When Does Plastic Surgery Become Racial Transformation?

    Leo Jiang grew up in an English industrial town, emotionally scarred by bullies who taunted him about being Chinese. A few years and tens of thousands of dollars later, he's not really Chinese anymore.

    Leo Jiang won't tell me why he spent the past nine days in Amsterdam. We're in a city center Starbucks in Newcastle, England, on the sort of bitter January evening when the dark envelops everything by 4:30. Jiang, a 24-year-old philosophy graduate now working as a teacher, is circumspect, evasive, and withdrawn, but after hours of demurring, finally admits he'd spent his time in the Dutch capital recuperating from his latest procedure — on his nose — though he's cagey about saying more, such as where his other operations took place. This was one of three he's undergone since July 2010 to help erase his past. And he's adamant that it won't be his last.

    When I first met him at school in 2007, he seemed reserved and quiet, but not necessarily outwardly sad. He looked normal, even if he didn't think so — black hair, average height, and small brown eyes. He's since changed: The eyes are fuller, the nose longer and straighter — though currently so sore post-surgery that he can't bear the weight of his glasses on its bridge — the jaw stronger, and the way he stands makes him seem taller than his 5 feet 11 inches, as if he isn't trying to fade away into the furniture anymore. Since the age of 8, he's been trying to pass.

    Jiang — his first name was Hao back then — was raised by his grandparents in the Shandong province of China until 1997, when he joined his parents, who'd been in the United Kingdom, in Sunderland, an industrial city in the northeast of England. Until 2003, less than 1% of Sunderland's population was Asian (even today it's still shy of 2%, compared with a nationwide total of about 8%). At his school the ratio was even worse: Jiang was one of just three Asian students in his class, and he was constantly barraged by racist taunts. Before he grew sick of it and took drastic measures, Jiang tried to compensate by simply doing the same to others.

    "As a child, I was very racist," he explains, looking straight at me with wide eyes. "Calling people 'Paki bastard,' 'black bastard' — can't get more crude than that. I was trying to fit in."

    It didn't work. Jiang became more aware of his otherness, and more uncomfortable in his own skin. For a whole year in high school, he barely attended class, instead sitting at home playing video games, smoking and drinking, pretending to be his own legal guardian when the school called looking for him. At 16, he asked a lawyer to draft a document, had his parents sign it, and changed his name to Leo. A more Western name would give people one less brickbat to swing at him. But it was just a name; he wanted to become this new person.

    Over those years since, Jiang sat in front of his computer and researched just how far he could go to fit in. He learned about the prevalence of plastic surgery in Asian society, the thrumming industry that has grown around it, and, crucially, compared himself to the 700,000 people worldwide each year who elect to have blepharoplasties and epicanthoplasties — eyelid tweaks that practitioners swear are devoid of racial context despite much evidence otherwise. "I'd sit in my philosophy class and think of various arguments about how to resolve this paradox," he explains. Surgeons and their customers could be in denial about the cultural implications, but Jiang has no use for obfuscating his intentions or his willingness to take full advantage of this ethical gray area. "People in Asia do this to feel more happy," he says. "People in the West do it to feel less sad. I'm prepared to throw money at the problem."

    He started visiting plastic surgeons on two continents and from six countries for consultations, using income from his job as a substitute teacher in local schools, loans from his parents, and the sale of personal items to fund procedures that will take his total expenditure beyond $16,000 within the next two years. He projects he will spend an additional $25,000 on future work he has planned.

    "This cosmetic surgery is a way to gain equality," he explains, taking a sip of his coffee. "Whatever I do, I can't become white. I told my father I was trying to learn some Chinese and he says, 'For a guy who was so desperate to forget his ethnicity, what you're doing now is ironic and pathetic.' That's the story of my life."

    Plastic surgery is a booming business in Asia: More than a million procedures were performed in China, Japan, and South Korea alone in 2011. A significant share of these are nips and tucks of the kind we have in the West; they're boob jobs and Botox, butt lifts and liposuction.

    But it's the East Asian blepharoplasty procedure, also called double eyelid surgery, which has caused the greatest controversy, used to give the the crease of skin between eyelashes and the eyebrow that Westerners have but most Asians do not. For as long as people have been getting the surgery, media outlets including CNN and Jezebel have been calling it a blatant attempt at Westernization. Online forums trill with the sound of commenters calling each other deluded or racist; academics debate the issue back and forth, and even Oprah got in on the action in a 2004 episode about the surgery, saying, "That would be like me having surgery to not look black. I don't get it."

