Boom and busts

Márcia Valim, 49, nurse: Procedures so far: breast implants Planned procedures: buttock implants, further breast implants

Márcia Valim confesses to a twinge of envy whenever she sees Rio de Janeiro’s famously full-figured carnival queens strut their stuff. It is one of the reasons why, despite undergoing breast augmentation three years ago, Valim, who works as a nurse, is still unhappy with her body. Now, as she waits to see surgeons at Santa Casa Misericórdia public hospital in downtown Rio, Valim says she wants to increase the size of her bottom.

“I’m turning 50 in March, and I want to be able to look good on the beach. Besides, in Brazil, big bums are part of our culture,” she says. Valim earns only R$3,000 (£990) a month but is prepared to borrow up to twice that to pay for buttock implants. “If I get plastic surgery my self-esteem will be a lot higher.”

That R$6,000 may be double Valim’s monthly income, but in fact it represents something of a bargain in a society where middle-class women can often pay three times as much for such an operation and the rich way beyond that.

The ward at Santa Casa where Valim hopes to have the procedure is funded by a charitable foundation set up by the country’s most famous plastic surgeon, Ivo Pitanguy, a man referred to in Brazil as “the pope of plastic surgery”. Operations are performed by resident physicians who are training at Dr Pitanguy’s private clinic and who volunteer at the ward in Santa Casa hospital. Working for nothing, they provide cut-price and even free surgery for poorer women. Talking at his private clinic in Rio’s Botafogo district, Pitanguy says the public hospital initiative represents “one of the most important things I did in my life”.

Pitanguy established the ward 50 years ago, a decision that reflects his longheld belief – he is now 86 – that aesthetic surgery should be freely available. “It is easy to understand why [poor people] would need reconstructive surgery, but difficult to understand that aesthetic surgery is not a luxury,” he says. “It’s something that’s deeper than that and should be available to everyone.”

The reason, he insists, is more complex than merely helping poorer women emulate in some small way the film stars, carnival singers and soap actors so beloved of celebrity-obsessed Brazil. Pitanguy sees his work as akin to a physical form of therapy. “Plastic surgery can bring dignity to your own image, and when you are happy with [that], you are happy with the world around you,” he says. “This part of the equation brings a psychological aspect to plastic surgery. Many times when we operate we are like a psychologist with a knife in our hands.”

And, thanks to a combination of increased social mobility and access to credit, it’s a view that resonates with the wider population more fully than ever before. “Brazilians now have higher incomes [and this] is chipping away at the idea that plastic surgery is a luxury for the upper class,” he says.

The result is that the once elite phenomenon of uma plástica is becoming increasingly common among poorer Brazilian consumers, many of them like those in the queue for treatment at Santa Casa – women such as Ali da Silva Vaz, a bubbly unemployed 39-year-old. She has already had a tummy tuck and now wants breast implants and lipo­suction for her thighs. “I used to be really heavy so when I lost all this weight I started to have a problem with sagging skin,” she says.

Also hoping to have plastic surgery at the Santa Casa ward is dental technician Diana Viana, 28. She earns R$2,000 (£660) a month and her procedure of choice is a tummy tuck. “After my son was born my stomach looked so awful that I didn’t even want to leave the house,” she says. “I just can’t wait for the day that I can wear a bikini again.”

Like da Silva Vaz, meanwhile, 21-year-old interior design student Isabella Romeiro is seeking breast implants. “I just want to slightly increase my cup size,” she says. It is only 10 months since she persuaded her grandmother to help pay for thigh-reduction surgery.

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Ali da Silva Vaz, 39, unemployed: Procedures so far: tummy tuck. Planned procedures: breast implants, thigh liposuction

Specialists such as Pitanguy are as celebrated as their many famous – but anonymity-craving – patients. Last month an account in Correio do Brasil of a party to mark the beginning of Rio’s carnival described Pitanguy, one of the high-profile guests, as having “the popularity of a superstar”.

