Screenshot of a plastic surgery live-stream. (Image credit: Seoul Leaguer Beaucare Hospital)

“He is making the incision now. There’s a lot of blood so I won’t show it on camera …” live-streamer Ye Xiaobin says as he narrates a grisly scene that wouldn’t look out of place in a horror movie.

Dressed in scrubs and a surgical mask, Ye does not resemble your typical Chinese online celebrity, but his videos have attracted hundreds of thousands of views. While others choose to chat about clothes or show off their video game skills, Ye focuses purely on plastic surgery. This time, he’s filming as his friend goes under the knife for a nose job.

Ye owes his online success and army of followers to the rapid rise of the country’s cosmetic surgery sector. The market is expected to be the second-largest globally by the end of the decade with a value of RMB 334 billion ($48.5 billion), according to a report from Deloitte. The industry’s value doubled between 2015 and 2017 when it hit RMB 193 billion.

Instrumental in the sector’s rise are countless nip-tuck apps that have brought such services online by incorporating social media aspects as well as e-commerce. This Taobao-style convenience has been key to the popularity of these procedures among China’s post-’90s generation.

China’s Facebook for cosmetic surgery

The leading players in the sector are Tencent-backed Gengmei and SoYoung, often dubbed the “Facebook of cosmetic surgery.” The pair have grown exponentially since starting out in 2013. Earlier this year, SoYoung listed on Nasdaq with a market cap just shy of $1.5 billion.

The platforms allow users to connect directly with doctors, finds local clinics, and even compare prices. They are also content-driven; users are encouraged to post diary entries of their procedures and share their experiences—both good and bad.

Ye’s platform of choice is Gengmei, which boasts some 3.6 million users. “Deeper double eyelids, a pointy chin, a higher nose bridge, and spotless skin” are some of the enhancements he has gained thanks to the dozens of operations he’s gone through over the last six years. In 2013, Gengmei approached him and invited him to share his experiences online. “As I kept having more surgery done, my diaries attracted great attention. And the more attention I got, the more dedicated I became to sharing,” Ye told TechNode.

As the trend caught fire, the two leading platforms have built up substantial online traffic. SoYoung, for instance, boasts 25 million monthly active users (MAU) as of May, according to data from Chinese data consultancy Analysys.

Surgery to die for?

Despite the heavy traffic, platforms like Gengmei and SoYoung have encountered issues with fake content, a problem that has plagued user-driven apps in China. Just last week, social e-commerce site Xiaohongshu was removed from app stores in the country, due to a spate of fradulent product reviews.

What sets Gengmei and SoYoung apart from Xiaohongshu is the subject focus. While Xiaohongshu offers reviews on just about anything, these plastic surgery platforms deal with elective medical procedures. Profit-driven fake product reviews on Xiaohongshu may threaten consumer rights, but unqualified doctors offering cheap operations online could put lives at risk.

Indeed, there have been multiple media reports in the country covering disfigurements related to poorly administered surgery and even deaths.

Gengmei maintains a strict stance. “We make sure that unlicensed surgeons or hospitals have no space on our platform,” Gengmei vice president Wang Jun told TechNode. “There are a lot of unlicensed clinics in the market, and surgeons there are not trained as well as doctors and surgeons at colleges. But we keep them off our platform; their business is illegal.”

Business users of the apps also admit that risks do exist for patients when they are selecting a service. “Many of our customers cannot differentiate between plastic surgery hospitals and cosmetic clinics, and this is how the safety issues emerge,” said Xin Baoyin, vice president of Seoul Leaguer Beaucare Hospital, which uses online platforms.

“An operation costing RMB 2,980 may be priced at just RMB 298 at a clinic, but the service and technology provided for customers are very different, and customers don’t know that,” Xin added.

Wang maintains that the smaller players who might lack the expertise of more experienced surgeons and facilities will be weeded out as users grow more savvy. “Those who are not so professional can be removed as our users become more educated day by day,” she said.

Regulators have also taken notice. “The government was heavily cracking down on unlicensed business in May. That’s why industry revenue in eastern China plunged by half that month,” Xin said. (Note: TechNode was unable to verify this decline.)

“It’s a good sign to see platforms are changing in step with regulations, but the transition could be painful for them,” said Xin. “In the future, the industry will be well-regulated and the low-price strategy won’t work anymore.”

The negativity surrounding fake content on SoYoung even hit the company’s share price in July after it admitted that 150,000 submissions had been purged last year.

Some Taobao sellers specialize in generating content for platforms like Gengmei and SoYoung. TechNode uncovered several results when searching for ghostwriting services related to cosmetic surgery on Baidu.