    Not all agree with these criticisms, and besides, blepharoplasty is a popular procedure the world over, used by some to tighten up sagging skin: 703,610 of these operations were carried out in 2011 by licensed physicians, third only behind lip surgery and the boob job. According to the American Society for Aesthetic Plastic Surgery (ASAPS), an eyelid tuck and fold was the fourth-most popular cosmetic procedure in the United States in 2012, with more than 150,000 operations carried out. At an average cost of $2,724 per procedure, that means over $400 million was spent on blepharoplasties in the U.S. last year.

    "Like most reputable cosmetic surgeons, alarm bells sound in my head when a patient requests anything out of the ordinary," explains David Cheung, who claims to perform the lion's share of double eyelid surgeries in the U.K., yet dismisses the most obvious reason why the surgery is so prevalent. "I personally don't perform any Westernization surgery at all," he insists. "I'm not comfortable providing that service." If a patient outright says they want to alter their ethnic appearance, he won't operate.

    This is a common line amongst surgeons worldwide. They take great pains to say that Asian blepharoplasty categorically is not Westernization surgery, a rote disclaimer found on their websites, despite reference in the American Medical Association Journal of Ethics that "some patients who seek this procedure are attempting to modify a feature linked to a racial or ethnocultural identity." (APACS, the Asia-Pacific Academy of Cosmetic Surgery, didn't respond when asked about its role in maintaining professional standards for surgeons.)

    Kimberly Lee, a plastic surgeon in Beverly Hills, notes that "there has been a shift away from Westernization of upper eyelid Asian blepharoplasty," with both the framing and the severity of the procedure toned down significantly from its harsh past. Archie Lamb, an Australian-based plastic surgeon, straddles the fence, saying in one breath that "the aim of double eyelid surgery is not to 'Westernize' Asians," while in the next noting that "part-Asians may choose to Westernize their appearance."

    Protestations of doctors like Cheung aside, the procedure's history belies its original intended purpose. In the 1950s, a U.S. Marine plastic surgeon, Dr. David Ralph Millard, shipped out to South Korea to carry out reconstructive surgery on patients caught up in the Korean War. It was "indeed a plastic surgeon's paradise," he later wrote.

    In treating the wounded South Koreans, Millard gained an interest in cosmetic procedures, particularly the way blepharoplasty could improve Asians' appeal to American soldiers serving in the country. He set to work, narrowing his attention to the eyes. Quickly he became an expert, and today is considered one of the forefathers of the procedure. The surgeon was unequivocal about the surgery, and it flies in the face of modern thinking: It was a way to bridge the racial gap. Millard photographed some of his best handiwork and published it in a 1955 monograph called "Oriental Peregrinations," and he later wrote in another titled "Oriental to Occidental":

    Folds that were exotic in Pusan or Kyoto will become strangely foreign to Main Street of a mid-western town or under the columns of a Southern Mansion. Especially in the products of the second generation, the plastic surgeon may be called upon to help them blend in with their surroundings.

    Political correctness and better awareness of cultural sensitivities have ensured that Millard's words, written almost 60 years ago, are no longer the norm. The question remains whether that's caused a simple linguistic shift, or a more meaningful change in culture. Until the 1980s, outright Westernization procedures were the norm, according to an overview of the topic by John A. McCurdy Jr., M.D., and Samuel Lam, M.D. Since then, surgeons have been eager to recast the procedure as more nuanced; their technique in creating the eyelid fold has become more careful too. (Some surgeons offer adjustment surgery, to try to counteract overzealous folding from previous operations.)

    "Race does not enter the consciousness [in Asia] in the same way it does here," explains Sharon Lee, an assistant professor at New York University who has written extensively about plastic surgery in Asia. "It's easy to pathologize a whole country of people." The West's preoccupation with race colors its opinion, projecting discomfort onto surgery that for many may not have any overt racial elements. "This notion that Korean women want to become white becomes a really easy answer," Lee says. "That's not to say that race isn't important, but when we stop there we're overlooking much larger structural and historical phenomenons. No Korean woman says, 'I want to look white.'"

