The poor have the right to be beautiful: cosmetic surgery in neoliberal Brazil

Alexander Edm onds Macquarie University

Drawing on ethnographic eldwork in hospitals that offer cosmetic surgery to the poor, this article examines the causes of a rapid growth in plastic surgery rates in Brazil over the past two decades. It argues that problems with diverse social origins manifest themselves as aesthetic defects, which are diagnosed and treated by the beauty industry. But plastic surgery also incites the consumer desires of people on the margins of the market economy and mobilizes a racialized beauty myth (a key trope in national identity) in marketing and clinical practice. Beauty practices offer a means to compete in a neoliberal libidinal economy where anxieties surrounding new markets of work and sex mingle with fantasies of social mobility, glamour, and modernity.

Only intellectuals like misery. The poor prefer luxury. Joo Trinta, Carnivalesco, Carnival parade designer The patients here have this philosophy of the masses: the beautiful live and the ugly die. Dr Marcelo, chief of a plastic surgery ward at a Rio de Janeiro public hospital1

In the universe of beauty

In contrast to the calm and comfort of the private clinics where I begin my eldwork, Rio de Janeiros public hospitals have a hectic environment. Lines of patients sprawl through the narrow corridors that serve as waiting rooms, while young residents in surgery bustle past with stacks of medical les in their arms (Fig. 1). The patients, mostly women and children, span the full range of colours celebrated in Brazil as the hallmark of the povo, the common people. For some it is easy to tell what the complaint is, as the residents say. A cleft palate, a chest burn, a mangled ear. But most patients come for cosmetic surgery, what they call simply plstica. On most days when I visit Santa Casa hospital, housed in an old convent in downtown Rio, the patients are eager for their operations and there is an excited buzz in the hallways. They have been waiting anywhere from a few months to several years. Strangers strike up conversations about their breast surgeries or discreetly lift up their blouses to compare results. Upstairs relatives crowd the corridors waiting to visit patients recuperating in shared rooms, while a team of forty surgeons perform the full range of cosmetic and reconstructive procedures. A Japanese television crew shoots a story one day. On another, former residents come to pay their respects from Europe. In the midst
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Figure 1. Patients waiting to be attended at the plastic surgery ward of Santa Casa Hospital, Rio de Janeiro. (Photo by author.)

of this daily routine the presence of an anthropologist will go mostly unnoticed, the founder of the clinic, Dr Ivo Pitanguy, tells me, and leaves me free to wander the hospital. Vera, a woman in her forties, explains why she decided to have a breast reduction. After having a child at age 20, her breasts enlarged. I decided to take better care of myself, n? I said to myself, I deserve this, its my time now. If its something bothering me, I have the total right to do it . Like many patients, Vera came to Santa Casa after seeing an interview on television with Dr Pitanguy. When he founded the plastic surgery ward in 1962, it offered only reconstructive procedures, and Pitanguy performed cosmetic operations in a private clinic. The two clinics one offering a luxury service, the other treating the victims of industrial res and car accidents seemed to illustrate Brazils stark inequality. But Pitanguy has said that plastic surgery is not only for the rich. The poor have the right to be beautiful. As the surgeons he trained open up new clinics around the country, demand for plstica has been steadily rising. Santa Casa, which is funded in part by Catholic charities, in part by the state health system, charges a small fee to cover anaesthesia and medical materials for cosmetic patients. But there are also fully public hospitals in Rio and around the country, supported by federal or municipal budgets, which offer cosmetic surgery at no cost.2 And in the private sector, aggressive price-cutting and credit plans offered by surgeons entering a saturated market have made plstica integral to the roster of middle-class aspirations (Os exageros da plstica 2002). During the 1990s, the number of operations performed increased six-fold. In 2001, Brazils largest news magazine Veja ran a story titled Brazil, empire of the scalpel, which claimed that Brazil had displaced the United States as the worlds champion of cosmetic surgery (Brasil, imprio do bisturi 2001).3 As if to conrm the victory, a samba school honoured Pitanguy in a 1999 Carnival allegory, titled In the universe of beauty. Brazils leading surgeon led the procession from a perch on a oat while hundreds danced to a samba song that celebrated his work:
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Creating and modelling nature The hands of the architect Are in the universe of beauty Giving men value with his chisel ... Love take me so I will delight in My narcissistic soul ... The image and likeness of the Lord Restored by the hands of the professor The self-esteem in each ego awakens ... Plastic beauty from subtlety to perfection The light of heaven conducts his scalpel Caprichosos sings Master Pitanguy. No universo da beleza, Mestre Pitanguy, performed by Caprichosos de Pilares Samba School, 1999

