“Ask a North Korean” is an NK News series featuring interviews with North Korean defectors, most of whom left the DPRK within the last few years.

Readers may submit their questions for defectors by emailing [email protected] and including their first name and city of residence.

Today’s question is about whether it’s possible to get plastic surgery in North Korea.

Joshua Kim (a pseudonym) — who was born and raised in North Korea and lived there until he defected in 2019 — writes about how cosmetic procedures have become more common in the DPRK in recent years, why many surgeries take place in people’s homes and the serious medical risks that patients face.

Got a question for Joshua? Email it to [email protected] with your name and city. We’ll be publishing the best ones.

Cosmetic surgery is a big business in South Korea, the so-called plastic surgery capital of the world. Around one in three women in the country have undergone a procedure, and prior to the pandemic, large numbers of medical tourists would fly in from abroad to undergo operations at Seoul’s many clinics.

On the northern half of the peninsula too, the standards of women are growing higher day by day in the pursuit of beauty. Many young women in North Korea now get double eyelid surgery to make their features stand out or go under the knife to make their noses higher. Treatments to make skin whiter or tattoo eyebrows are also popular.

Beauty standards in the North differ from the South. Whereas round faces used to be the ideal, South Koreans now prefer slim, egg-shaped faces with sharp chins, while desiring thinness. In the DPRK, on the other hand, being too skinny makes one appear poor.

The North Korean government views tattoos and surgery as antisocial and restricts them, it’s normal for people to get away with it. Working women in the DPRK look after their appearance to get into a good company and undergo plastic surgery or other beauty treatments.

Double eyelid surgery is so common that mothers take daughters as young as seven years old to get the procedure. The hope is that these children will grow up and be selected to work in restaurants or hotels abroad, where they can earn valuable foreign currency earners. 

Competition for such jobs is tough, and a pretty face and figure are basic necessities to enter North Korean high society. The selection process for elite party organizations begins early, with authorities selecting the prettiest middle and high school girls to go on to work for the government overseas and in other important jobs. Many study at art schools.

The variety of plastic surgery procedures available in the DPRK is much less extensive than in South Korea. Most commonly, women will get eyeliner, eyebrow or lip tattoos to reduce the need to apply makeup, including housewives who run marketplace businesses or office workers who simply can’t be bothered to put on makeup before work. Most female defectors have such tattoos. Many others do relatively simple nose or double eyelid surgeries.

But actresses or rich people with a strong interest in beauty may even undergo procedures to reshape their jawline, insert breast implants or get a facelift. The lack of medical facilities and surgeons with the necessary technical skills means these operations aren’t very trustworthy or popular among the public.

BLACK MARKET SURGERIES

Plastic surgery is carried out at regular hospitals in the DPRK, as the country does not have specialized centers for such procedures. Pyongyang Red Cross Hospital or eye and dental clinics carry out double eyelid and nose surgeries as well as orthodontics. 

In name, North Korea has a system of free healthcare, which makes it illegal for hospitals to accept money. Yet in practice people will secretly pay doctors for various treatments and procedures. 

Up until around 1990, it was possible for North Koreans to get double eyelid surgery at a hospital for a couple packs of cigarettes. But with the growth of the country’s informal market economy, doctors started to illegally accept money for such procedures.

When I was still in the country, a specialist in Pyongyang would charge around $20-50 for nose implants. Double eyelid surgeries normally came to around $10-15. While these prices are significantly cheaper than the thousands of dollars one will likely pay in South Korea, they are still ridiculously high when compared to official monthly salaries in North Korea.

Many of the doctors who perform plastic surgery are unlicensed and do them illegally. North Koreans hear about these doctors through word of mouth, or when an acquaintance’s surgery goes well.

Some North Koreans learn the necessary skills from Chinese surgeons and bring medicine and machines over from China. They often perform the procedures at their own or others’ homes rather than in hospitals, and sometimes people will even gather in the same house in order to undergo surgery together.  

DANGEROUS BEAUTY

Because most cosmetic surgeries are not performed in hospitals, side effects such as infections are not uncommon. And while Pyongyang hospitals always administer local anesthesia, this is not typically the case for surgeries performed in homes. Bearing the pain is the norm.

The people who perform cosmetic surgeries, however, are often ignorant and lack a sense of responsibility, so many things can go wrong. And in such cases, patients  have no recourse to complain because the procedures are illegal.

In the case of tattoos, for example, the color often appears unnatural (even blue) and the shape doesn’t suit the person. People end up in vicious cycles of removing and redoing their tattoos. This includes female defectors, many of who redo double eyelid surgeries as well after they resettle in South Korea.

At dermatology clinics, North Koreans will undergo skin whitening procedures that involve rapidly freezing the skin, causing the top layer to peel off and preventing patients from going outside for months. Sometimes a patient’s skin can end up looking worse than it did originally.

High school and university students will often opt for an easier method, buying exfoliating creams at the markets. But after a while, their skin becomes sensitive from using these products and they have to go to the hospital for skin problems.

For all the downsides of plastic surgery in the DPRK, demand for such procedures is rising, in large part because people stand to make a lot of money from this business of beauty. I’ve heard that these days, in line with global medical developments, Pyongyang’s medical conferences now have a division for plastic surgery.

Yet even as cosmetic surgery grows more common, it’s unlikely to become widely popular until the lives of North Koreans improve.

Edited by Bryan Betts