TOKYO —

Lovely expat wife rushes to her appointment at Ebisu’s Azabu Skin Clinic for cosmetic dermatology. Her thick brown hair is pulled into a messy bun and her skin is taut and glowing. She steps off the elevator, and three assistants draped in peach ’50s-era nursing uniforms smile, stand and hand her a clipboard. Classical music hums in the background as Lovely slips off her shoes in the entrance, then pads over to look at the before-and-after pictures in the waiting room. A woman’s sagging jowls are tightened and smoothed, a teenager’s acne-stained face becomes clear, a flabby post-delivery belly reverts to its former flatness. Lovely’s eyes are wide. “Look at that! That one’s amazing! Though they always show you the best ones.”

She wears no makeup, and her perfectly groomed eyebrows lift when she talks, sending almost imperceptible wrinkles through her forehead. “I frown all the time. If I’m concentrating, I’m frowning; if I’m moody, I’m frowning; if I’m tired, I’m frowning.” She’s here to banish her frown lines with injections of Botulinum Toxin A, more commonly known as Botox. Lovely’s pet name for it is “Bowie.”

Lovely is ushered into Dr Chiaki Kawashima’s office. Perched behind her giant desk, Kawashima is petite and professional, with a porcelain, unmoving face and long swinging hair. As a cosmetic dermatologist, Kawashima sees 40-50 patients a day and specializes in quick fixes: procedures that she swears will take five to 10 years off your face, and all without the hassle of general anesthesia or incisions into the skin.

According to Kawashima, such treatments are gaining popularity in Japan. She says that in the past, Japanese people resisted getting invasive, surgical cosmetic work because they were suspicious of being anaesthetized or because they didn’t want nosy neighbors to gossip. Or because they were “just too busy.”

To address these obstacles, Kawashima says that cosmetic surgeons and cosmetic dermatologists began to switch tactics. Around 10 years ago they began to add quick and increasingly effective age-defying treatments to their menus. These non-invasive (though sometimes painful) treatments take 30-40 minutes, have easy recoveries, and don’t require going under the knife. Patients can fit a treatment into a lunch break, returning to work with only a little soreness or redness.

Increase in ‘med spas’

Outside of the hospital setting, Japan has seen an increase in “med spas,” which offer not only cosmetic dermatology or surgery, but also spa-like beauty treatments and “lunchtime procedures.”

These new clinics specialize in services that sound like the names celebrities give their children: Aurora, Comet, Affirm, Skoog, Strombeck, Vela and Polaris, to name a few. The sheer number of options advertised in magazines indicates their popularity. This demand has created a niche for businesses that can offer the appearance of a face-lift without the actual face-lift.

Traditional plastic surgery has become increasingly popular in Japan as well. J-pop divas like Ayumi Hamasaki and Kumi Koda are rumored on celebrity-watch websites to have had 30-40 surgical procedures apiece. Fans publish before-and-after pictures showing the effect — from normal-looking Japanese schoolgirls to aliens with huge round eyes, new noses and giant lips.

A small oval mirror sits on Kawashima’s desk, and she instructs Lovely to squint into it, purse her lips, raise her eyebrows. The face contortions will reveal which areas need work. The ladies talk shop. Lovely knows how many units of Botox she’s had in the past, but it’s less than what the doctor usually uses.

After they settle on a Botox plan, Lovely moves on to her skin. She seeks a procedure that will “tighten and make me look as fresh as possible.” In rhythm with each of the doctor’s explanations of new treatments, an assistant gives Lovely a corresponding handout. Kawashima takes a stern look at the flab on Lovely’s arm; it barely jiggles. They discuss options. She takes a look at the thickness of Lovely’s hair. They decide on laser hair removal. Lovely is an educated consumer and tells the doctor about a new procedure that even the doctor hasn’t heard of. Kawashima counters with a complex description of light that somehow sprouts collagen under the skin, and draws intricate diagrams. Lovely is open to suggestions.

All in all, the visit takes less than 2 1/2 hours. About 30 minutes is spent in the waiting room, 45 minutes with the doctor, 15 minutes discussing prices with the receptionist, 20 minutes of numbing before the Botox, 10 minutes for the injections, and 20 minutes to ice afterward.

