Why Plastic Surgery Is So Popular in Brazil? Essay Example

Cosmetic Surgery and Cultural Identity: Exploring and Understanding the Popularity of Aesthetic Surgery in Brazil

Introduction

In the age of globalisation cosmetic surgery has become just another commodity, and is growing in popularity around the world. Nowhere is cosmetic surgery more popular than in the nation of Brazil; in fact, Brazil is the only nation that has made cosmetic surgery a readily-available component of its nationalized health services. In the last half-century cosmetic surgery has become a routine part of life in Brazil, so much so that it is firmly intertwined with the Brazilian national identity. In order to understand why cosmetic surgery has become so embedded in the Brazilan national psyche is is necessary to explore a number of historical and contemporary factors. This paper proposes a theoretical framework that contextualizes the popularity of cosmetic surgery as a constructive and evolving expression of the Brazilian national identity.

Theoretical Framework

In the essay “’The Real Me’: Therapeutic Narrative in Cosmetic Surgery,” anthropologist and plastic surgeon Rebecca Huss-Ashmore discusses a theoretical framework for the patient/doctor discourse involved in plastic surgery.  Of particular note is the relative power imbalance between doctor and patient in most surgical contexts (e.g.- medically-necessary surgeries) as compared to the relationship between patient and doctor in the context of plastic surgery. Patients seeking cosmetic procedures have a greater balance of power; as Huss-Ashmore describes it, the “consumerist” setting means that patients are typically negotiating the purchase of a service they want, as opposed to a service they need (Huss-Ashmore, 2000). Moreover, patients often construct what Huss-Asmore describes as a “therapeutic narrative” for themselves; this narrative is the story they have developed that contains their reasons for seeking surgery, their fears about the surgery, and their hopes for the outcome of the surgery, both in terms of the direct physical changes and the larger implications such changes will have for their sense of well-being and their future lives. In short, this “therapeutic narrative” is the before-and-after story the patient constructs around his or her decision to undergo cosmetic surgery.

Huss-Ashmore’s work offers a potentially rich contextual framework for a discussion of plastic surgery in Brazil. The construction of a national identity in Brazil involves a confluence of often-conflicting ethnic and racial backgrounds and historical and contemporary social forces from both outside and inside the nation. The popularity of cosmetic surgery in Brazil is marked by notable trends towards particular standards of beauty that are, in essence, amalgamated from the various ethnic and racial backgrounds found in Brazil. These standards reflect ideals that are based on common physical traits yet also combined in ways that serve as heightened idealizations of such traits. For the purposes of this discussion, Hu8ss-Ashmore’s “therapeutic narrative” will be extrapolated and applied to the larger quest for a national identity in Brazil. This quest for a national identity will be viewed as the “therapeutic narrative,” and an examination of the historical and contemporary forces shaping that quest will help elucidate the underlying nature of what it means to be Brazilian.

Overview of Research and Literature

An enormous body of literature has been written about the general subject of plastic surgery, and a significant amount of such research is devoted specifically to discussions and examinations about how and why it has become so popular in recent decades. Much of this research is, not surprisingly, focused on the explosion in popularity of plastic surgery in Brazil and throughout Latin America. In order to fully address and consider the variety of factors that have conspired to bolster the popularity of plastic surgery in Brazil and beyond, it will be helpful, and perhaps even necessary, to examine the larger issue through the specific lenses of several different disciplines. Primary among these will be the anthropological and ethnographic perspectives; these will be supported by research that examines the subject from historical, psychological, and economic perspectives. To the degree that looking at the subject from these various perspectives, such alternation points of view will be sought in service of bolstering the underlying anthropological framework.

The following section will discuss a number of different articles, research reports, books, and other sources which focus on one or more aspects of plastic surgery and particularly its popularity in Brazil. This section will be framed as a Literature Review, with discussion given to each of the sources individually. Following this Literature Review will be a discussion about the some of the issues, themes, and ideas contained in the literature, with an emphasis on finding the ways in which these various themes and ideas support the goal of understanding from an ethnographic perspective why plastic surgery has become so popular in Brazil.

