SPECIAL EDITORIAL

Why Cosmetic Surgery is Prevalent in Korea:

A Perspective Grounded in Basic Values
Kun Hwang, MD, PhD

Abstract: The aim of this review is to explore the reasons behind

the prevalence of cosmetic surgery in Korea from the viewpoint of
H istorically, Korea has been influenced by Confucianism for
over 500 years. In particular, Neo-Confucianism empha-
sizes that one’s body, hair, and skin are gifts from one’s parents,
“basic values.” In societies characterized by high levels of preju- reflecting a profound sense of filial piety and respect for the
dice, the hierarchy of values from highest to lowest is as follows: (1) body as an extension of one’s ancestors (身體髮膚受之父母).
political, (2) economic, (3) religious, (4) social, (5) theoretical, and According to this principle, altering or damaging the body
(6) aesthetic. Conversely, in societies with low levels of prejudice, could be perceived as showing disrespect to the parents and
the ranking of values from highest to lowest is: (1) aesthetic, (2) ancestors who provided it.
Despite the enduring influence of Neo-Confucianism, mod-
social, (3) religious, (4) theoretical, (5) economic, and (6) political.
ern Korea has become a global leader in cosmetic surgery, ex-
In mature societies, higher levels of stability, cultural development, periencing a high demand for aesthetic procedures. In South
emphasis on quality of life, and greater tolerance and openness Korea, 1.2 to 1.3 million cosmetic operations are performed
drive the appreciation of aesthetic values. As Korea’s economy has each year, as reported by the International Society of Aesthetic
developed and basic needs have been met, there has been an in- Plastic Surgery (ISAPS) and various local surveys. In terms of
creasing emphasis on aesthetic values, including beauty standards per capita rates, South Korea has one of the highest frequencies
and self-presentation. This trend is evident in the flourishing Ko- of cosmetic surgery in the world.
rean beauty industries (K-beauty). There is a growing societal focus In this review, I explore the reasons behind the prevalence of
on physical appearance, fashion, and plastic surgery, which has cosmetic surgery in Korea from the viewpoint of “basic values.”
become normalized in certain aspects of Korean culture. Rapid
modernization, shifting social norms, competitive pressures, and THEORY OF VALUES
evolving interpretations of traditional values have normalized and Gordon Allport, an American psychologist, developed a theory
even popularized cosmetic surgery in Korean society. The combi- of values to explain how individual personality traits and mo-
nation of cultural expectations, advanced medical care, and social tivations influence people’s behavior and preferences. In this
factors has positioned South Korea as a world leader in cosmetic theory, he identified 6 major value types, each representing
surgery, despite its relatively small population. To keep pace with different ways in which people prioritize and interpret
the rapidly evolving aesthetic values of Korean society, plastic their world.
surgeons must align with contemporary beauty standards, thor- Each value is oriented toward a fundamental principle: (1)
oughly understand surgical anatomy, and strive to minimize theoretical, which focuses on truth; (2) economic, centered on
usefulness; (3) aesthetic, emphasizing harmony and beauty;(4)
patient dissatisfaction.
social, rooted in love for people; (5) political, concerned with
power and leadership; and (6) religious, aimed at unity or moral
Key Words: Epidemiology, plastic, republic of Korea, social excellence. These 6 values represent diverse perspectives through
values, surgery, value of life which individuals perceive and prioritize their lives, influencing
their decisions and actions. Although people generally exhibit a
combination of these values, typically 1 or 2 predominate and
From the Department of Plastic Surgery, Armed Forces Capital Hos- guide their behavior.1,2
pital, Bundang-gu, Seongnam-City, Gyeonggi-do, and Department
of Anatomy, College of Medicine, Ewha Womans University, Seoul,
Republic of Korea. RANK OF BASIC VALUES IN SOCIETIES WITH
Address correspondence and reprint requests to Kun Hwang, MD, HIGH OR LOW PREJUDICE
PhD, Department of Plastic Surgery, Armed Forces Capital Hos-
pital, 81 Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam-City,
In societies characterized by high levels of prejudice, such as
Gyeonggi-do, 13574, Republic of Korea, and Department of significant antisemitism, the hierarchy of values from highest to
Anatomy, College of Medicine, Ewha Womans University, 260 lowest is as follows: (1) political, (2) economic, (3) religious, (4)
Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea; social, (5) theoretical, and (6) aesthetic. Conversely, in societies
E-mail: [email protected] with low levels of prejudice, such as minimal antisemitism, the
This work was supported by the Korean Military Medical Research ranking of values from highest to lowest is: (1) aesthetic, (2)
Project funded by the ROK Ministry of National Defense (ROK- social, (3) religious, (4) theoretical, (5) economic, and (6) po-
MND-2024-KMMRP-006). litical (Supplemental Table 1, Supplemental Digital Content 1,
The author reports no conflicts of interest. http://links.lww.com/SCS/H133).
Supplemental Digital Content is available for this article. Direct URL
citations are provided in the HTML and PDF versions of this article In contexts of high antisemitism, social and theoretical val-
on the journal’s website, www.jcraniofacialsurgery.com. ues are ranked lower, whereas religious values are listed higher.
Copyright © 2024 by Mutaz B. Habal, MD Conversely, in situations of low antisemitism, aesthetic values
ISSN: 1536-3732 occupy the highest place, contrasting with previous perceptions
DOI: 10.1097/SCS.0000000000010940 of aesthetic values as neutral in relation to antisemitism.