During the procedure, patient and doctor have a slight disagreement about technicalities — if pressing will cause the Botox to “migrate.” Lovely has been told never to press by her previous doctors, but Kawashima is quite firm that extra pressure is necessary to stop the bleeding. All is resolved by the time Lovely leaves. The only sign of the procedure is a few red splotches on her forehead where the injections went in.

Well-educated clients like Lovely are helping drive the boom in instant beauty treatments. And as customers demand better procedures, better procedures are developed. A savvy doctor can act as the middleman, choosing products and equipment that will be both lucrative and best serve his or her patients.

Going for the quick fix

Lovely says she is always convincing friends to get Botox. Her knowledge and enthusiasm even convinces a vegetarian yoga-fanatic friend to give it a try. For a second friend, she lays it out in economic terms: if you spend $300 on bottles of Crème de la Mer, then why not spend the same amount to Botox one area? (Each treatment is around 32,500 yen per area and lasts a few months.) Plus, she says, no cream could ever be as effective as a good shot of Bowie.

Lovely says that there are “types” who opt for quick fixes: men who are feeling a little paranoid because they are dating younger women; women who are over 35 and still single or dating a younger guy; and women and gay men who are very, very vain — adding with a laugh that she might fall into the last category.

Kawashima adds that patients come to see her because “they have high income and are aware of the quality of life.” But, she says, this doesn’t mean maintenance is an easy task — her upscale clientele come to the clinic even when they would rather not, seeing these procedures as necessary to maintain their youthful beauty. Kawashima’s non-Japanese patients — most of whom want laser hair removal — make up 25% of her business. The other 75% are Japanese, and most are after “photofacials,” which claim to banish redness and acne scars. A whopping 90% of her patients are women, with a quarter still in their 20s.

Scott Austin is the marketing director of the International Medical Aesthetic Information Center, a consultation company for expats who are considering surgery in Japan. He has helped hundreds of foreigners in Japan and offers free consultations by phone or email. Austin sees a major problem in the Japanese Ministry of Health’s refusal to approve plastic surgery products and almost complete failure to regulate cosmetic surgery.

Austin says some clinics “promote products that I know are not FDA approved, and say that they are FDA approved.” This false advertising means that doctors can advertise one product but use a cheaper one in surgery. “You think you’re getting one FDA approved product. The doctor will do the surgery, and while you’re asleep, he’ll probably put in a cheap Chinese implant…”

With Botox, Austin has seen Japanese doctors use Chinese or Korean brands that cause severe drooping, and he warns that if a clinic is charging under 25,000 yen per area, chances are you’re getting the Chinese Botox.

Even if you’re getting the real Botox, there still might be reason to fret: disturbing news has surfaced about Botox’ effect on the brain. Although the drug Botox was approved by the FDA in 1989, in April the Italian Institute of Neuroscience found that it was sliding into neurons and neural pathways unnoticed.

Journalist Sharon Begley wrote in Newsweek that botulinum, the main ingredient in Botox is “one of the deadliest poisons in nature and a possible bioterrorism agent.”

The popularity of “quick fixes” has created an increasingly lucrative and competitive market. But the boom has also led to the emergence of “discount chain clinics,” which Austin says offer low prices — and high complication rates. These chains are usually controlled by an owner or partnership, and “they [offer] quick surgery and young doctors who are learning to do the work” as they go. Treatments can be temptingly cheap, but performed with only one doctor in the room and no anesthesiologist.

Kawashima agrees, saying that chain clinics are always looking for doctors, and so they often settle for those fresh out of school and without practical experience in the field. With a degree, she says, “anyone can be a surgeon or cosmetic dermatologist.” But the mark of a good doctor is how many years of practical experience they have and the caliber of doctors who train them. Kawashima says she has heard horror stories from patients of cheap clinics who were never briefed of the possible complications of their surgeries.

Lovely’s Botox looks great. Her frown lines are gone, the little creases on her forehead have vanished. For the most part, she’s happy with the outcome, though she may go to another doctor for a touch-up — “just a few more units in the corners.” She’s scheduled additional procedures with Kawashima but warns that everyone has to draw a line somewhere: “I think it’s addictive — I’ve heard stories of girls who feel like they’ve gone too far. But I always think,” with a wag of her finger, “remember Michael Jackson!”

Latest 15 of 23 Total Comments Show All

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  Plutonian at 07:00 PM JST - 24th June

  Plastic Surgery is simply wrong. Women are turning into androids. I feel sick, if I see all those puppet like rubber dolls. Where have all the women gone that radiated charm, style and uniqueness? If they dont take care, one day they will all be replaced by robot-sexdolls.

