BRAZIL’S PLASTIC SURGERY KING
‘The poor deserve beauty as much as the rich’
It’s 10am on a Wednesday and I ambeing guided by a doctor through a series of sweltering corridors in Rio’s Santa Casa de Misericórdia hospital, one of the oldest medical facilities in South America. Brazil may have access to healthcare enshrined in its constitution, but walking around this building, once a convent, it’s clear why the middle classes tend to avoid the national health system – the infrastructure is dilapidated, the queues long and, from my brief observations, the hygiene quite questionable.
However, the atmosphere at our ultimate destination, a lecture theatre in the 38th ward, is rather different. On stage, the professor in charge, a small man in his 80s, is having an animated conversation with a prospective patient, a woman in her late forties. A dozen or so trainee surgeons from places as far afield as the Dominican Republic, Lebanon and the UK listen intently, occasionally laughing along.
Even with the help of a translator I follow only about 40 per cent of what is said, but the overall vibe is that of a TV chat show. Until the patient suddenly disrobes, that is, and the professor examines her body and suggests how she might benefit from plastic surgery.
It’s a startling moment for me – I didn’t, frankly, expect such intimacy when I was invited to spend a day with Ivo Hélcio Jardim de Campos Pitanguy, the most famous plastic surgeon in the world, and a man who has been referred to as “arguably Brazil’s second most famous person after football legend Pelé”. But it’s startling, too, for Rozina Ali, the 46-year-old British Harley Street plastic surgeon who has just arrived for a two-week secondment and is sitting on my left. “How undignified for her,” she mutters.
But the patient doesn’t seem to mind at all. And neither do any of the cases that follow: a perfectly pretty student aged 17, who complains that her nose is “too masculine” and is told in response that she will get the nose job she wants and be “made beautiful”; a woman, about 50, who says “her face doesn’t look how she feels inside” and whose gratitude for a promised facelift takes the form of tears and a request for a selfie with Pitanguy; and a 40-something woman whose rear has been left visibly misshapen after silicone injections, and who points out her six-year-old daughter in the room, prompting the professor to ask the child, “So, what can we do for you?”
Welcome to Brazil, the world capital of plastic surgery, where copies of Plástica & Beleza (Plastic & Beautiful) sit next to Vogue on news stands; where the 2001 winner of the national beauty pageant had a reported 19 surgical interventions; where during the Nineties the number of plastic surgery operations performed multiplied sixfold; where celebrities, politicians and even activists from the LandlessWorkers’ Movement talk about the cosmetic work they have had done; and where the poor are as keen on nips and tucks as members of high society.
It may seem bizarre in a country still afflicted by extreme poverty that some 54 per cent of people should, according to a recent survey, have considered cosmetic surgery (compared with 30 per cent of Americans) and that the population should exhibit five times the per capita cosmetic surgery rates of much richer European countries. And that more than 20 public hospitals in Rio should offer discounted or free cosmetic surgery to the poor.
The clinic at Santa Casa, originally founded more than half a century
ago by Pitanguy, was the first. Indeed, Pitanguy, who has during his long career been nicknamed everything from the “Renoir of rhinoplasty” to “the Botticelli of breast surgery”, can be largely credited, or blamed, depending on your view, for the prevalence of plastic surgery here.
T he first plastic surgeon to chair the Brazil’s Academia Nacional de Medicina, his hundreds of academic papers are apparently so erudite that they have also earned him a place in the Academia Brasileira de Letras – a respected cultural institution in Rio de Janeiro whose mission is to improve Brazil’s language and literature. He also runs the world’s most competitive postgraduate training school for plastic surgeons, with hundreds of surgeons applying for one of 15 spaces each year. If that weren’t enough, he lectures around the world, has had characters in TV dramas based on him, he’s been the subject of a samba, appeared on
60Minutes in the US, has served as president of Rio’s Museum of Modern Art for a decade, lives on his own private island near Rio, has a list of awards and honorary degrees so long that I gave up reading after 15 pages, is fluent in Portuguese, English, Italian, Spanish, German and French and has performed more than 50,000 operations in his career on patients who have reportedly included Sophia Loren, Stan Getz, Zsa Zsa Gabor, François Mitterrand, Brigitte Bardot and Niki Lauda.