The Journal of Craniofacial Surgery  Volume 00, Number 00, ’’ 1

Copyright © 2024 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Hwang The Journal of Craniofacial Surgery  Volume 00, Number 00, ’’

As societies mature, aesthetic values often gain importance. and modesty were highly valued, often placing outward ap-
These values, which highlight an appreciation for beauty, art, pearance as secondary to one’s moral character. This per-
and harmony, tend to increase in significance in more developed spective aligns with the Confucian doctrine of inherent
and stable societies where basic needs, such as economic se- goodness, which posits the innate goodness of people. Thus, in
curity and social order, are largely met. Once a society reaches a such a society, the emphasis was placed more on living virtu-
certain level of security and maturity, people may increasingly ously than on prioritizing physical appearance.
focus on cultural, artistic, and intellectual pursuits, seeking As Korea has undergone rapid economic growth and in-
higher forms of expression and meaning. This shift might also creased prosperity, particularly since the late 20th century, there
indicate that an appreciation for beauty and harmony can play has been a noticeable shift in societal focus. In a more eco-
a significant role in reducing prejudice. nomically secure and affluent environment, individuals are in-
creasingly able to concentrate on self-presentation, beauty, and
THE REASON WHY AESTHETIC VALUES personal grooming as expressions of their individuality and
status. This shift signifies a move away from traditional Con-
BECOME MORE IMPORTANT IN MATURE fucian values toward a more modern, consumer-driven culture,
SOCIETIES where appearance often symbolizes success, self-care, and con-
In mature societies, higher levels of stability, cultural develop- fidence.
ment, emphasis on quality of life, and greater tolerance and This shift illustrates how, during periods of economic pros-
openness drive the appreciation of aesthetic values. perity, the pursuit of beauty and aesthetics gains prominence.
People are no longer solely focused on survival or economic
Higher Levels of Stability stability; they also pay attention to their presentation and how it
When societies achieve a level of security in their material affects their social status. Although traditional values have not
needs and safety, individuals frequently shift their focus towards completely vanished, there is a noticeable integration of Con-
self-expression, creativity, and appreciating the beauty in their fucian moral ideals with contemporary aesthetics and consum-
surroundings and culture. erism in today’s Korea. The cultural evolution from a focus on
inner virtue, as emphasized by Confucian ideals, to a modern
Cultural Development emphasis on external beauty can be attributed to the broader
In mature societies, the arts, literature, and design increas- societal shift towards aesthetic values that typically occurs as a
ingly influence collective identity and values. Individuals often society grows wealthier and more stable.
seek deeper meaning and emotional fulfillment through aes-
thetic experiences.
COSMETIC SURGERY BEYOND CONFUCIAN
Emphasis on Quality of Life VALUES
Aesthetic values significantly enhance a society’s quality of Rapid modernization, shifting social norms, competitive pres-
life. Beautifully and thoughtfully designed public spaces, along sures, and evolving interpretations of traditional values have
with cultural festivals and artistic endeavors, improve people’s normalized and even popularized cosmetic surgery in Korean
well-being. These elements foster a sense of connection to one’s society.
environment and to each other.
Modernization and Westernization
Greater Tolerance and Openness As Korea underwent rapid modernization in the late 20th
Emphasizing aesthetic values can lead to increased openness century, it became increasingly exposed to global trends, in-
and tolerance. Art frequently serves as a bridge across cultural cluding Western beauty ideals. This shift led to a growing em-
and societal divides, encouraging individuals to appreciate phasis on individualism and personal expression, values that
perspectives and experiences that differ from their own. This stand in contrast to traditional Confucian collectivism. Along-
approach aligns with the values observed in low-prejudice en- side this modernization, the beauty industry in Korea has
vironments, as demonstrated in studies such as those by Allport. boomed, with cosmetic surgery emerging as a way to enhance
Over time, as societies develop, aesthetic values often become personal appearance and, consequently, social and economic
integral to how people interact with the world and each other, opportunities.
fostering a more fulfilling, inclusive, and enriched way of life.
Societal Pressure and Competitiveness
Korean society is highly competitive, particularly in the
AESTHETIC VALUES IN MATURED KOREAN realms of education and employment. Appearance significantly
SOCIETY influences social mobility and professional success, leading
As Korea’s economy has developed and basic needs have been many to believe that enhancing their looks through cosmetic
met, there has been an increasing emphasis on aesthetic values, surgery can boost their prospects in the job market and social
including beauty standards and self-presentation. This trend is life. This pursuit is frequently viewed as a form of “self-im-
evident in the flourishing Korean beauty industries (K-beauty), provement” rather than a defiance of Confucian ideals, re-
both domestically and globally. In addition, there is a growing flecting the contemporary drive for success in a competitive
societal focus on physical appearance, fashion, and plastic environment.
surgery, which has become normalized in certain aspects of
Korean culture. Changing Interpretations of Filial Piety
In a modern context, the Confucian value of filial piety may
be reinterpreted. Instead of strictly adhering to the idea of
CONFUCIAN INFLUENCE AND SHIFTS IN preserving one’s natural body, some may argue that improving
VALUES IN KOREA one’s appearance can be seen as a way to honor the family by
Historically, Confucianism has significantly influenced Korean presenting oneself in the best possible light, thus contributing to
values. Within this framework, inner virtue, moral integrity, the family’s reputation and status.

