgence of local culture in the past few years, which has affected trends in cosmetic surgery.

Lin states that after World War II, Taiwan was swept by Hollywood culture, with idolization of high noses and large eyes. People had surgery to fill in their cheeks, raise their noses, lengthen their lower jaws, and make their lips bigger. The silicon injection method used at that time made every feature the same from one person to the next. However, these days many people would prefer to keep that special Oriental look. Even those who have double-fold eyelid surgery generally ask that the delicate and long Asian character of their eyes be preserved.

Another popular procedure is elimination of bags under the eyes.

At one time these were called "children and grandchildren bags." In an age when life expectancy was short, they symbolized longevity and good fortune. Haven't you ever noticed that in paintings of the emperors of old, all of them have bags under their eyes? However, with changing times, bags under the eyes now represent exhaustion and aging, and people want to get rid of them.

Lin Jean-yin says that most of the people who underwent such surgery years ago were women over age 40. But in recent years the average age has been dropping, and the percentage of men increasing.

It may be that modern people spend too much time squinting at computer monitors, and produce more skin around their eyes. Anyway, the pace of modern life seems to make the phenomena of aging show up earlier. Certainly modern people are simply less willing to accept eye-bags.

Besides traditional techniques of surgery, in recent years there has been popularity for injecting a toxin into the skin to eliminate wrinkles.

Clostridium botulinum is a toxin that causes flaccid paralysis by blocking motor nerve terminals. By paralyzing the nerves on a certain part of the face, the muscles in that area will not contract and give rise to wrinkles.

Currently a single injection costs NT$8000-10,000, but just one can be effective against crow's feet, brow lines, and those wrinkles you get on the bridge of your nose when you concentrate intently. As Lin explains, "Botulinum toxin is just what modern people want." It is not very painful, it is fast and easy, and nobody ever has to know.

However, botulinum toxin is no panacea. A single injection is effective for only four to six months. If you want to keep the wrinkles away, you have to get an injection every half year.

All in vain?

Besides costs as measured in dollar terms, the pursuit of beauty also carries certain risks.

All surgery leaves scars of some kind, and, adds Lai Yung-lung of Chang Gung Memorial Hospital, "there's always some risk in any kind of surgery." There's no guarantee that, with the passage of time, an intrusion into the human body will not produce changes.

However, financial costs and possible side-effects cannot stop those who feel they have no choice but to pursue beauty.

Lin Jean-yin points out with so many people now working in the service industry, and people having so little time to get to know each other well, first impressions often can decide everything. Under these circumstances, external appearance is more and more important.

But not everyone accepts such explanations for the growing prevalence of face- and body-reshaping. "This is a cultural sickness, a lack of confidence in oneself," says Nan Fang Shuo. This cultural illness is particularly serious in United States. American girls begin to be extremely concerned about their appearance from high school on, and many people are constantly depressed about their weight.

Though the situation is not so serious in Taiwan, the mass media puts out a virtually unvarying message that beauty equals success. It is difficult for young people to resist the message implied in teenage beauty pageants, love-at-first-sight stories pairing up beautiful girls and handsome guys, and the images of pop superstars. Correspondingly, the media rarely emphasizes that there's a place in this world for everyone. Look at even Hollywood stars for example. Meryl Streep's face is downright crooked, but it hasn't stopped her from becoming successful.

Nan Fang Shuo claims: "I think every woman in Taiwan is a beautiful woman." Everyone has the raw materials necessary for beauty. For example, older people have the character that comes with experience, which often makes a deeper impression than superficial good looks. "On the other hand, if a person is largely artificial, they won't be much to look at when they are older."

There's beauty to be found in each season: spring, summer, autumn, and winter. If a 70-year-old looked 20, this might be more frightening than appealing. As Lin Jean-yin concludes: "With every age a person lives to, they will naturally produce beauty through their life."

In that case, are you still to looking to change faces?

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Do you want the face of a movie star? The eyebrows of Kaneshiro Takeshi? The eyes of Vicki Zhao? Mix and match-with modern cosmetic surgery there's no limit. But there are risks.

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Thanks to technology, the monitor can give you a clear picture of your epidermis, your pores, your pigmentation....

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It was said of the Tang dynasty concubine Yang Guifei: "Face fair as hibiscus, eyebrows like a willow, skin like snow...." The secrets of the beauties of ancient times are now being revealed.(courtesy of the National Palace Museum)

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Women in Taiwan used to use the wanmian method to care for their skin, removing tiny hairs and dead skin cells from the epidermis using thread, to give skin a glossy look.

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There are a dazzling array of products to get that pallid look or eliminate blotches. But they are only effective if they can be absorbed by the skin.

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This cross-section image shows that some blotches go down to the dermis layer. It is not likely you can get rid of these with skin care products alone.

sebaceous gland

eccrine gland

sweat pore microvascular network

epidermis

dermis

subcutaneous tissue

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Beauty and skin care centers line the streets. They offer not only skin care and skin whitening, but also a chance to get away from the pressures of life. The clients are mostly women, but there are a few guys as well.

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Tsai Yen-ping declares: "Natural is beautiful." The best ways to beautiful skin are cleanliness, staying out of the sun, and good eating habits.

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The first step to snow-white skin is staying out of the sun. It's common to see women and girls carrying parasols during summer in Taiwan.

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In recent years lasers have become widely used in cosmetic surgery to eradicate blotches. Many blemishes that proved stubborn in the past can now be cleared away.

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Lin Jean-yin, who became quite famous after performing cosmetic surgery on Tseng Wen-hui, wife of former president Lee Teng-hui, says that with cosmetic surgery you really can change a person, and that the most important result is increased self-confidence.

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The media makes idols out of handsome guys and beautiful girls. Who can resist the implicit call to pursue beauty?