A 15-year-old girl who lives in the greater Tokyo metropolitan area underwent double eyelid surgery in early February just before she graduated from junior high school. 

The girl had a crease over one eye, but a fold on the other side was barely visible. She did not like this asymmetric feature of her face.

Her mother said her decision to have surgery “may have been correct,” looking at how her daughter is now enjoying her high school days. But that doesn't mean the daughter's decision didn't have consequences. 

“I am afraid my daughter may feel people have no significance unless they are beautiful,” said the mother. “Her deciding without due consideration that paying money is sufficient to achieve beauty is another thing that I fear.

“We might be happier if we had been born in a time when readily accessible plastic surgery was not available."

At this time, junior and senior high schoolers and even elementary school children are increasingly having cosmetic surgery in Japan.

Teens are wanting to have double eyelids to shed their inferiority complex.

Questions are raised about what is behind the trend and how parents should respond to it.

PLEASURE AND AGONY OF DAUGHTER, MOTHER

The girl who had double eyelid surgery learned on Instagram about the procedure.

It is called the investing method under which double eyelids are fastened with sutures without the help of a scalpel. When she was in elementary school, the student told her parents that she wanted the procedure done.  

Her father promised to allow his daughter to receive the surgery if she “passes a high school’s entrance exam.” Encouraged by her father’s words, the girl studied hard and entered a prestigious school.

The student found a hospital flier that stated that tens of thousands of yen were enough to pay for the costs of a surgery that were not covered by health insurance.

Visiting the clinic, she was told that total costs would actually come to 200,000 yen ($1,390) though. Her father showed reluctance and the operator proposed offering “the special price for our focus group” of 50,000 yen.

The clinic told the girl that it was impossible to guarantee the procedure as 100 percent safe given its inherent risks as medical surgery.

However, the girl had the operation on a Saturday evening and went to her junior high school the following Monday. Her friends quickly noticed and admired her change. One sighed and envied her for having “understanding parents.”

The swelling went away a week later. She had shied away from making eye contact with others during conversations but now “feels more cheerful after my inferiority complex disappeared.”

The girl’s mother in her 40s has mixed feelings. She asked her daughter whether she agreed that “what one looks like cannot represent the entire value of that person” as part of their family discussions.

In response, the daughter called it “worth noting that those who look better are awarded preferential treatment in society as long as their abilities are equal.”

Hearing the reply, the mother was aware that her daughter had given consideration to the issue from various perspectives. The parent thus decided to respect her choice.

MAY WORSEN DISCRIMINATION

The Tokyo Isea Clinic, which offers cosmetic surgery, said teens are more often seeking to undergo beauty operations these days.

Especially sought-after among such procedures is reportedly one to add creases to eyelids. The number of those aged 10 to 19 who had the surgery at the clinic rose sharply between 2015 and 2021.

Katsuyuki Yoshitane, director of the Tokyo Isea Clinic, said patients were largely motivated by new features on smartphones and social media.

“Now that ‘ideal selves’ can readily be created on photo processing applications and elsewhere, many people long to come closer to their ‘processed selves,’” Yoshitane insisted.

Rintaro Asahi, a lecturer at Nippon Medical School who researches the aftereffects of cosmetic medicine, called for caution.

“Medically speaking, it is not the case that risks are higher for teenagers,” said Asahi. “But it may be cruel to have those as young as junior and senior high school age bear the responsibility for any complications and aftereffects that can arise.”

Asahi pointed out that patients might desire plastic surgery because they mistakenly believe they are ugly due to what is known as body dysmorphic disorder. For that reason, working with psychiatrists is essential in some cases.

Beauty medicine is unavoidably associated with lookism--prejudice or discrimination based on an individual's appearance.

An advertisement released by the Shonan Beauty Clinic in February showed three apparent high school girls running while stating, “We want to stay cute as long as possible during our fleeting three-year high school lives.”

The ad of the major cosmetic medicine provider based in Tokyo offered “double eyelid surgery for teens for 39,000 yen.” The procedure was offered commercially starting from one year ago, according to the clinic operator.

As soon as the ad went viral on Twitter, it drew criticism from people who deemed it as “promoting lookism” and felt that sort of offering “should not be recommended for high school students.”

Yuji Katayose, president of SBC Marketing Co., which is responsible for the Shonan Beauty Clinic’s business planning and publicity, explained the controversial ad.

“Not all children interested in beauty medicine can easily discuss it with their friends,” Katayose said. “We aimed to promote it as a casual option for them.”

Katayose continued, “We had no intention of touting lookism but the possibility of the ad worsening the problem cannot be denied. We take the criticism seriously.”

The Shonan Beauty Clinic saw 26,500 girls and women from ages 10 to 19 obtain eyelid creases there in 2022, logging a dramatic increase from 16,000 in 2019. Of that number in 2022, the youngest patient was 11 years old.

Naho Tanimoto, a cultural sociology professor at Kansai University, who studies issues connected to cosmetic medicine, argued that children should not be blamed over the topic.

“There is no problem with them simply desiring beauty medicine,” she said. “If kids seek advice on undergoing plastic surgery, parents and other guardians should say neither ‘OK’ nor ‘no way.’ They should instead explain that there are many beauty criteria and that their children’s desire may be affirming lookism.”