Having double eyelids was a dream of Zhang Yiwen, a 31-year-old in east China's Jiangsu Province, for many years, and it was finally realized during the Spring Festival holiday in February with a surgical procedure at a general hospital.

"From my perspective, having double eyelids is part of the standard of beauty," she told Beijing Review. The swelling lasted a long time, so she had to meet friends during the festival with swollen eyelids. But their reactions did not bother her. "The waiting period to be pretty made me excited and happy," she said. Now she is fulfilling a new goal: braces.

"To want a better me does not mean that I do not like myself," Zhang said. "Making such decisions about my body is bold and needs courage."

Popular among people like Zhang, the cosmetic surgery industry in China is developing rapidly, with a scale of 224.5 billion yuan ($32.4 billion) in 2018, which is expected to exceed 500 billion yuan ($72 billion) by 2030.

Love of beauty

Medical beauty refers to the changing of people's appearance and body through surgery, medicaments, medical apparatuses and instruments and other medical technology methods that are invasive. Its technologies were not mature when Zhang was younger, which was the major reason why she delayed her surgery until this year. "I also struggled before I decided to change. Luckily, my family has always been supportive of me."

While at the hospital, Zhang noticed many young girls, some accompanied by their open-minded parents, seeking consultations about various surgeries.

"In July and August, we receive nearly 900 customers a day. In September, when the cooler weather is better for recovery, the number will increase," head of a Beijing cosmetic surgery agency said, adding that many university students plan to have cosmetic surgery before the new semester starts.

In 2018, the proportion of cosmetic surgery customers below 28 years old was 54 percent, according to a report released in December by Gengmei, an online platform of medical cosmetology and health services. Its top three programs include face slimming, hydrating and whitening. As people become more accepting of medical beauty, minor surgeries for the nose and eyelids have become more popular.

Last year, 22 million Chinese people bought aesthetic medicine services, with an average annual consumption of 22,000 yuan ($3,170). Residents in first-tier and new first-tier cities are the main consumers in the medical beauty sector, accounting for 58.7 percent. Men accounted for 15 percent of the total, with hair transplant their major focus.

Along with the trend among the younger generation, other people's opinion of plastic surgery has changed. After a study of personal characteristics, consumers can choose the plan that best suits them instead of plans that make them all look like celebrities.

Growing pains

As a leader in the industry which began in the 1930s, the U.S. has the most mature industry in the world with the largest market size. The numbers of cosmetic surgeons and cosmetic procedures are the highest as well.

However, between 2004 and 2011, the U.S. suffered an industry downturn. The development of technology reduced market entry barriers, while, at the same time, the supervision of the industry did not keep pace. As a result, a large number of unqualified personnel flooded into the market.

It is quite similar to the current situation in China, explained Zhao Yan, Chairperson of the Bloomage Biotechnology Corp. Ltd. based in Jinan, capital of east China's Shandong Province. She pointed out during a forum that it is difficult to establish trust among consumers due to the rampant expansion of the industry.

"Safety is one of my major concerns regarding medical beauty," Zhang told Beijing Review. There are too many confusing ads everywhere, which frighten her. "So my only choice is to go to a regular general hospital."

At present, there are still many sham clinics in the Chinese medical beauty market, carrying out services in violation of regulations. Surgeons in these institutions do not receive enough systematic training and don't have required qualifications. In recent years, most medical accidents that have occurred during plastic surgery were caused by these people and agencies.

The poor quality of products is also a reason for medical malpractice. According to a survey by the China Association of Plastics and Aesthetics (CAPA), 70 percent of the hyaluronic acid and botox products sold in China are either fake or smuggled in without approval by authorities. These products have great safety risks.

"Unqualified clinics, agencies and services without a license and low entry barriers put the industry at risk, which also damages consumer confidence," she said.

Other illegal activities have also targeted the industry for potential profits. Some loan sharks and illegal medical institutions collude with each other to provide loans promising zero deposit or collateral down. In fact, these loans have many hidden terms which eventually lead to high interest rates.

Zhao believes that to end the unchecked growth and forge the healthy development of the industry, upgrading through good product development and technology is vital.

"We must strengthen basic research to win customers and seize the opportunity to develop," she said.

Firm determination

The rampant expansion has aroused great concern from governments at all levels. From May 2017 to April 2018, the National Health Commission launched a campaign to crack down on illegal medical cosmetology, with joint efforts from seven other administrations. Local governments have also taken action to regulate the development of the industry. In Beijing, all unlicensed medical beauty services are either suspended from operation or punished to protect consumer rights and interests.

CAPA President Zhang Bin told People.cn that as an emerging industry, problems such as disorderly competition in its early development are inevitable. During this process, the government or industry associations should step in to create a sound industrial atmosphere.

Industrial insiders call for strengthening comprehensive supervision of the entire industrial chain to standardize its management. Industrial associations should play a leading role during this process.

"In most private clinics, plastic surgery practitioners usually go to conferences or training classes to learn how to perform a surgery, which is not standard or scientific," said Xiao Ran, director of the research center at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College.

She suggested that a complete training system should be formulated along with the construction of practice bases. Trainees would only be able to receive licenses after passing examinations and taking training classes, while non-specialists should be banned from working in the industry.

In addition, it is even more important to create a healthy and diversified view of beauty in the whole society. After all, beauty has never had a single standard.

Copyedited by Rebeca Toledo

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