A shrinking state with a crumbling health system provides free plstica. A right to beauty is celebrated in a country where human rights are disparaged as privileges for bandits (Caldeira 2000: 39). And perhaps not least, a tribute is paid to plstica during Carnival that beloved folk opera of Bakhtinians and Brazilianists (myself included) when the long-suffering povo supposedly do not pay homage to elites but, for a moment, take their place. These juxtapositions make good news copy, and numerous articles on plstica have appeared in Western media. The tone is one of outrage or amusement. The Brazilian media, however, have been remarkably positive about the growth of plastic surgery. Some stories cite the international reputation of Brazilian surgeons as a point of national pride. Others view the growth of plstica as an indicator of economic health, a exing of Brazils consumer muscle. The fact that more Brazilians are having cosmetic surgery, Veja reasoned, simply means that more Brazilians are becoming middle class (Brasil, imprio do bisturi 2001). But the growth of plstica cannot be explained as a product of economic prosperity. Wealthier European countries have per capita cosmetic surgery rates only about a fth of Brazils (Brasil, imprio do bisturi 2001), and the so-called democratization of plstica occurred during a period of rising economic inequality in the 1980s and 1990s, a period where the term brazilianication became a synonym for savage capitalism (Mello & Novais 1998). Why is demand for plastic surgery rising in one of the most unequal societies in the world? How can beauty be offered as a right in a cash-strapped public health system? And why is there an operation called correction of the Negroid nose in a land known as a racial democracy? Focusing primarily on the West and relying on textual and media materials, several scholars have argued that beauty practices are an exercise in patriarchal power that disciplines, normalizes, and medicalizes the female body (e.g. Bartky 1990; Bordo 1993; Chernin 1981; Jeffreys 2005; Morgan 1991; Rankin 2005; Wolf 1991). I nd it necessary to modify this framework, however, in moving from the implicitly middle-class subjects in these accounts, to patients who belong to the popular classes, who have a different relationship to modernity, medicine, and consumer culture. In taking an anthropological approach, I instead try to balance a hermeneutics of suspicion, which analyses the structural factors feeding the beauty industrys growth, with a hermeneutics of retrieval (Ricoeur 1970), which interprets local meanings across gaps of culture and class (and, in my own case, gender, as plstica is a primarily feminine realm). I argue that a range of problems with diverse social origins manifest themselves as aesthetic defects, which are diagnosed and treated by the beauty industry. But with its
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powerful clinical and consumer visualization of the body, plstica also taps into the aspirations of people on the margins of the market economy. Beauty practices offer a means to compete in what I call a neoliberal libidinal economy where anxieties surrounding new markets of work and sex mingle with fantasies of social mobility, glamour, and modernity. At a time when plastic surgery is growing in developing countries around the world, from Latin America to the Middle East and East Asia, the Brazilian case, I hope, will offer insights into how new congurations of medicine, therapy, and aesthetics are consumed in the peripheries of capitalism.