 Literature Review

Over three decades ago, Dr. Ricardo Baroudi,a plastic surgeon from Brazil, began authoring a series of essays on how and why plastic surgery has become so popular in his home country. In the first of these essays, simply titled “Plastic Surgery in Brazil,” Baroudi points to the development of the Latin-American Society of Plastic Surgery in 1940 as the primary basis on which this popularity has been built. This organization devoted itself not only to the refinement and advancement of plastic surgery techniques and procedures, but also to public proselytizing about how plastic surgery could benefit many people (Baroudi 1981, 420–423). As far back as 1919, notes Baroudi, Jose Rebelo Neto “established plastic surgery as a specialty in Brazil” (Baroudi 1981, 420–423), paving the way for the establishment of plastic surgery as a popular and widely-available option for Brazilians of all economic and social backgrounds. By the late 1940s, according to Baroudi, plastic surgery came to be seen in Brazil as something that was not just the province of society’s elite.

A decade later, Baroudi authored a follow-up to his 1981 essay entitled “Why Plastic Surgery Became So Popular in Brazil.” In this essay Baroudi again addresses many of his original pointes about the historical bases and antecedents for plastic surgery’s contemporary popularity in Brazil, though he takes his argument further by placing the issue of plastic surgery in a contemporary cultural context. Baroudi discusses the manner in which plastic surgeons, through the voice of the Latin-American Society of Plastic Surgeons, provided “ethical promotion of aesthetic plastic surgery” (Baroudi 1991, 396–397) in the decades following the organization’s founding. Along with this ethical promotion, however, Baroudi argues that many doctors performed surgeries with less-than-desirable results, and many of these doctors were not properly trained. This set off tension between trained and certified plastic surgeons and those who were poorly-trained or even incompetent. The public, caught in the middle of this, became involved in developing an unofficial network of reviews and assessments of physicians. This word-of-mouth campaign had the effect of bolstering the careers of some surgeons and ending the careers of others (Baroudi 1991, 396–397). It also helped to make discussions about plastic surgery a common component of public discourse in Brazil, a phenomenon which helped, and continues to help, make plastic surgery acceptable and popular in Brazil (Baroudi 1991, 396–397). Plastic Surgeons in Brazil now openly seek the support of official organizations as well as the testimonials of members of the public, most of whom are happy to discuss their surgeries openly in a culture and society which so openly embraces plastic surgery.

The article “The Rise of the Cosmetic Nation: Plastic Governmentality and Hybrid Medical Practices in Brazil” examines the manner in which plastic surgery has become an integral part of Brazil’s public healthcare system. While plastic surgery has become popular and accepted in the U.S. and other parts of the world, it is still largely viewed as elective surgery; in Brazil plastic surgery has come to be viewed as “a basic health need” (Jarrin 2012, 213–228). The author examines the sociopolitical and historical bases on which plastic surgeons have taken it upon themselves to popularize their techniques and practices in Brazil; moreover, the article argues that these efforts to develop and maintain the popularity of plastic surgery have often been fundamentally unethical. While Dr. Baroudi asserts that organizations such as the Latin-American Society of Plastic Surgeons has typically engaged in the “ethical promotion” of plastic sugery, Jarrin counters that position, arguing that Brazilian plastic surgeons have “portray(ed) their work in public settings as humanitarian in nature, while simultaneously using poor patients as experimental subjects to train new surgeons and develop new techniques” (Jarrin 2012, 213–228). Moreover, Jarrin argues that individual surgeons and professional organizations in Brazil have sought to characterise physical features that deviate from culturally-acceptable standards as flaws, and have characterized aesthetic surgery as reconstructive surgery (Jarrin 2012, 213–228). This research discussed in this article supports a social-constructivist view, arguing as it does that the very nature of plastic surgery is shaped by social forces to be necessary as a corrective for physical features or characteristics that in other societies would not be perceived as flaws.

