Individuals consume products and services as a means of symbolic self-expression in private and public contexts (Ahuvia, 2005; Belk, 1988; Harmon-Kizer et al., 2013). The body should be seen as the continuation of the individual, as the self is exhibited to others via its embodiment (Borelli and Casotti, 2012). Thus, the body functions as object that can serve self-expressive purposes and consumption behaviors (Schouten, 1991). Meanwhile, cosmetic surgery is described as a “fashion object” (Venkatesh et al., 2010, p. 468) and a form of extreme symbolic consumption that uses the body as an object to express the self (Schouten, 1991). Research indicates that individuals use of cosmetic surgery as a means of self-identity reconstruction (Askegard et al., 2002) and that motivational antecedents such as sociocultural influences, competition with others, media influence, body appreciation, and a materialist orientation are drivers of cosmetic surgery (Henderson-King and Brooks, 2009; Markley-Roundtree and Davis, 2011; Swami et al., 2009). Contrary to prior evidence, we argue that besides being a consequence, cosmetic surgery acts also as an antecedent that influences materialist consumption practices through changes to a consumers’ self. Surprisingly, despite the growing number of cosmetic surgery procedures around the globe and the self as a key driver of consumer behavior, no study to date has explored how cosmetic surgery acts as an antecedent of materialistic consumption practices through potential alterations of an individual’s self. We carried out semi-structured in-depth interviews with 10 South Korean participants. Our participants were 22 to 57 years old, representing a range of income and professional roles. They had previously undergone plastic surgery procedures such as double eyelid surgery, breast enhancementt and nose surgery. First, our findings suggest that materialism is not just an antecedent of cosmetic surgery propensity (Henderson-King and Brooks, 2009), but also that cosmetic surgery influences materialist consumption practices (e.g. cosmetics, beach vacations) through changes to the self. Second, our findings indicate that individuals need to control influences how cosmetic surgery shapes the self. Specifically, consumers seek cosmetic surgery to bridge the discrepancy between the physical self (provided by nature) and their “sought” psychological self. Third, our findings illustrate the role of marketplace cultures and, in particular, socio-cultural driven factors that interact with the self in a cosmetic surgery context (Arnoud and Thompson, 2005). Fourth, our findings show that cosmetic surgery leads to various emotional outcomes through changes to the self (i.e. pride, self-satisfaction, subjective happiness, and increased guilt). We contribute to discourses of embodied practices (e.g. cosmetic surgery) related to the self and materialism (e.g., Richins, 2012; Schouten, 1991; Venkatesh et al., 2010).
“If you‟re ever found yourself wondering what to do during an annoyingly long layover (hi, hello, all of us), „get Botox‟ will soon join your list of possibilities – at least if you‟re traveling in South Korea”(MacKenzie, 2017).
Introduction
Cosmetic surgery has become a new attraction for Chinese tourists to visit Korea. According to the Ministry of Health and Welfare of Korea, 27,646 of 127,648 Chinese medical tourists who visited Korea in 2016 did so to obtain cosmetic surgery (Nam, 2017). This paper presents how external desire influenced the socio-historical development of the cosmetic surgery tourism in South Korea, focusing on Chinese crossborder consumption. In analyzing this relatively new phenomenon, we identified two intertwined desires. Specifically, while popularity of cosmetic surgery in South Korea is driven by the desire of individual Chinese consumers to obtain symbolic capital by achieving so-called K-beauty, this directly supports the collective desire of the Korean nation to construct a new Korean-ness. This trend has led to the promotion of Medical Korea, aiming to erase the former image of uncool industrial emerging country. In examining these complex practices, we employed the conception of “nation-ness” (Taylor, 1997) to elucidate the renewal of Korean national identity in the medical tourism industry and the global marketplace (Anderson, 1991; Appadurai, 1996; Lee, 2017). This paper commences with a brief outline of the socio-historical development of cosmetic surgery in Asian societies. We then discuss the connection of beauty and social capital among the Chinese consumer society and how Korean‟s cosmetic surgery industry has become the icon site for the achieving the ideal beauty. The paper closes with an illustration of the inter-relationship between the emerging consumer desire for beauty and the reconstruction of Korean-ness.
