Beauty standards in China’s influencer industry have been a major issue, as content creators undergo dangerous cosmetic procedures to stand out in an oversaturated market. From “bone cement” high foreheads to “elf ears,” these transformations reflect a desperate response to economic pressures and dwindling income opportunities.
The most controversial procedure involves injecting polymethylmethacrylate, a polymer material typically used in orthopedic surgeries, directly onto the skull. During this 20-minute operation, doctors cut an opening in the scalp and inject semi-liquid bone cement between the scalp and skull.
They have just five minutes to shape it before the material hardens permanently. The result is an artificially elevated forehead that creates the illusion of a smaller face on camera.
However, the consequences can be severe.
One woman who underwent the procedure years ago now warns others against it. She warned: “Imagine having cement stuck to your skull. It’s hard and attached directly to your bone. You often get migraines and feel fatigue.”
“Also, the skin on that part of your head has no hair. None at all,” she said after spending nearly 200,000 yuan on the initial procedure and subsequent corrections. “I strongly, strongly, strongly advise against this.”
For those seeking less permanent solutions, hyaluronic acid injections have become popular, with some influencers injecting over 100 syringes into their scalps. One woman who spent 1 million yuan on the procedure experienced devastating side effects.
“It kept spreading. When you stand during the day, the more it moves back. When you lie down at night, it spreads to the sides,” she explained, describing how the filler migrated throughout her scalp, causing hair loss and depression in the skull.
The “elf ears” trend involves injecting hyaluronic acid or implanting artificial materials behind the ears to make them protrude, theoretically creating a slimmer face appearance. What was once considered a flaw has been rebranded as desirable, though many recipients end up with disproportionate features that one practitioner described as making people “look less intelligent.”
This obsession stems from what Chinese social media users call “aesthetic PUA,” where beauty institutions continuously promote narrow standards, convincing people that every perceived imperfection requires surgical correction.
However, the real catalyst is economic. China’s influencer market is experiencing what insiders call a “capital winter.” Tips in online viewing sessions have dropped by over 80%, with many small and medium-sized influencers earning only a few hundred yuan per broadcast.
Data shows that while 2.2 million new entertainment influencers joined platforms like Douyin in just six months, the top 1% take home 80% of gift revenue, leaving 98% struggling to survive. In the first half of last year alone, 120,000 influencers left the industry or switched careers.
Making matters worse, Chinese authorities recently banned heavy makeup and filters on viewing platforms while cracking down on illegal cosmetic procedures. This “forced removal of makeup decree” has pushed influencers toward permanent surgical alterations as their only remaining competitive advantage.