The self-esteem in each ego awakens

Denise is a 17-year-old seeking a breast reduction and lift. She is moderately overweight, wearing jeans that even by Rio standards seem painfully tight. Her shoulders are tense, her arms folded over her chest. Dr Afonso tells her to lift up her t-shirt, but pauses to ask a woman standing at the back of the room if she is her mother. (Minors cannot be examined at the hospital without the presence of a guardian.) Why? Denise responds to the doctors request, but then gives in without an answer, pulling up her t-shirt halfway. Sensing her discomfort, Dr Afonso does not, as he usually would, pinch the sides of her breasts to simulate the effect of the lifting operation. Its a Friday morning at Santa Casa, the day of the plano cirrgico, a pedagogical discussion of technique led by a senior surgeon. Under a ceiling fan that ineffectually stirs the humid air, residents sit in rows of tiny school desks. Patients are asked to expose the relevant part of the body, while the residents take turns leading the examination. Dr Afonso explains that Denise should wait until she has lost some weight in order to get the optimal aesthetic result. Wait? Denise interrupts him. Ive been waiting in line for three years. The mother seems embarrassed and tries to explain. Doctor, its really hard. She has back pain. She pauses, then adds helpfully, Her self-esteem is low. The surgeon turns back to Denise and adds, Okay, well do it. If you lose more weight come back and well do a touch-up (retoque). He applies his signature to her le. After Denise has left the room he explains his reasoning to the residents. She is not pretty, she has low self-esteem, and shes poor. She has no access to psychotherapy, to gyms, to nutritional guidance. And do you think shes going to lose weight? The reason we operate is not because of her back. Her principal illness is poverty. It is doubtful Denises mother swayed the doctor since patients are rarely turned away. But she did hit upon plsticas key legitimating concept: autoestima or selfesteem. As cosmetic surgery sought to establish itself as a medical practice in the United States at the turn of the twentieth century, the central difculty it faced was how to dene the disorder that it treated (Gilman 1999: 175-6; Haiken 1997: 91-130). Since a botched operation harms an otherwise healthy patient, surgeons who practised aesthetic surgery risked breaking the Hippocratic oath. Early plastic surgeons denounced beauty doctors as quacks. But after the First World War, surgeons realized that the improved techniques developed while reconstructing the mutilated faces of soldiers could successfully be applied for purely cosmetic purposes. All that stood in the way of the widespread peacetime growth of the specialty was the discovery of a proper illness.
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The discovery was made not by medicine but by popular psychology. In the early twentieth century, the notion that appearance is integrally linked to the psyche became publicly accepted. Concepts such as the inferiority complex helped make cosmetic surgery acceptable by giving it a therapeutic rationale (Haiken 1997: 114-17). But in Brazil, this therapeutic rationale has been pushed into new territory in a sense, to its logical conclusion as it is deployed in Brazils public health system serving a population described simply as carente, needy. Over thirty-ve years ago, Dr Claudio founded a plastic surgery ward at a municipal hospital in Rio de Janeiro located at the foot of Mangueira shantytown, home to Rios most famous samba school. In the past, he told me, the public health system only paid for reconstructive surgery. And surgeons thought cosmetic operations were vanity. But plstica has psychological effects, for the poor as well as the rich. We were able to show this and so it was gradually accepted as having a social purpose. We operate on the poor who have the chance to improve their appearance and its a necessity not a vanity. This reasoning, however, raises the question of why if patients are suffering psychologically they should not be treated by psychologists? In fact, some surgeons do agree that their patients could benet from therapy or pharmaceuticals. Pitanguy employs a psychologist at his clinic who gives all patients a pre-operative interview. But while she believes that the majority of patients are contra-indicated, she rarely turns them away so as not to disappoint them. Other surgeons, those struggling to get a toehold in a crowded market, appeal to the therapeutic rationale as a marketing tactic: for example, through ads that promise to raise your breasts and your self-esteem. But many surgeons I talked to also seem sincerely to believe that plstica is a form of public health to which the poor should have access. Look, no surgeon would put in a prosthesis when theres no need, the Chief of Plastic Surgery at a federal hospital told me. There are women with a really fallen ego. After four children, the breasts are so shrivelled and ugly ... theres a psychological indication and so we authorize the surgery. The surgeons sense of condence seems to be reinforced by the long lines they see every day at their clinics, by requests for operations from the wives and relatives of their colleagues, by the fact that female staff at hospitals, from nurses to coffee vendors, all want operations. Some patients even revere their surgeons as artists or geniuses with gifted hands an association exploited in ads that juxtapose before and after pictures with images of works of art. But while Pitanguy acknowledges that there is a lot of art in our eld, he argues that ultimately plastic surgery is normative: I cannot like a Picasso have three breasts or whatever. But inside our limitations we can do many things. Pitanguy, however, does feel it necessary to warn his less experienced colleagues to be wary of an excess of self-condence. He calls this the Pygmalion complex, in which the surgeon-artist repeats the drama of the sculptor, and falls blindly in love with his work (Pitanguy 1992: 271). The surgeon falls in love, not with the patient, but rather with the physical form he creates a condition that blinds him to the patients real complaint. More common than the Pygmalion complex is a kind of patient reaction that surgeons compare to psychoanalytic transference and projection. The spectre of the complaining patient haunts plstica more than other medical specialties because defects are psychologically invested. Post-operative reactions range from depression and crises of regret to euphoria, exaggerated gratitude, and sexual invitations to the surgeon (Pitanguy 1992: 271).
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Such reactions prove that surgical incisions do not just alter the face, but go beneath the skin, touching the psyche too (Pitanguy 1983: 8). But while they are wary of the scalpel slave the patient addicted to surgery most surgeons tend to believe that plstica is simply the most effective therapy. Thus a plastic surgeon joked, What is the difference between a psychoanalyst and a plastic surgeon? The psychoanalyst knows everything but changes nothing. The plastic surgeon knows nothing but changes everything. Moreover, surgeons point out, psychoanalysis has limited efcacy with working-class patients. But the suffering that plstica cures is, unlike neurosis, distributed across classes. As Dr Herbert put it, Faced with an aesthetic defect, the poor suffer as much as the rich.
Giving men value with his chisel