The article entitled “The Poor Have a Right to Be Beautiful: Cosmetic Surgery in Neoliberal Brazil” explores some of the same issues as were covered in the previous article, but places them in a broader sociopolitical and economic context. The auhor begins by examining the ways that plastic surgery, referred to simply as plastica, has become widely available to even the poorest of Brazil’s citizens. The availability of plastic surgery for nearly all Brazilians is made possible by a nationalized healthcare system and by the social constructs that have served to make such surgeries be seen as a basic healthcare need. While the more affluent members of Brazilian society can and do seek the services of the nation’s premiere surgeons, those at the bottom of the socioeconomic ladder must settle for the services of government-employed surgeons who typically work in crowded clinics and hospitals (Edmonds, Alex, 2007, 363–381). Many of these patients have saved their money for months or even years to be able to afford the co-payments needed to fund their surgeries; such co-payments are a common aspect of the entire healthcare system, but their amounts vary according to the treatments or procedures being sought by patients (Edmonds, Alex, 2007, 363–381). Despite the challenges of paying for plastic surgeries, a significant number of Brazilians seek the services of plastic surgeons every year for procedures ranging from rhinoplasties to liposuction to breast augmentations.

The economic and political context in which the booming popularity of plastic surgery is set is fraught with contradictions. The neoliberal economic and political policies that underpinned the expansion of globalism in the 1990s have had a significant impact on many parts of the world, and Brazil and the rest of Latin America are no exception. Many industries have been privatized as the economic demands of keeping up with Western-style capitalism have eroded the traditional constructs of socialism and even dictatorships that were common in Latin America for much of the late 19^thand early 20^th centuries. Despite the changes wrought by neoliberalism, Brazil has maintained a public health system that operates in parallel with a private for-profit system. In essence, Brazil has two distinct healthcare systems; one serves the needs of the country’s more well-off citizens, while the other is directed to the poorer members of Brazilian society. One aspect of healthcare that bridges the divide between these two systems is the popularity of and access to plastic surgery.

In the book “Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil,” the author of the previous article more fully explores many of the same issues, fleshing out the details of how the nation came to embrace plastic surgery and attempting to contextualize this popularity in the county’s cultural framework. The author credits individual plastic surgeons and professional organizations with “democratizing” plastic surgery, using the marketing and sales techniques of neoliberal capitalism to “sell” the Brazilian public on the notion that plastic surgery is a basic healthcare need, and even a human right (Edmonds, 2010).  As other researchers have done, the author examines the ways in which plastic surgery –once seen in a primarily “cosmetic” context- has come to be framed as “reconstructive” surgery (Edmonds, 2010). In this framework, deviations from normative standards of physical beauty are seen as not just as deviations, but as problems that must be corrected. The author makes reference to a surgeon named Ivo Pitanguay, who founded a plastic surgery clinic in the 1960s. Pitanguay, whose goal was to make plastic surgery widely available, is described in this book as “a psychologist wielding a scalpel” who operates not just on a patient’s face or body, but on his or her “suffering psyche” (Edmonds, 2010).  This passage begins to make it clear how deeply the issue of plastic surgery is entrenched in the individual and social consciousnesses of Brazilians.

Pitanguay has openly asserted his desire to unite the realms of reconstructive and cosmetic surgeries, and in his role as a promoter of such a union he has come to be known as the “philosopher of plastica” (Edmonds, 2010). Like many proponents of plastic surgery in Brazil, Pitanguay argues that performing cosmetic and aesthetic surgeries does not just repair outward problems (he does, of course, assume that deviations from normative standards of beauty are in fact “problems”) it also helps to repair psychological problems associated with the anxiety of such deviations. What separates Brazil from nearly every other country where plastic surgery is concerned is not its popularity –it is popular in many parts of the world- but in the way that the public health care system provides access to such surgery for those who could not otherwise afford it. It is Pitanguay who provides the quote seen in the title of another author’s work: “the poor have a right to be beautiful.” It is not just the public sector that has made plastic surgery widely available in Brazil; the private sector has taken great steps to ensure access for those in the middle and lower classes. The sheer ubiquity of plastic surgery, from the number of surgeons to the proliferation of clinics and surgical centers, has created downward pressure on prices as surgeons compete for business. Many clinics offer payment and financing plans, making their relatively low prices even more attractive to a society growing accustomed to making purchase on credit. Some proponents of plastic surgery go so far as to claim that its prevalence is an indicator of the nation’s “economic health” and has become a “point of pride” for many Brazilians (Edmonds, 2010).