2 Copyright © 2024 by Mutaz B. Habal, MD

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The Journal of Craniofacial Surgery  Volume 00, Number 00, ’’ Prevalent Cosmetic Surgery in Korea

Cultural Norms of Beauty Rapid and Less Invasive Options

Korea has long held strong cultural standards of beauty, The availability of non-surgical cosmetic enhancements,
closely associated with social acceptance and success. The me- including Botox, fillers, and laser treatments, enables more
dia and entertainment industries, especially K-pop and individuals to undergo procedures with minimal downtime.
K-dramas, actively promote specific beauty ideals. Cosmetic This accessibility further increases the frequency of cosmetic
surgery is frequently seen as a viable way to attain these ideals, interventions.
carrying less stigma than in other countries. This broad cultural
endorsement of cosmetic surgery enables it to integrate with
Confucian values within a more adaptable, contemporary DISCUSSION
framework. This paper examines the reasons behind the prevalence of cos-
metic surgery in Korea from the perspective of basic values. In
mature societies, higher levels of stability, cultural development,
THE REASONS FOR KOREA’S HIGH an emphasis on quality of life, and greater tolerance and
PREVALENCE OF COSMETIC SURGERY openness drive the appreciation of aesthetic values. Rapid
The combination of cultural expectations, advanced medical modernization, changing social norms, competitive pressures,
care, and social factors has positioned South Korea as a and evolving interpretations of traditional values have enabled
world leader in cosmetic surgery, despite its relatively small cosmetic surgery to become a normalized and even desirable
population. practice in Korean society, extending beyond Confucian values.
Recently, researchers in business and accounting from Ma-
Emphasis on Appearance, K-Pop and K-Drama, laysia and China utilized the theory of reasoned action (TRA)
and Lookism to examine the cosmetic surgery industry in Seoul. Their study
South Korean society places a strong emphasis on physical focused on various factors, including attitudes, subjective norms
appearance, valuing beauty ideals such as a small face, large (influences from celebrities and the media), and psychological
eyes, a sharp nose, and fair skin. The global popularity of attributes (such as social status and self-esteem), that affect
K-pop idols and K-drama actors has popularized certain facial patients’ intentions to undergo cosmetic surgery. The TRA aims
features and body types, inspiring many to undergo cosmetic to elucidate the connection between attitudes and behaviors in
surgery to emulate these celebrities. In Korea, there is a strong human actions. This theory is commonly used to predict in-
societal expectation to maintain a polished and aesthetically dividual behavior based on existing attitudes and behavioral
pleasing appearance, which extends into both personal and intentions.3,4
professional spheres. Examples of low aesthetic value can be found in studies from
Islamic nations using the TRA to examine attitudes toward
Job Market and Gift Surgery cosmetic surgery. For instance, a study conducted in Iran found
In some cases, cosmetic surgery is viewed as a career in- that the intention to undergo cosmetic surgery was significantly
vestment. An attractive appearance may boost employment associated with attitudes toward one’s body and subjective
opportunities and social mobility in a fiercely competitive job norms (P = 0.013). Higher body satisfaction correlated with a
market. It is also not unusual for parents to present cosmetic reduced intention to pursue cosmetic surgery (P = 0.01). Inter-
procedures, particularly double eyelid surgery, to their chil- estingly, the authors concluded that family status and a sense of
dren as a high school graduation gift to enhance their future security were the most significant factors influencing the deci-
prospects. sion to undergo cosmetic surgery. They suggested that this in-
tention stems from psychological insecurity; thus, community-