The surgeon, whose clients are reputed to have included Frank Sinatra and Jacqueline Onassis, has a reputation as something of a philosopher of his craft, as seen in works such as The Right to Beauty: Memoirs of a Grand Master of Plastic Surgery. He has even won membership of Brazil’s academy of letters, alongside novelists including Paulo Coelho.

Alvaro Jarrin is an anthropologist at Union College, New York, who has written extensively on Brazil’s plastic surgery phenomenon. Submitting to the knife is normal among the elite, he says. “If you have the means to do something about [your appearance] and you don’t look the part you are not being a proper defender of your class.”

Mirian Goldenberg, a social anthropologist at the Federal University of Rio de Janeiro, says that “the question in Brazil is not why did you get plastic surgery, it’s why didn’t you?” Nor is it a taboo subject, she says. “Modifying the body is not something that provokes fear, nor is it frowned upon. It’s the opposite, it’s a symbol of wealth and modernity and sexuality, principally.”

In the past two decades the number of plastic surgery procedures in the country has risen dramatically. According to the Brazilian Society of Plastic Surgery, 905,124 operations were carried out in Brazil in 2011, second only to the richer and more populous US.

“We all talk most about liposuction and putting in silicone,” says Daniella Magno, a 42-year-old systems analyst from Salvador in northeast Brazil. “Almost every woman I see in the gym [attached to the gated community where she lives] has an implant because it increases self-confidence.”

Magno, a tall, smartly turned-out woman in pressed designer jeans and high-heeled sandals, had surgery to flatten and straighten her tummy following the birth of the younger of her two children. She is now consulting plastic surgeons about a breast reduction. “They told me it would leave a big scar and they were not prepared to do it [but] I’m looking for other opinions. I’ve got some good names. My breasts are not what they were.”

She adds that most people in her circle have had work done. Her sister spent several thousand dollars on having her thighs surgically reduced and two close friends are paying for breast reductions. A 21-year-old niece – a dentistry student – has just had a breast augmentation. “She was very flat-chested and her parents paid for it,” she says.

Magno has noticed that poorer acquaintances are also having plastic surgery procedures. “My mum’s cook paid to have her breasts reduced. She is paying in I don’t know how many instalments. And my own empregada [maid] is dying to get her thighs reduced.”

Dr Ivo Pitanguy: Brazil’s celebrated ‘pope of plastic surgery’

It is demand from the less well-off that accounts for the surge in treatments. Since the early 1990s, economic stability, falling unemployment, social welfare programmes and a growth in the availability of credit have transformed the lives of poorer Brazilians. Once socially marginalised, such people are now significant consumers.

The plastic surgery market is growing in other ways as well. For one thing, younger people – such as Romeiro – are more likely to seek treatment. The Brazilian Society of Plastic Surgery estimates that the average age of clients has fallen from 50 to under 30 in the past 10 years.

Men too are increasingly likely to undergo surgery, with discreet facelifts and tummy tucks quite common. Marcelo Norio Inada, a plastic surgeon based in São Paulo, says competition for jobs is driving interest. “When two people have the same qualifications but one of the two is slim and fit there is no doubt who will be preferred,” says Inada. “Generally speaking, men don’t like to do plastic surgery but they adore it when people say they look young. Guys with experience are doing all they can to keep themselves young.”

None of this, however, fully explains why plastic surgery is so much more popular in Brazil than anywhere else in the world. Brazilians tend to say it’s down to the country’s tropical climate, a natural response to a lifestyle that allows fewer clothes – and lots of time on the beach. “Brazil is a country where people are much more exposed to the sun and often when you are more exposed, you are a better observer of yourself,” says Pitanguy. “When you have to be covered, you don’t have to know much about your own body.”

It is no coincidence that companies such as Procter & Gamble and Unilever, two of the principal competitors in the lucrative personal care market, are big investors in Brazil – its personal care and cosmetics sectors are not just fast-growing but among the biggest in the world. Brazilians spend more per head on products such as shampoos, deodorants and soap powder than their counterparts in similar middle-income countries. Spending on lipsticks, face cream, nail varnish and perfumes is also relatively high, particularly among the new consumer classes, helping domestic cosmetics companies such as Natura and O Boticário to rank among the most successful businesses in the country.

