Cosmetic Surgery: Beauty That's Made, Not Born

Five-year-old Wei-wei has typical oriental eyes with single-fold eyelids. Every time her vain and frivolous aunts see her they coo, "It's all right, child. Aunty's already set aside the money to have your eyes fixed?" To which pixyish little Wei-wei adds, "And don't forget the money to fix my nose, too!"

Different motives: No one has a perfect face, and cosmetic surgery should be considered a normal medical procedure for people with congenital defects or functional disabilities such as a harelip, cleft palate, ingrown eyelashes, scars from an automobile accident and so forth. But cosmetic surgery purely for the sake of vanity is something else again. It may be as minor as an eyelid operation or as major as a face-lift, where "the skin on one's face is actually lifted up and trimmed," but it all involves pain and surgery. What makes people willing to submit to the knife just for the sake of good looks?

"Older people have the notion that the only people who have cosmetic surgery are women of a certain profession or the mistresses of rich men, but things have changed," says Lin Ching-yun, the first female cosmetic surgeon in Taiwan.

The head of another cosmetic surgery clinic, Chiang Hsiao-shan, differentiates between "external" motives and "internal" ones. "Occupational requirements" are a major factor in external motives. In stage, film and television, for instance, "where nine women out of ten aren't all real" and where winning features and a good figure are a woman's greatest assets, cosmetic surgery is quite reasonably seen as a sound professional investment. When beauty pageants were a hot item in Taiwan a while back, quite a few contestants who wanted to have a run at the crown checked in at cosmetic surgery clinics first.

Men get face-lifts too: "Occupational requirements" aren't limited to people who earn their living with their looks. Some middle-aged corporate managers come to the clinics for a face-lift or to have the bags under their eyes removed so they won't look so old in front of their subordinates. And some salesmen have an eyelid operation "to make them look more warm and friendly."

"There's no way around it. Commercial and industrial society puts a lot of stress on packaging, image, the first impression and so forth," says Li Yuan-chen, a former president of the Women's Awakening Foundation, who points out that cosmetic surgery can provide a quick and effective "good first impression," so it's no wonder that most people consider it at one time or another.

In addition, no small number of women seek help from cosmetic surgery--especially breast enlargement and liposuction--when they meet with a setback in their love life. Middle-aged wives whose husbands are having an affair and lonely women over 30 who don't have a boyfriend are typical examples.

A cosmetic surgeon who has seen all kinds of lonely hearted women come in for help often tries to talk them out of it, citing his own male psychology as an example: "You can't win back love with a cosmetic operation." But "it's like they're drowning. They refuse to give up that last glimmer of hope, and if I don't take them, they'll just go somewhere else. Sometimes you've got to compromise," he admits helplessly. "As long as they're not emotionally distraught or as long as they're already divorced and looking for a new, self-confident beginning, I'll do the operation."

Better looks, better luck? Besides those struggling in the whirlpool of thwarted love, quite a few others--probably a third or so in all--suffer from career disappointments or bumpy interpersonal relationships and hope that cosmetic surgery will "turn their luck around."

"Chinese people hold certain deeply ingrained beliefs about physiognomy, such as a small jaw means hard luck in your old age, a flat nose means a poor career, an upturned nose means poor luck with money, high cheekbones mean a wife who brings bad luck to her husband and so forth and so on," Chiang Hsiao-shan points out. It may not necessarily be related to any standard of beauty as such, but since "improving" a patient's physiognomy can help build self-confidence, doctors often go along anyway.

External motives come in all kinds, but since the passive attitude of "a woman should look good for her man" lingers on, there are still a high proportion of patients who haven't made cool, calm decisions beforehand and end up dissatisfied, depressed or filled with regret afterwards. Fortunately, now that it is becoming more common in our society for women to dress up and look good for themselves rather than for someone else, the number of people who have cosmetic surgery based on purely internal motives--to "make myself happy" or to "give myself a better image"--is increasing by the day.