Frankly, he sounds like a character out of a South American magic realist novel, and it is hard to tally meet the ambidextrous surgeon at his smart private clinic. It could not feel any more different from the public hospital. Instead of being overcrowded, the dark rooms, where the glass in the mirrors is smoked to minimise the shock for postoperative patients, are only partly occupied owing to the preference among the rich of Rio to have surgery in winter.
B
‘You associate it with vanity. But plastic surgery is about being happy with who you are’
any of it with the elderly man who is helped on stage by his trainees and who, for all his fabled eloquence, I struggle to get answers out of as a group of us chat over morning coffee. The 87-year-old responds to basic questions about the day’s cases with digressions on the geography of Brazil, Goethe and the tale of a horse he once owned that fell into the sea but was found alive three days later, and subsequently developed a close friendship, I think, with a duck.
The dissonance doesn’t ease when, later that same day, I go to ored bodyguards lounge about in black limousines in the car park or flick through art catalogues in the air-conditioned waiting rooms. An entire room on the ground floor is given over to displaying Pitanguy’s awards, and when I go up to his office on the top floor, I find it is lined with fish tanks, birdcages and modern art.
“That’s a very interesting picture,” he says when he spots me examining a Dalí. Did he know the artist?
“I knew him well. But this was a gift of a patient. You notice that the king in the picture has no body, while the queen does? The message, the way I see it, is that power doesn’t need a body.”
He mentions a book he is reading about Lucian Freud. “I try to read one or two hours every night. TV is so superficial. Have you come across it?” I haven’t, and as we sit at a table, I am more interested in having another stab at a question I’d failed to get an answer to in the morning: Wasn’t the 17-year-old girl too young for plastic surgery?
The quiet room seems to make it easier for him to followmy English. “She would not be operated on without her parents’ consent. But she will be 18 in April, so it is no problem.”
But isn’t it sad that such a pretty girl should want plastic surgery? “It is not sad; it is the opposite! She wants to improve. And it is a correct decision because she will be much prettier her whole life. I will do her nose, her chin, a very small implant.”
I wince. And tackle the issue from another angle. Should people of her kind of limited financial means be wasting money on surgery? While reconstructive surgery is free at Santa Casa, which is run with help from Catholic charities and some state funding, and while cosmetic patients get their operations at ‘bargain prices’, they still have to make contributions towards basic hospital costs and anaesthesia, even bringing their own sheets and drinks. Contributions that surely would be more useful elsewhere.
“The people you saw this morning are not poor; they are not rich. They are an emerging class.” He takes a sip of water. “But, nevertheless, the service they get is in some ways better than at my private practice. At Santa Casa, all the patients have to undergo a psychological exam before surgery, a health test and social screening. We can also, for example, insist they lose weight before surgery. Whereas with private clients, they can always go to another doctor.”
He pulls his chair closer to me. “But when you speak of plastic surgery there is prejudice in your voice. You associate it with vanity. But plastic surgery is about more than that: it is about becoming happy with who you are.”
At this point Pitanguy articulates, at length, his famous vision of plastic surgery, which he describes as ‘humanistic’ and ‘anthropological’. He says that when he first started working in a public hospital in Rio, the patients whose appearance he improved were often more grateful than the patients whose lives he had saved. This made him come to the view that there was no real difference
between reconstructive and aesthetic plastic surgery, because both “heal the psyche”. Or as he famously put it in one paper: “A plastic surgeon is a psychologist with a scalpel in his hand.” He adds that the poor have as much “right” to this “beauty” as the rich.