An exposé in the Beijing News (in Chinese) revealed that at least one doctor was illegally selling human placenta injections that are said to have anti-aging effects. SoYoung responded on its Weibo account that it had removed that vendor and warned that anyone else providing illicit procedures on the platform would face the same consequences.

The rate of complaints on the platform is also high; as of July 16, 390 submissions had been made to Sina’s Black Cat consumer platform concerning false advertising, arbitrary charges, and difficulties in obtaining refunds.

Cosmetic KOLs

In spite of the apparent cause for concern, business is booming on the platforms. While Ye Xiaobin has racked up views, he rejects the notion that he has become a KOL through his postings on Gengmei. Ye maintains that his cosmetic surgery has made him feel more confident and he works harder now to seize opportunities. “I currently work as a principal in a private school. Before that, I was a senior manager. That’s all gained by my efforts,” he said. “Prior to that, I always followed my boss’s instructions regarding my career and never spoke up.”

However, from the perspective of the platform operators, the content generated from regular users like Ye has contributed significantly to their growth by helping to educate users and raise awareness of what plastic surgery procedures have to offer.

“At the very beginning of our business, users had vague perceptions of aesthetics,” Wang told TechNode. “So we built up a huge number of media accounts to provide content for the public.” SoYoung also said previously that the platform built user trust through WeChat posts and community content.

Screenshot of one plastic surgery platform (Image credit: TechNode)

Cosmetic fairy tales

The apps play a crucial role in exposing China’s younger generations to plastic surgery and normalizing such operations. The barrage of engaging content is paying off. Deloitte’s research shows that the vast majority of those going under the knife to improve their looks are under the age of 35; in the US, only one-quarter of participants are in the same age range.

“It’s like reading fairy tales about people who become prettier each day,” says Bai Ge, a 26-year-old IT worker in Beijing who regularly browses Gengmei diaries to kill time on her commute each day.

For years, Bai had been tempted to pursue double-eyelid surgery but had been put off after hearing about the gory details of such a procedure. The Gengmei app changed all that. Three days after she first logged on, she was in a doctor’s office discussing a surgery plan and had already put down a 20% deposit. “When I saw some of the wonderful examples from other users, I immediately felt the strong desire to get the same surgery done,” she said.

The platforms are also a boon for doctors and smaller clinics due to the amount of exposure they provide. Jin Zhu, a surgeon based in Shanghai, explained to TechNode that when he entered the industry nine years ago, customers would come into the hospital two or three times before taking the plunge and paying a deposit. Explaining the processes involved in the surgery to potential patients tended to take up a lot of his time.

“But now deals are made when they first arrive,” Jin said. “Sometimes they appear as well-informed as our surgeons. They’ve already learned a lot about what happens from these platforms.”

For Bai, the vast amount of information available via the apps gave her confidence when she began discussing the surgery with doctors, since she already knew most of the details.

Jin only became a surgeon two years ago, having previously been a hospital assistant. As a relative newcomer to the sector, it was initially hard for him to find clients, and he found himself resorting to cutting prices.

He then started working with the hospital’s marketing team to create short-video and livestream content to interact with users on these apps and raise awareness. Two years on, he has performed 209 surgeries and received feedback from 120 customers on SoYoung.

Xin, the VP at Seoul Leaguer Beaucare Hospital, readily admits his facility would not see as many customers without the help of the online platforms.

“Within the first month of joining the platform, we hit around RMB 200,000 revenue, and now it is around 30 times that figure,” Jin told TechNode, adding that if the platform ever ceased to operate, he would have to start again from scratch and rebuild his portfolio.

Slow uptake among bigger players

Adoption of the platforms has been more gradual among larger chain hospitals because it takes longer for their managers to accept newer ideas on marketing and advertising, Xin said. “They thought it was irrational,” he said, because they already had a stable inflow of customers and had less motivation to change.

As a result, it was small clinics, especially those staffed by younger doctors, that were the platforms’ earliest adopters.

To persuade doctors in his hospital to accept the apps, Xin spent time a lot of time with his colleagues guiding them through future trends and inviting them to meet with managers from the platform for panel discussions.

“Several doctors signed up first, and they gradually gained a lot of followers. More and more customers would come to the hospital just to see them. Those who didn’t join at first saw how effective it was and soon caught the bug,” he said.

Nowadays, Xin’s customers come to his Shanghai hospital from all around the country to seek out plastic surgery procedures.

Rachel Zhang is a reporting intern in TechNode's Shanghai office. She is earning a master's degree in journalism at the University of Hong Kong and holds a bachelor's degree in electrical engineering....

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