Perhaps Denise experienced the same suffering that Rogria did, a teenager whose parents paid a private Ipanema clinic about $5,000 for an identical operation. But if we accept for a moment that these patients have been healed, we might still ask how they came to have a defect in the rst place. In the absence of physical pain, what motivates patients to confront the bureaucracy of public hospitals, wait on lines along with the disgured, endure a painful period of recuperation, and undergo the risk of complications and even death? One answer, as we have seen, is low self-esteem. But Dr Afonso also voiced a minority opinion: Her principal illness is poverty. The comment indicates that the psychological suffering that plstica heals has roots in larger social problems. When President Cardoso was inaugurated in 1995 he announced the end of the Vargas era. His claim was that the policy of modernization as dened by the populist leader in the 1940s and 1950s could no longer serve as a guiding vision of national development (Reis 2000: 178). Whether a new incarnation of modernization will emerge or what new forms of polity will take its place remains to be seen. During this time of transition undergone by Brazil, many have argued that the emergence of new rights has coexisted with a split in citizenship between the market-able and those surviving on the margins of the formal economy (Biehl 2001: 105; 2005). While the human rights movement has grown in Brazil, there has also been an increase in violence and in police terror, and a partial privatization of security (Caldeira 2000). In the area of health care, the split between private and public sectors of different quality has deepened, even as the new democratic state ambitiously provided a universal right to health care (Biehl 1999: 54-7).4 Thus the right to health care, like many social rights in Brazil, is based on a public-private division that reproduces the larger inequalities of the market economy. With the shrinkage of the state and an inux of foreign goods, others have argued that citizenship is increasingly dened in the sphere of consumer culture (Canclini 2001; ODougherty 2002). If Brazil is Belndia, as an economist put it, half-Belgium, half-India, then its two sides are drifting further apart. In this time of uncertainty, diverse social anxieties emerge as symptoms in the beauty industrys psychological and medical discourses. And so while surgeons believe the aesthetic defect is located in the patients psyche, and imply that they are treating a psychosomatic disorder, I argue that the aesthetic defect is also sociosomatic (Kleinman & Becker 1998: 292): produced by connections between mind, body, and society. Receptionists, elevator operators, maids, cooks, hotel staff, vendors, telemarketers, events promoters, English teachers, and secretaries. This list of commonly encountered
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patient occupations points to three related social trends in Brazil: the rise of female employment, the feminization of the working class, and the growth of the service sector (Ribeiro & Scalon 2001: 3). Service work places a special emphasis on the appearance of the worker, who faces direct contact with the customer. Traits such as youth and sexual allure can add value to the service interaction, while colour continues to act as a bar to some job categories (Fry 2005: 267-9; Hasenbalg & Silva 1999). The boa aparncia (good appearance) unofcially required by many service jobs is a euphemism for white.5 Colour is a provisional classication in Brazil, subject to adjustment hence the saying money lightens. By the same logic, subtle cosmetic changes may nudge a job-hunter a little closer to a boa aparncia. These conditions present fertile ground for anxieties about appearance. Aline is a 24-year-old breast implant candidate who lives in a working-class area in Rios North Zone. After seeing an ad, she went with a friend to a cheap private clinic close to home. At 3,000 reais, the surgery would still have been a large sacrice. Her friend backed out and decided to buy a car instead. But then Aline decided to try Santa Casa because she heard that it was a good deal. The breast is a thing that bothers me. Its something for my work because they really demand a good appearance. I pass through a selection each day, and the better I am ... Ill have a return on that. Aline works at product promotions and events, distributing paper cups of Gatorade at bars near Rios South Zone beaches. The job pays well, about 20 dollars a day, but work is irregular. She has been doing it for ve years, hoping to save enough money for college. Lots of girls apply to the company and were selected by the body and appearance ... I want to improve myself. After the breasts, Ill do a lipo on the saddlebags and little tires . Will you earn more money? I think so. No ones going to hire someone who will ruin the image of the product. They hire the best they can get. And in any case, it will boost my self-esteem. References to work and the wider social world punctuate discussions of the decision to have plastic surgery. Some worry about being red, others hope to break into a new job market. Nanc is to have rhinoplasty after losing a job because, she says, her nose is too ugly. She is surprised when I ask her why she wants to have an operation, as if it were obvious that she needed it. Its very at, she points to her nose. I want to make it ner, turn it up. During the operation unsupervised as it turns out the residents disagree about the surgical indication. There isnt much indication, Dr Hermano says,because its a very Negroid nose, its her type. Theres not much we can do. But his colleague argues, Her nose is very ugly. Not even Pitanguy could make that a pretty nose. But we can do something and it bothers her a lot so I think theres an indication. In the end they can agree their job is to please the patient. Plstica has been democratized not only via the public health system but in the private sector as well. After years of hyperination the 1994 Plano Real expanded access to consumer credit. Plstica nancing plans began to target what one company called the long line of secretaries, ofce assistants, and maids ... waiting for cosmetic surgery at public hospitals. Other consumers formed plstica consrcios associations that use a lottery to enable members to make large purchases, traditionally cars or higher
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education. Surgeons appear on talk shows such as Before and After, perform free plastic surgery on models or beauty contestants (Fig. 2), or take out ads in glossy monthlies with names like Plstica & Beauty and Plstica & You. Though patients view such publications as educational, they are, in fact, a kind of print infomercial where stories on the latest medical technologies mingle with images of celebrities, plastic surgeons in tuxedos, and miraculous before and after images. Such marketing exuberance is hardly unique to Brazil. But I argue that while the beauty industry is clearly global, as a consumer phenomenon it should be understood in relation to specic dynamics of consumption and status in Brazil. In the post-war period, Brazil underwent the wrenching transformations of accelerated capitalist development. In a few decades, a backwards coffee economy grew into a consumer society with the ninth largest GDP in the world. During this period of giddy economic growth, Brazil also created one of the largest and most sophisticated media networks in the developing world (Mello & Novais 1998). Established with the support of the military dictatorship, the Globo network dened its programming mission as presenting an image of a populace moving together toward modernity, glamour, and a materially enriched, upwardly mobile lifestyle (Kottak 1990: 37). Nearly twenty years after the fall of the dictatorship, the middle class remains a minority in Brazil, at less than a fth of the population, though Globos vision elaborated in export-quality dramas dominates national airwaves. This situation is one in which consumption is both symbolically central and beyond the reach of many. In this context, public hospitals and cheap private clinics can promise not only bodily change, but also the allure of First World modernity and glamour. Marilene arrives at her consultation holding up a picture of Sharon Stone torn from a magazine. I want to be plsticaed, Luanda declares. Slang terms such as turbinada and siliconada evoke qualities such as streamlined and smooth, while ads promote moderno beauty procedures. Many surgeons are alarmed by patients who lack the culture to understand that plastic surgery is a serious medical procedure. Dona Firmina, who ed a life of

Figure 2. Miss Siliconada, winner of the highly publicized 2001 Miss Brasil contest. This contestants multiple plastic surgery operations were the focus of media coverage of the event. (Photo by author.)