P itanguy’s thoughtfulness on the topic, which has earned him yet another nickname, the “philosopher of plástica”, is almost as disarming as his CV. There is a common view of plastic surgeons as superficial and money-grabbing, an impression intensified for me on the plane to Rio by watching Rob Lowe play Liberace’s grasping plastic surgeon in Steven Soderbergh’s Behind the Candelabra.
It would be wrong to say Pitanguy displays no such brashness – he dismisses my concern that 70 per cent of deliveries in some private hospitals in Rio are caesareans, on the grounds that, “Medicine has improved; you cannot go back,” and although he denies going under the knife himself, a 1980 piece in
The New York Times claimed that “several friends say he has already had plastic surgery”.
He also rejects my theorising that the Brazilian obsession with beauty might be explained by a high-calorie diet (carbohydrate-laden meals seem to feed a maniacal interest in dieting), or impulsiveness (Brazil has been a boom-and-bust place for centuries, arguably making its people want to live for the moment), putting it, instead, down to the weather: “If you go to England, where it is colder, it is not natural to worry about your body, but here you show it.”
But he is remarkably subtle by the standards of his profession. He does not, for instance, believe in providing patients with computer-generated images of what they will look like after surgery. “My feeling is that if you give someone an image, you are projecting a false idea of what they might become.” He claims that there is no need for plastic surgery if you are self-confident. “If you have a good
‘If you have a good ego, you don’t need surgery… The important thing is it’s there if you need it’
ego, you don’t need [plastic] surgery... The important thing is that it is there if you need it.”
The father of four children (aged 45-57), and grandfather of five (aged 16 to 28), employs his own 55-yearold daughter, Gisela Pitanguy, as a psychologist at his private clinic for patients, which he wouldn’t need to do if he were just interested in maximising returns.
And he is so articulate on the subject of beauty for the poor that I begin reconsidering my presumptions. If you’re in a favela, and you know beauty might lead to better employment opportunities (research in theWest shows that the beautiful have better job prospects) and better marriage prospects, then is having plastic surgery any worse than, say, developing a talent in football?
However, you can’t become as famous as Pitanguy without attracting criticism, and he has received his fair share of brickbats, the most common complaint being that he has an “assembly-line approach’’ to plastic surgery.
In the Eighties it was rumoured he often delegated operations to his assistants. In 2010’s PrettyModern: Beauty, Sex and Plastic Surgery in Brazil, anthropologist Alexander Edmonds claimed, “Pitanguy seems to complete an entire operation himself only rarely these days and leaves patients in the hands of his medical team.”
And he admits to me, albeit reluctantly, that since being injured skiing and developing arthritis in his hands, he does not operate any more. “But I am there for each patient.
“I give guidance. I make the surgical plan. And I’ve always believed in teamwork.”
T he other common complaint is that he is a better salesman than pioneer. A complaint that can be countered with the simple facts that Ivo Pitanguy has made a number of breakthroughs that are still used in plastic surgery across the world, that his works are still set texts on plastic surgery courses and surgeons still come from abroad to learn from him.
Indeed, Rozina Ali, who I catch up with on my return to London, is gushing with praise. “For aesthetics he is top of the tree,” she observes.
“He treats it very seriously, and seeing him in action, coming into surgery every week, I was amazed at how modern he is. He routinely uses the kind of implants in breast surgery, for instance, that are considered too expensive even in the UK, and has a very enlightened attitude to patients. I was really astonished by his understanding of people and the human condition in general.”
The third common criticism Pitanguy faces is that he deliberately blurs and exploits the line between the professional and the personal.
There have been rumours throughout his career that he operates on celebrities on his private island, allowing them to recuperate in privacy, and that he ended up working on many of the beautiful people he partied with in Rio and who appeared alongside him on the social pages of Rio’s papers in the Eighties and Nineties.
In 1982 he was even thrown out of the American Society of Plastic and Reconstructive Surgeons after he was charged with violating the society’s advertising and marketing guidelines. But Pitanguy, who has considered the relationship between plastic surgeon and patient in great depth, points out that he was readmitted in 1990 and puts the entire episode down to professional jealousy.