Cosmetic surgery in contemporary asian consumer society
Drawing on Giddens‟s (1991) notion of reflexivity, Belk (1988) and other consumer researchers have revealed that consumers consider their body as their possession and a reflection of their self. Consequently, some see it as a resource for constructing their desired identity through cosmetic surgeries (Askegaard, Gertsen, & Langer, 2002; Schouten, 1991; Thompson & Hirschman, 1995). While this phenomenon has mostly been examined in the context of contemporary Western consumer society, it is increasingly becoming more widespread. Such practices have resulted in human body no longer being viewed as a biological entity, but rather as “the finest consumption object” that can be further refined if needed (Baudrillard, 2005, p. 129). Altering one‟s body has traditionally been considered a taboo in many Asian cultures. In ancient Chinese society, there was a general perception that our bodies, down to a single hair and a flake of skin, are given to us by our parents. Therefore, any modification to the way our body looks and functions would be considered disrespectful to one‟s parents (Hua, 2013). However, in the world of cable TV and mass-circulation of Hollywood movies, in which social media has become an indispensable part of everyday life for most individuals, it is not surprising that Western beauty ideals have emerged as a dominant reference for the rest of the world. As the Westernized values and lifestyles become more easily accessible through media, they challenge these former social norms. Consequently, Asian women are increasingly seeking body modifications, such as plastic surgery, in an attempt to attain the elusive ideal beauty. In her research on body alternations, Orbach (2011) reported that 50 percent of teenage girls in South Korea planned to alter their faces or bodies through plastic surgery. According to the available evidence, in 2011, South Korea was rated first in the world in terms of the per capita ratio of aesthetic plastic surgeries (Shin, 2011). The success of South Korea‟s plastic surgery industry then made the country one of the best site for body alternations in the global beauty marketplace.
Chinese desire for new face: beauty as capital
Although it directly counters old Confucian doctrine of not tampering with one‟s body for filial piety, cosmetics surgery is very popular in China. In her book Buying Beauty, Hua (2013) noted that the increasingly brutal competition for jobs has prompted Chinese women to regard beauty as capital. It is thus not uncommon for Chinese parents to finance their daughters‟ cosmetic surgery, as they have come to perceive a pretty face as a worthwhile long-term investment, as it may increase the future career and/or marriage prospects of their daughters. For this reason, Chinese women are undergoing cosmetic surgery at a much younger age than do their Western counterparts. “Being good-looking is capital” has become the epitome of Chinese young girls. They consider attractive appearance that a cosmetic surgery may proffer as a form of capital, which they believe can give them a competitive advantage in the increasingly fierce job market (Hua, 2013). This attitude is prevalent among women, as gender and appearance discrimination is widespread in Chinese job market even in occupations where outward appearance usually has no relevance, such as civil service and government institutions (Hua, 2013). Owing to the increasingly widespread access to popular and social media and TV as a result of China reopening its doors, Chinese beauty standards have changed, whereby the perception of ideal image is heavily influenced by Western movies, pop culture, and the fashion and beauty industry (Hua, 2013). As Luo‟s (2012) research demonstrated, however, these newly adopted Western beauty ideals are coming into conflict with those that have traditionally been held by the Chinese. Yet, as Li et al. (2007) have shown, not all recent changes to the perceptions of and attitudes toward external appearance can be attributed to the Western influence. In their cross-cultural study on skin-whitening practices in four Asian markets, the authors reported that the desire for “white skin” in many Asian cultures (Chinese, Japanese, Korean, and Indian) has a long history. Saraswati (2010) concurred with this finding, stating that, in the non-Western context, the desire for “whiteness” cannot be equated to the desire for “Caucasian whiteness,” implying that the concept of whiteness may be context-dependent. This tension seems to be relieved by the adoption of Korean beauty ideal, which blends the Western and Korean physical traits and has resulted in Hallyu or the Korean Wave. Since the late 1990s, the term “Hallyu” has been used to describe the influx of South Korean popular culture in Asia. Korean TV dramas, movies, and popular music (K-pop) have in recent decades become staples in Asian markets formerly dominated by Japan and Hong Kong (Seabrook, 2012). Since the Korean Wave hit China, the visual appearance, fashion trends, hairstyle choices, and make-up styles of Korean stars have become highly popular. Consequently, many Chinese people regard Korea as the cosmetic surgery hub of Asia, as Korean beauty is admired by Chinese people who thus aspire to attain it by undergoing various surgical and non-surgical procedures. This growing trend was spurred by the success of the TV drama, Jewel in the Palace, which resulted in the popularity of the lead actress Lee Young Ae among Chinese women, who would ask plastic surgeons to make them look like her (Hua, 2013). The popularity of Korean pop culture and the widespread adoption of the Korean beauty ideals can be interpreted as counter-standard against the Western beauty. Yet, as Hua (2013) and others argue, the rise of Korean influence in the Asian markets can also be viewed as an indication of the submission to the Western beauty imperialism. This tension exists, as their Mongolian heredity with more prominent noses and lighter skins than other Asians gives Koreans certain “Western” features (Fairclough, 2005).
