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Extra Extra

Cut & Paste Plastics: A Look into the Culture of Plastic Surgery and Asian Americans

Plastic surgery for many Asian Americans, especially blepharoplasty (double eyelid surgery), has been a hot topic that has been going on for a long time. It may seem, to an outsider of the community, a radical action, but for Asian Americans it is an integrated part of their lives and a normative part of youth culture.

Despite its proliferation in both Asia and here in America, the procedure still remains a culturally loaded issue today. Are Asians remaking themselves in an attempt to look Caucasian? It’s a charge many deny, but still, the controversy remains.

Like it or not, plastic surgery among Asian Americans is on the rise. According to the American Society of Plastic Surgeons, between 2006 and 2007, cosmetic surgery procedures increased 26 percent in the Asian American population. The increase is even higher, 246 percent, when compared to the data in 2000. The types of procedures remain consistent, with Asian Americans requesting eyelid surgery, nose reshaping and breast augmentation most commonly.

Innumerable articles and essays have been written on the topic, most arguing that Asian blepharoplasty is a manifestation of internalized racism and Western aesthetic brainwashing. I decided to investigate whether it really is this simple. I sought to uncover the cultural and institutional forces that motivate Asian American women to surgically alter themselves and also if the general public and media’s view of the phenomenon carried any weight.

Lost In Translation
Through the 60s and 70s, textbooks and medical journals called the double eyelid procedure “westernizing the eye” and Asian patients went to plastic surgeons specifically requesting to look Caucasian in order to better assimilate. So there was a time when the ethnic self-hate argument applied.

Dr. Geoffrey Kim, a plastic surgeon in Littleton who performs numerous Asian blepharoplasties a year, says, “That may have been the motive 30 or 40 years ago, but that’s also how their motives were perceived by the Western world.” He emphasizes that this is not the case today and any interpretation of the desire among Asian Americans to have the double eyelid crease as an attempt to look Caucasian is a cross-cultural miscommunication.

As decades passed, an appreciation for diversity grew and with that came advances in technique and a deeper understanding of the Asian eye. Dr. Ben Lee, a plastic surgeon in Englewood, says that starting in the 80s, surgeons began to acknowledge racial distinctions and develop techniques to preserve ethnic characteristics. Robert Flowers, a renowned pioneer in Asian plastic surgery, really advanced the field. Because of his influence, “We now make the crease line lower for the eyelid surgery to preserve ethnicity,” says Dr. Lee.

Dr. Kim adds that there is a distinct procedure for surgeons working with Asian eyes, in which experience is a must. The procedure is called anchor blepharoplasty, a technique that Dr. Flowers developed, which requires the doctor understand the anatomy of the Asian eye.

Today the trend in plastic surgery is a more natural and subtle change – one that complements ethnic features rather than mimicking those of another. More and more Asian American women are going to their plastic surgeons requesting natural-looking double eyelids, the kind that occurs in about half of the Asian population naturally. Thus it can be argued that those Asians who undergo surgery for double eyelids are aiming for Asian looks, that they are not necessarily conforming to a Western standard.

In fact, patients who have had the double eyelid surgery done by doctors who did not respect the ethnic qualities of the Asian eye, ended up with undesirable results. Tia, a Thai-American woman, got her eyelids done 12 years ago at the age of 50. The crease the doctor created was way too high and way too deep. She says he also did not take out enough fat, leaving her eyes looking puffy and tired – definitely not an improvement.

Eye of the Beholder
So if the trend is not to achieve a Caucasian look, then what can explain the explosion of Asian Americans getting their eyelids and other cosmetic procedures done? From talking to women who have gotten their eyelids done, the reasons range from easier makeup application to wanting a bigger-looking eye to wanting to look like their other Asian friends.

After years of taping her eyes to achieve the double crease look, Jamie, a 20-year-old Korean American student, decided to get her eyes done after her high school graduation. She says she envied her Asian friends who had double eyelids and thought she looked better with them too, so she went to Korea to make it permanent. “A lot of girls in Korea do it, so my decision didn’t come out of the blue. It’s always been an easy option,” she says.

Tia got her eyes done at an older age. “I decided to get mine done when I noticed my eyelids beginning to droop and sag,” she says. Most women of her generation get this surgery later in life, compared to younger women these days. “These days in Asia, girls who are practically toddlers get them done,” she remarks. Tia attributes the craze to the influence of Asian actresses, mostly Korean superstars, who are all the rage these days. “They all have them done, so it became the fashion. And you know Asians are crazy when it comes to following trends.”

Sandy, a 25-year-old Korean American, says she was happy with her looks before her surgery but got it done simply because it would make her life easier when applying eye makeup. “I love makeup. But before, I couldn’t wear any eye shadow or even mascara without looking like someone had punched me,” she says, “and now I just have so many more options. But for sure it wasn’t because I wanted to look more Westernized.”

Jamie agrees that she’s not trying to emulate a Western appearance. “I’m not trying to look Western at all! If anything I would want to look like the Korean celebrities.”

