Natalia Zuo
with the BBC
Abby Wu was only 14 years old when she first underwent cosmetic surgery.
After receiving hormone therapy for the disease, Abby gained weight from 42 to 62 kilograms in two months.
The change did not go unnoticed by her acting teacher.
"My teacher told me, 'You were our star, but now you're too fat. Either give up or lose weight quickly,'" recalls Abby, who was studying for her acting exams at the time.
Her mother came to her aid, taking her for liposuction to remove fat from her stomach and legs.
Abby recalls her mother's words as she waited at the clinic in her hospital gown, nervous about her upcoming surgery.
"Just go in bravely. You'll be beautiful when you come out."
The surgery was traumatic.
Abby received only local anesthesia and remained awake throughout the procedure.
"I could see how much fat had been removed from my body and how much blood I had lost," she says.
Now 35 years old, Abby has had more than 100 procedures, worth more than half a million dollars.
She co-owns a beauty clinic in downtown Beijing and has become one of the most recognizable faces of China's cosmetic surgery boom.
But the surgeries also had a certain physical cost for her.
Sitting in front of the mirror in her luxury duplex apartment in Beijing, she gently dabs concealer on the bruises from a recent facial slimming injection - a procedure she undergoes once a month to help her face look "smoother and less chubby" after three jaw reduction surgeries removed too much bone.
But she insists she has no regrets about the surgeries and believes her mother was right all those years ago.
"The surgery was a success. I became more confident and happier, day by day. I think my mother made the right decision."
Once seen as a taboo subject, plastic surgery in China has exploded in popularity over the past 20 years, motivated by rising disposable incomes and changing social attitudes, fueled in large part by social media.
Every year, 20 million Chinese pay for cosmetic procedures.
Those who seek surgical procedures are overwhelmingly young women – under pressure to meet ever-increasing standards of beauty.
Eighty percent of patients are women, and the average age of those undergoing surgery is 25.
Although appearance has always been important in Chinese culture, especially for women, beauty standards in the country are changing.
For years, the most sought-after features were a mix of Western ideals, anime fantasies, and K-pop inspirations: double eyelids, a sculpted jawline, a prominent nose, and a symmetrical face.
But lately, there has been a rise in interventions that are a little more disturbing — the pursuit of an unrealistic, hyper-feminine, almost infantile ideal.
Botox is now injected behind the ears to tilt them slightly forward, creating the illusion of a smaller, more delicate face.
A surgical procedure on the lower eyelids, inspired by the glassy gaze of anime heroines, widens the eyes to achieve an innocent, childlike appearance.
Shortening the upper lip narrows the space between the lip and the nose, which is believed to signal youth.
But most of this beauty is designed for screens.
Under filters and stage lighting, the results can look flawless.
In real life, the effect is often eerie – a face that is neither quite human nor quite childlike.
Cosmetic surgery apps such as SoYoung (New Oxygen) and GengMei (More Beautiful) – which claim to offer algorithmic analysis for so-called "facial imperfections" – are becoming increasingly popular.
After scanning and evaluating users' faces, they provide surgical offers from nearby clinics, taking a percentage of each contracted surgery.
These and other beauty trends are shared and promoted by celebrities and influencers on social media, rapidly changing what is considered desirable and normal.
As one of the earliest cosmetic surgery influencers in China, Abby documented her own procedures across social media platforms and joined the SoYoung app shortly after it launched.
Yet, despite having had more than 100 surgeries, when she scans her face using the "Magic Mirror" feature on SoYoung, the app still points out "imperfections" and suggests a long list of recommended procedures.
"She says I have dark circles under my eyes. Get a jawline augmentation? I've already had that done."
Abby seems to be having fun with it all.
"Nose thinning? Do I really need to get another nose job?"
Unlike typical e-commerce websites, beauty apps like SoYoung also have a social networking function.
Users share detailed "before" and "after" diaries, and often seek advice from superusers like Abby.
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'I felt like there was cement under my skin'
To meet the huge demand, new clinics are rapidly opening across China.
But there is a shortage of qualified staff, and a large number of clinics operate without a license.
According to a report by iResearch, a marketing research firm, as of 2019, 80.000 clinics in China were providing cosmetic procedures without a license, and 100.000 cosmetic surgeons were working without proper qualifications.
As a result, it is estimated that hundreds of accidents now occur every day at Chinese cosmetic surgery clinics.
Dr. Yang Lu, a plastic surgeon and owner of a licensed cosmetic surgery clinic in Shanghai, says that in recent years the number of people coming to him for procedures to fix botched surgeries has been increasing.
"I see a lot of patients whose first surgeries were ruined because they went to unlicensed places," says Dr. Young.
"Some even had surgeries in private homes."
Jue Jue (28) is among those who underwent surgeries that went horribly wrong.
In 2020, she received collagen injections for a baby face – designed to make her face appear rounder – at an unlicensed clinic opened by her close friend.
But the fillers suddenly hardened.
"I felt like there was cement under my skin," she says.
Desperate to repair the damage, Jue Jue turned to clinics she found on social media – well-known names – but their repairs only made matters worse.
One clinic tried to extract the fillers using syringes.
Instead of extracting the hardened material, they extracted her own tissue, leaving her with loose skin.
Another clinic tried to lift her skin near her ears to reach the filler underneath, leaving her with two long scars and a face that looked unnaturally tight.