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rural poverty in the interior of Minas Gerais to work as a maid in Rio, and now, at 58, sells snacks at the beach, never had time for school. She had been to a hospital only once in her life, to give birth to her daughter, until she decided to have a facelift at Santa Casa: My face was awful because I was in the sun so much.6 In principle these patients are contra-indicated because they misunderstand the benets and limitations of surgery or, like Aline and Nanc, hope through plstica to get somewhere in society, in the words of one psychologist employed by Santa Casa. They approach plstica instrumentally in the belief it will confer social mobility, erotic powers, or actual physiological rejuvenation. But while such patients betray an imperfect grasp of the therapeutic purpose of plstica, they understand perfectly well the market value of appearance. Beauty then can become a right during a neoliberal regime where rights are re-interpreted as access to goods and the antidote to social exclusion is imagined as market participation.If a girl from Ipanema can have a $5,000 breast job, a shantytown resident said, then I have the right too.

Plastic beauty, from subtlety to perfection

Brazils beauty culture illustrates Freuds (1961: 58-63) idea that nationalism is fuelled by a narcissism of minor differences, but in ways, of course, that he never intended. Physical beauty, along with samba and soccer, is a clich of Brazil. As a tropicalist fantasy of Northerners it runs through ve centuries of Brazilian history, from the letters of Portuguese sailors describing the ardent Indians who greeted their ships to the brochures of the online sex tourism business. But in the twentieth century, corporeal beauty became a trope in the ongoing political and cultural re-imagination of racial mixture (mestiagem) as crucial to modern Brazilian identity (Parker 1991).7 As a liposuction patient put it, Our country is a country of pretty people. This miscegenation here gives us a different tone I think. In contrast to the multicultural model of racial difference found in many contemporary Western societies, and to an older segregationist logic with its fears of racial contamination, in Brazil eroticized and aestheticized hybridity has been a key symbol in elaborations of national identity. Inspired by the new anthropological views of culture and race he learned while studying with Franz Boas, in the 1930s Brazilian historian Gilberto Freyre (1956) successfully attacked scientic racism in Brazil, and created a new nationalist image of Brazil as a unique tropical civilization founded in mixture. Freyres place in Brazilian thought, and the myth of racial democracy8 that his work helped create, have been much debated (Fry 2000; Goldstein 2003; Vianna 1999). I highlight here a lesser-known aspect of his work: Freyre believed that racial mixing has not only moral and cultural benets, but aesthetic ones as well. He claimed that inter-racial unions in Brazils slave plantations led to a gradual improvement in the appearance of the population, as if miscegenation were accomplished through anthropologically eugenic and aesthetic experiments (Freyre 1986: 61). These experiments created racially mixed female beauty as a national patrimony. He praised, for example, the brown, rounded bundas (bottoms) portrayed by Brazilian modernist painters such as Emiliano Di Cavalcanti as a subversive attack on Europes Apollonian aesthetic values. And he urged Brazilians to embrace morenidade (brownness) as a kind of moral, creative, and aesthetic condition that could harmonize social differences. For example, he advocated sun tanning because the new ritual, like miscegenation itself, would democratically darken Brazilians, helping to create a meta-race (1986: 116).9 Freyre in
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effect re-envisioned the relationship between morenidade and modernidade, so that brownness becomes not a barrier to modernity, but its sensual and democratic realization.10 Freyres work helps identify what I call a nationalist and populist beauty myth, which is celebrated in popular culture and deployed by the beauty industry. Paula, 25, is a single mum with a full-time job in telemarketing. She lives with her 5-year-old daughter and mother in a working-class area in the North Zone. At rst she tells me that a breast lift and liposuction are her rst plstica. But later she reveals that she had once had liquid silicone injected into her buttocks in a beauty parlour in order to t the Brazilian padro (pattern or standard). Liquid silicone an industrial oil that is injected directly into the bodys tissues is considered to be an unsafe practice (as opposed to silicone implants), and has been banned by the government. It is currently used mainly by male transvestites. But in the 1990s and before it was also used by women such as Paula, some of whom now come to public hospitals to have the substance surgically removed from their bodies. Both women and transvestites use silicone to shape the body according to a national corporeal ideal, described as large hips, thighs, and buttocks, a narrow waist, with little attention to breast size (Hanchard 1999: 78; Kulick 1998: 233).11 This ideal is used by media and marketing materials to provoke demand for particular beauty practices. A Globo news programme, for example, featured a woman who had decided to trade her bottom, on the thin side, which God gave her, for another that a plastic surgeon moulded according to the national preference. And plastic surgeons advocate certain types of operations, such as the buttocks implant, that are rare in other parts of the world. As plstica has been democratized, there has been an increase in operations that contour the body as opposed to rejuvenating the face. In 2004, 77 per cent of cosmetic surgeries were performed on the body, while the average age of the patient has sharply dropped, from 50 in 1980 to 35 in 2000 (Brasil, imprio do bisturi 2001; SBCP 2005). In some instances surgeons explicitly link body-contouring operations, such as liposculpture, which redistributes fat from the waist to the hips and buttocks, to AfricanEuropean racial mixing, which a surgeon claimed has blessed women with small waists. The Brazilian padro, however, is not always racialized, or rather there is a slippage between the