It is not just Brazilians who are seeking the services of the nation’s plastic surgeons. Te article “Almost Invisible: Medical Tourism in Brazil” examines the rising number of tourists and visitors who come to Brazil seeking plastic surgery. Brazil’s reputation as a home for affordable and competent surgeons is driving this practice, and the number of medical tourists every year is fast becoming a significant component of the country’s overall plastic surgery industry (Edmonds, Alex, 2011, 297–302). Just as individual plastic surgeons and professional organizations have actively promoted the purported benefits of plastic surgery to Brazilians, so too have they begunto promote such benefits internationally. Plastic surgeons work in partnerships with Brazil’s governmental tourism agencies and with private-sector organizations to advertise Brazil as a destination for medical tourism (Edmonds, Alex, 2011, 297–302). In addition to seeking the influx of patient’s dollars, Brazil has established a number of public and private training and certification facilities and organizations, making them available to surgeons from around the world who wish to benefit from Brazil’s experience in the field of plastic surgery.

In the article “Globalization of Plastic Surgery: the World of Plastic and Reconstructive Surgery in Brazil” the authors pick up on many of the same themes address in the extant body of literature on this subject. As the authors describe it, “plastic surgery in Brazil is truly a cultural phenomenon” (Rohrich and Stuzin 2012, 967–968). This phenomenon must be understood not just in terms of how it is manifested in Brazil, but also in the ways that these manifestations are so markedly different from those in virtually any other country. According to the authors, “(plastic surgery) is a regular topic of conversation among all sectors of the population, and plastic surgeons are often regarded as celebrities. Ivo Pitanguy is revered almost as a national hero. In this environment, plastic surgery is not only thriving but booming, and the need and hunger for knowledge and expertise among plastic surgeons are truly amazing and overwhelming” (Rohrich and Stuzin 2012, 967–968). Plastic surgery has become deeply embedded in the culture of contemporary Brazil in a way that is entirely unprecedented and entirely unique.

What many of the aforementioned articles and books make clear is that plastic surgery has become extraordinarily popular and widely-available in Brazil. Moreover, each of these articles examines in its own way the contribution that the public and private sectors have made to advance the popularity and ubiquity of plastic surgery. In addition, some researchers have examined and discussed the psychological aspects of plastic surgery, and how making changes to an individual’s outward appearance can, according to proponents, have a positive impact on his or her psychological state as well. Underneath the surface of these discussions, however, is a larger, deeper set of cultural factors to consider. The ways in which plastic surgeons, professional organizations, and even the Brazilian government have promoted plastic surgery are all clearly visible; what is less visible are the reasons why the messages and practices promoted by these individuals and organizations have met and continue to meet with such a receptive Brazilian population.

The book “Brazil on the Rise: The Story of a Country Transformed” the author explores the nations’ complicated history, a history that has largely been defined over the last several centuries by its relationship with the United States and other parts of the Western world. This history is marked by an often-contentious series of political and economic changes wrought in Brazil and throughout Latin America as the U.S. sought to impose the strictures of capitalism and its ideas of progress over the 19^th and 20^th centuries. The influences of the outside world have left Brazil and Latin America with a tangled and complex set of ethic and cultural traditions; over the course of the last century the cultural standards of physical beauty in Brazil have alternated between those that reflect U.S. ideals and those that push back against such ideals to embrace its native ethnic roots.