Advanced Medical Infrastructure oriented nurses who provide family support could help improve
South Korea has some of the world’s top plastic surgery these psychological traits.5
clinics, featuring highly skilled surgeons and cutting-edge Another paper from a military medical school in Iran iden-
technology. This reputation has established the country as a tified a significant relationship between attitudes toward cos-
center for medical tourism. Although these operations can be metic surgery and participants’ intentions (P < 0.0001). Given
costly, the relative expense of cosmetic procedures in South that attitudes are a key predictor of cosmetic surgery, the au-
Korea frequently remains lower than in Western countries, thors concluded that it is crucial to design and implement in-
thereby attracting a broader range of patients, including those terventions to diminish favorable attitudes toward elective
from abroad. cosmetic surgery among college students.6 The above 2 papers
seemed to use the TRA with the objective of identifying strat-
Normalization and a Youth-Driven Market egies to dissuade individuals from undergoing cosmetic
In Korea, the acceptance and even encouragement of cos- surgery.7
metic surgery are widespread in certain circles. It is common for A unique characteristic that distinguishes humans from other
individuals to openly discuss their operations without fear of animals is our capacity for self-reflection. We can identify our
judgment. This openness among younger generations toward own shortcomings and strive for self-improvement. This sense
cosmetic improvements has contributed to the expansion of the of incompleteness not only drives us to create but also to re-
market for both surgical and non-surgical procedures. create ourselves, often through the consumption of goods and
services.8 In comparison to other consumer goods and services,
Medical Tourism cosmetic surgery is irreversible, costly, painful, and carries po-
Korea is a popular destination for medical tourism, partic- tential risks. Symbolic self-completion theory offers insights into
ularly for people from China, Japan, and Southeast Asia, who goal-striving behaviors and has been applied to understand
travel to South Korea specifically for cosmetic surgery. Korea’s patients’ motivations for undergoing cosmetic surgery.9 The
reputation as a leader in plastic surgery has attracted thousands degree to which a woman is consciously or unconsciously con-
of international patients, further boosting the number of pro- cerned about her appearance to others can predict her use of
cedures despite its small population. symbols for self-completion.

Copyright © 2024 by Mutaz B. Habal, MD 3

Copyright © 2024 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.
Hwang The Journal of Craniofacial Surgery  Volume 00, Number 00, ’’

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These surgeons face unique anxieties stemming from potentially surgery and services in Seoul. Int J Community Develop Manag Stud
mismatched beauty standards, unexpected anatomical findings, 2019;3:1–16
4. Hwang K. They are analyzing us: our own survey is needed. Arch
and the possibility of patient dissatisfaction, collectively referred
Plast Surg 2019;46:397–398
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metic surgery becomes more widespread, surgical anxiety cor- 6. Dehdari T, Khanipou A, Khazir Z, et al. Predict the intention to
respondingly escalates. perform cosmetic surgery on female college students based on the
To keep pace with the rapidly evolving aesthetic values of theory of reasoned action. J Mil Caring Sci 2015;1:109–115
Korean society, plastic surgeons must align with contemporary 7. Hwang K. Use of the theory of reasoned action in plastic surgery.
beauty standards, thoroughly understand surgical anatomy, and J Craniofac Surg 2021;32:e849–e850
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consumption? J Craniofac Surg 2021;32:e847–e848
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4 Copyright © 2024 by Mutaz B. Habal, MD

Copyright © 2024 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.