The high school student gets off the train from Qingdao, Shandong province, and walks into a plastic surgery clinic in Beijing's central business district of Guomao at about 9 am on a weekday.

The second-grader, surnamed Wu, is accompanied by her parents, and is hoping to improve her appearance in the belief there are "better plastic surgeons" in the capital.

With short hair and glasses, wearing a purple T-shirt, dark sport pants and gray sneakers, she says she is after medical advice about whether she should undergo surgical or non-surgical procedures.

Wu is one of the many high school students who get plastic surgery during the summer and winter vacations.

Around 3 million surgical and non-surgical operations to improve looks were conducted in China in 2009, and the figure is estimated to double every year, according to partial data from the Ministry of Health, released in October 2010.

Up to 80 percent of plastic surgery patients in Beijing last summer were high school and college students, with the rate expected to hit 90 percent this year, according to a study on the Beijing market by China Medical Treatment Orthopedics and Beauty Association.

A few days before Wu came to Beijing, another high school graduate surnamed Guo had a breast enlargement procedure at the same clinic, Guomao clinic of Plastic Surgery Hospital of Chinese Academy of Medical Sciences.

Guo, who has been admitted to Beijing Film Academy, also had work done on her eyes and nose during the last summer vacation. The three operations cost her wealthy mother nearly 100,000 yuan ($15,451).

The good-looking girl says she simply "wants to become prettier", while her mother admits a better appearance may help her daughter find more acting opportunities in the future.

"High school students usually aren't so clear about what they want, compared to their parents, especially those who want their children to have a career in entertainment," says Ding Xiaobang, a veteran surgeon at the clinic, adding he never sees anyone "ugly" come to his clinic.

Ding says high school and college students accounted for nearly 80 percent of the more than 100 operations he did in July 2010, the majority of whom were female high school graduates and students in their second year.

He says the most common operations are for double eyelids and nose jobs. He does not recommend that students under the age of 16 seek a sharper nose through surgery as their bones are still growing.

Hu Xiaogen, a doctor who works at the plastic surgery department of China-Japan Friendship Hospital, says it is safer for women above 20 and men above 25 to undergo plastic surgery.

Besides being physically immature, Hu says high school students are less prepared mentally to make such decisions.

He says one 16-year-old student pulled out of an operation just as he was about to anesthetize her, as she was afraid the injection to her eyelids would be too painful.

Hu says students should seek operations at qualified hospitals, and it is better for them not to undergo surgery involving significant trauma, such as two or three small but simultaneous operations on the eyes.

"Parents should offer objective and reasonable suggestions to their children. Not all of them are suitable to become actors or actresses, even after they take the risk of undergoing plastic surgery," Hu says.

"Enhancing all-round capabilities is the correct way forward to a prospective career. Appearance is not everything."

China Daily