For many in the West, the sight of Asian people wearing surgical masks will bring back surreal memories of the (actually quite worrying) SARS outbreak in Hong Kong in 2002. Within weeks, SARS had spread from Hong Kong to infect individuals in 37 countries – causing 774 deaths worldwide. The incident nearly caused a pandemic.

In the scale of things, however, SARS was small-fry. In 1918 a hardcore pandemic really did occur. The Spanish flu killed at least 50 million people, with 23 million affected in Japan alone. It’s now widely accepted that the long-standing mask subculture of the East is a by-product from those days when people would try anything to stop the virus entering their bodies and turning their lungs to mush.

Regardless of origin, surgical masks are big business all over Asia. Only recently Beijing was subjected to its first ever smog ‘red alert’, effectively shutting down the Chinese capital. Sales of face masks reportedly increased to the point where many outlets were completely out of stock. This year also saw intense (and highly illegal) forest fires sweeping across Indonesia, resulting in more masks on the streets of Malaysia, Singapore and even Thailand. (In Kuala Lumpur in September the smog was so bad you couldn’t see the sun.) But where does Japan fit into the equation? Why do so many people wear masks in a country with relatively safe pollution levels compared to its Asian counterparts?

Some may wonder if Japanese people wear surgical face masks as a response to the fallout from Fukushima. Maybe there are some who think like that. But the truth is that the Japanese have been donning masks for decades, long before the troubling radiation levels caused by the 2011 ‘quake’. For the majority, it’s all about protecting your own health and preventing disease transmission. Flu, cedar pollen, pollution: these are technically all ‘valid’ reasons for wearing a mask – even if studies have shown no conclusive proof that wearing one can actually stop airborne viruses. (Some studies even go as far as to state that the warm, moist environment that a mask creates only goes to increase infection rates.)

Japan is a country that builds its foundations on social etiquette. If you’re feeling sick, you ‘do the right thing’ and wear a mask. But there are also other, more surprising, reasons why people choose to strap up and have half their face covered by a white piece of paper.

Increasingly, people are choosing to wear masks for cosmetic reasons: they’re not wearing any makeup and want to hide their face. Think of it like wearing a hat when you can't be bothered to style your hair. Others take it one step further, wanting to hide their emotions. The honne–tatemae divide is considered by some to be of paramount importance in Japanese culture – the contrast between a person’s true feelings and desires (honne) and the behaviour and opinions one displays in public (tatemae). By wearing a mask, these emotions can remain hidden.

“Kids at Japanese hardcore punk shows wear masks, not for one minute thinking it will affect their street cred” 

With so many masks in the marketplace, then, it was only a matter of time before the companies behind them started to try and market them as fashionable. In 2011, Japanese news site News Post Seven surveyed 100 people in Shibuya, Tokyo, and found that 30 per cent of them were wearing masks for reasons unrelated to sickness. Many girls claimed wearing a mask gave them a ‘mysterious’ appearance since only their eyes were showing. Others were convinced it made their faces smaller.

While plain white masks are still the norm, it’s not uncommon to see different colours and shapes on the streets of all major Japanese cities. Lolita girls often wear pink masks, while black-metal fans may wear black leather ones with studs on them. (Yes, these exist.) One such supplier of mainstream ‘fashionable’ surgical masks is Picomask – offering styles such as zebra-print and army camo. These are pretty tame, but in boutique stores in Harajuku you can pick up printed and anime designs. On eBay there are also all sorts of K-pop inspired masks. The interesting thing is that there seems to be no stigma attached to wearing them: for example, kids at Japanese hardcore punk shows wear masks, not for one minute thinking it will affect their street cred.

Live in Asia long enough and masks become part of everyday life. They are as commonplace as someone holding an umbrella. Whatever the reason for wearing them – be it health, fashion, or both – they are now embodied in Japanese and Asian culture, and show no signs of going anywhere soon.