    Others disagree. Chinese-American Carrie Chang launched a now-defunct magazine designed to celebrate fellow Asian-Americans in 2000. She called it Monolid as a demonstration of pride in her uncut eyelids. From an article titled "Why Asian Women Need to Say No to Eyelid Surgery":

    Worshipping of the west has been a deleterious part of Chinese society for centuries, but never has it been manifested so clearly as in the sudden rush to alter our faces to idealize the features of another race. Never has self-loathing been so utterly transformed into the core of the Asian aesthetic. Beauty has been warped to fit into a Caucasian person's ideal, making Asians slaves to an aesthetic ultimately not of their making.

    The truth is more complicated, if you ask Jiang: "There is a difference between looking more like a white person and looking less like your race," he believes. "At the highest echelons of beauty, the categories all begin to look the same. We're all trying to achieve racial transformation, but in a homogenized center ground. My personal view is that there is a white, idealized version of beauty associated more with Western beauty ideals. The argument is whether it's coincidental or constructed."

    "The biggest difference between how Westerners and South Koreans approach plastic surgery is in the normality of it all," says Andrea Sherrodd, an American writer who taught sixth grade in South Korea and has blogged extensively about the subject. "Nearly every woman will admit that she's had eyelid surgery, and women will openly discuss their desire to get more." And it's not just women: According to the Korean Association for Plastic Surgeons (KAPS), 15% of South Korean men have gone under the knife, compared with around 10% of the male population in the U.S. and U.K. ("Yes, [being a man] is an anomaly," Jiang admits.) You may not know it, but you're already aware of where many go to get their surgery.

    The Gangnam district of Seoul is home to what professes to be a "mecca of world renowned Korean plastic surgery." The BK (short for Beauty Korea) Dongyang Clinic building stands 16 stories high and houses 16 operating rooms, 14 consultation rooms, dental and dermatology clinics, a plastic surgery museum, and a rooftop lounge where black metal chairs sit under parasols on a wooden deck. It's one of 500 clinics in a section of the Gangnam district nicknamed the "Beauty Belt" that serves a local population of half a million people. Psy raps about how Gangnam is affluent and aspirational — perhaps you've heard his song? — and the BK Clinic is where you go to achieve physical perfection. And though Psy was poking fun at the concept — he claims he was encouraged to get a little work done himself to ensure global superstardom — for many South Koreans, it's an alluring way to live.

    The BK Clinic's website is a slick, glamorous presentation of Gangnam style writ large, without the tongue-in-cheek. "Desire to Have Bigger and Beautiful Eyes!" "Eyelid Surgery" bounces out of the screen in a fake-diamante effect, superimposed over a crystal chandelier and a flashbulb of light from what could be a paparazzo. The site lists 15 plastic surgeons and offers advice in English, Chinese, Korean, Japanese, and Mongolian — and email addresses for those seeking advice from Singapore, Indonesia, Mongolia, Malaysia, and Vietnam. Roughly a third of the group's patients are foreign — 90% of whom are from China — not, it seems, that they're wanting for domestic clientele. It's estimated that 10% of South Korean adults, and a fifth of all women in Seoul, have had cosmetic surgery.

    Other clinics set up shop in South Korean shopping malls and advertise before movie screenings. Banners and posters are pasted up on the Sinsa and Apkujong subway station walls in neighborhoods such as Gangnam and Hongdae. "I feel like I saw them everywhere," Sherrodd admits.

    "They are everywhere," agrees NYU's Sharon Lee. That's troubling for various reasons — not least that using before and after photographs of plastic surgery patients to advertise clinics is illegal in South Korea. A campaign group, Yosong Minuhoe (Womenlink), carried out an awareness campaign against the posters, managing to bring them down. But, says Lee, "shortly thereafter the ads re-emerged, and no real structural change has emerged from it."

    Meanwhile, since 2007, China's young plastic surgery industry (cosmetic work was only legalized in 2001) has been growing at 16.3% per year — faster than its general national growth rate. Their advertising can be blunter than that in South Korea, reflecting a wry sense of humor that borders on the fatalistic, such as in this one, where two pretty parents are surrounded by ugly kids. The caption above their heads reads, "The only thing you've got to worry about after plastic surgery is explaining it to the kids."

    Of course, that's not true. "Plastic surgery is major surgery, and yet somehow it gets treated as a magical transformation," says Lee. "What gets talked about less are the risks."

