At least until recently, plastic surgery that altered facial features very noticeably was disliked by the Japanese public. Seen as artificial and overly "Western," patients with bold surgical eyelid creases were called "Kewpie dolls" and men who underwent surgery were denigrated as "cute."

Known for their gentle and meticulous technique and high attention to detail and precision, Japanese plastic surgeons have traditionally been more conservative in adopting new operations, instead being content to stick with the established but apply it in a fastidious manner, providing a nip here and tweak there to create subtle modification.

Times have changed, and so have expectations. Some authors have commented that, for instance, a defined double eyelid has become the "average" for the Japanese population, not so much to look like Europeans but rather their young pop celebrities. Having internalized such anatomic alterations as "ideals," eyelid surgery is no longer looked upon as strange or odd but rather more like a mainstream beauty treatment. The same holds true for any number of the operations discussed from the links provided above.

Some surgeons in Japan have adjusted to modern demand, while others have not, instead suggesting that Japanese plastic surgery meets a higher standard that that performed elsewhere in Asia. However, this distinction that may have once existed has been blunted as time and experience have allowed plastic surgeons in other countries to not only advance their skills with traditional operations but innovate whole new approaches.

While arguable among those involved, any perceived edge by the Japanese cosmetic surgeon mostly disappeared. Today's finest practitioners are not based in just one single city or country but rather scattered throughout Asia and beyond.