Why do attractive young men and women of East Asian descent choose to undergo cosmetic plastic surgery to alter inborn natural features? Is it to look like other Asians who inherited different natural structure? Is it to refresh a worn out appearance? Is it to help them look more beautiful? Is it to more resemble another ethnic group?

At first glance, the best answer given these few choices might seem to be "all of the above." After careful consideration, though, it becomes apparent that the truth is hardly so simple.

That said, most public and professional opinion encountered these days suggests otherwise and comes across as superficial or even naive. Consequently, about all one can really count on is that whatever explanation is offered, it will be politically correct and non-confrontational.

Nowhere is this now more apparent than in the recent mass trend among American surgeons in suddenly promoting "ethnically-sensitive" cosmetic surgery that strives for "racial preservation."

After all, who among patients or doctors wants to invite the inevitable outrage and verbal attack that is all but guaranteed after an airing of "insensitive ideas" such as opinions based on actual experience? Why risk the wrath of armchair critics who continue to invent more reasons to prove that all cosmetic surgery performed on anyone not of European descent constitutes an immoral attack on ethnic identity and is racist?

Scary stuff, indeed.

Just because we authored this article doesn't purport to imply that we have all the answers, so please draw your own conclusions. However, here are a few other ideas on patient motivation that are sometimes brought up by the more thoughtful willing to brave negative feedback:

The so-called "Asian" group of plastic surgery procedures are designed for patients seeking at least some degree of physical "westernization."

For example, epicanthoplasty subtracts out the epicanthal fold, a structure present on almost every Asian eyelid, while double eyelid surgery adds in a defined crease, a structure present on almost every European lid.

Jaw, cheek, and calf reduction surgery are all "Eastern subtractive," while forehead, nose, and temple augmentation, all operations rarely used on other than East Asian patients, are "Western additive."

None of the distinctly Asian operations ever goes the other way, i.e., "Eastern additive" or "Western subtractive." Thus, "de-asianization" is just as valid a label of intent as "westernization," although this may seem a harsher way of looking at it.

Could all of this be just by chance? Not likely.

Okay, but does undergoing subtle change really strip away one's identity? No. Does aggressive surgery that ignores preexisting anatomical variation do so? Overdone surgery looks unnatural on everybody, Asian or non-Asian.

Between subtle and too much exists a continuum. How far one can go before terms like westernization should be applied is a matter of opinion and experience. The best surgeons have always recognized this and work hard to avoid crossing the line.

A big problem with attaching pejorative terms to an objective observation is that the terms themselves can incite more passion and negativity than the phenomenon being considered.

East Asians want to look like people from the United States.

To not acknowledge American cultural influence as a main stimulus in the development of modern Asian plastic surgery seems disingenuous if not dishonest, but, in any case, that was then and this is now. The phenomenon has since transcended this once-important connection and now feeds almost entirely on itself.

The Korean Wave has all but dispensed with the "cultural superiority" myth as a driver of current demand. If East Asians ever wanted to look like another group, it's not the Americans but rather their own K-pop performers who have undergone so much body modification that some observers have commented that they seem eerily transformed into a distinct new racial grouping.

Asian patients seeking surgery desire to look like other Asians who inherited natural features they find more desirable.

While there is some truth to this, for the most part it's of minor significance. Sure, some Asians do have inborn double eyelids, but such creases are usually quite low and weak and not that similar to those obtained after eyelid surgery.

Plus, how many patients go the other way--for instance, ask a surgeon to remove whatever natural eyelid creasing they were born with? If the requests always go strictly in one direction, there must be something more elemental driving such "personal" preferences.

Young Asians have surgery to perk up features that have lost their previous zing.

For that to be true, this group would need to be closer in age to fifty, which is not the case. Sure, everybody grows older, and aging is a major driver of plastic surgery in the West. But what we know as "Asian plastic surgery" has little to do with restoration or rejuvenation.

Asians undergo plastic surgery to "look beautiful."

This argument is the most empty of them all because most young Asians already look beautiful to start. One seldom hears the "beautiful argument" from anyone but plastic surgeons in the East, who, interestingly, often feature pictures of American women on their websites and local advertising. Western surgeons better understand that there are no set beauty standards (or at least that marketing the concept doesn't seem to fly in the United States). In South Korea, however, the "look more beautiful" goal (with an overtly Western twist) is widely emphasized.

In the end, the motivation for undergoing cosmetic surgery is too personal, complex, and variable to allow broad generalizations across entire populations or assign value judgments. As in the West, most people in East Asia seem to choose cosmetic surgery less out of insecurity or coercion and more to try to feel a little better about a physical feature that may, for whatever reason, be bothering them.

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