It’s no secret that confidence is boosted by appearance, and looking good on the outside, it’s often claimed, makes you feel good on the inside. Patients are choosing to undergo procedures at younger and younger ages, heading to the cosmetic surgeon in some cases after high school or university graduation.

Cosmetic surgery in Asia has been catching up with the West, with the Thai capital Bangkok developing a reputation throughout Asia and beyond as a medical tourism destination – with everything from Botox injections and tattoo removal to invasive surgery including breast augmentation and liposuction. Companies promoting this kind of travel offer up to 60 percent off US and European surgery costs, and insist that they refer patients to only the highest-qualified, internationally-certified surgeons.

Walter Yeo, a British soldier, is often cited as the first known person to have benefited from plastic surgery, receiving a skin graft performed by Sir Harold Gillies in 1917. Today cosmetic surgery – as opposed to reconstructive – is hugely commonplace and widely accepted in countries as varied as the United States, Japan and South Korea – the latter to the degree where it is not uncommon for parents to encourage procedures performed on children as young as 14.

“As in the rest of Asia, South Korea's primary cosmetic obsession is with the eyes,” a recent Time article claims. “Having bigger eyes is every girl's dream, and it can now be realized through a simple US$800 operation, in which a small incision or suture is made above the eye to create an artificial double lid. Teenagers as young as 14 are doing it, and eye jobs have become a favorite high school graduation gift from proud parents.”

In the United States, over 10.2 million cosmetic surgical and nonsurgical procedures were performed in 2008, according to statistics released by the American Society for Aesthetic Plastic Surgery. The Aesthetic Society, after collecting multi-specialty procedural statistics since 1997, says the overall number of cosmetic procedures has increased 162 percent since the collection of the statistics first began. In 2008, the most frequently performed nonsurgical procedure was Botox injections and the most popular surgical procedure was breast augmentation.

"For the first time in the twelve years these statistics have been collected liposuction is a runner up in popularity to breast augmentation. There is no doubt that this turnabout will generate discussions in the medical community and the public at large," Alan Gold, MD, Aesthetic Society president, says. "Changes in fashion, i.e. décolletage-baring styles, might be a factor behind this change."

Synovate undertook research on beauty trends in 2008 and the survey pointed to some interesting responses in a variety of geographic areas. Overall, two thirds people surveyed said that beauty is primarily about non-physical attributes, yet as many as 40 percent would change their looks if they could. “Humans are complex,” said Virginia Weil, Synovate Senior Vice President, Consumer & Business Insights, in response to the research. “Some of us are quite open about wishing we were beautiful, others feel they already are, and many dismiss beauty as an 'on-the-surface' issue. Still more of us think all these things at once!"

Portrayal of beauty in the media and advertising may account for the high number of respondents willing to undergo surgery. Nearly half of all people questioned in the Synovate survey think beauty advertisements make women feel inadequate, and 28 percent agreed beauty advertisements do the same for men.

Medical advances have made it increasingly possible for people to achieve the look – at least in part – they desire. Non-invasive procedures is the one category of cosmetic surgery that has shown the most marked increase, and further results from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) showed three quarters of the procedures performed by the Academy’s surgeons in 2010 were non-surgical procedures, highlighting a trend that more people are choosing non-surgical procedures to delay more invasive surgical procedures.

The most common non-surgical procedures in 2010 were Botox, which eases wrinkles and brow furrows by enabling controlled weakening of muscles, and hyaluronic acid injections, a volume-enhancing eyelid filler.

A majority of surgical procedures, including facelift, revision surgery, rhinoplasty, forehead lift, chin augmentation, lip augmentation, and scar revision, also increased in cost from 2009 to 2010, which may be one reason why people opted for less invasive surgeries.

“Non-surgical procedures are an excellent option for some people, with the added benefits of lower costs and shorter recovery time - two things that are consistently important to those considering facial plastic surgery,” said Jonathan M. Sykes, M.D., President of the AAFPRS. “We have been seeing a trend over the past few years that people who want to look and feel younger and rejuvenated are turning to non-surgical, less invasive procedures to obtain the refreshed look they want.”

Surgery is, of course, not for everyone and horror stories abound of botched jobs. A recent story in the media in the US highlighted a botox job gone bad with a woman no longer being able to fully close her eyes afterwards. Opponents of plastic surgery point to the fact that there are many alternatives to going under the knife or the Botox needle. Adopting a healthier lifestyle and diet, along with increased exercise can lead to a more conventionally attractive body and younger-looking skin. Using certain types of products, such as those containing collagens, along with makeup and clothing tricks, can also flatter a range of body- and face-types.

In the past, if one was dissatisfied with one’s physical appearance, the only recourse was to go under the knife. Cosmetic surgery has become a much broader palette and while many are looking to non-invasive treatments in the hope that they will delay – or even avoid – more serious procedures, patients would do well to bear in mind that any medical solution carries risks - so it’s best to do their research.