TOKYO - A growing number of young doctors in Japan are moving directly into cosmetic medicine after obtaining a medical license and completing their initial clinical training, raising concern that the trend may be worsening staff shortages in insurance-covered medical care.
The career path is known as "Naomi," a term used for doctors who enter beauty medicine without first working through mainstream fields such as internal medicine or surgery. The rise of such doctors has become a point of debate as Japan faces mounting pressure on the medical system people rely on when they are injured or fall ill.
A 26-year-old doctor who joined a major cosmetic clinic group this spring said the appeal of the field came from personal experience. "From around the latter half of university, I had quite a lot of skin trouble myself, and I was helped by cosmetic medicine," the doctor said. "By changing only my appearance, to put it dramatically, my whole life became more positive. That was why I felt attracted to it."
After completing two years of initial clinical training, Naomi doctors move directly into cosmetic medicine rather than entering general fields. The clinic group where the 26-year-old works hired five new Naomi doctors this year. A manager at the group said the industry is now attracting graduates from top institutions, including medical faculties at national universities and Tokyo Medical and Dental University, and that from a business standpoint it makes sense to hire talented people when they become available.
According to a government survey conducted in 2022, there were 198 Naomi doctors nationwide, roughly 12 times the level of a decade earlier.
One clinic visited for the report had opened only last year. It was headed by Yutaro Ishida, who joined a major cosmetic clinic in 2023 after completing two years of initial training and opened his own practice just one year later. The clinic, decorated with a red carpet meant to evoke roses, sometimes sees as many as 100 patients a day.
Ishida said he focuses on careful but fast procedures. "I have confidence in double-eyelid surgery," he said. "It is cheap, good and fast, a little like Yoshinoya. Shorter surgery times also reduce the risk of infection and shorten patients' downtime, so I want to finish procedures as quickly as possible."
Ishida said he originally wanted to become a pediatrician while at university, but changed his mind after seeing the harsh working environment and strict hierarchies at university hospitals during his initial training. "For the first few years, or as long as about five years, it can really feel like life at the bottom," he said. "There are systems where doctors are made to do work that even non-doctors could do, such as paperwork, and are treated almost like slaves. I saw many seniors and classmates become mentally unwell and quit."
By contrast, Ishida said he felt a sense of freedom in cosmetic medicine. He said the field lacks the huge volume of administrative work and institutional constraints he saw at university hospitals, allowing doctors to gain practical experience more quickly and efficiently.
Some critics say Naomi doctors lack sufficient skills because they begin operating at a young age, but Ishida rejected the idea that experience in insurance-covered care automatically makes a doctor better. "Even if you go into insurance-covered medical care, if you work carelessly, you are still a low-quality doctor," he said. "What matters is how many cases you handle and how much effort you make. If young doctors can see many cases and make even one patient happy, then starting with cosmetic medicine is not necessarily the wrong choice."
While some doctors choose the Naomi path after hesitation, others aim for cosmetic medicine from the beginning. Yuriko Kiya, director of a cosmetic clinic in Osaka, said she had long been interested in beauty, fashion and makeup and had never seriously considered another field. "I went to medical school to become a cosmetic surgeon," she said. "I never thought about any other option."
Kiya said the greatest satisfaction in her work comes from making patients happy. One patient said surgery had changed daily life by allowing her to lower her chin naturally without worrying about a double chin.
Kiya is also strict about her own beauty routine. Her lunch on the day of the report was chicken and other diet food, which she said helps her stay beautiful. She said she avoids convenience-store meals because they quickly cause skin problems.
On that day, Kiya handled five consultations and operations and finished all her work by 7 p.m. She said she usually starts and finishes work on time. After work, she went out for grilled meat with friends she met through a shared interest in the same K-pop idol. She said having clear boundaries between work and private life helps her stay motivated. "Because my on and off time are clearly separated, I can work hard," she said. "I have time to go out for meals like this and enjoy my hobbies, so life is very fulfilling."
Another Naomi doctor has taken the glamorous side of cosmetic medicine even further. Dai Tsuji, who runs two cosmetic clinics, lives in a tower condominium in Tokyo and calls cosmetic surgery "reincarnation." His specialties include liposuction.
Tsuji said he spent about 10 million yen renovating the living room of his rented apartment. Like the home, his clinic has a striking, luxurious interior, and business is strong enough that he plans to expand to Osaka's Umeda district in November.
Tsuji has also undergone extensive cosmetic surgery himself. He said he has had facial liposuction about three times, bone-cutting surgery, an incision facelift and thread lifts about 100 times, adding that he has experienced most major procedures. He said he tries every new treatment on his own body and has spent about 50 million yen on cosmetic procedures.
"Because I have experienced it myself and thought it was good, I can tell customers how wonderful it is," Tsuji said. "It is similar to someone saying LASIK is good while still wearing glasses. That would not be persuasive."
Competition in the cosmetic medicine industry is also intensifying as the number of Naomi doctors increases. Tsuji said many clinics are opening, but many are also closing, and stories of friends' clinics going out of business are common. He described the industry as entering a period of fierce rivalry.
To survive, Tsuji has put heavy emphasis on social media, actively posting about his own experiences, including the effects of procedures such as liposuction and areas where sensation has disappeared. He said patients often choose doctors based on personality, speaking style and online presence. His Instagram following has surpassed 200,000, and he said 95% of people who contact him through Line come after seeing his social media.
Tsuji said the work is less easy than it may appear. "I spend so much time thinking about social media outside of operations that I wonder what my real job is, whether I am an old man doing social media," he said. "In that sense, I have almost no free time or break time. It may look easy, but I devote my private life to it 24 hours a day, so it is actually hard."
Source: MBS
