For Many Chinese, New Wealth and a Fresh Face

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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.

Shi Da, Li Bibo, Zhang Jing and Jonathan Kaiman contributed research.