Ms. Lin, who is in her early thirties and works as a secretary in a large corporation, spent 50 or 60 thousand NT dollars for liposuction at a big hospital on part of her inner thighs. Going to all that trouble over a place that "can't be seen even when I'm in a short skirt" was just to "let myself feel a little more comfortable." And 26-year-old Ms. Chou, after having two operations to improve her "jug ears," had a nose job that was so slight even her friends and family didn't notice it. But it still made her happy. "It's enough for me to know my nose has been improved," she says. "It isn't like a new hairdo or a new outfit that you have to go around showing off to people!"

Ms. Wang, who is divorced and has two grown sons, points out that in her case she no longer has to worry about problems with breast enlargement like whether or not she will still be able to breast feed. It's time she "lived well for herself for once." Even the news recently that silicone implants may cause cancer hasn't fazed her: "Spending NT$10,000 to make myself 10 years younger is worth it, no matter what anyone says!"

When visits from Taiwan to mainland China were opened up a few years ago, it became a fad for elderly veterans to have the bags under their eyes removed and for mainlander women to have face-lifts. Tsai Shang-jung, who has been a cosmetic surgery nurse for six years, says that they once had a terminal cancer patient ask for cosmetic surgery just to "let my face look a little better when I die!"

A new face for a new life: All of us would like to look nicer than we do, and most people's impulses to vanity simply involve "a touch-up here or there" or "trying to make something look even better than it already does." But most doctors gain the greatest sense of accomplishment from being able to help people who truly need work done but who don't require a major "functional overhaul."

Lu Hsu-yen, director of cosmetic surgery at a major general hospital, cites his mother, who is in her sixties, as an example. He says that many older people suffer from drooping eyelids, which block their vision and are tiring to hold up all day long, without realizing there is an easy operation that can fix them. After repeatedly turning down the idea that she "get a face-lift," Mrs. Lu finally "saw the light." In the six months since her operation, she has felt much more comfortable and looks a lot younger, too.

Similarly, Lin Ching-yun believes that if people's appearance gives rise to severe unhappiness or to low self-esteem, then appropriate cosmetic surgery really can afford them a new life.

She cites an example. Many years ago a student at the Taipei First Girls High School and her parents came to see her, hoping she could perform on operation on the girl's nose. It turned out that her nasal septum was too short, and she had been teased by her classmates as "elephant snout" ever since she could remember--some of them would even give it a tug as soon as they saw her. After putting up with this for years, she finally broke down and refused to set foot in the school door. Her parents, who were both highly educated and taught at National Taiwan University, were angry and upset. They couldn't understand how a minor defect that seemed so trivial could nearly ruin a child's life. In the end, the girl had a successful operation and went back to school, and the problem was solved.

Emotional problems need handling first: "Cosmetic surgeons have a nickname," Lu Hsu-yen says. "Psychiatrists with a knife. It's no lie." Lin Ching-yun calls it "operating on the psyche via the epidermis." Chiang Hsiao-shan points out even though the vast majority of patients are open, extroverted, positive types with a considerable degree of self-confidence who are bold enough to want to change their image, the longing for a better appearance often involves tangled emotional complexes that are difficult to resolve, and most doctors must still carefully evaluate the patients who walk in their doors. Cosmetic surgery departments in some large hospitals even keep a psychologist or a social counselor on hand. The need is there.

What kind of patients do doctors have to be careful about? The first, Lu Hsu-yen says, are people "in search of miracles," who expect, for instance, that a face-lift will make them look 20 years younger overnight. Some patients even say, "Doctor, please go ahead and fix up whatever needs to be done all in one go!" Patients like that require guidance.

In addition, doctors have to be wary of patients who have strong "supplementary objectives" and are depressed or overeager. "Some patients have succumbed completely to the myth of a pretty face or a good physiognomy and think an operation is an easy solution to big problems like a husband having an extramarital affair, a failed career or the slings and arrows of outrageous fortune," says Chiang Hsiao-shan, pointing out that people who are unwilling to face reality and given over to fantasy are apt to blame the doctor for their eventual disappointment, creating unhappiness on both sides.

