On the cosmetic treatment informational platform RealSelf, surgeons around the United States submit before-and-after pictures of their patients. For a particular procedure called double eyelid surgery, also known as blepharoplasty, you'll find around 1,000 example images. The people in the photos vary in age and gender, but one recurring factor is their ethnicity. The operation is sometimes called Asian eyelid surgery because the procedure involves creating a crease in a monolid upper eyelid, which is a common eye shape in people of Asian descent. In short, the operation has the effect of toning down the 'Asianness' of that particular feature, and on RealSelf's site almost 90 percent of double-eyelid surgery patients say it's "worth it."

Blepharoplasty is the most popular cosmetic surgery in Asia and the third most popular amongst Asian Americans. Asia has a robust and unabashed relationship with plastic surgery. It's so socially prevalent, it can be openly credited with someone's aesthetic improvement in the same manner as, say, finishing puberty. And in the West, the stigma of cosmetic enhancement is dissipating. 

Celebrities are publicly thanking their frequented clinics, and leagues of popular social media accounts are dedicated to documenting celebrities' alleged cosmetic upkeep. "Botox babies" are so common now, the New York Times wrote a whole story about them. We collectively cackle at our selfies taken with the "pillow face" filter, which mimics the effects of getting too much filler. The days of clinics offering a backdoor entrance for discretion feel distant — just ask Beverly Hills Plastic Surgery founders and Bling Empire stars Christine Chiu, who both owns BHPS and is a producer on the Netflix series, and dermatologist Gabriel Chiu. Their clinic is situated in a ground-floor storefront.

But for Asian Americans, the more openly pro-surgery attitude in the West brings with it some interesting developments, creating a demand for a face tweaked and blended with Western features, and in some cases, strongly informed by an unrealistic Instagram aesthetic. But it's not only Asian Americans who are gravitating towards this look. A growing obsession with ethnic ambiguity in the U.S. is changing beauty standards to include a mix of features from different races and ethnicities (like the almond-shaped eyes prominent in many East Asian people).

The Asian American Aesthetic

For inhabitants of East Asian countries, a proclivity for Western "corrections" remains. South Korea, for example, is home to the highest plastic surgery rate per capita. With regard to cosmetic adjustment, double-eyelid surgery is just the tip of the Westernization iceberg. Things start to get a little different when you consider the Asian American beauty aesthetic.

"Asian American standards follow the Western beauty standards, but even more closely: more contouring, more highlights, bigger, better," shares Christine. "Whether it's cheeks or jawline, breasts or butt, everything is highly carved… [The Asian look] is youthful and genteel, kind of fading away as much as possible."

" I am seeing much more interest in Eastern aesthetic surgery even amongst my non-Asian patients."

The procedure that bridges both Eastern and Western Asian beauty ideals, apparently, is the nose job. New York-based board-certified facial plastic surgeon Edward S. Kwak specializes in rhinoplasty for Asian patients, in which he says "treatments are made to address a poorly-defined tip and bridge." In effect, this creates a higher bridge and a more traditionally Eurocentric nose shape. However, Kwak says over the course of his 15 years in practice, he's seen the globalization of beauty with "more of a blend of beauty standards between the Eastern and the Western face."

"I frequently have patients come in with photos of their ideal goals. In the past, the models [in the photos] skewed more towards traditional Western beauty," says Kwak. "Now I am seeing much more interest in Eastern aesthetic surgery even amongst my non-Asian patients."

Social Media and Unrealistic Expectations

Orange County-based board-certified plastic surgeon Goretti Ho Taghva opened her clinic in part because she felt that plastic surgery failed to represent her own "ideals of beauty" as an Asian woman. Classical medical training, she says, is "heavily based on Caucasian anatomy that in many cases isn't applicable to treating Asian faces." A few years ago, she noticed an influx of celebrity-influenced Asian patients wanting "exaggerated features" like large eyelid creases, high nose bridges, and fuller foreheads (achieved through fat transfer). Taghva is particularly uncomfortable with some of her patients' expectations: the huge eyes, button noses, and perfectly full mouths informed by photoshopped social media posts filtered through third-party apps.

"If it seemed like something that was going to stay as a beauty enhancement then I would do it for that patient"

"[Beauty camera] apps like Meitu have made some of the beauty ideals unattainable, and sometimes quite strange looking in my opinion," Taghva says. "What makes me most anxious are patients who have poor self image but also unrealistic expectations."

