The culturally loaded issue today is the number of Asians looking to remake themselves to look more Caucasian. It's a charge many deny, although few would argue that under the relentless bombardment of Hollywood, satellite TV, and Madison Avenue, Asia's aesthetic ideal has changed drastically. "Beauty, after all, is evolutionary," says Harvard psychology professor Nancy Etcoff, who is the author of Survival of the Prettiest: The Science of Beauty—not coincidentally a best seller in Japan, Korea, Hong Kong and China. Asians are increasingly asking their surgeons for wider eyes, longer noses and fuller breasts—features not typical of the race. To accommodate such demands, surgeons in the region have had to invent unique techniques. The No. 1 procedure by far in Asia is a form of blepharoplasty, in which a crease is created above the eye by scalpel or by needle and thread; in the U.S., blepharoplasty also ranks near the top, but involves removing bags and fat around the eyes. Likewise, Westerners use botox, or botulinum toxin, to diminish wrinkles—while in Korea, Japan and Taiwan, botox is injected into wide cheeks so the muscle will atrophy and the cheeks will shrink.

Just as Asian faces require unique procedures, their bodies demand innovative operations to achieve the leggy, skinny, busty Western ideal that has become increasingly universal. Dr. Suh In Seock, a surgeon in Seoul, has struggled to find the best way to fix an affliction the Koreans call muu-dari and the Japanese call daikon-ashi: radish-shaped calves. Liposuction, so effective on the legs of plump Westerners, doesn't work on Asians since muscle, not fat, accounts for the bulk. Suh says earlier attempts to carve the muscle were painful and made walking difficult. "Finally, I discovered that by severing a nerve behind the knee, the muscle would atrophy," says Suh, "thereby reducing its size up to 40%." Suh has performed over 600 of the operations since 1996. He disappears for a minute and returns with a bottle of fluid containing what looks like chopped up bits of ramen noodles. He has preserved his patients' excised nerves in alcohol. "And that's just since November," he says proudly.

The cultural quirks of the plastic surgery business in Asia also extend to sexuality. In China, Korea and Indonesia, where virginity is highly prized, young women go in for hymen reconstruction in time for their wedding night. In Japan, Indonesia and Korea, men ask for penis-enlargement procedures, in part to avoid shame when bathing en masse. In Thailand, with its sizable population of so-called "lady boys," a thriving industry has sprung up to provide male-to-female sex-change operations.

Traditionally, most Asians going under the scalpel were women. But a mutant strain of male vanity has turned into a virtual epidemic. "Men are uptight about seeming too vain," says Dr. Takasu after completing the procedure on Kimura. "But it's true that when you look old, you're treated that way." He clicks his computer mouse and a close-up of a saggy-faced, dour man appears on a flat, wall-mounted monitor. "That's me four years ago," he says with a satisfied chortle. "Lifts," he explains, batting his eyes and stroking his jaw. "Chemical peel," he says, sweeping a hand across his face. "Plugs," he adds, tilting his brown-dyed hair forward. "I had a colleague insert a golden wire in my chin to prevent sagging." Takasu, who looks a decade younger than his 57 years, uses his own face as an advertisement prop for his trade, and it glows like a large peach.

Today, all beauty requires is cash—and Asians are blowing it on surgery at an unprecedented rate. "People want to look more beautiful as a way to show off their newfound wealth," explains Dr. He Xiaoming of the Peking Medical Union College's Plastic Surgery Hospital. Dr. Jean Lin, a plastic surgeon in Taipei, adds: "When the market goes up, I get more patients. When it drops, so do my appointments." On the other hand, a tight labor market also forces workers to compete by trying to look more attractive. In Japan, salarymen buzz about "recruit seikei"—cosmetic surgery for the sake of landing a job. The owner of a "beauty center" in Shenzen's Jiulong City Mall observes, "China has too many people. How do you make yourself stand out from 1.3 billion? Imagine your boss sees two people of similar ability. He will definitely pick the person with the better appearance."

In China, surgically enhanced beauty is both a way to display wealth and a tool with which to attain it. Audis of the rich and well connected cram the parking lot of the high-tech Shenzhen Fuhua Plastic & Aesthetic Hospital, where the operating rooms look like a Star Trek set. The surgery center at Northwest University in Xi'an, a city in western China, targets a different demographic, handing out promotional flyers that offer procedures including hymen reconstruction at a 50% discount for students—"in order to make you tops in both your academic achievements and your looks!"

In recession-plagued Thailand, even the government has recognized the money-making potential of plastic surgery. The Tourism Authority of Thailand helps promote institutions like the Bumrungrad Hospital to foreigners, who make up one-third of its patients. "We're a hot commodity," says Ruben Toral, the hospital's director of international programs. Located on a traffic-clogged street in Bangkok, the 12-story, $90 million hospital is like a five-star, round-the-clock plastic surgery factory. There's a Starbucks in the lobby, high-speed Internet connection for the patients and room service offering halal and kosher meals.

In the mid-'70s, Thailand had only 10 plastic surgeons, so locals tended to go abroad to Japan or Singapore for cosmetic help. Today, the tide has reversed, and Thailand has become a surgical hub. "No country can compete with Thailand," says Dr. Preecha Tiewtranon, a surgeon specializing in sex reassignment at Bangkok's Preecha Aesthetic Institute, where 80% of the clientele is foreign. Much of the appeal is price: Preecha, who performed 300 operations last year, charges only $6,000 for a sex change, compared to $25,000 in the West.

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