Similarly given over to fantasy are people who "come in with a picture of a movie star," hoping the doctor will turn them into another Liu Teh-hua or Lin Ching-hsia. It sounds ridiculous, but "quite a few people really do make unreasonable demands like that," says Chiang Shang-jung, recalling that someone once had even carved a perfect nose for himself and asked the doctor to "install" it for him.

Misconceptions about beauty: "Some people seem to think a face is like a piece of putty that can be shaped or molded any way you like," Chiang Hsiao-shan laments. "Take the nose for instance. They don't realize that even if the doctor can do a good job on the cartilage, it won't hold up if the skin isn't flexible enough or if it's too thin or too tight." That's precisely why doctors often caution their patients, "It takes so much cloth to make such and such a dress."

Lu Hsu-yen adds that there are many people who are vain to endure the pain of the knife but who have failed to acquire even the most rudimentary knowledge about cosmetic surgery. More than half the thousands of people a month who have liposuction in Taipei, for instance, say they do it "to lose weight." In fact, liposuction isn't designed to eliminate obesity or to lower a person's weight. All it does is remove fat from a certain portion of the body (especially the waist or thighs) and help contour it. Patients who rant and rave that they are still overweight after liposuction have only their own ignorance to blame--and poor communication with the doctor.

There are even people who have become "addicted" to cosmetic surgery. They're the ones who have been to every clinic on the island, having each part of their face worked on by different doctors, caught in an interminable nightmare of changing big to small and back again--but never coming up with the perfect "mirror, mirror on the wall" face they're after.

A Chinese standard of beauty: Doctors have to be wary about selecting patients, but many patients have a similar concern: God gave people faces that aren't perfect. How can doctors, who are mere humans, be so sure of doing any better?

"Actually, there are a lot of rules that we can work with or get around, but the most important principles are constants--harmonious proportions and natural balance," Chiang Hsiao-shan says.

Regrettably, since cosmetic surgery is a product of the West, the criteria of beauty that most doctors learn are based on Western standards. There's a principle in Western aesthetics called the "golden ratio," for instance, that is considered the ideal proportion between the lips and the width of the nose or between the lips and the eyes. The ideal "Greek nose" should be rise at an angle of 32 degrees for women and 34 degrees for men, and the nostrils should be no wider than a pair of imaginary lines extended downward from the insides of the eyes. The eyes should be spaced one eye-length apart, and when looking straight ahead, the eyelid shouldn't cover any part of the pupil and the white of the eye should be covered at the bottom.

Examined closely, none of these rules or ratios is completely suitable for Asians.

"Orientals have broad nostrils and low noses," Lu Hsu-yen points out. "Sixty percent have single fold eyelids. The eyeballs protrude slightly, the sockets are smaller and there's more fatty tissue under the skin, which makes the eyes look sort of puffy." Eyelid operations are the most frequently performed cosmetic surgery in Taiwan, almost as prevalent as in Korea, where mothers commonly save up "eyelid money" for their daughters to have the operation. It's discouraging to think how Oriental women have elevated a Western feature into an indispensable criterion of beauty.

When fashions change: Of course, many people have cosmetic surgery to change their fortune, and for them Chinese physiognomy is the prime standard. Men who have their noses raised, for instance, aren't just after an impressive proboscis. It has to be shaped according to the Chinese principle of "five evenly balanced peaks"--balanced proportions among the forehead, nose, jaw and the two cheekbones. And sometimes there's a clash between aesthetic beauty and the demands of a good physiognomy. A good-looking "melonseed-shaped" face spells hard luck, since "a fair face is often ill-fated," and a woman with peach-blossom eyes is flirtatious and flighty.

"In fact, beauty is subjective and standards of beauty differ among different people at different times," Chiang Hsiao-shan points out. Being flat chested was fashionable among ladies in Victorian England, and the women of certain tribes in Africa use all kinds of devices to stretch their nostrils and lips. A Ms. Chang, 26, recalls that when she was in high school, before being "well endowed" became such an obsession, classmates of hers with big breasts felt they were cumbersome and were ashamed. How times change! Only who knows: If big breasts fall out of favor in another ten years, how many women who have spent money on breast enlargements will come to regret it?

