Cosmetic medicine in Japan (fillers, Botox, double-eyelid surgery) — what should I check to avoid trouble?
This answer is a draft. It stays unpublished until legal review and source verification are complete.
Hyaluronic acid fillers, botulinum toxin ("Botox"), double-eyelid suture procedures, fat-dissolving injections. Social media and low prices have made cosmetic medicine (美容医療, biyō iryō) part of everyday life in Japan, and complaints to the National Consumer Affairs Center of Japan run to thousands a year and keep rising. Most trouble comes from contracts signed as if this were not medicine, and from poor explanation. This article sets out what to check.
Main risks by procedure
| Procedure | How long it lasts | Main risks | Cost guide |
|---|---|---|---|
| Hyaluronic acid filler (nasolabial folds, lips, nose, chin) | 6 months to 2 years | Blocked blood vessel → skin necrosis, blindness (reported for nose and glabella), lumps, asymmetry, infection. Use of unapproved products is prominent in complaints | ¥30,000–100,000 per syringe (1 cc) |
| Botulinum toxin ("Botox") (expression lines, jaw, sweating) | 3–6 months | Unnatural expression, drooping eyelid (ptosis), asymmetry, rarely allergy | ¥10,000–50,000 per area |
| Double-eyelid suture (埋没法, buried thread) | Several years or more (can come undone) | Asymmetry, exposed thread, infection, worsened ptosis. Chains of corrections | ¥50,000–300,000 |
| Fat-dissolving injections | Varies widely | Swelling, lumps, little effect. No product is approved in Japan — all are unapproved | ¥10,000–50,000 per session, several sessions |
| Laser and IPL light therapy (spots, hair removal, skin texture) | Depends on the procedure | Burns, darkening (especially melasma and tanned skin), white patches | ¥10,000–50,000 per session |
| Thread lift | 1–2 years | Dents, puckering, exposed thread, infection | ¥200,000–600,000 |
| Surgery (breast augmentation, liposuction, bone contouring, etc.) | Long-term | Anaesthetic risk, bleeding, infection, deformity, deaths (liposuction) | ¥500,000–3,000,000 |
Five things to check before signing
| Check | Details |
|---|---|
| 1. Who examines and who performs | Does a doctor examine you and explain the plan? Avoid places where an unlicensed "counsellor" takes you all the way to the contract. Facilities with only a "name-lending" managing doctor (licensed on paper, not present) have also become a problem |
| 2. Drug or product | Product name, manufacturer, approved in Japan or not. For unapproved products, the clinic must explain that it is unapproved, how it was obtained, and that it falls outside the Adverse Drug Reaction Relief System (2024 guideline). A low price is sometimes explained by an unapproved product |
| 3. Risks and what follows | A written explanation of complications, and who deals with them, where, and at what cost (partner hospital, correction fees). Avoid any facility that says "there are no risks" |
| 4. Cost and contract | Total, extra charges, anaesthetic and medication fees, correction fees, cancellation fees. A contract over ¥50,000 and longer than one month counts as a "specified continuous service", so cooling-off (8 days) and mid-term cancellation apply (one-off procedures are excluded). For "monitor" (discount-for-photos) contracts, check how the photos may be used |
| 5. Do not decide on the spot | "X% off if you sign today" and add-on menu items are classic sales tactics. Take it home and consult several facilities. Before-and-after photos on social media may be edited or of a different person |
- Complaint numbers: complaints about cosmetic medicine run to about 4,000–6,000 a year (National Consumer Affairs Center; fiscal 2023 was around a record high), mostly women in their 20s and 30s, with "double eyelids", "liposuction", "hyaluronic acid" and "medical hair removal" the most common. Both contract/cancellation problems and results/harm.
- Advertising rules: under the Medical Advertising Guidelines, before-and-after photos must be accompanied by the procedure, cost and risks, and "absolutely safe", wording that promises results, and "X% satisfied" are prohibited. An advert that breaks these rules is itself a warning sign.
- Doctors' qualifications: "cosmetic surgery" and "cosmetic dermatology" are self-declared specialities in Japan with no qualification requirement. Look for board certification from the Japan Society of Plastic and Reconstructive Surgery, the Japanese Dermatological Association, or the Japan Society of Aesthetic Plastic Surgery (JSAPS) as a guide. Ask about years of experience and number of cases.
- If something goes wrong: contact the facility that performed it first (keep a record), if symptoms are serious go to another medical facility (plastic surgery, dermatology, ophthalmology), the consumer hotline on 188, the Medical Safety Support Centre (in each prefecture). Keep photos, the contract and receipts.
- Minors: parental consent is required, and many facilities restrict procedures for under-18s.
- Procedures abroad (South Korea, etc.): may be cheaper, but handling of complications, language and follow-up after you return are the problems. Before travelling, line up a doctor who will see you after you get back.
[Verify] Check the complaint figures (National Consumer Affairs Center), the 2024 cosmetic-medicine guideline (duty to explain unapproved drugs) and the scope of the Act on Specified Commercial Transactions against the latest published material. Costs are typical clinic figures.
Misunderstanding 1｜Cosmetic medicine is a service like a hair salon, so take it lightly
It is medical practice, with risks that include blindness, skin necrosis and deaths. A doctor's examination, explanation and written documents are the starting point.
Misunderstanding 2｜Cheap clinics are just efficient
Unapproved products, unlicensed staff and name-lending doctors are sometimes the reason for the low price. Check the product name and who performs the procedure.
Misunderstanding 3｜The results on social media look great, so the clinic must be reliable
Edited photos, different people and showing only the good cases have become a problem, and the advertising guideline requires risks to be stated alongside. Judge by how carefully the risks are explained, not by the photos.
Misunderstanding 4｜Once you sign, you cannot cancel
Multi-session, high-value contracts qualify for cooling-off and mid-term cancellation. One-off procedures do not, so checking before you sign matters.
Misunderstanding 5｜If something goes wrong there is nothing you can do
The consumer hotline (188), the Medical Safety Support Centre and a second opinion at another clinic are all open to you. Keep photos, the contract and receipts.
---
Sources
- Ministry of Health, Labour and Welfare (MHLW), "Study group on ensuring the safety of cosmetic medicine: report and guideline (explanation of unapproved drugs, safety management)" [美容医療の安全性確保等に関する検討会 報告・ガイドライン（未承認医薬品等の説明、安全管理）] (2024)
https://www.mhlw.go.jp/stf/shingi/other-isei_127518.html
- Ministry of Health, Labour and Welfare (MHLW), "Medical Advertising Guidelines" [医療広告ガイドライン] (advertising rules for cosmetic medicine)
https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/iryou/kokokukisei/
- National Consumer Affairs Center of Japan, "Trends in complaints about cosmetic medicine services" [美容医療サービスに関する相談の動向]
https://www.kokusen.go.jp/
⚠️ Editorial note: the source URLs above were identified by search. Our working environment cannot reach go.jp domains, so the contents have not been checked against the text. Verify every source before publication and record who checked it and when.
About this article
What we share here are ideas and everyday practices passed down among people living in Japan, together with general information drawn from public sources. They are not official recommendations, and they are not professional instruction. Practices vary between households and regions.
This is general information. Results vary from person to person and depend on your own conditions and surroundings.
Please decide for yourself, using your own judgement, whether any of this suits your situation. We cannot accept responsibility for any damage, loss or injury arising from following this article.
Cosmetics are not medicines and are not meant to diagnose, heal or prevent any condition. If your skin reacts, stop using the product and see a dermatologist.
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