So he doesn’t operate on patients on his island? “The island has always been a private thing, not a medical thing at all. But some clients have become friends, and friends come to visit.” He adds, “I always become friends with my patients. It is important to have a good interaction. And they call me for advice. For example, I had a patient whom I operated on two years ago call me the other day because she has a very small cyst. They don’t know if it is a tumour, but she trusts me, and tomorrow we will do the small operation, and I will be present during the procedure.”
This story serves as a reminder of the fact that, as well as being the man who made Brazil into a world capital of plastic surgery tourism, Pitanguy began his career as a conventional doctor. His father was a surgeon, and so intense was his desire to follow in his footsteps
‘A lady in her 80s asked for a nose job saying she didn’t want to be buried with the family nose!’
that he lied about his age to get into medical school at 16.
After training in America, France and the UK, where his mentors included Sir Harold Gillies, the father of plastic surgery, he persuaded the Brazilian authorities to give him seed money to open the clinic at Santa Casa.
Early patients included hundreds of children burnt in a terrible circus fire in Niterói, across the bay from Rio de Janeiro, whom Pitanguy treated for weeks, and a pickpocket whose hand had been filleted by an angered victim.
But over time he began experimenting with cosmetic procedures, performed some of the world’s earliest breast and bottom lifts, transformed sagging stomachs, and did something remarkable for the time: he began sharing the techniques he had developed.
Not only does Pitanguy’s career span the 20th-century transformation of plastic surgery from the realm of reconstruction to the realm of the cosmetic, he has also inspired a revolution in types of cosmetic procedure.
Men are increasingly turning to surgery, with Pitanguy’s numbers rising from 6 per cent in the Eighties to around 23 per cent now.
“Before, if a man wanted to do something, they had to invent an accident, or say they couldn’t breathe. But there will always be more women than men… Men have other outlets for ego.’’
And then, of course, as life expectancies have extended, there has been the rise in surgery among the elderly – with people asking for facelifts in their seventies and eighties.
“Actually, the other year I had a German lady in her 80s come to see me, saying she wanted to have a nose job.” Did he operate? “Yes,” he laughs. He is always laughing. “She said, all my family had this nose, but I don’t want to be buried with it. She was very happy with the results.” Of course, Pitanguy himself is older now than the lady in question and although he may once have had a black belt in karate, and while one of his bodyguards may once have referred to the doctor as his personal trainer because of the amount of weight he lost following him around, it is poignant to listen to such a fragile old man discuss beauty and physical perfection.
It is possible he finds it poignant, too, for he seems to want to distance himself from the glamour and excesses of his former life, which once meant, according to one report, “his every move, short of his pulse beat, being recorded in Rio’s gossip columns”. He claims he no longer has a private jet (“I had one for 25 years but now I go by boat or car”), that he has never been motivated by money (“I never cared about anything material. You should live simply”) and is not interested in fame (“It is pleasant. But one must not overestimate yourself. Someone recently came up to me and I thought he had recognised me, but he actually just wanted to know the time”). The man who prefers the title of Prof to Doctor adds, “If I would like to be known or remembered for anything, it is for sharing knowledge.”
His iPhone starts ringing and it is clear he has a cosmetic or medical emergency to deal with. But before we part I can’t resist asking if he thinks I’d benefit from some cosmetic work. I’ve always hated my nonsymmetrical ears, I say. “If you look at human ears, they all look funny, no?”
What about my nose then? It’s huge. “Take off your glasses.” He examines my Punjabi profile, as he had the teenage girl that morning. “The nose is a very interesting organ because when you are 12 it starts to grow, during the problematic period of puberty.” I’m beginning to wish I hadn’t asked. “But with you, the nose is probably normal. Your nose looks racially very good. It’s masculine… and your forebears had that nose. I would keep it. But if there was something smaller you wanted to do, we could do it.” He puts a soothing hand onmy shoulder and smiles a bright smile. “But listen. You should not be so analytical about yourself.”