    In 2005, Wang Bei was a finalist on Super Girl, China's version of American Idol. Hundreds of millions watched her perform on Hunan Satellite Television; she finished ninth. Unsuccessful in her pop career, by 2010, at 24, she decided to have plastic surgery. (Her mom joined her in the hospital to get a little work done herself.) Bei was undergoing jaw-narrowing surgery — a slightly, but only slightly, more nuanced version of taking an angle grinder to your lower jawbone — in the Zhong'ao Cosmetic Surgery Hospital on Nov. 15, 2010. She didn't wake up.

    "There are risks," Jiang shrugs. "Things have gone wrong." He's talking largely about minor imperfections in his surgery: an uneven eyelid here, an off-kilter nose there. I ask if he's lost the perspective that this is a medical procedure and things can go wrong. Again, it doesn't seem to properly sink in.

    A few weeks earlier, over a game of pool at a city center club, Jiang shouted at me above the loud music blaring out of the speakers, "I had one surgeon tell me that I was mentally ill. And I just said, 'Well, look, this has been a complete waste of your time and mine.' What is good cosmetically is not necessarily good medically."

    On a late afternoon in March we're in a bustling café attached to an inner-city library. Jiang is wearing a suit, having come straight from work, and is clean-shaven, his hair swept gently to the right with a dab of wet-look gel. His walk is poised, confident, and cool.

    For months we've talked about his journey, about the reasons behind his surgery, and what he hopes to do in the future. But Jiang, articulate, intelligent, and using his philosophical skills to their fullest, often talks in the abstract. It's all a way to muddle the real emotion behind the actions — 16 years ago some dumb people made some dumb comments and it's still dominating his life.

    "I believed that my ugliness was in part due to my ethnic features," he says. "My father thinks I'm ridiculous for building a complex system of beliefs based on that initial shallow stimulus. He says, 'You've gone and done this, so you must be very proud of it, but initially it was some stupid kids opening their mouths to you.'"

    His thick black eyebrows raise slightly as he looks up: "In 10 years' time, I will decline. Beauty is not forever. I just want to have my moment in the sun. What comes after is, live a good life. I view this as a facilitator. It makes me happy. It makes me confident. The longer I live, the less racial overtones will hang over it."

    He lingers for a second. "I have deracialized myself to a certain extent." Taking away, or dulling down, the features that made him stand out and becoming more integrated with Western society have led him to be neutralized. "I no longer think like Chinese people think. And in some sense I often don't think the way the British people think. It's unavoidable."

    He had met a girl six weeks after his blepharoplasty. She was white and had dyed-blonde hair — her own, decidedly less invasive attempt at physical reinvention. ("You can't get much more flagrant than hydrogen-peroxide hair," he says.) Best of all, "She didn't guess I'd had it done. That's something I'll always remember. I'm doing more than just surgery. Without it, none of this would have happened. I'd have not had the confidence to do everything else. I have a life now."

    After we part, he'll walk to a private dance class for which he's paying $80 an hour. "I've never really danced in a nightclub before," he admits. A few weeks later he'll wake at 5 a.m. for voice and drama lessons to learn how to act confidently in social situations. There is a plan.

    "If you spent most of your life in a room," he explains, "trying to build a life from scratch, you can't do it much more methodically than I have. Everything — friendship, looks, career — was hatched after 2009. That was the lowest point. I was hit by a car. Nobody came [to see me], I saw a very depressing life ahead of me. And last year, I had a surgery, this girl liked me, and I saw a very different future."

    By now Jiang's smiling, and in all the time I've known him, I realize I haven't seen a lot of that. But there are plenty of other people out there in Jiang's situation who aren't as analytical about their motivations, because the culture categorically ignores his reasoning. "The literature doesn't mention me," he worries, furrowing his brow. After all, Westernization doesn't happen anymore, and hasn't since the 1980s.

    The sun's almost dropped out the sky now. "I'm catching up on the life that people my age, people who lived in Britain all their life, will have had," he says, puffing his chest and jutting out his chin, which will soon be more chiseled, courtesy of a $7,500 augmentation slated for 2014. "I was not used to being treated like a normal person. Once I get over the surgery, I will live my life as normal. Have money, have friends, go traveling, get a dog, get a cat, that kind of thing."

    "And you're getting there?" I ask.

    "Yeah," he says. "It's been confusing trying to square this circle." Jiang has lived two lives: He started out Hao and ended up Leo — but Leo's not fully formed yet. He smiles again. "It all depends on where you end up."