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  bamboohat at 08:16 PM JST - 24th June

  women get plastic surgery because they get results from it. guys notice them more, they make more money, they feel younger. Face it, girls are valued for their looks far more than anything else. It's not sad, it's not immoral, it's not wrong. It is just a matter of supply and demand. Beauty is the supply, male attention is the demand. Of course, the flip side is lots of pretty girls grow up getting by ONLY on their looks, so they don't really develop any character.

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  Pukey2 at 11:39 PM JST - 24th June

  The only successful cosmetic interventions in Japan are on the Kano sisters.

  You've got to be kidding, right? The face of one of them looks as if it's melting. She also looks like a drag queen.

  I'm sure I've added this link before, but it's always interesting to look at again. Beware, some faces are unrecognisable:

  http://jpoptrash.nihon-fr.com/chirurgiens/chirurgiens.htm

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  KitsuneYoukai at 12:20 AM JST - 25th June

  What a long article...They could have shortened this quite a bit and still been able to make their point.

  I agree women are looked at or valued, as some might say, for their looks and mostly by men. The minor cosmetic stuff like facials and the occasional blemish remover works and looks normal but all that other stuff well, anyone can spot a botox injectee or chest enlargement a mile away.

  When guys they turn gray they are called "distinguished" while women that turn gray are called "old." It's a societal difficiency I think.

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  rurika at 01:10 AM JST - 25th June

  Plastic surgery is the natural progression of extreme consumerism and unbridled capitalism. It sells the illusion that being young and beautiful will make all your issues go away. It won't. Your happiness and self-esteem should come from things other than your looks or you will never be at ease with yourself.

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  Azrael at 07:19 AM JST - 25th June

  The Japanese are pressured to conform to beauty patterns which walk away from Japanese natural features. Breast augmentation, eye enlargement, surgery to acquire double-layered eyelids, botox for thicker lips, chin prostheses for men, liposuction to remove the fat below the eyebrows, and so on. As long as Japanese media keeps on bashing the features predominant in Japanese faces, plastic surgeons will have a boom in business. Anyway, if their clients want to spend money, the surgeons are only helping the clients to spend. I do suppose that makes everyone content enough.

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  8iamhappy8 at 07:57 AM JST - 25th June

  Hana Yori Dango: "So what if you want to buy beauty with money"?

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  8iamhappy8 at 08:00 AM JST - 25th June

  "When guys they turn gray they are called "distinguished" while women that turn gray are called "old." It's a societal difficiency I think."

  No. Guys can still reproduce at that age. A guy becomes more financially "powerful" as he ages. Thus, his status in society ever increases. But for a woman, her reproductive ability diminishes as she ages... She is said to be getting "old". ;)

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  chardk1 at 11:03 AM JST - 25th June

  And in related news, Yumiko Shaku received an award for most beautiful E-line! That should drum up more business!

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  romulus3 at 12:00 PM JST - 25th June

  a nurse at a cosmetic surgery clinic asked me to gues the most popular surgery. I said "face job" she said "no". I said "liposuction" she said "no". I said "boob job" she said "no". I sad "then what?" she said "Japanese woman have big labia's and it hurts when they ride a bike so they get it trimmed and tucked". Romulus was speechless for once.

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  Bovinus at 12:16 PM JST - 25th June

  And you have to keep having plastic surgery for the rest of your life or you'll look even worse than Michael Jackson.

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  Sarge at 12:22 PM JST - 25th June

  "Lovely expat wife"

  I'm sure her picture will be in Weekender.

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  rtrhead1 at 11:11 AM JST - 30th June

  I'd be speechless to if someone told me something so dimwitted and stupid. Possibly true for her office, but still smacks of stupid. This one seems to up there with that whole "Japanese have longer intestines, so American beef isn't good for us..." crap.

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  zanza123 at 03:46 PM JST - 30th June

  I would argue that plastic surgery is for some people because have you seen the pervasive occurence of the Japanese people in getting moles? Especially big black hairy moles on their face, now isn't that a good thing you hide something like that from showing in the public, it sure would do me a lot of good NOT looking at it.

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  rtrhead1 at 11:23 PM JST - 1st July

  Yes. Yes it is.

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