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Mrcia Valim, 49, nurse: Procedures so

far : breast implants Planned procedures:

buttock implants, further breast implants

February 22, 2013 5:13 pm

Boom and bustsBy Richard Lapper and Amy Stillman

The once elite phenomenon of plastic surgery is becoming increasingly

common among Brazilians of all classes and ages

Mrcia Valim confesses to a twinge of envy whenever she sees

Rio de Janeiros 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 atSanta Casa Misericrdia public hospital in downtown Rio, Valim

says she wants to increase the size of her bottom.

Im 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 Valims 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 bey ond that.

The ward at Santa Casa where Valim hopes to have the

procedure is funded by a charitable foundation set up by the countrys 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 Pitanguys 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 Rios 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

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49.5 %

Percentage of Class C

Brazilians who s ay they would

consider p lastic surgery for

aesthetic purposes, compared

to 49.1 per cent from classes A

and B combined

not a luxury, he says. Its something thats 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 psy chologist with a knife in our hands.

And, thanks to a combination of increased social mobility and access to credit, its 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 plstica 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 didnt even want to leave the house, she says.

I just cant 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.

. . .

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 Rios 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


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Ali da Silva Vaz, 39, unemployed:

Procedures so far: tummy tuck.

Planned procedures: breast implants,

thigh liposuction

33.4%

Percentage of Brazilian men

who say they would consider

aesthetic plastic surgerySource for highlighted data on

this page: Brazil Confidential

survey of a sam ple of 1,488

Brazilians in December 2012

905,124

Plastic surgery proceduresperformed in Brazil in 2011, the

second-highest number in the

world after the richer and more

populous US

Source: Brazilian Society of

Plastic Surgery

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 Brazils academy of letters, alongside

novelists including Paulo Coelho.

Alvaro Jarrin is an anthropologist at Union College, New York, who

has written extensively on Brazils 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

dont 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, its why didnt you? Nor is it a taboo subject,she says. Modifying the body is not something that provokes fear,

nor is it frowned upon. Its the opposite, its a symbol of wealth and

modernity and sexuality, principally.

In the past two decades the number of plastic surgery procedures i

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 hertwo 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] Im looking for other opinions.

Ive 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

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Dr Ivo Pitanguy: Brazils celebrated pope of plastic

surgery

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

mums cook paid to have her breasts reduced. She is paying in I dont know how many

instalments. And my own empregada [maid] is dying to get her thighs reduced.

It is demand from the less well-off that accounts for the

surge in treatments. Since the early 1 990s, 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 So Paulo, says

competition for jobs is driving interest. When two people

have the same qualifications but one of the two is slim andfit there is no doubt who will be preferred, say s Inada.

Generally speaking, men dont 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 its down to the countrys 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 moreexposed, you are a better observer of yourself, says Pitanguy. When you have to be covered,

you dont 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

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Anthropologist Alvaro Jarrin says the surgery boom

is driven by Brazils mixed-race heritage

and perfumes is also relatively high, particularly among the new consumer classes, helping

domestic cosmetics companies such as Natura and O Boticrio to rank among the most

successful businesses in the country.

. . .

Yet the radicalism of the plastic surgery trend suggests

that Brazils 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, Brazils 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 nationalistgovernments started to defend Brazils 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 Brazils 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.

It was in this context that Brazils 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

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Isabella Romeiro, 21, student:

Procedures so far: thigh liposuction.

Planned procedures: breast implants

The grandmother of Isabella Romeiro helped pay for

her thigh-reduction operation

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 Mrcia 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 tobe ugly physical attributes with low-grade work and few prospects,

the attractions of the consumer dream are powerful.

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 Cear.

We have not overcome our obsession with our body

image. This used to be a medical ethic about when you

should and shouldnt 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 dont 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

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-------------------------------------------

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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