In 2021, actress Cao Lu shared shocking images on Weibo of her nose after a failed cosmetic surgery in Guangzhou. The tip of her nose had necrotized, turning black and bruised.

Doctors at many Chinese hospitals also keep dozens of photos of patients with swollen faces or blackened, swollen foreheads seeking help due to botched surgeries.

This represents the dark side of China's booming cosmetic surgery industry, a field experiencing rapid growth among urban millennials, especially young women. These individuals often seek laser treatments for hyperpigmentation or filler injections to smooth wrinkles.

A doctor examines a patient undergoing eyelid surgery at a hospital in Shenyang, Liaoning province, in May 2024. Photo: AFP

The confluence of social media, aggressive cosmetic clinics, and unqualified practitioners is creating a dangerous shadow zone.

"Some clinics only want to make money; they don't care about the patient's health," said Lin Ruiyu, a cosmetic surgeon in Shanghai, noting that many establishments pressure clients into unnecessary procedures.

Young women in China are bombarded by countless social media posts about cosmetic surgery, making them feel "if they don't do it, they will become ugly, lose their jobs, or lose their friendships. This mindset is completely wrong," Dr. Lin shared.

The demand for cosmetic procedures in China began to increase about one decade ago, as the middle class became more affluent and the stigma surrounding surgical interventions lessened.

Despite a relatively low percentage of the Chinese population undergoing these procedures, the market is estimated to reach USD 42 billion by 2025, making it the second largest globally after the United States, according to international consulting firm Deloitte.

In Shanghai, China's economic hub, the surge in demand for cosmetic surgery is evident. At the Maio clinic, overlooking the Bund, nurses and patients constantly move in and out of VIP recovery rooms, operating rooms equipped with liposuction machines, and a studio for before-and-after photos.

Cao Wenhong, co-founder of Royal Life Group, which operates Maio and 11 other aesthetic clinics across China, attributes this boom to China's "appearance economy." An increasing number of people choose surgical methods to enhance their looks, aiming to improve job prospects or dating opportunities in China's highly competitive society.

This demand is clearly visible on social media and popular platforms such as WeChat, as well as specialized cosmetic surgery apps like So-Young and Gengmei.

So-Young, a company founded in 2013 with current revenues exceeding USD 200 million, operates an application allowing users to find doctors and chat with other cosmetic surgery enthusiasts. An AI feature called "Magic Mirror" scans a user's face to determine eye, nose, and lip ratios, then enables users to modify their face in various styles, such as "hot girl face" or "luxurious face."

A patient undergoes eyelid surgery at a hospital in Shenyang, Liaoning province, northeastern China, on 17/5/2024. Photo: AFP

Beijing is taking strong measures to regulate the cosmetic industry with new, strict regulations, coupled with a media campaign on state channels to warn about the risks of all procedures, from abdominal liposuction to Botox injections.

In 2021, the State Administration for Market Regulation (SAMR) began cracking down on aesthetic advertising, prohibiting content that incites "appearance anxiety." Two years later, the agency further tightened the qualification review process for practitioners and training regulations.

In May 2025, SAMR issued guidelines requiring internet platforms to strictly control advertisements for medical procedures. This move led to large-scale purges on social media networks like Xiaohongshu. In December 2025, the platform announced it had locked over 300,000 violating accounts and collaborated with police in 8 regions to handle cases involving fake medical supplies.

State media also continuously published investigative reports in 2025. Notable articles exposed the profiteering tactics of "touts" who bring clients to clinics, and the reality of rapid aesthetic training courses, where individuals without medical knowledge are taught injection techniques after only a few days of study. Immediately afterward, China's top health authority pledged to launch an investigation.

In July 2025, China Central Television (CCTV) advised high school students against cosmetic surgery after the university entrance exam, a time when Chinese parents often reward their children with face-slimming packages or Botox injections. The station emphasized that even minimally invasive procedures "can cause many complications," leading to "psychological damage" for adolescents.

Amanda Yang, co-founder of the Iduna aesthetic center, observed that "the government is monitoring the aesthetic industry much more closely" and is "very cautious" with any field related to medicine. To receive its operating license in late January, Iduna had to overcome many legal hurdles, including extensive paperwork, inspections, and a waiting period lasting many months.

However, not everyone believes that everything is now in order.

Meg Lu, 51 years old, underwent her first cosmetic procedure in 2017 in Tianjin. Within about one year, she had a series of treatments, including minimally invasive facelifts and filler injections, resulting in a stiff, unnaturally swollen face, and a rigid, pointed chin.

This experience caused her years of distress, always avoiding crowds. "At that time, I wasn't even myself anymore. I couldn't smile, I didn't dare look in the mirror," she recalled. "I know many people like that. I wasn't even the worst case."

She believes that "things are improving, but it's very difficult to completely eradicate underground clinics."

The "Botched Cosmetic Surgeries" chat room on Baidu confirms Lu's concerns. Over 50,000 posts, most accompanied by photos, describe post-procedure nightmares. A woman's post in October 2025 reported a dark indentation on her nose after a rhinoplasty.

"The indentation is getting deeper and deeper," she wrote. "I started to get depressed."

The proliferation of photo editing software and applications is raising concerns about unhealthy beauty standards. According to a survey by Meituan and Roland Berger, about 60% of cosmetic surgery clients in China last year were between the ages of 26-35.

"When we become too accustomed to edited images, it's hard to accept our real appearance," said Lu Yufan, an artist in Tianjin.

Patient Xia Shurong looks in a mirror after cosmetic surgery at a clinic in Beijing in July 2021. Photo: AFP

However, not everyone agrees that cosmetic surgery leads to anxiety. Some view it as a statement of female empowerment. Susan, 37 years old, a social media influencer living in Hangzhou, believes that more women are undergoing cosmetic procedures to "please themselves, not others."

Beauty standards are also evolving. Previously, many clients wanted to resemble celebrities or Westerners, but the current Gen Z generation is more confident in Chinese beauty ideals and beauty that suits their individual personalities.

Cao, the owner of the aesthetic facility in Shanghai, had eyelid surgery when she was younger but believes this demand is decreasing. "Our aesthetic taste has changed. We used to lean towards Western beauty ideals, but in the past two years, Chinese beauty has been embraced more," she said. "Chinese people are learning to respect and love their own culture."

Hong Hanh (According to Washington Post)