Even in a blue-striped hospital bathrobe, her face wiped clean of makeup and marked with purple lines by her surgeon, the young woman who called herself Devil embodied an image of beauty widely admired in China: large, luminous eyes, a delicate nose and softly sculpted cheekbones.
But her jaw line? Too square for her liking. So the 22-year-old television reporter recently traveled from a coastal province to a private hospital in downtown Beijing to have it reshaped — for about $6,000. Her boyfriend, a 29-year-old businessman wearing designer eyeglasses, picked up the bill.
“I am not nervous at all,” said Devil (the English first name she chose for herself, and the only one she would reveal) as she awaited surgery at Evercare Aikang hospital in downtown Beijing. “I will look more sophisticated and exquisite.”
The breathtaking pace of transformation for upwardly mobile Chinese — from bicycles to cars, village to city, housebound holidays to ski vacations — now extends to faces. In just a decade, cosmetic and plastic surgery has become the fourth most popular way to spend discretionary income in China, according to Ma Xiaowei, China’s vice health minister. Only houses, cars and travel rank higher, he said.
No official figures exist, but the International Society of Aesthetic Plastic Surgery estimated in 2009 that China ranked third, behind the United States and Brazil, with more than two million operations annually. And the number of operations is doubling every year, Mr. Ma said at a conference organized by the Health Ministry in November.
“We must recognize that plastic and cosmetic surgery has now become a common service, aimed at the masses,” he said.
Face-lifts and wrinkle-removal treatments are in vogue, just as in the West. But at Evercare, which runs a chain of cosmetic-surgery hospitals in China, two-fifths of patients are in their 20s, said Li Bin, the general manager and one of the founders.
Nationally, the most requested surgeries have nothing to do with age: The No. 1 operation is designed to make eyes appear larger by adding a crease in the eyelid, forming what is called a double eyelid, said Zhao Zhenmin, secretary general of the government-run Chinese Association of Plastics and Aesthetics.
The second most popular operation raises the bridge of the nose to make it more prominent — the opposite of the typical nose job in the West. Third is the reshaping of the jaw to make it narrower and longer, he said.
The youthful patients include job applicants hoping to enhance their prospects in the work force, teenagers who received cosmetic surgery as a high school graduation present and even middle school students, most of whom want eye jobs, surgeons say.
China’s regulatory system, by all accounts, has not kept up. At the conference in Beijing in November, Mr. Ma, the vice health minister, said the situation “can even be called neglect.”
Out of 11 clinics and hospitals offering cosmetic or plastic surgery that were inspected late last year, he said, fewer than half met national standards. Employees lacked professional credentials, he said; equipment and materials were subpar. Beauty parlors are flagrant violators, illegally administering Botox injections and performing eyelid surgery.
Mr. Ma likened the industry to a medical “disaster zone,” with frequent accidents. His point was underscored when a 24-year-old former contestant on the Chinese reality show “Super Girl” died after her windpipe filled with blood during an operation to reshape her jaw in Hubei Province.
Health officials demanded an inquiry. But Mr. Zhao, who also serves as the vice director of Beijing’s government-run Plastic and Cosmetic Surgery Hospital, said it was impossible to gather evidence because the body was quickly cremated — a common practice in China when hospitals privately settle malpractice claims.
“Personally speaking, I think this is pretty despicable,” he said. “We need to get to the bottom of such cases in order to protect people in the future.”
The shortcomings of China’s medical system are hardly limited to cosmetic and plastic surgery. But the industry now generates an estimated $2.3 billion in revenue, and the government has begun to take note. Officials say new regulations will probably be issued this year.
One implicit goal is to halt the flow of Chinese patients to better-established hospitals in South Korea. Mr. Ma estimates that Chinese make up 30 percent of cosmetic surgery patients in Seoul.
For now, many beauty salons, like one downtown Beijing branch of a major chain, are capitalizing on the lack of oversight. One recent afternoon, a 62-year-old woman in a white coat who described herself as an internist said she could summon a doctor who could give a visitor double eyelids in 20 minutes about $180, a fraction of the standard hospital fee.
“Immediately you will look different,” she said.
“Strictly speaking, this thing is not allowed,” she added. “But why do we have it? Because many people want to look good and find the price of the procedure too high and they can’t afford it.”
Of two dozen Beijing beauty salons contacted by phone, 15 said they offered either double-eyelid surgery or Botox injections or both, along with manicures, pedicures and facials.
At the other end of the spectrum is Evercare’s Aikang hospital, with a grand piano in the lobby, an underground tunnel for patients who want privacy and surgeons like Dr. Wang Jiguang, who has performed thousands of operations. Patients younger than 19 are told to return when they are old enough to make a decision about a permanent change to their looks.
Mr. Li of Evercare, a 46-year-old former government journalist, said the typical procedure cost between about $1,500 and $3,000. Having renovated one part of their face, many patients find the lure of more work irresistible. Between 30 to 40 percent return, he said.
Chen Xiaomeng, a petite 25-year-old, said her double-eyelid surgery two months ago made her look less sleepy — an effect she once tried to achieve by using thin strips of clear tape, available at 7-Elevens throughout Beijing. Now she is considering a nose job.
She made no effort to hide her operation from her colleagues at a Beijing advertising and entertainment agency or from her friends, five of whom have undergone the same procedure.
“Cosmetic surgery is now accepted in practically every household,” she said cheerily as she picked at her lunch. “It is not a big deal any more.”
Not everyone is so open. Down the hall from Devil’s V.I.P. suite, a Chinese military officer had secretly arranged an operation that cost about $9,000 to reshape her 23-year-old daughter’s jaw. First the officer told her husband that their daughter was traveling with friends. Then she called him from the hospital and asked him to deliver chicken soup to help the daughter’s sore throat. The father found the girl in bed with a heavily bandaged jaw and a swollen face, barely able to speak.
“She looked very pretty before, but now Chinese want to be perfect,” said the mother, who refused to give her name. “If she had my jaw,” she added, “I wouldn’t have allowed her to have this operation.”
After a classmate had her jaw reshaped, the mother said, her daughter pleaded for the operation until finally she gave in.
A 23-year-old bank employee from Harbin in northeastern China said she deliberated for a week before she underwent a $15,000 operation to reshape her cheekbones and jaw line. Her other thought, she said, had been to open a Starbucks with her savings.
“It was a snap decision,” she said, seated on her hospital bed, her face swathed in bandages. “I was curious to see what I would look like.”
Her family had no idea. Asked how she would explain her new face to them, she paused before replying, “I am right now trying to figure that out.”