When I met Mia in her massage parlour, she had recently undergone cosmetic surgery. She openly showed me the sutures, dense and deep, tracing almost her entire hairline. Two weeks earlier, she had travelled to Shanghai for a major facelift involving the lifting and tightening of the skin. She even showed me videos of the operation: the surgeon peels back the skin of her face, pulls it taut, and sutures it into its new position. It reminded me of The Painted Skin in Strange Tales from a Chinese Studio (Liaozhai Zhiyi), where the demon peels off a face like a mask and replaces it with another. However, what gave Mia her new face was not a supernatural spell but modern surgery: a painful, costly, and carefully planned intervention made possible by highly sophisticated surgical techniques. More important, it carries Mia’s hope for work. Originally from China and now a permanent resident in Singapore, Mia has been working in the sex industry for more than ten years. “I’m fifty now,” she told me. “Just look at all the young, beautiful girls in the building. If I don’t undergo cosmetic surgery, what choice do I have? How could I ever compete with them? I need to survive. I still have to work and make money.” For Mia, cosmetic surgery was crucial to both her work and her future. If her appearance determined her competitiveness in the market, then surgery was an investment in her livelihood.
Window display of a bar. Photograph taken by the author during fieldwork (2026)
Like Mia, many of the ageing sex workers I encountered had turned to cosmetic surgery. During my fieldwork, it was common to meet sex workers over the age of forty. This observation complicates the assumption that sex work is primarily a profession for young women, or that it is simply a form of qingchun fan (“eating the rice of youth”), with little place for older workers (Hyde, 2007). Cosmetic surgery has long been part of sex workers’ efforts to maintain a youthful body. However, the proliferation of newer, quicker, and more accessible procedures has made surgical intervention an increasingly routine expectation. For women whose livelihoods depend on how their bodies are desired and valued, surgery offers a means to extend their working lives, sustain their earnings and a sense of desirability and self-worth as their bodies age.
Much of the scholarship on cosmetic surgery has focused on consumer culture and beauty ideals, on the value of appearance in reproducing social hierarchies (Edmonds, 2007), and on how biopower shapes and disciplines beautification practices (Jarrín, 2017). Alexander Edmonds (2007) offers a productive framework, saying “beauty practices offer a means to compete in what I call a neoliberal libidinal economy where anxieties surrounding new markets of work and sex mingle with fantasies of social mobility, glamour, and modernity.” For ageing sex workers, this libidinal economy is the market on which their livelihoods depend. Through approaching cosmetic surgery through the lens of ageing and sex work, I examine: how do ageing sex workers manage cosmetic surgeries? What is their vulnerability in an industry structured around the male gaze and standards of beauty tailored to youth (Näre & Diatlova, 2024)? And how does the pursuit of beauty, even as it produces such vulnerability, also engender affects and forms of meaning for those who undertake it?
Managing Plastic Bodies
Mia had a clear understanding of which parts of her body required modification and why. As she grew older, reducing the visible signs of ageing became her primary concern. She regarded a facelift as the most important procedure because, in her words, it was the key to “covering up age.” Her reasoning reflects a broader pattern during my fieldwork in which cosmetic surgery is approached not only as a generalised pursuit of beauty but as a series of targeted interventions responding to the embodied demands of ageing within the sex industry. Facial procedures, including facelifts, brow lifts, blepharoplasty, rhinoplasty, and injectable fillers, are intended to restore a youthful appearance. Breast augmentation remains one of the most common surgeries, while liposuction and autologous fat transfer is used to reshape the body by redistributing fat to the face, lips, hips, or hands. Among transgender female sex workers, ageing introduces a different set of bodily concerns, particularly the way long-term hormone therapy modifies facial contours, skin elasticity, and the distribution of soft tissue over time. Facial feminization surgery therefore becomes a way of correcting for these hormonal changes.
These interventions suggest that the body, for my interlocutors, is never finished but continually assessed, monitored and revised in response to changing bodily conditions, market demands, beauty ideals and aspirations over the life course. In sex work, this dynamic is especially explicit. Since the body is at once a productive asset and an instrument of aesthetic labor, these women understand the body to depreciate with age unless actively maintained. Jasmine, a 48-year-old Chinese sex worker, travelled to Vietnam for breast augmentation several years ago, when she was planning to work in the United States. She believed that larger breasts better matched the preferences of white clients and would therefore increase her earning potential. The procedure was about tailoring her body to what she perceived as the aesthetic expectations of market. Later, she had also received double-eyelid surgery to have more “European-looking” eyes, to enhance what Starr (2023) called Whiteness market value.
For aging sex workers, the clientele available to them often shifts and, in many cases, gradually shrinks. Moreover, time is money. Stopping work means less income and the risk of losing regular clients. Women therefore carefully calculate their surgeries, which must be scheduled, managed, and budgeted like any other capital expenditure: the trip, the doctor, the caretaking, and the days away from work are all weighed against cheaper alternatives when money or time is short. Mia’s facelift cost more than RMB 50,000 (~US$7,400). Rather than travelling to South Korea, a destination long associated with cosmetic surgery, she chose a large public hospital in Shanghai. When I asked why she preferred Shanghai, she explained that an increasing number of women now considered Chinese surgeons more skilled and their techniques more advanced. She also described comprehensive service packages, including flights, hospital appointments, accommodation, postoperative nursing, daily necessities such as meals, and caregivers during recovery, as well as a short tour of China. These packages offered more than convenience. For ageing sex workers, time itself becomes an economic resource. High-quality medical services, coordinated logistics, and professional postoperative care shorten recovery and reduce uncertainty, enabling women to return to work sooner.