Cindy, a Vietnamese American who opted for a rhinoplasty four-years-ago to increase the bridge of her nose, says she did it to fit in. But what is surprising is that it was the Vietnamese community that she wanted to fit into. “Nose jobs are common among the Vietnamese – six other women in my family have done it, including my mom. But I guess I was trying to fit into both worlds [Vietnamese and American] because I also got a breast augmentation,” she says with a chuckle, “and that is really more of an American thing.” Cindy also expressed a concern prior to the rhinoplasty that it would look too Caucasianized and unnatural, like her mom’s nose job that ended up being too high and noticeable. She found a plastic surgeon who respected this, and is very pleased with the results. Unlike her Vietnamese peers who have had the eyelid surgery, Cindy grappled with the idea that it may look too Western, and ultimately decided that getting her eyes done wasn’t that important and not worth the risk of looking unnatural.

The White Fight
Of course, just because we do not want to look white, does not necessarily mean that we have completely escaped the grip of the white American beauty ideal– a beauty ideal that affects all groups of women and girls regardless of race or class, with detrimental effects on self-esteem. We are still bombarded daily by our society’s promotion of the white beauty standard – in movies, magazines, television and advertisements. There is definitely a large impact on Asian American women. Growing up in America, you start to measure yourself by white beauty standards, and sometimes feel inadequate because you know you can never fully achieve it. But even so, you try to fit in as much as possible.

Jamie says that the celebrities on television have shaped what she considers to be beautiful. “Unless you have a really strong personal taste, it’s difficult to get around it,” she says. Lisa felt similarly influenced, saying, “If I didn’t live in America, I don’t think that I would have gotten my breasts done.”

Dr. Daryl Maeda, an assistant professor of ethnic studies at the University of Colorado, finds that the popularity of plastic surgery among Asian Americans goes beyond just the white American beauty ideal. Whether or not an individual sees his or her motivations as being about changing ethnic identities, Dr. Maeda points out, “if we look at the numbers in aggregate, we see that Asian Americans are more likely than any other racial group to modify this distinguishing physical feature [the eyes] and that says something about the pressures that Asian Americans face.”

He elaborates, “On the one hand we are told that we have it made, that we’re the model minority and we don’t suffer from any racial problems, that our hard work and dedication has gotten us to where we’re at – but on the other hand, we’re still subject to racism. Asian Americans are in a unique position of being subjected to racism at the same time we’re being told that we’re not. No other racial group has this label of the model minority attached to it.”

Dr. Maeda theorizes that this unique position maybe why Asian Americans are more likely to alter their facial features – in order to deal with the contradiction we get from mainstream America in terms of our racial identity.

The Betties Abroad
Interestingly, while the Asian American women I interviewed attribute the American media and women like Angelina Jolie as a major influence, it seems as though their family and Asian friends provide the main source of pressure. Cosmetic surgery of Asian Americans is a cultural pattern, within ethnic enclaves, rather than a sole mode to westernization.

The interviewees who have had cosmetic surgery are not from predominantly Caucasian demographic areas. Rather, most of them, being immigrants or children of immigrants, spent the majority of their adolescence in ethnically rich areas like Aurora or Southern California. The pattern is that Asian American women who grew up in predominantly Asian neighborhoods are consumers of cosmetic surgery.

Which leads me to believe that Asian peers and families are significant influences on these young women’s decisions to do so. Not only are these women’s standing in society a double-minority by gender and race, but the cultural implications and expectations of the Asian American community acts as a driving force for much of their practices.

Could the allure of plastic surgery for Asian Americans, if not an attempt to look like our white American peers, then be due to Asian influences? In the past, Asia had lagged behind the West in catching the plastic surgery wave, held back by cultural hang-ups, arrested medical skills and a poorer consumer base. But today the popularity and increase in plastic surgery in the United States is no rival to Asia’s.

Consider these numbers. In Japan, nearly 43,000 surgical cosmetic procedures were performed last year. In Korea, surgeons estimate that at least 1 in 10 adults have received some form of surgical upgrade. And each year the Chinese spend over $2 billion on cosmetic surgical procedures.

Blepharoplasty and rhinoplasty are also among the top requested procedures in Asia, but it doesn’t stop there. Doctors in Asia perform all sorts of procedures few have heard of in the States, like leg lengthening in China, where the calf bone is forcibly broken and then slowly, excruciatingly stretched out over the span of six months; botox injections to shrink volume in the cheeks; nerve severing in the calves to shrink the muscle for a leaner leg; and hyaluronic acid injections to build up flat noses and chins.

The social phenomenon lies in the void of cultural taboo. The double eyelid procedure has become a norm over in Asia. Few Asian celebrities are still single-lidded and many girls, as young as 12, are doing it. Cosmetic surgery has become another product in Asia’s consumer-driven culture. Young women succumb to eyelid surgeries and nose jobs like any other material good. It has become another signifier of wealth, like name brand fashion, reinforcing self-worth and defining identity.

Indeed, beauty standards predominant in Asia often have a profound effect on Asian women in America, but lets not forget the even more overpowering effect that America has on the rest of the world. Under the relentless bombardment of Hollywood, Asian aesthetic ideals have changed drastically. Dr. Kim says that the concept of beauty has evolved and, “Media has certainly contributed to it. If you look at any Asian magazine, the eyelid crease is pretty much universal.”