"My whole appearance was ruined. I lost my shine and it started to affect my job [in human resources for a foreign company in Shanghai]."
She found Dr. Yang through the SoYoung app last year and has since undergone three reconstructive surgeries, including her eyelids, which were damaged during a previous operation at another clinic.
But while Dr. Young's surgeries have brought visible improvement, some of the damage from previous botched procedures could remain permanent.
"I don't want to look prettier anymore," she says.
"If I could go back to how I looked before the surgery, I would be perfectly happy."
'It ruined my career'
Every year, tens of thousands of people like Jue Jue fall victim to unlicensed cosmetic clinics in China.
But even some licensed clinics and qualified surgeons do not strictly follow the rules.
In 2020, actress Gao Liu's nose surgery gone wrong – during which the tip of her nose turned black and died – went viral.
"My face was disfigured and I was very unhappy. It ruined my acting career."
Her nose was operated on at a licensed clinic in Guangzhou called She's Time's, and the operation was performed by Dr. He Ming, introduced as the clinic's "chief surgeon" and an expert in nose surgery.
But in reality, Dr. He was not fully qualified to perform surgeries without supervision and had not received the status of a licensed plastic surgeon from the Guangdong Provincial Health Commission.
Authorities fined the clinic, which was closed shortly after the scandal, and banned Dr. He from practicing for six months.
However, just a few weeks after She's Time's officially closed, the new Kingja clinic requested to register at the same address.
BBC Eye found strong links between She's Time's and Kingja, such as the same Weibo account and the retention of the same staff, including Dr. He.
The BBC also learned that Dr He only gained his licensed qualification as a plastic surgeon in April 2024, although he was technically barred from applying for the status for five years from the date he was convicted in 2021.
Kingja now claims to have opened 30 branches.
Dr. He, Kingja and the Guangdong Provincial Health Commission did not respond to the BBC's request for comment.
The Chinese Embassy in the UK said: "The Chinese government consistently requires enterprises to operate in strict accordance with national laws, regulations and relevant policy provisions."
Four years and two reconstructive procedures later, Gao Liu's nose remains irregular.
"I sincerely regret that. What did I do?"
China's Central Health Commission has been trying to address the problem of unqualified health workers performing tasks outside their expertise in recent years - even ordering local health authorities to improve regulations and issue stricter guidelines - but the problem persists.
From job offer to loan and operation – within 24 hours
In today's China, good looks are important for professional success.
A quick search of popular job boards reveals many examples of employers listing physical requirements for various positions, even when it has little to do with the job itself.
One receptionist position requires applicants to be "at least 160 centimeters tall and pleasing to the eye," while an administrative job requires "pleasant appearance and elegant demeanor."
And now that pressure is being exploited by a growing scam at some Chinese clinics where vulnerable young women are offered jobs, but only if they pay for expensive surgeries to be performed by their future employers.
Da Lan (not her real name) applied for a job as a "beauty consultant" at a clinic in Chengdu, southwest China, on a popular job site in March 2024.
After the interview, she was offered the job that same evening.
But she says that when she started working at the job the next morning, her boss took her into a small room where she was scanned from head to toe and given an ultimatum - get cosmetic surgery or lose her job.
Da Lan says she was given less than an hour to make that decision.
Under pressure, she agreed to undergo double eyelid surgery – which cost more than 13.000 yuan ($1.800) – more than three times her monthly salary at that job – with more than 30 percent annual interest.
She says staff took her phone and used it to apply for a so-called "beauty loan", falsifying her tax details.
Within minutes, her loan was approved.
She passed medical tests before noon.
An hour later, she was on the operating table.
From job offer to loan and surgery – all within 24 hours.
The surgery did not help her progress at work at all.
Da Lan says her boss humiliated her, shouting her name in public and cursing her.
She quit after just a few weeks.
Looking back today, she believes that the job wasn't real at all.
"They wanted me to leave from the very beginning," she says.
Despite working there for more than 10 days, she was only paid 303 yuan ($42).
With the help of her friends, Da Lan paid off the debt for the procedure after six months.
BBC Eye spoke to dozens of victims and met with three of them, including Da Lan in Chengdu, a city that has vowed to become China's "plastic surgery capital".
Some have remained trapped for years in much greater debt.
The clinic that Da Lan says scammed her has previously been reported by other graduates and exposed in local media, but remains open and is still hiring for the same position.
This scam is not limited to clinic jobs – it has begun to spread to other areas.
Some live-streaming companies are pressuring young women to take out credit for the surgery, promising them the chance to become famous as influencers.
But behind the scenes, these companies often have hidden agreements with clinics – to receive a percentage of every applicant they send to the operating table.
In a bohemian cafe in Beijing, a perfect setting for selfies, Abby meets her friends for coffee.
The trio poses and edits their faces in detail – lengthening their eyelashes and reshaping their cheekbones.
Asked what they love most about their own faces, they hesitate, struggling to name even one part of themselves that they wouldn't change.
The conversation turns to jaw implants, upper lip shortening, and nose surgery.
Abby says she's considering another nose job - her current one is now six years old - but surgeons find it difficult to operate on it.
"My skin is no longer stretchy after so many surgeries. The doctors have nothing left to work with. You can't give them enough fabric for just a vest and expect them to sew you a wedding dress."
The metaphor remains hanging in the air, underlining the price she had to pay in all those operations.
But despite everything, Abby doesn't plan to stop.
"I don't think I'll ever stop striving to become even more beautiful."
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