national-cultural notion of a preference and a racial-biological notion of a type. Like mestiagem itself, this padro implicitly encompasses all colours, even whites, who are mostly mixed in any event, according to Freyre (as descendants of Iberian colonizers marked by the cultural and physical inheritance of the Moors). Some operations, such as breast surgeries, for example, can be linked to national but not racial identity. Until the 1990s, the most popular breast surgeries were reductions and lifts, some of which make minute changes (which nevertheless can leave large scars), creating improvements that can only be seen through the lens of the national preference.12 I have argued that a racialized beauty myth elaborated in diverse spheres of national culture incites demand for cosmetic practices. But the idealization of hybridity also co-exists with historically entrenched aesthetic hierarchies, which are inscribed on the body through cosmetic practices. And so while mestiagem is celebrated in expressions of aesthetic patriotism, surgical practices point to a more complex relationship between cosmetic practices and racial inequalities. Eugenia Kaw (1993) has argued that cosmetic surgery on perceived racial traits in the US reinforces negative
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stereotypes about racial minorities. But in Brazil with its idealization of hybridity and history of inter-racial mixing there are different cultural links made between phenotypic traits and imputed membership in racial groups. Brazil has been described as having a exible system of colour classication that recognizes phenotypic differences along a continuum rather than race as dened by origin (Fry 2005). Some surgeons argue that this folk taxonomy and Brazils history of miscegenation increase demand for surgeries that correct racial features because racial identities are more uidly dened. The black Brazilian is more miscegenated than the black American, Dr Marcelo told me. And so he has more inclination to improve the nose, diminish the width, rene the tip. In the United States the black person wants to maintain his own characteristics so he doesnt do much nasal surgery there. Dr Marcelos comments suggest that more uid racial or colour identications have facilitated a view of rhinoplasty as beautication rather than racial change. And in fact some candidates for this procedure, such as Vilmar, a 46 year old with light, reddish skin, do not identify as negra, black. I have one black grandparent, one Italian, she told me. And the others? Dont know. But my nose took after (puxou) the black one. Everyone else in the family has a thin (anado) nose, but I have one like hers, this nose of a little pig. Her comments reect a popular view of family inheritance as a kind of aesthetic lottery, where relatives exhibit different permutations of racial features, skin colour, and hair type, leading sometimes to ugly combinations, as a surgeon put it. Farid Hakme, former president of the Brazilian Society of Plastic Surgery, argued that due to the mix and match of different races ... the nose sometimes doesnt match the mouth or the buttocks dont match the legs (quoted in Gilman 1999: 225). This view echoes earlier concern among the Brazilian elite about racial mixing, though now the problem is not physical and moral degeneracy, but aesthetic defects. The logic behind such operations aims at a merging of the extreme of unmixed race into the national norm of mixture. The goal seems to be not to pass as white, but to join Freyres meta-race, where racial identities as such are dissolved. Of course, patients do not put it in these words. They say they simply want to look prettier, although they blame Indian or African ancestry for features that need improvement. When pressed, however, surgeons readily admit that patients always want to move the nose in the direction of Europe, not Africa, and in fact ofcially term the procedure correction of the Negroid nose. Beauty practices show that Freyres vision of triumphant brownness has not, in fact, entirely displaced an earlier ideology: embranquiamento, whitening. In the early twentieth century, eugenicists hoped that the people could be lightened by European immigration and inter-racial marriage (Skidmore 1974). Plstica suggests how this dream has been transformed from a collective project of social hygiene that would allow Brazil to enter the ranks of civilized nations into a private practice aiming at self-improvement. Brazil, then, has an aesthetic imaginary rooted in its particular history of racial mixing and nation-building that classies and values appearance in distinct ways. Miscegenation can be praised for its aesthetic products, but also blamed for creating disharmonies. The racially mixed female body can be celebrated as national patrimony, while facial features and hair perceived as negro are stigmatized. On the other hand, brown or very dark skin is considered to be less of a racial indicator, and in any event is often aesthetically valued in a country where sun tanning is a cross-class national pastime (Winddance Twine 1998). Brazils beauty myth, based in mestiagem, contrasts
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with North American multicultural models of beauty that stress not one national norm but a plurality of distinct racial types, in which authenticity is linked not to national but racial identity. In both cases, however, these contrasting principles of racial vision and division (Bourdieu & Wacquant 1999: 44) co-exist with aesthetic hierarchies that mirror larger inequalities. Anthropologists have argued that the remarkably diverse forms of body modication that they have encountered must be understood not as exotic forms of mutilation, or simply beautifying, but as practices with roots in interlocking social spheres. Plstica is of course different from many tribal practices of body modication in that it is part of an international medical specialty. Nevertheless, one of the reasons why the beauty industry has been democratized so rapidly in a developing country is that it has been indigenized. The encounter between global media and medicine and a distinctive logic of aesthetics and race in Brazil has produced a localized form of the beauty industry capable of mobilizing both national meanings of beauty and racial hierarchies to incite demand for its services.