Holding back beats cutting out: Just because standards of beauty are so hard to agree on, it often happens in operations designed to "change one's image"--such as eyelid fixes, nose jobs, jaw building and breast enlargements--that "the operation is clearly a success, but the patient can't accept it and begs the doctor to 'make me look the way I used to.'"

To avoid any "irretrievable" situations like that, Lin Ching-yun's first tenet of cosmetic surgery is that "anything that goes in must be able to come back out." Lu Hsu-yen carefully keeps in mind some words that a friend once told him: "Holding back beats cutting out." In face-lift operations, for instance, it's better to leave a little extra skin behind than to take off too much. If the patient is dissatisfied, you can always do another operation to remove it. But if you take off too much and the patient ends up with taut skin and a wooden expression, it's too late to go back.

If people are unhappy with the looks or the figure that God gave them and drum up the courage seek help at a cosmetic surgery clinic, they have to fall back on trusting the aesthetic judgement and techniques of the doctor. Most patients are passably satisfied with the results. Thirty-eight-year-old Mrs. Lu, who had a breast enlargement operation, is pleased that she no longer asks herself when dining out, "Why can she wear such a pretty dress and I can't?" And 42-year-old Mrs. Cheng, who switched from cleaning lady to sidewalk vendor, believes that "a bigger nose makes me look more like a business proprietor."

No perfect results: Many people are satisfied, but there are also quite a few who find "it gets worse the more I look at it" and have to go back for tinkering.

Ms. Lin, for instance, who had liposuction on her inner thighs, frankly admits she "regrets it a bit." There was a livid scar that wouldn't go away at first, and more than four years later "the skin still looks a little dark." Next, she didn't expect that the pain afterwards would be so hard to take: "The doctor had said I would have to wear an elastic protector for six months or so. But it pressed on the scar, and taking it off and putting it back on every time I had to go to the bathroom hurt like my hide was being skinned." What's worse, the part that was treated is still uneven, numb to the touch, hard as wood and looks ugly under the light. To remedy the situation, she is considering going back and redoing the operation with a newly invented device that "removes the fat particles more evenly."

Ms. Huang, a high school teacher in her early 40s, experienced a similar difficulty. After having a face-lift last year, she discovered that the skin over her left eye was too tight and tugged down a bit, and she had to go back and have her eyelid fixed. Some patients have had no fewer than four or five operations, large and small, in the space of so many years. It's not that they've become cosmetic surgery junkies. It's just that each operation has been more or less imperfect. In for a penny in for a pound, they've had no recourse but to go back under the knife time after time.

Myths about beauty: There are a passel of stories about the joys and sorrows it has produced, but for better or worse, cosmetic surgery--like grooming and hairstyling--has become an integral part of life for more and more people, regardless of age, sex or occupation. But the concept of beauty doesn't stop at the skin level. There's more to it than meets the eye.

For instance, some worry that when people meet from now on it will be so hard to tell the real from the artificial that there won't be any truth or sincerity left in the world. Feminist Cheng Chih-hui believes that people aren't encouraged to meet frankly with each other in our society any more anyway. Under assault by the modern Western concept that "it's not polite not to make up," the fine old Chinese story of "meeting the emperor in a plain face" is no longer suitable. Cosmetic surgery is simply a form of "putting on permanent makeup"--no more artificial than cosmetics.

Others worry that as more and more people turn their efforts to improving their image through quick, superficial cosmetic surgery, the long-cherished values of "the face reflects the heart" and of cultivating an inner beauty through wisdom and virtue will go neglected.

As to that point, Li Mei-chih, a professor of psychology at National Chengchi University, believes there is no conflict between the pursuit of beauty and the pursuit of the intellect. No matter how times change, there will always be only a small minority of people around who are willing to dedicate themselves to cultivating their minds and bodies or engaging in the pursuit of serious topics. The fad for cosmetic surgery is merely another facet of social phenomena and doesn't pose a social problem of increasing vulgarity and superficiality.

