'I would live your life so much better than you if I had your face' remarks Sujin, one of the characters in Frances Cha’s eponymously titled debut novel If I Had Your Face. This superficial remark has excoriatingly poignant consequences for the lives of the four fictitious women whose journey Cha documents. A novel that is in equal parts dangerous, delightful and deliriously compelling, Cha provides an intoxicating insight into South Korean culture—where both personal and private lives are dominated by a cut-throat economy, a darkly addictive K-pop scene and an aesthetic medicine industry that flaunts perfection at any cost.
Kyuri works at ‘Ajax’, an elite 'room salon' in Seoul that caters to the sexual needs of South Korea’s wealthiest businessmen.  As one of the ‘ten percent’ rooms, Kyuri’s salon only employs the top ten percent of the prettiest women in South Korea. The level of aesthetic perfection Ajax requires of its employees comes at a cost. Kyuri is long-time frequenter of the ‘Cinderella Clinic’, an elite plastic surgery centre where she has undergone multitudinous procedures: double eyelid surgery, jawline reduction, cheekbone reduction and forehead augmentations. Although Kyuri’s looks are enviable, their consequences are more than just cosmetic; Kyuri may convince herself that her self-financed features are the face of modern feminism, but ultimately they serve as an aesthetic reminder of her responsibility to satisfy the demands of her clients. 
Ara is Kyuri’s hairdresser, a woman rendered voiceless by an act of violence buried in her past. Ara deflects the chaotic vibrance of the world around her by immersing herself in deeply-harboured fantasies of her K-pop idol, Taein. Ara’s dreams, grossly manufactured and encouraged by a business that has become one of South Korea’s most profitable cultural exports, reach the point of hysteria when she is afforded the opportunity to meet Taein in person. The subsequent realisation that she can only ever remain parasitic to the glamorous lives of the elite drives Ara to the point of despair.
Mother-to-be Wonna lives downstairs from Ara in a tiny flat that she is barely able to afford. Cha charts Wonna’s journey as she struggles with the crushing social expectation of motherhood, whilst her fragile financial status threatens to completely obliterate her precarious position in the social hierarchy. This unflinching portrayal of female ‘success’ is an indictment on a country where most young people worry more about their job prospects than the nuclear threat post by their militant neighbours. 
Orphaned Miho wins an art scholarship that allows her to study in America. Free from the unrelenting pressure of the South Korean social hierarchy, Miho’s life becomes tragically enmeshed with the offspring of the South Korean elite who are studying alongside her. Upon her return to Seoul, Miho finds herself to be a talented but adrift member of the art world, unable to anchor herself to the tumultuous eddies of wealthy individuals that dominate the artistic cultural landscape.
Dubbed the ‘plastic surgery capital of the world’ South Korea’s history with aesthetic medicine is long and complex. The wealthy neighbourhood of Gangnam in Seoul is home to the so called ‘Improvement Quarter’. This area of the neighbourhood houses the ‘Beauty Belt’—a mile long mecca of aesthetic medicine facilities, offering everything from rhinoplasties to body contouring.  Yet Cha’s novel challenges the idea that South Korea’s relationship with plastic surgery is based on vanity alone. Plastic surgery first entered South Korea’s cultural consciousness in the 1950’s and 1960’s with the arrival of the American military. Military doctors would perform double-eyelid surgery (the insertion of a crease into the eyelid to make the eye appear larger) on nationals, to ‘fix’ the appearance of the eye and align it with Western-centric beauty standards.  Today, double-eyelid surgery is the most commonly performed cosmetic procedure in South Korea.  Additionally, South Korea’s competitive job market has normalised employers’ prerequisites that applicants provide accompanying headshots with their CV, along with information about their height and weight. This method of ‘streamlining’ potential candidates is commonly referred to as “외모지상주의 (oe-mo-ji-sang-ju-ui), or ‘Lookism’—prejudice or discrimination based on physical appearance.  Plastic surgery is both a cause of this prevalent discrimination, and also a mechanism by which some individuals opt to increase their employability status.
South Korea’s K-pop culture also has contributed to the notion that Western beauty standards are not only desirable, but normal. The K-pop industry ruthlessly manufactures and promotes celebrities that epitomise surgically enhanced beauty standards—double eyelids, small faces and round foreheads—often the result of numerous grueling and dangerous cosmetic procedures. This has given rise to what anthropologist Dr Eugina Kaw refers to as ‘self-racism’, whereby certain physical traits are linked to negative characteristics. Women, and men, are increasingly opting for plastic surgery to correct natural features which an internalised racist ideology casts as defects, not purely as a means of empowerment and choice. 
This poses some interesting ethical concerns for myself as a physician and for South Korea’s booming aesthetic medicine industry as a whole, an industry which is often the specialty of choice for many of South Korea’s most accomplished medical graduates. ‘Plastic surgery’ is commonly divided into reconstructive surgery and cosmetic surgery. Whilst it is easy to reconcile the commitments of the Hippocratic Oath with the undeniable necessity of reconstructive surgery, an area often synonymous with military medicine, cosmetic surgery poses more of an ethical dilemma. In an industry increasingly incentivized by economics as opposed to holistic patient care, the cosmetic medicine industry treads a fine balance between promoting public awareness and creating demand that would not otherwise exist if not for its own advertising.  Additionally, medical practitioners operating in the aesthetic medicine industry must also consider their duty to ‘do no harm’—balancing the risks of medically superfluous procedures against the perceived psychological harm that accompanies the feeling of being ‘outside’ of sociocultural norms.
Nevertheless, there is an increasing backlash against the ubiquitous nature of plastic surgery in South Korea. Seoul metro has plans to ban all plastic surgery advertisements from its stations by 2022, following increasing numbers of complaints from the public.  Additionally, ‘Escape the Corset’ is a growing feminist movement that seeks to dispel the manipulative hold of the unobtainable beauty standards imposed on South Korean women by society. 
It would be overly-simplistic to demonise South Korea’s aesthetic medicine industry, a practice with complex cultural origins, or to blame its rise solely on the vanity of its often exploited consumers. As Frances Cha demonstrates, South Korea’s relationship with plastic surgery is a multifaceted entity, not without blemishes of its own.
Jasmine Virk, Junior Doctor, 2020
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