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Anthropologist Alvaro Jarrin says the surgery boom is driven by Brazil’s mixed-race heritage

Yet the radicalism of the plastic surgery trend suggests that Brazil’s body culture has more complex roots than sun, heat and a passion for cosmetics. Anthropologists such as Jarrin say that the importance of body image is intimately linked to a complicated pattern of colonisation, settlement and the formation of a multi-ethnic identity.

Unlike their more puritan Anglo-Saxon counter­parts, Portuguese colonists and settlers regularly found sexual partners among the indigenous populations and, later, among the millions of black African slaves forcibly brought to the country. But in the late 19th century, Brazil’s white elites started to encourage immigration from southern Europe in order to deliberately “whiten” the population. In line with the racist thinking of the day, they also hoped to “improve” its genetic characteristics.

As Brazil slowly moved towards democracy in the early 20th century, these ideas changed again and nationalist governments started to defend Brazil’s mixed-race heritage. In 1933, the Brazilian historian Gilberto Freyre proposed that Brazil represented a new form of tropical civilisation in which its racial profile was a national asset, and one that could help to harmonise social differences. Yet such pride in Brazil’s mixed-race identity was always ambiguous, because darker-skinned people in Brazil have consistently tended to be poorer than their fellow citizens. And although the official Brazilian aesthetic valued brown skin and the African body form, popular culture tended to favour – and still does – European facial characteristics.

Isabella Romeiro, 21, student: Procedures so far: thigh liposuction. Planned procedures: breast implants

It was in this context that Brazil’s plastic surgery industry emerged in the 1930s. In Europe, plastic surgery was developed to help soldiers mutilated in the first world war; in Brazil, says Jarrin, surgeons saw themselves as fighting against “ugliness”.

Pitanguy, who came to notice after treating hundreds of victims of a fire at a circus near Rio in 1961, takes a broader view. In a piece written for a medical journal in 1998 he argued that plastic surgery helped Brazilian victims of social inequalities and violence. “We live in an era of permanent traumas. Even if war created a greater concentration of it, the day-to-day succession of urban violence creates just as many mutilations as war,” he wrote.

More recently, his philosophy has reflected a society that values the free market and individual choice and where inequality is less acute; one where plastic surgery can help individuals to realise their potential. He rejects, however, the idea that plastic surgery is simply a commodity like any other. “We plastic surgeons, the majority have always been against this kind of banalisation,” he says.

Even so, talking to Brazilians such as Márcia Valim or Isabella Romeiro, it is hard to avoid the impression that body shape is just one more product to be bought off the shelf, like a shampoo or face cream. For poorer Brazilians raised to equate what are perceived to be ugly physical attributes with low-grade work and few prospects, the attractions of the consumer dream are powerful.

The grandmother of Isabella Romeiro helped pay for her thigh-reduction operation

Some feminist critics, however, point to a culture of sexist body imagery in advertising. Even as Brazilian women are playing a greater role in the workforce and sexual norms are becoming more liberal, women are “going backwards in this area”, says Lola Aronovich, who teaches English literature at the University of Ceará.

“We have not overcome our obsession with our body image. This used to be a medical ethic about when you should and shouldn’t do plastic. We still see a woman as someone whose principal function is to be pretty and decorative.”

Mirian Goldenberg has a more nuanced view. “When I speak to women who get plastic surgery they say that they don’t do it for men, they do it for themselves. But what you can say is that in a culture where women are valued for their bodies, and their sexuality, they need to invest in their bodies [because] their bodies have more value.”

Meanwhile, Valim is thinking about a third operation. She says that if she does get the implants in her bottom that she wants, she will need to alter the size of her breasts in order to make sure her body is “in proportion”. Her ultimate aim? To have “breasts like an American woman, but a bum like a Brazilian”.

Richard Lapper is director and Amy Stillman is a senior researcher at Brazil Confidential, an FT research service. Additional reporting by Lucinda Elliott and Cecilia Briones

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