The political uprisings and independence movements that spread throughout Latin America in the 19^th and 20^th centuries saw many countries rejecting the influence of the West and the emergence of cultural identities that more closely and accurately reflected native cultural traditions. In this context, writes the author, new and unique cultural identities were formed that embraced the most popular aspects of European and North American culture, while balancing them with cultural standards that celebrated the region’s ethnic diversity (Rohter, 2010). Ironically, these competing forces had the perhaps unintended effect of promulgating standards of beauty that diverged both from Western ideals and from the reality of those rooted in native ethnicities. Unlike many nations in the developed world, Brazil did not reject brown skin or dark hairs the bases for common standards of beauty, but it did embrace a set of body types and physical attributes that were as unattainable for many Brazilians as were the standards of beauty imposed on people –especially women- in the U.S. and Europe.

Summary and Discussion

As the research and literature on this subject makes clear, the question of why plastic surgery has become so extraordinarily popular in Brazil is not one that has any easy answers. What answers can be found are deeply rooted into the nation’s cultural psyche and the individual identities of Brazilians. There is no question that the driving forces that have helped to popularize Brazil’s plastic surgery industry are derived largely from factors originating from outside, rather than from inside the country. Over the past few centuries the U.S., Europe, and other parts of the Western world have imposed their economic and political will on Brazil and the rest of Latin America, often to the detriment of the region’s population. At the same time, many of the most significant aspects of Western-style capitalism and the cultural structures that accompany it have been embraced by Brazilians, who have also balanced them against the social programs and other aspects of government that have characterized the provision of public services. Brazil is unique in the manner in which it has framed plastic surgery as a public health need, and has developed institutions and organizations that support this framework. Plastic surgery has become an integral component of contemporary Brazilian culture, and of individual and cultural identity. The examination of further research in to this subject will provide greater insight into the ethnographic framework in which plastic surgery has become such a significant component of Brazilian culture.

Bibliography

Baroudi, Ricardo. “Plastic Surgery in Brazil.” Annals of plastic surgery 6, no. 6 (1981): 420–423.

Baroudi, Ricardo. “Why Aesthetic Plastic Surgery Became Popular in Brazil.” Annals of plastic surgery 27, no. 5 (1991): 396–397.

Cash, Thomas F. Encyclopedia of body image and human appearance. Amsterdam: Elsevier/Academic Press, 2012.

Edmonds, Alex. “‘The poor have the right to be beautiful’: cosmetic surgery in neoliberal Brazil.”Journal of the Royal Anthropological Institute 13, no. 2 (2007): 363–381.

Edmonds, Alex. ““Almost Invisible Scars”: Medical Tourism to Brazil.” Signs 36, no. 2 (2011): 297–302.

Edmonds, Alexander. Pretty modern. Durham, NC: Duke University Press, 2010.

Hanchard, M. G. (1999). Racial politics in contemporary Brazil. Durham [N.C.]: Duke University Press.

Holliday, R. & Elfving-Hwang, J. (2012). Gender, Globalization and Aesthetic Surgery in South Korea. Body \& Society, 18 (2), pp. 58–81.

Huss-Ashmore, R. (2000). ” The Real Me”: Therapeutic Narrative in Cosmetic Surgery. Expedition-Philadelphia–, 42 (3), pp. 26–37.

Jarrin, Alvaro E. “The rise of the cosmetic nation: Plastic governmentality and hybrid medical practices in Brazil.” Medical anthropology 31, no. 3 (2012): 213–228.

Lesser, J. (2013). Immigration, ethnicity, and national identity in Brazil, 1808 to the present.

Lesser, J. (1999). Negotiating national identity. Durham, N.C.: Duke University Press.

Rohrich, Rod J and James M Stuzin. “Globalization of plastic surgery: The world of plastic and reconstructive surgery in Brazil.” Plastic and reconstructive surgery 130, no. 4 (2012): 967–968.

Rohter, Larry. Brazil on the rise. New York, NY: Palgrave Macmillan, 2010.