BRAZIL’S PLAS­TIC SURGERY KING

‘The poor de­serve beauty as much as the rich’

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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.”

RE­PORTAGE

Pi­tan­guy has per­formed more than 50,000 op­er­a­tions

Pi­tan­guy’s clinic is in a gated villa in the Botafogo area of Rio

Sophia Loren is ru­moured to have been one of Pi­tan­guy’s pa­tients

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