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cosmetic surgeries conducted every year. Within Brazil, São Paulo and Rio de Janeiro are the two main centres for this surgery and have the largest number of public and private beauty and cosmetic studios, clinics and hospitals (in Portuguese, studios de beleza, clinicas de beleza and clinicas e hospitaís de cirurgia plástica) in the country.11 In fact, there seem to be an endless number in Rio de Janeiro. In some areas, I found at least one on every corner as I moved around the city. Rio de Janeiro is not only associated with beach culture, carnival, football and hedonism, but also with beautiful and perfect bodies. In recent decades, a boom in the beauty industry and the growing popularity of cosmetic surgery can be observed. In a worldwide survey conducted by Unilever, 63% of Brazilian women were reported to have said that they would like to have cosmetic surgery (the largest percentage of any national group).12 The official statistics on cosmetic surgery in Brazil, published by the Sociedade Brasileira D Dorneles de Andrade / Reproductive Health Matters 2010;18(35):74–83 75 de Cirurgia Plástica (SBCP) in 2009,* of all plastic surgery procedures (629,000) in Brazil, two-thirds were cosmetic and one-third reconstructive. Of the cosmetic surgery patients, 88% were women and 15% were adolescents under the age of 18, 38% were aged 19–35 and 34% aged 36–50. An increase in “tourism” to Brazil for cosmetic surgery has also been observed, which is ascribed to lower prices than in the USA and Europe, and also to Brazilian expertise in plastic surgery. The most frequently sought surgeries were breast augmentation, followed by liposuction, abdominoplasty (tummy tuck), breast reduction, and surgeries on the face, including eyelid surgery, rhinoplasty (nose modification) and face lifts. In research conducted by Datafolha, two-thirds of cosmetic surgery patients were categorised as caucasian and one-third as coloured or black. The most frequented locations for cosmetic surgery were private hospitals (58%), followed by private clinics (28%) and public hospitals (14%).13 Some authors have analysed why the body is considered to have such an important role in Brazilian culture. North American anthropologist Alexander Edmonds, who conducted field research in Rio de Janeiro in 2002, talks about a “democratic concept of beauty” in Brazil, which implies that “the poor have the right to be beautiful too”. He believes, as Gilberto Freyre suggests,14 that in Brazil physical appearance is an essential element in the construction of uma identidade nacional brasileira (a national Brazilian identity). Edmonds points out the association between social class and beauty in Brazil, and asks whether beauty practices can be regarded as a means of social mobility, or a form of esperanca popular (in this context hope for better social status) in Brazil.15 Brazilian anthropologist Mirian Goldenberg also talks of the high value assigned by Brazilians to the body (o corpo como valor), especially by cariocas (people from Rio), and of the body itself as a status symbol.16 The ideal of eternal youth – hand-in-hand with permanent discontent with the body as it is, always needing improvement – is denoted by the local expression for a trained and well-shaped body – “a boa forma”. Is Goldenberg right to say that Brazilians see the body as economic, symbolic and physical capital?16 What is the most crucial characteristic of Brazil’s body-cult, and why is it so important to transform, modify, adapt and correct one’s body in Brazil? My research sought to answer these questions. Body fashions and beauty ideals are common to every culture and at all times in history, and people of both sexes have shaped their bodies to meet the predominant beauty ideals of their societies. Thus, the body is a social body, which “embodies” signs and symbols of a culture,17 and which is individual and public at the same time. Surgery on a healthy body, according to Ensel,18† reverses the actual intention of “healing” in medicine. In this context, the phenomenon “cosmetic surgery” can be seen as an indication of how societies and individuals who practise it think about and express themselves through their bodies. The development of female genital cosmetic surgery (FGCS) is relatively new. In the mid1980s the first operations of this type, as we know them today, were conducted in the USA. Accurate numbers on how many women actually undergo FGCS and its consequences are not known. Some research on this issue uses critical cultural approaches in their analysis.19,20 The authors refer to pictures of and ideas about female bodies, which form the basis for this practice. Virginia Braun notes that the profile of the “natural” vs. the “perfect” female body represents the role-model for these interventions, and comes from pornographic depictions of the female body.19 The construction of “normality” vs. “deviance” or “normal” vs. “abnormal” regarding female genitals and their surgical alteration is culturally shaped in the discourses of aesthetic medicine and the media. My aim, looking at this issue in Brazil, was to * The study was conducted by Datafolha, on behalf of the SBCP, founded in 1948, the official union of about 4,000 practising plastic surgeons in Brazil. Their members have to qualify to be admitted to the Society and must follow official ethical and medical guidelines. See: . † In
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