Creating and modelling nature

Walking into the waiting room of a plastic surgery ward, one has the impression of entering a distinctly feminine realm, and those patients who have either not yet learned or reject the therapeutic language of the specialty describe their operations as simply uma coisa da mulher, a womans thing.13 In public hospitals, male cosmetic patients, aside from a few borderline reconstructive cases boys with donkey ears or enlarged breasts are particularly rare.14 Plstica is also gendered in its association with female life-cycle events: puberty, pregnancy, breast feeding, and menopause.15 Motherhood, for example, is blamed for thickened waists, dead esh, Caesarean scars, and bellies and breasts that are fallen, accid, or shrivelled like an old passion fruit. Plstica can be said to medicalize the female body in that it constructs real or imagined bodily changes due to ageing and childbirth as deformities requiring surgery. Diagnoses in clinical language and images do not necessarily create a negative body image, but the language and expert eye of the professional give dissatisfaction a powerful objectivity. But plstica does not only work through a negative logic of pathologization and rejection of deformities. I argue that both the body and medicine exist in a libidinal economy in which positive incitement is particularly effective in stimulating demand. Surgeons claim that they are merely following the desire of the patient. Such desires are mobilized, however, not only by the beauty myth, as I have argued, but also by the mystique of modern medicine, new expansive notions of health, and broad changes in sexual and social relationships. While there are few defenders of cosmetic surgery (outside its own marketing apparatus), those who have taken a view sympathetic to real or imagined stigma experienced by cosmetic surgery patients have stressed that patients are motivated by what is after all a human desire: to t into a social group. Sander Gilman (1999: 21-6), for example, develops an interpretation of plastic surgery as a means of passing enabling stigmatized people (originally syphilitics who received skin grafts to rebuild their damaged noses) to pass as normal. Kathy Davis similarly argues that Dutch cosmetic surgery patients whom she interviewed do not have cosmetic surgery because they want to be more beautiful ... but to become ordinary, normal, or just like everyone else (1995: 161).
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In Brazil, many patients do aim to correct traits that they believe make them fall outside norms. But as we saw in the last section, a growing number of operations aim to make patients look not average but sexier. While many patients say they undergo surgery to raise self-esteem, others such as Sheila claim that after their operations, Men are hot for us more, they have more sexual appetite, n? Surgeons are encountering more patients who have beautiful bodies but seek out multiple operations to achieve more perfect forms, as Dr Luciana said. The redundant more perfect suggests that for some plstica is not a one-time passage into normality, but a never-ending pursuit of incremental improvement. Plstica tends to cluster in networks of female relatives and friends, creating a kind of hothouse environment with an intensely competitive and mimetic body aesthetics. This kind of perfectionist self-tooling can be compared to what Joo Biehl (2001: 120), in the context of AIDS testing in Brazil, calls technoneurosis. In conditions of scarcity, a hunger for modern consumer and technological wonders can produce medical and corporeal fetishism. I use the metaphor of fetishism here to describe a mingling of economic and psychological processes, the embrace of hi-tech medical and cosmetic services, and the division of the body into eroticized and pathologized fragments. In clinical practice and the surgical imagination of patients, plstica is linked to a broad range of medical and cosmetic procedures that manage reproductive health and sexuality. ObGyns and other specialists refer patients to plastic surgeons (Goldenberg 2004). Tubal ligations are combined with cosmetic procedures to take advantage of the anaesthesia or are performed for free when linked to a Caesarean delivery in the public health system (both surgeries, like plastic surgery, occur at very high rates in Brazil [Bhague, Victora & Barros 2002]). And Caesareans, like plstica, may be chosen for sexual-aesthetic motives. Maria Carranza points to a popular belief that a Caesarean birth is capable of preserving the vaginal anatomy of the woman, while a vaginal birth would produce distensions making sexual relations more difcult (1994: 113).16 But though patients associate plstica with other female surgeries, they also distinguish it as being uniquely benecial to self-esteem, capable of making the libido rise to the head. As Maria Jos put it: After pregnancy and breast feeding, after Caesareans, mastectomies, we feel old, ugly. In truth, its because women have difculty living out their own sexuality. As if after becoming a mother, the role of woman becomes secondary.17 And so Maria Jos urges other women to have cosmetic surgery, because after the sacrices of motherhood, plstica is good for the self . Plstica, then, is not an isolated consumer service, but rather is part of an emerging eld of aesthetic medicine (medicina esttica) that offers an array of medical, therapeutic, and cosmetic tools for the pursuit of an expansive notion of health (Edmonds 2003: 127-90). This eld is emerging during a time of rapid change in the social organization of sexual and affective relationships. Since the legalization of divorce in 1977, steadily rising divorce rates have made new domestic arrangements more common: single mothers like Sheila living with their single daughters and dating at the same time (Castells 1997; Figueira 1996). The right to sex as well as the duty to manage sexual allure have been legitimated for new groups of women: the middle-aged, the divorced, the adolescent (Bassenezi 1996; Goldenberg 2004). Plstica rates on teenagers have grown particularly fast, reaching 21 percent in 2004 (SBCP 2005). Sex after 40 has become a topic in the media, while gures such as the menopausal playboy have entered into the cultural imagination. More generally religious and moral discourses surrounding sex
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are being supplanted by therapeutic, medical, and consumer ones (Parker 1991). In this new social environment, cosmetic surgery can be a means to remain competitive. In the past, Paula said, a 40-year-old woman felt old and ugly. And she was traded for a younger one. But not these days. A 40 year old is in the market competing with a 20 year old because of the technology of plastic surgery. She can stretch [her skin], do a lift, put in silicone, do a lipo, and become as good as a 20 year old. In arguing for the therapeutic effects of plstica, a surgeon told me that it aimed at a more expansive state of health: Our strongest argument went like this. The World Health Organization said many years ago that health is a state of physical, social, and mental well-being, not simply the absence of illness. You have to reach health by being happy. Plstica, however, pushes the positivity of this conception of health in directions never imagined by public health professionals. Instead of being negatively dened as the absence of disease, health becomes a more amorphous state of aesthetic and sexual as well as physical, social, and mental well-being that can be actively and continuously cultivated. Plstica, then, can be seen as one technology among many in a sexual republic where citizenship requires participation in a consumer lifestyle, the medical management of sexuality and reproduction, and an aesthetic tinkering with the body for therapeutic ends. Several scholars have shown how biomedicine can act as a form of politics by other means. But in some contexts a disarticulation of medicine from state governance is also occurring. In travelling the enormous social distance from the elite to the povo (common people), medical beauty practices are shaped by diverse anxieties, expectations, and fantasies into a novel experimental practice. And so from its unique position on the borders of proper medicine, plstica not only medicalizes the body but also in a sense de-medicalizes itself. Of course, cosmetic surgery is a medical specialty like any other in that its practitioners follow professional norms, and are indeed trained in the same techniques used in reconstructive surgery. But as plstica becomes infused with the frustrated desires of patients, the competitive logic of markets, the imagery of a nationalist beauty myth, and the medical and consumer fetishisms of popular culture, the question arises as to whether it is medicine in any recognizable form, though it continues to benet from the prestige of this perhaps largest of all modern systems of expert knowledge.
Beauty and capital