“Hollywood is not an American phenomenon anymore, it’s actually a global phenomenon,” states Dr. Maeda, “The reach of Hollywood and the global society that we live in would suggest that these white standards of beauty get exported across national borders.”

Jamie agrees that Hollywood has a huge appeal to Koreans. “Koreans follow the Western look rather than shaping their own beauty and are ruled by what’s in style right now,” she says, ”When something gets really popular, it spreads fast because Korea is such a small country and everyone there wants to fit in.”

There is evidence of Western influence existing on both the Asian and Asian American side, but the trends seem to be emerging in different manners, or at least at different times. Asian Americans participate in rituals like eyelid surgeries and nose jobs to a lesser extent than their Asian counterparts today, but this was not always the case.

Trickling Trends
At one time, Asian Americans did strive to assimilate to American culture by attempting to look more Caucasian. Now, the Asians abroad are the ones trying to look and act “white.” Dr. Lee points out that, “Asian clients [from Vietnam] come in requesting procedures to make them look more Caucasian, but no Asian American would request the same thing anymore. It’s the Asians in Asia who want to assimilate more.”

In regard to plastic surgery, if Asians in Asia are where Asian Americans were 30 years ago, then one theory could be that plastic surgery trends begin here in America but invariably trickle East. This can also explain why Asian Americans who live in predominantly Asian communities are more likely to be influenced by the trend wave in Asia, while Asian Americans living in less diverse areas, are participating in newer trends. If trends in plastic surgery are a result of a trickle-East effect, the emerging trends that we see in the young contemporary Asian Americans will presumably cross over to Asia in the not-too-distant future.

The increasing popularity and acceptance of breast augmentation in the U.S. is a good example. This procedure has been a long-time favorite among plastic surgery patients in America, but not until just this past year has it topped the chart as the most frequently performed procedure. At the same time that its popularity has increased in the American population at large, it has also climbed up to be one of the top three procedures that Asian Americans request. Therefore, if forced to predict, I would say that the trend in breast augmentation will also trickle East and potentially have the same widespread effect in Asia that the double eyelid surgery is having today.

Implant Posse
The doctors unanimously agree that more and more younger generation Asian American women are opting to increase their bust lines. Yet, most studies and articles are still hung up on Asians and their double eyelid surgeries, and no one seems to be addressing the prevalence among young Asian Americans getting breast augmentations.

In Dr. Ben Lee’s Denver plastic surgery practice, most of his Asian clientele consists of tiny Vietnamese women requesting breast augmentations, which he feels is certainly an American influence. Dr. David Broadway, a plastic surgeon in Lone Tree also primarily performs breast augmentations on his Asian clientele.

And according to Lisa, a 25-year-old Cambodian American, breast augmentation is so commonplace among her Asian American peers she has trouble recalling anyone in her circle of friends who hasn’t gotten a boob job. Cindy also stated that more than half of her friends have had their breasts done.

Dr. Ben Lee connects this trend again, to Asian Americans who live in ethnically rich communities and tight social environments. “Asians who are cloistered have an effect on each other. All it takes is one of them to do it and then before you know it all of them are getting it done.”

Indeed, Dr. Broadway finds that a large portion of his Asian American clientele come to him through word of mouth. “Asian Americans tend to rely on referrals and they take it very seriously. I’ll get a good result in one patient, she will tell someone else and it cycles through shops and hair salons,” he says.

A New Gold Standard
Upon inspection, the new trends that have emerged in cosmetic surgery among the Asian American population reveal much broader social currents like the new beauty standard and the course of popular culture. So what does the future hold for Asian Americans and plastic surgery? Some say the trends are taking a turn for the worse, whereas others have a more optimistic outlook – one that predicts an international standard of beauty – one that transcends race.

As the world media becomes increasingly globalized, we can expect to see the standard of beauty morph into something more multicultural and complex. Dr. Lee finds that there has already been a shift in the American standard of beauty, especially among Asian Americans, one that is less Caucasian and more interracial. The idea is to retain ethnicity, but a much more muted form of it. “No Asian American wants to look white,” states Dr. Lee, “just more beautiful in a subtle way.”

Finally! After decades of a predominance of a white beauty standard, there is a stirring in the American beauty ideal. There is now a place for Asian Americans in Hollywood and television, and I think it’s well accepted that these women are beautiful. Seeing stars like Lucy Liu, Sandra Oh and Lindsay Price in leading roles is a healthy trend, and young Asian American women can use more role models in the mainstream media that look like them.

Even with the alarming rate of increase in plastic surgery among Asian Americans and no indication of it slowing down, I take some comfort in the increasing desire of more Asian American women, if they do decide to undergo plastic surgery, keeping their ethnic identity and a look that is naturally Asian. What is most important is that we as Asian American women embrace our ethnic and cultural heritage. Whether we decide to modify our physical appearance, a little or a lot, hopefully the motivation is simply a desire to enhance what we already have, and not a desire to deny who we are.

By Perry Santanachote
Asian Avenue magazine

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