Dawn of a new era: From a woman's perspective. Li Yuan-chen says, cosmetic surgery is nothing to be judgmental about, and women should avoid "being taken in by what is supposedly the standard," overlooking their own qualities and insisting, for instance, that eyes have to be big and round to be beautiful or not being satisfied with a bust line of less than 34 inches. In fact, when you come right down it, such standards are often simply those of Western consumer capitalism, where advertisements encourage everyone to wear the same brand of designer clothing or to buy the same kind of famous-name watch and have no relation to real beauty.

Lin Ching-yun believes that the greatest significance of cosmetic surgery is that it provides another option for people who think they "aren't good looking." She is well aware herself of the frustrations and low self-esteem that a "plain Jane" is subject to growing up in today's society: "My hair didn't grow out until I was five, my features were nothing to look at, and I was teased as an ugly duckling ever since I can remember.

"Maybe when beauty can be man made and is no longer prized as something rare and precious, beautiful people won't be blindly worshipped or plain people made fun of. That will be an era of true equality for everyone."

COMMON COSMETIC SURGERY AND POSSIBLE COMPLICATIONS [Picture]

Source: Hospital plastic surgery departments.

[Picture Caption]

Standards of beauty constantly change. In today's world, where being fit and trim is so much admired, even Venus might want to have liposuction!

Round eyes, big chest, broad hips--why don't you look like we do, Barbie?

The ancients believed that "the face reflects the heart." People nowadays hope to change their physiognomy through a quick operation and thereby improve their luck.

Cosmetic surgery, even if it's only skin deep, involves cuts and bleeding. Submitting to the knife for the sake of beauty takes courage. (photo courtesy of Dr. Lin Ching-yun)

Can silicone and salt water really rebuild a woman's confidence?

Lovely Tahitlan women, with their broad noses and thick lips, represented a natural beauty to Gauguin that he admired. (reproduced from Famous Contemporary Paintings of the World)

Classical Chinese women--coy, demure and weak as a willow bending in the wind-- had a beauty worth savoring, didn't they? (photo courtesy of the National Palace Museum)

From buxom to petite, from Western shapeliness to Eastern mystique, cosmetic posters over the past decade have reminded us that beauty standards, like fashion in couture, constantly go in and out of style. (photos courtesy of Shiseido Cosmetics)

When contestants from around the world line up at a beauty pageant, it looks as if beauty really does have a standard after all. (photo by Cheng Yuan-ching)

From dieting and calisthenics to liposuction and breast enlargement, many women spare no pain or hardship trying to meet the standards of beauty held up to them in movies and magazines.

Round eyes, big chest, broad hips--why don't you look like we do, Barbie?

The ancients believed that "the face reflects the heart." People nowadays hope to change their physiognomy through a quick operation and thereby improve their luck.

Cosmetic surgery, even if it's only skin deep, involves cuts and bleeding. Submitting to the knife for the sake of beauty takes courage. （photo courtesy of Dr. Lin Ching-yun）

Can silicone and salt water really rebuild a woman's confidence?

Lovely Tahitlan women, with their broad noses and thick lips, represented a natural beauty to Gauguin that he admired. （reproduced from Famous Contemporary Paintings of the World）

Classical Chinese women--coy, demure and weak as a willow bending in the wind-- had a beauty worth savoring, didn't they? （photo courtesy of the National Palace Museum）

From buxom to petite, from Western shapeliness to Eastern mystique, cosmetic posters over the past decade have reminded us that beauty standards, like fashion in couture, constantly go in and out of style. （photos courtesy of Shiseido Cosmetics）

When contestants from around the world line up at a beauty pageant, it looks as if beauty really does have a standard after all. （photo by Cheng Yuan-ching）

From dieting and calisthenics to liposuction and breast enlargement, many women spare no pain or hardship trying to meet the standards of beauty held up to them in movies and magazines.