The dark side of the ‘plastic surgery’ fever in China

In 2021, actress Cao Liu shared on social network Weibo shocking images of her nose after a failed cosmetic surgery in Guangzhou. The tip of her nose was necrotic and turned black and bruised.

Doctors at many Chinese hospitals also store dozens of photos of patients with swollen faces or black foreheads asking for help because of botched surgery.

This is the dark side of China’s cosmetic surgery industry, which is booming among urban Millennials, especially young women, who often seek laser treatments to treat melasma or injectable fillers to erase wrinkles.

The combination of social networks, cosmetic clinics soliciting customers and unprofessional practitioners is creating a dangerous dark area.

“Some clinics just want to make money and don’t care about the patient’s health,” said Lin Ruiyu, a cosmetic doctor in Shanghai, noting that many clinics force customers to perform additional unnecessary procedures.

Young women in China are surrounded by countless social media posts about cosmetic surgery, making them feel “if I don’t do it, I will become ugly, lose my job or lose my friendships. This thinking is completely wrong,” Dr. Lin shared.

Demand for cosmetic surgery in China began to increase about a decade ago, as the middle class became more prosperous and the prejudice against plastic surgery became less strict.

Although the proportion of the Chinese population undergoing these procedures is relatively low, the market is estimated to reach $42 billion by 2025 and be the second largest market in the world after the US, according to international consulting firm Deloitte.

In Shanghai, China’s economic capital, one can clearly see the skyrocketing demand for cosmetic surgery. In the Maio clinic overlooking the Bund, nurses and patients constantly move in and out of VIP recovery rooms, an operating room equipped with liposuction machines and a studio for pre- and post-procedure photography.

Cao Wenhong, co-founder of Royal Life Group which operates Maio and 11 other cosmetic clinics across China, attributes the boom to China’s “appearance economy”. More and more people are choosing to go under the knife to improve their appearance to increase their chances of getting a job or dating in an extremely competitive society like China.

This need is evident on social networks or popular platforms such as WeChat and specialized cosmetic surgery applications such as So-Young and Gengmei.

So-Young, a company founded in 2013 and currently generating more than $200 million in revenue, operates an app that allows users to search for doctors and chat with plastic surgery enthusiasts. The AI ​​feature called “Magic Mirror” will scan the user’s face to determine the proportions of eyes, nose, and lips, then allow users to edit the face in many different styles such as “hot girl face” or “classy face”.

Beijing is aggressively cracking down on the cosmetic industry with strict new regulations, combined with a media campaign on state media to warn of the risks of every procedure, from liposuction to Botox injections.

In 2021, the Market Supervision Administration (SAMR) began cracking down on cosmetic advertising, banning content that arouses “appearance anxiety”. Two years later, this agency continued to tighten the process of assessing practice capacity as well as training regulations.

In May 2025, SAMR issued guidance documents requiring Internet platforms to strictly control medical procedure advertising. This move led to large-scale purges on social networks such as Xiaohongshu. In December 2025, this platform announced that it had locked more than 300,000 violating accounts, and coordinated with police in 8 regions to handle cases related to fake medical supplies.

State media also continuously published investigative reports in 2025. Notably, articles exposed the profiteering tactics of “baiters” who bring customers to clinics, or the reality of intensive cosmetic training courses – where people with no medical knowledge are taught to perform injection techniques after just a few days of studying. Immediately afterward, China’s top health agency pledged to investigate.

In July 2025, China Central Television (CCTV) advised high school students not to have cosmetic surgery after college entrance exams – a time when Chinese parents often reward their children with face-slimming packages or Botox injections. The station emphasized that even minimally invasive procedures “can cause many complications”, leading to “psychological damage” to minors.

Amanda Yang, co-founder of Iduna cosmetic center, commented that “the government is monitoring the cosmetic industry much more closely” and is “very cautious” with any medical-related field. To be licensed to open at the end of January, Iduna had to overcome many legal hurdles with many documents, inspections and a months-long waiting process.

However, not everyone believes that everything is okay.

Meg Lu, 51, had her first cosmetic procedure in 2017 in Tianjin. For about a year, she had a series of treatments such as a minimally invasive facelift and filler injections, resulting in her face being tight, unnaturally swollen, and her chin stiff and pointy.

This experience made her depressed for many years, always avoiding appearing in crowded places. “At that time I wasn’t even me anymore. I couldn’t smile, I didn’t dare look in the mirror,” she recalled. “I know a lot of people like that. I’m not even the worst case.”

She believes that “things are getting better, but it is very difficult to completely eliminate underground clinics.”

The “Failed Cosmetic Cases” chat room on Baidu proved Ms. Lu’s worries. More than 50,000 posts, most with photos, describe post-beauty nightmares. A woman’s post in October 2025 said her nose had a black indentation after augmentation.

“The dent is getting deeper and deeper,” she wrote. “I started to get depressed.”

The explosion of photo editing software and apps is raising concerns about unhealthy beauty standards. According to a survey by Meituan and Roland Berger, about 60% of cosmetic intervention customers in China last year were people aged 26-35.

“When we are so used to edited images, it is difficult to accept our true appearance,” said Lu Yufan, an artist in Tianjin.

However, not everyone agrees that cosmetic surgery leads to anxiety. Some see it as a statement of women’s empowerment. Susan, 37 years old, a social media influencer living in Hangzhou, believes that more and more women are having cosmetic intervention to “please themselves, not for others”.

Beauty standards are also changing. In the past, many customers wanted to look like celebrities or Westerners, but today’s Gen Z generation is more confident in Chinese-style beauty and beauty that suits their own personality.

Cao, the owner of a cosmetic clinic in Shanghai, had eyelid surgery when she was young but thinks the demand is decreasing. “Our aesthetic taste has changed. We used to lean towards Western beauty ideals, but in the past two years, Chinese-style beauty has been more accepted,” she said. “Chinese people are learning to respect and love their own culture.”