Micchi, 9, has no memory of going under the knife. Instead, the girl recalls the countless conversations she’s had with her mother about her monolids. In the months leading up to the big procedure earlier this year, they discussed what type of double eyelids she wanted. Would she opt for the less invasive and subtle surgery? Or would she select the more expensive option, which requires a surgeon to cut the creases of her eyelids to trim sagging skin?
Her mother Rucchi urged her to choose the latter. If her daughter was going to do it, she should go all the way, Rucchi said, requesting the use of their nicknames citing fear of being judged by the public.These discussions between mother and daughter are posted on Rucchi’s YouTube account. She’s also uploaded a video of her daughter’s surgery, during which the girl sobbed and had a panic attack.The video, which was also shared widely on TikTok, has since set off a severe backlash from internet users. Many question how such a young girl—so evidently in pain—could get plastic surgery, even if her mother consented.
Double eyelid surgery, which makes some people's eyes look bigger, is a highly popular procedure in Japan. Photo: Shutterstock
But Micchi is just one of a generation of young people undergoing plastic surgery years before they become adults, many seemingly of their own volition.In 2021, a Japanese clinic found that nine in 10 respondents in their teens wanted plastic surgery to address their insecurities, an increase from about 7 in 10 just two years before. Many young people have done the same elsewhere in the world. In the United States, more than 220,000 cosmetic procedures are performed on patients ages 13 to 19 annually.
Medical experts and governments are alarmed by these numbers. Just last year, British lawmakers made lip filler procedures, a popular minor procedure—or “tweakment”—among young people, illegal for anyone under the age of 18 to protect children. Critics warn that younger generations, many of whom grew up with social media, are pressured to conform to physical beauty standards, causing psychological—and at times physical—damage to minors. Toru Aso, a cosmetic surgeon in Tokyo, has personally witnessed the growing number of minors visiting his clinic in recent years. Having practiced for over 20 years, he’s operated on mainly women in their 20s and 30s. “Ten or so years ago, I had about one underaged client a month. Now, I have one minor visiting every day,” he told VICE World News.Among Aso’s patients, the most popular procedure is eyelid surgery, a trend seen nationally. In 2020, eyelid surgery—or blepharoplasty—accounted for over 64 percent of all surgical procedures in Japan. Though relatively safe compared to other more physically demanding surgeries, such as the Brazilian Butt Lift or liposuction, there are still risks associated with the procedure like blindness or injury to surrounding eye muscles.
In Japan, anyone under the age of 18 can get plastic surgery, so long as they have parental consent. But some guardians attempt to abuse this law, Aso said, and project their own standards of beauty onto their children. That’s why he pays extra precaution to minors visiting his clinic. “I meet with them separately to gauge if the child really wants the procedure—I’ve had parents drag their children and try to force them to get plastic surgery,” he said.Tomohiro Suzuki, a professor who studies child psychology and body image at Tokyo Future University, acknowledged that plastic surgery can have positive effects on people’s psyche, such as improved self-esteem.But when performed on minors who are still physically and psychologically developing, they can grow up to regret their procedures, he said. Many also don’t know what their ideal “look” is yet, given they’re still growing, and some have repeatedly gone under the knife to achieve their perfect image.“Then you get trapped in a loop, unable to stop getting plastic surgery,” Suzuki told VICE World News.
An increasing number of young people are getting plastic surgery in Japan. Photo: Stephen J. Boitano/LightRocket via Getty Images
Recent plastic surgery trends have often been associated with the rise of social media. Studies have shown that social networking apps—like Instagram or Facebook—make people far more aware of how they look to themselves and others. These sites also have filters that give people the “perfect” look, whether it be high cheekbones or full lips, which can look far different from the reflection they see in the mirror.
Domestically, some Japanese surgeons like Aso have attributed the double eyelid surgery’s popularity to the influence of Western, often Caucasian, beauty standards. White and Japanese mixed race people have historically been used in Japan’s fashion and media industry to represent an aspirational, ideal look. “It’s a face that looks just a little foreign, a face that’s more unusual,” Aso said. But Laura Miller, a professor of Japanese studies and anthropology at the University of Missouri in St. Louis, said suggesting Japanese people opted for double eyelid surgery because they were trying to “look White” was missing the point entirely. In her research on this topic, Miller has never seen a Japanese young person name a non-Japanese person as the desired ideal. Rather, “Many women believe the surgery will help them achieve a more kawaii appearance that is similar to popular Japanese models and entertainers,” she told VICE World News in an email. Though actors and singers have traditionally shaped a generation’s beauty standards, social media has produced a new form of celebrity with just as much power: influencers.
That’s how Nonoka Sakurai, whose real name is Rie, found fame as a plastic surgery influencer. She’s wanted to get plastic surgery since she was eight because she was bullied by her peers throughout her academic career for having large nostrils that “made her look like a gorilla.” Once 18, a nose job was the first procedure she got.