To Be Successful
For my interlocutors, surgery was bound up with a moral and professional aspiration: to become, and to remain, “a successful sex worker.” For many of them, sex work is not merely a source of income. Having spent decades in the industry and possessing few opportunities to transition into other forms of employment, they had come to regard longevity in sex work as an important marker of achievement and social recognition. Much like other occupations, they believe that remaining in the profession for many years demonstrates experience, skill, and reputation. Being able to continue working is interpreted as a form of recognition through which they affirm both abilities and their place within the occupation. For women like Mia and Jasmine, cosmetic surgery not only extended participation in career that might otherwise have ended in their forties but also opened new markets, as they reshaped their bodies to match the preferences.
However, this carefully cultivated appearance remained fragile because its value ultimately rested on the standards of the market. Several older sex workers acknowledged that others might still recognise their procedures, yet insisted that their faces had to appear natural. Authenticity demonstrated professionalism, even though it was produced artificially. As Carol explained this to me: “My face has to look natural and real. That’s why I can’t go back to work until I’ve completely recovered. This is my professionalism. My clients need to feel that I’m serving them with a natural body.” One day, a client mocked Carol for her old age. Afterwards, she complained to me with frustration and anger: “I spent so much money on these surgeries, and people still say I look old. Then I’ve wasted all my time and energy. It’s such a failure.” The client’s remark undermined the value of the labor: the time of planning, financial investment and tremendously physical pain. Her “failure” therefore referred not to the surgery itself but to the collapse of social recognition and of affective capital that is convertible into economic capital (Jarrín, 2017).
This vulnerability is compounded by the unequal distribution of informational, social, and economic resources. A successful cosmetic outcome requires considerable labor and resources long before entering the operating room: researching surgeons and hospitals, comparing procedures, seeking recommendations from trusted friends, and weighing costs against risks. Mia, for example, spent months carefully planning her surgery, gathering information through her own networks before deciding where and how the operation would be performed. An agent for sex workers also explained that a successful cosmetic surgery requires the mobilization of a wide range of resources, relationships and knowledge. Some women navigate the cosmetic market safely, while others unfortunately rely on uncertain information and informal providers.
For many women with fewer financial resources, expensive surgery and comprehensive postoperative care were often out of reach. Bodily maintenance instead took the form of smaller interventions, such as regular Botox injections or dermal fillers, perceived as more affordable ways of delaying the visible signs of ageing. To reduce costs and downtime, some women relied on informal networks of care. Several interlocutors purchased Botox online and asked friends to administer the injections. Others sought treatment from providers circulating within sex workers’ networks, often unlicensed nurses working from their own homes. Without adequate medical supervision or aftercare, women might face heightened risks of infection, improper injection, vascular complications, and other adverse reactions. Every step of cosmetic surgery carries hopeful anticipation, yet it also inserts their bodies into uncertainty and risk.
Conclusion
Throughout their career, sex workers navigate structural inequalities shaped by immigration constraints, racialization, gendered labor markets, and regulation of sex work. As they grow older, they must also confront the material consequences of ageing. Unlike structural forms of exclusion, these changes are experienced concretely through the body. Women repeatedly described rougher skin, loss of elasticity, wrinkles, changes in body shape, and, perhaps most directly and importantly, increasing vaginal dryness. As several interlocutors explained, the vagina, what they call “tool for work”, made intimate labour increasingly difficult to sustain. For ageing sex workers, these biological changes matter because they directly affect their capacity to earn a living, sustain intimate labor, and remain desirable within the industry.
Cosmetic surgery delays some of the visible signs of ageing and offers a form of bodily improvement. More importantly, it affirms ageing sex workers’ existential value and brings new hope to their careers: the possibility of working a little longer, earning a little more, and proving that they still have value. Yet even as I recognize the significance of these meanings, I should also acknowledge that cosmetic surgery produces new forms of bodily, social, and economic vulnerability. Still, I do not want to describe this as cruel optimism (Berlant, 2011), for such a reading risks dismissing the women’s efforts and the better future these efforts promise. To do so would place me in much of the same position as the client who overlooked Carol. Their practices of bodily maintenance, including saving for surgery, enduring pain, caring for recovering bodies, and continually adapting to bodily change, are not simply attempts to resist ageing. They are persistent forms of labor through which new possibilities for meaning and hope are created in everyday life. They also push me to think further: What continues to shape women’s unfinished body projects? And within the structural inequalities where the sex market, the male gaze, and medical technology intersect, how should women’s agency be recognized and understood?
This post was curated by Contributing Editor Sook-Lin Toh and reviewed by Multimodal Contributing Editor Chen Shen.
References
Berlant, L. G. (2011). Cruel Optimism. Duke University Press.
Edmonds, A. (2007). “”The Poor Have the Right to Be Beautiful”: Cosmetic Surgery in Neoliberal Brazil.” The Journal of the Royal Anthropological Institute, 13(2), 363-381. https://doi.org/10.1111/j.1467-9655.2007.00427.x
Hyde, S. T. (2007). Eating Spring Rice: The Cultural Politics of AIDS in Southwest China. University of California Press.
Jarrín, A. (2017). The Biopolitics of Beauty: Cosmetic Citizenship and Affective Capital in Brazil. University of California Press.