The new face and desire for the new national identity
Not long ago, Korea had the reputation as an emerging industrial nation that manufactures low-cost cars and appliances (Fairclough, 2005; Seabrook, 2012). South Korea has a long history and reputation as an industrial hub in East Asia. Some of the top global brands, such as Samsung, Hyundai, and LG, began as the key manufacturing partners of Western brands in the early and mid-twentieth century. Korea is also often associated with the Korean War, as described in US motion pictures, such as MASH (Preminger & Altman,1970). However, in the late 1990s, this image began to change with the increasing popularity of aforementioned Hallyu entertainment contents (Fairclough, 2005). In fact, the latest “Korean Wave” has ushered a brand-new transnational representation of Korea into the global marketplace. Following a highly successful cultural Hallyu, Korea has recently launched medical Hallyu, promoting cosmetic surgery (Eun, 2013). In the 2000s, Korean cosmetic surgery emerged as a successful byproduct of the Korean Wave. This growing trend has since become a source of great national pride in South Korea (Holliday, Bell, Cheung, Jones, & Probyn, 2015). While Korean entertainment products were generating enormous revenues, cosmetic surgery was recognized as a profitable addition to the already lucrative export industry, as foreign tourists were willing to travel to the country in order to undergo operations that would make them look like Korean Hallyu stars. In recognition of this change in attitudes towards physical appearance and beauty ideals, “Korean cosmetic surgery” (Hanshi zhengxing) and “Korean-style beauty” (Hanshi meirong) became key words in the cosmetic surgery advertisements in China (Davies & Han, 2011). Cosmetic surgery clinics in the trendiest Gangnam and Apgujeong districts of Seoul often provide medical tourism packages targeting foreign tourists coming from China and other Southeast Asian countries (Eun, 2013). As Hallyu boasts a creative integration of the Western and Korean elements in its entertainment contents (Shim, 2006), Korean cosmetic surgeons are attempting to achieve the same. According to a doctor that took part in Shim‟s (2009) study, Korean surgeons have the best skills to operate on Asian patients, as they have smaller physique and denser subcutaneous tissues compared to their Western counterparts. Although Korean surgeons used to travel to the U.S. to obtain training for the popular procedures, such as eyelid surgery, they subsequently modified the American techniques, realizing that they were inappropriate for the “Korean Body.” For instance, removing too much fat from the eyelids created an unnatural Western eyes that were not suitable for Korean facial structure. Such specialism, which is now internationally recognized, makes aspirant youths from neighboring China and Korean diaspora more than willing to travel to Korea to undergo elective cosmetic procedures that would improve their visual appearance (Holliday, Bell, Cheung, Jones, & Probyn, 2015). The Korean government‟s active support for the export of cultural products has also helped the proliferation of cosmetic surgery tourism. In 2009, the Korean National Assembly passed an amendment to the medical law, enabling hospitals to advertise their services and promote medical tourism (Eun, 2013). Korea Tourism Organization (KTO), a subsidiary organization of the Ministry of Culture and Tourism, runs an online medical tourism platform website, visitmedicalkorea.com, to provide foreign tourists with information about Korean medical tourism. It also supports the overseas marketing of companies and hospitals as a means of attracting more tourists to the country (Korea Tourism Organization, n.d.). While the KTO website is not solely dedicated to cosmetic surgery tourism, Visit Medical Korea‟s website boasts the massive number of cosmetic surgery operations performed every year in Korea. The country is now the third largest cosmetic surgery market after the U.S. and Brazil, as the recognition of the high skill level of Korean surgeons and their use of modern technology motivates many individuals to visit Korea for their beauty enhancement (Korea Tourism Organization and Korea Health Industry Development Institute, n.d.). The fact that Korea has achieved economic progress through rapid modernization but did not give up many of its traditions is another allure to many Asian tourists (Fairclough, 2005). This is emphasized in the promotional video published by KTO through the juxtaposition of the beauty of traditional porcelain making inherited from Joseon dynasty with cutting edge medical technology and skills of Korean medical industry (Korea Tourism Organization, 2016).
Conclusion: renewing “Korean-ness” in the global marketplace
Desire to be beautiful and prolong one‟s youth is not unique to modern times. Yet, medical advances now make even extending one‟s height by breaking and separating the thigh bone to prompt growth possible. While this sounds scary and can be highly dangerous, it is a very popular operation in Shanghai. Cosmetic surgery is no doubt a popular service high on many Chinese consumers‟ list. Although it may be cynical to say that our desire for beautiful body is perpetuated and exploited by the style industries, it is true that the beauty, cosmetic, fashion, media, and celebrity industries are playing an important role in shaping our beauty standards and promoting the ideal body size/shape in the contemporary marketplace (Orbach, 2011). In this study, we connected Chinese consumers‟ desire for new facial features with the emerging plastic surgery tourism in South Korea as an exemplar of the reconstruction of national identity. The term “nation-ness” is comprehensive and links disparate phenomena, such as nation, nationalism, and nationality by including “everything from the bureaucratic fact of citizenship to the nationalist‟s mythical construction of nation as an eternal entity” (Taylor, 1997, p. 277). In this study, we argued that cosmetic surgery has become a new Korean national identity, which is not solely reflected in the rise of Korean beauty and style in the Pan-Asian (Cayla & Eckhardt, 2008) or even global marketplace. The new identity has also inherited the techno-industrial past, as the preciseness and high quality of Korean “industry” are valuable traits to transfer to this new medical field. In this paper, we demonstrated that the creation and promotion of ideal beauty and body is part of a broader political strategy, in which governments, corporations, and key cultural stakeholders are actively, and sometimes collectively, shaping and monitoring individuals‟ bodily practices.