Chen Yan is 35 and fears middle age is upon her, so like all of her friends she sees cosmetic surgery as the solution: time to get a new nose.

Plastic surgery is booming in China, fuelled by rising incomes, growing Western influences, and the imperative of looking good on social media.

Some parents are even paying for teenage children to get work done to help their employment prospects.

"We Chinese think that after you've married, given birth to a kid and you're past 30, they call you a middle-aged woman," said Chen.

"I don't want to be a middle-aged woman that early."

The shop owner travelled from the central province of Hunan to pay 52,515 yuan ($8,000) in a quest for the perfect nose at Shanghai's private Huamei Medical Cosmetology Hospital.

Spread over four floors and featuring a peaceful convalescent roof garden complete with tea house, the vast majority going under the knife are young women.

It offers an array of options including breast augmentation, ear shaping, bone shaving, pubic-hair transplants and a procedure that promises to reduce armpit odour.

- Summer rush -

Stepping inside the hospital is like entering a five-star hotel.

In the immaculate foyer, patients are greeted by bowing hostesses in striped blouses, short black skirts and high heels as soothing music plays. A sign outside entices teachers and students with a 20-percent summer discount.

The surgeon Li Jian says 90 percent of his patients are women aged 16 to 70.

The under-40s want to look more beautiful, the over-40s want to look younger.

The most requested procedures involve removing bulk from the face and body, and nose jobs -- Chinese women typically seek slimmer, more "Western-looking" noses.

This year 14 million Chinese are expected to have cosmetic surgery, a 42 percent surge from last year, according to SoYoung, a popular app on the industry that used data from several sources including international consultancy Deloitte.

Summers are especially busy at the Shanghai clinic because recent university graduates believe better looks lead to better employment prospects, particularly in the entertainment business.

Increasing numbers seek plastic surgery in their teens, although the hospital does not treat those under 16, while 16 and 17 year olds require parental consent.

"Most Chinese people believe the thinner the face or nose, the more beautiful they look," Li said.

"Some people want to make themselves more beautiful when they take pictures of themselves. So they want themselves to become more European," he added.

"As a plastic surgeon I don't think that is beautiful, at least that is not Chinese style. So I refuse many girls who have that kind of opinion."

- Becoming addicted -

Sun Yibing, now 22, had her first procedure at 17 and has since become something of a celebrity after going under the knife 12 more times.

Bullied at school because of her looks and weight, she had operations on her eyes, nose, jaw, temples and elsewhere, and now sports rounder eyes, as well as a sharper nose and jawline.

But as her appearance has morphed, so has her view of surgery.

"I got addicted to surgery and yet was never satisfied with myself. I am not against plastic surgery but you have to be yourself instead of turning into others," Sun, who is from the central province of Henan, told AFP.

Sun partly blames minor celebrities who make their names on the internet in China -- often by live-streaming themselves singing or dancing and boasting about their surgery -- for hastening the stampede.

She now fears that the rush to cash in has brought growing numbers of unscrupulous and poorly trained surgeons into the industry.

"A couple of years ago people still were quite conservative about having cosmetic surgery," she said.

"But I am afraid that the plastic surgery industry is a mess now with good and bad clinics mixed so customers don't know what is what," she added.

- 'I'm the last one' -

Back at the hospital a woman in a waiting room peers out from beneath her bandaged eyelids. Another, in obvious pain after surgery, appears almost to be trying to hold her head together.

Chen had already done minor work to her nose and had a crease inserted in her eye lids -- so-called double eyelid surgery aimed at creating rounder, more Western-looking eyes is one of the most popular in China.

But it took her six years to summon the courage for a full nose job, finally taking the plunge after all her friends did so.

"I got here later. I'm the last one to come," she said.

Following surgery, she said that the hospital recommended a bone-shaving operation to narrow her jawline using a surgical drill.

Some Chinese women hanker for a more "V-shaped" visage, but the procedure comes with potential complications including infection or even facial paralysis.

"I just want to make myself look more beautiful," said Chen, who is unsure whether to proceed.

She explained: "No matter how old a woman is, she should make herself more and more beautiful."

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