Beverly Hills Plastic Surgery experiences similar requests. "Something that comes up a lot, too, is anime: cartoon-y big eyes and shaved face and translucent skin," notes Christine. Gabriel adds that while social media has enhanced the desire for "refinements" in lieu of major surgery, "flipping through your phone there are a lot of filters that are very unreasonable."

Gabriel unravels the rationale for cosmetic enhancement with each of his patients. Christine says he often reminds her of a "therapist" in his attempts to devise whether his patients are seeking an adjustment to genuinely benefit their mental and physical health, or simply follow a trend. In the case of the "fox-eye" look, Gabriel attempts to dissuade consultees, fearing the trend may not last. "If it seemed like something that was going to stay as a beauty enhancement then I would do it for that patient," he says.

The Fetishization of the Eurasian Face

Each doctor we spoke to notes that the prevailing shift among their patients — Asian or otherwise — is age. As procedures have become less invasive and social media has decreased their stigma, the younger generation is both looking to delay aging as well as, Gabriel articulates, better "refine" their features. Specifically, a newfound obsession with the jawline has arrived — and no where is this more evident than on TikTok. Along with increased interest in gua sha and treatments like Kybella (which reduces the appearance of a double chin), Kwak says that amongst his clientele, he has seen an upswing in Asian American patients in their 20s and 30s seeking to reduce facial jowling and remove buccal fat beneath the cheekbones to contour the face into a heart shape (for reference of a heart-shaped face, see Bella Hadid).

"In general, beauty trends tend to be highly influenced by the media," says Kwak, who claims to be "uncomfortable" with patients seeking surgery based on trends alone. "These requests [often] propose changes a focal point of the face rather than creating balance and harmony."

"It really depends on your surroundings and the culture you're in," explains Gabriel. "On social media, television, and in print, you have images of people you find attractive or look up to. So you see what's popular; if nine of your friends are doing this thing, you're going to give it a try for yourself."

There's little wonder why so many Asian Americans readily subscribe to Western beauty. Hollywood and the fashion and beauty industries alike have long privileged Asian talent with distinctly Eurocentric features. Kevin Chung, a talent agent in New York City who is well-known for speaking on the white-washing of Asian models and Asian appropriation, recently shared on Instagram a casting brief that reportedly called for two Asian models with "oval faces," "pale skin," and "very beautiful mouth/lips and nose." "Just say you want an Asian who looks white," Chung responded on social media.

Even when attempting to be inclusive, these industries often fall short. "It feels lazy to stick a very Chinese-looking [model] in a beauty campaign and say, that's our job, we threw in an Asian," says Christine. "The 'China look' isn't a one-size-fits-all look for Asian Americans."

Surgical Appropriation

For many, the adoption of an "Eastern aesthetic" among non-Asian people has raised red flags of appropriation. The "fox eye" trend, where the skin around the forehead has been stretched up and back for a dramatic almond-shaped eye, has been fueled by social media and people's desire to emulate the look of models with similar eye shapes, like Bella Hadid and Kendall Jenner. The fox eye effect is usually achieved by threading (which, Gabriel notes, is temporary and leaves scar tissue) or a more permanent temporal brow lift.

The last several years have seen many try to mimic this effect non-surgically for their social media followings by pulling back their skin for pictures. Chung has been a vocal advocate for the eradication of the forehead-tugging pose and has posted repeatedly on the subject. In an Instagram post last year, he wrote that for Asian Americans, "It's taken many of us our entire lives to love our eye shape, and it's inappropriate for others to turn this into a 'trend'… I am truly so dumbfounded by the stupidity and ignorance."

"Why not build a campaign celebrating the beautiful Asian almond eye? "

The Chius are similarly uncomfortable. "I've been personally made fun of by a seven-year-old [saying] I had 'ching chong eyes,'" says Christine. "If there wasn't an association with a racial aesthetic, then it might be different. Why not build a campaign celebrating the beautiful Asian almond eye? By instead attributing it to an animal, it feels like a slap in the face."

"[It's] Asian appropriation," echoes Gabriel. "And crazily enough, certain people didn't want to attribute it to where it began and compliment a culture for their look."

At this point, cultural appropriation by the dominant society seems par for the course. But no matter how homogenous the Facetuned and filtered Western beauty ideals appear on Instagram, Kwak says a wide spectrum of individual preferences still prevails among his Asian patients. While cosmetic trends undoubtedly persist, as will so-called universally-attractive features, representation will always be key to avoiding nip-tuck uniformity — and that's 100 percent worth it.

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