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Now, over a decade and 25 million yen ($171,801) worth of procedures later, Nonoka said she’s much more confident in her appearance. “I was insecure because I was so unpopular among men at school,” she told VICE World News. She realized she was unpopular because she was ugly, she said. So the solution was to change her face. “Thanks to plastic surgery, I’m able to walk with pride and my head held up high,” she said. She’s now a full-time plastic surgery influencer and runs a girls bar, where customers interact and converse with attractive women servers.But making money from her physical appearance isn’t always as rosy as the self-love tale the 33-year-old likes to paint for her followers.
Because plastic surgery has become more commonly accepted, there are far more trends than the simple double eyelid surgery that she has to keep up with, she said. “People tell me, my face is outdated,” she said. Sometimes, those comments come from anonymous accounts on the internet. Others are remarks made by her customers at her bar, who tell her they liked her face from five surgeries ago, she said.Keeping up with the constant rotation of trends can also be physically exhausting for Nonoka. Cartilage is put in then taken out mere months later. Silicone is injected everywhere. The anesthesia and post-surgery recovery can also be so painful, she said, that sometimes she wishes she were dead.
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But until she finds someone who can tell her that she’s the most beautiful person in the world, there’s no stopping her, Nonoka said. Rucchi, the mother who pushed her daughter to have plastic surgery, never had aspirations to be the prettiest in the room.
But having grown up with a younger sister and mother who both had double eyelids, Rucchi always felt she was treated differently. She recalls her sister getting compliments and sweets from the neighbors, while she was always empty handed. “Everyone adored my sister way more than they loved me,” she said. When Rucchi turned 18, she got rid of her monolids. Now a mother to five children—three boys and two girls—she said she wants to do the best she can to raise her daughters without any insecurities, even if that means pushing them to get plastic surgery. “I’ve never seen a girl with monolids who I thought was pretty,” she said. The same doesn’t apply to her sons because society is more accepting of ugly boys, she said, so long as they’re successful and smart.Once Micchi turns 18, her mother wants her to get a nose job. Maybe breast augmentation too, she said. “She’s still growing though, so we don’t yet know how big they’ll get. But if she’d be worried they were too small, I’d give her a push toward it,” she said. As far as Rucchi is concerned, nothing is off the table. Follow Hanako Montgomery on Twitter and Instagram.
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That’s how Nonoka Sakurai, whose real name is Rie, found fame as a plastic surgery influencer. She’s wanted to get plastic surgery since she was eight because she was bullied by her peers throughout her academic career for having large nostrils that “made her look like a gorilla.” Once 18, a nose job was the first procedure she got. Now, over a decade and 25 million yen ($171,801) worth of procedures later, Nonoka said she’s much more confident in her appearance. “I was insecure because I was so unpopular among men at school,” she told VICE World News. She realized she was unpopular because she was ugly, she said. So the solution was to change her face. “Thanks to plastic surgery, I’m able to walk with pride and my head held up high,” she said. She’s now a full-time plastic surgery influencer and runs a girls bar, where customers interact and converse with attractive women servers.But making money from her physical appearance isn’t always as rosy as the self-love tale the 33-year-old likes to paint for her followers. 
Because plastic surgery has become more commonly accepted, there are far more trends than the simple double eyelid surgery that she has to keep up with, she said. “People tell me, my face is outdated,” she said. Sometimes, those comments come from anonymous accounts on the internet. Others are remarks made by her customers at her bar, who tell her they liked her face from five surgeries ago, she said.Keeping up with the constant rotation of trends can also be physically exhausting for Nonoka. Cartilage is put in then taken out mere months later. Silicone is injected everywhere. The anesthesia and post-surgery recovery can also be so painful, she said, that sometimes she wishes she were dead. But until she finds someone who can tell her that she’s the most beautiful person in the world, there’s no stopping her, Nonoka said. Rucchi, the mother who pushed her daughter to have plastic surgery, never had aspirations to be the prettiest in the room. 
But having grown up with a younger sister and mother who both had double eyelids, Rucchi always felt she was treated differently. She recalls her sister getting compliments and sweets from the neighbors, while she was always empty handed. “Everyone adored my sister way more than they loved me,” she said. When Rucchi turned 18, she got rid of her monolids. Now a mother to five children—three boys and two girls—she said she wants to do the best she can to raise her daughters without any insecurities, even if that means pushing them to get plastic surgery. “I’ve never seen a girl with monolids who I thought was pretty,” she said. The same doesn’t apply to her sons because society is more accepting of ugly boys, she said, so long as they’re successful and smart.Once Micchi turns 18, her mother wants her to get a nose job. Maybe breast augmentation too, she said. “She’s still growing though, so we don’t yet know how big they’ll get. But if she’d be worried they were too small, I’d give her a push toward it,” she said. As far as Rucchi is concerned, nothing is off the table. Follow Hanako Montgomery on Twitter and Instagram.
