Science Meets Sensitivity: How Plastic Surgeons Preserve Ethnic Integrity

When Dr. Jamil Asaria was studying to be a plastic surgeon in the early aughts, he was taught that the ideal eyelid is 10 mm high — a standard rooted in Western cosmetic textbooks. These generalizations were common at the time, like “ski jump” rhinoplasties that surgeons idolized well into this century. Cosmetic plastic surgery once followed a single standard, and in many countries, that standard was rooted in predominantly white ideals. “When you look at the medical literature, photos and conferences, everything was very western-centric,” says Asaria, a facial plastic surgeon who runs Face Toronto. Before returning to Toronto to set up his practice in 2010, he adds, “Ninety per cent of my patients [had] fair skin, light hair…I had to invest my time and efforts into figuring out: How do I serve a diverse clientele?”

Today, leading surgeons like Asaria are doing just that by preserving patients’ cultural identity. This practice is generally referred to as ethnic plastic surgery. At its heart is this truth: “A patient’s face reflects their heritage, their family resemblance and their personal history. Surgery should never erase those elements; instead, it should harmonize the features while respecting the anatomical characteristics that make someone uniquely themselves,” says Dr. Julian De Silva, from London Facial Plastic Surgery in London, England.

Dr. Myung Ju Lee, board-certified plastic surgeon and founder of VIP Plastic Surgery in Jeju, South Korea has long pioneered this approach and watched as the world caught up. “Two decades ago, South Korean patients often requested Western features — larger double eyelids, higher nasal bridges -— driven by globalized beauty standards,” says Dr. Lee, who specializes in facial rejuvenation and has been practicing for over 25 years. “Today, we’ve witnessed a cultural renaissance where individual distinction and ethnic features are celebrated.”

He attributes this, in large part, to the USD $11.2-billion K-Beauty industry, which he says helped reinforce global appreciation for Asian features. Korea is known as the cosmetic plastic surgery capital of the world due to its high per capita surgery density and a booming industry serving both local and international patients. Case in point: In 2023, the government announced it planned to attract 700,000 medical tourists by 2027; by the end of last year, that number already hit 1.2 million. Half of these were coming for cosmetic plastic surgery or non-surgical treatments, Business of Fashion reported in July.

“Korea has become the global epicentre of aesthetic innovation precisely because we’ve moved beyond imitation to innovation. Our culture emphasizes holistic beauty, integrating skincare, nutrition, and wellness. Korean surgeons pioneered techniques that work specifically with Asian anatomy rather than adapting Western procedures,” says Lee, noting, for example, he only uses a patient’s natural tissues such as fat and cartilage, rather than any synthetic materials. “This expertise in ethnicity-specific techniques has made Korea a destination for patients worldwide seeking culturally sensitive enhancement.”

Alka Menon, an assistant professor of sociology at Yale University in the Women’s Gender and Sexuality Studies Department, agrees that South Korea, along with Brazil, has led globally. “North America is certainly famous for its plastic surgeons. But they’re not trying to radically upend what is possible to do with the body. They’re trying to help people look more in line with conventional ideals of beauty,” she says. “A Brazilian Butt Lift, for example, is a procedure that is a little bit more reflective of Brazil’s own melting pot.” Menon is referring to the technique that makes the buttocks bigger by transferring fat there; in 2024, it was one of the top five procedures in the country, according to the International Society of Aesthetic Plastic Surgery.

Still, we can’t ignore the racial politics around BBLs, especially given Brazil’s complicated history with plastic surgery. “The notion of the idealised Brazilian bottom, which some rich white Brazilian women disdain because of its stereotypical associations with biracial women, has become the desired shape among certain white women in the US and Europe,” Sophie Elmhirst wrote in an analysis of the surgery in The Guardian in 2021.

Conversely, if you look at South Korea, which is traditionally a more racially homogenized society, we see similar experimentation with jaw shaving or eyelid height, says Menon. “It’s pushing the boundaries of what you could do with a human body. To think about not just what kinds of ethnically inflected looks there are, but what a modern body could look like, and what modern investment in the self might be. The lines there were not always about race or ethnicity in the same way.”

Historically, in the U.S. at least, ethnic plastic surgery was associated with assimilation with whiteness. Menon spent six years speaking to cosmetic plastic surgeons around the world to write her 2023 book, Refashioning Race: How Global Cosmetic Surgery Crafts New Beauty Standards, and watching this shift to more inclusive procedures in real time, driven by social media, as well as globalization of surgeon networks and the sharing of techniques and technologies.

Dr. De Silva, for example, has designed a facial-mapping software to analyze facial proportions and adapt to the patient’s ethnicity and individuality. “People want subtle refinement, not homogenization,” he says. “This evolution has raised expectations: Surgeons must understand diverse anatomy and cultural aesthetics, and must protect identity as part of good surgical practice.”

There’s still plenty of work to be done, of course. The term ethnic plastic surgery, which not every surgeon uses, is itself othering and continues to reinforce hierarchical beauty standards with whiteness firmly at the top.

For Dr. Asaria, the best way forward is simple: “What do you identify with? What looks good with your other features? What looks good to you,” he says. “There are so many things [about ourselves] that are naturally imperfect, but make you who you are. Taking them away and making you mathematically more beautiful, robs you of something that you have.”