Is the popularization of plstica another example of the povo misbehaving, or not behaving the way intellectuals would like them to? There is a long history of this in Brazil. Recently both the Liberation Theology and black consciousness movements have had to confront the reality that they are losing converts to apolitical Pentecostal churches (Lehmann 1996). And after decades of a military dictatorship, the newly enfranchised povo elected a telegenic and corrupt populist. Does the right to beauty constitute another form of alienation? In their analyses of the cultural and psychological ramications of capitalist development, Gilles Deleuze and Georg Simmel emphasize the increasing fungibility and circulation of different forms of capital. Drawing on Marx, Deleuze calls the world economy a universal cosmopolitan energy which overows every restriction and bond (1993: 236). Simmel argues in a similar vein that money levels traditional distinctions: through generalized transactions it draws attention to the relativistic character of existence (1990 [1907]: 512). In earlier stages of capitalism, such fungibility aided the
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rise of the bourgeoisie, enabling the conversion of capital into social position. In late capitalism, this process might be said to be extended to the body as it is brought into relations of exchange in the markets of production and reproduction, work and sex. I argue that the same processes of capitalist development that are undermining older forms of authority, including a paternalistic state and some formal patriarchal structures, are also paving the way for the expansion of beauty culture. The weakening of moral restrictions on cosmetics, legal constraints on womens economic activity, and the social regulation of female sexuality free the body but also insert it in the market. Aspirations rise with ows of cosmopolitan culture. The growing importance of body capital incites fantasies of social ascent. And so in a sense, beauty mirrors the ambiguous emancipatory power of capital itself: it challenges traditional hierarchies, but exposes the liberated body to the new hazards of generalized exchange. I have argued here that the mingling of sexual, labour, and medical markets facilitates the projection of social anxieties onto the body as aesthetic defects, but also stimulates desires for social mobility and medical consumption. While some disciplinary moral discourses and practices governing the female body have diminished within this libidinal economy, older gender ideologies persist, not least of which is the nationalist beauty myth, which is inscribed on the body by this localized form of the global beauty industry. But analysis of the structures that are fuelling demand for the beauty industry must be balanced by a hermeneutics of retrieval that interprets local meanings. For workers and consumers on the margins of the market economy, beauty, then, does not simply encode social hierarchies, it can also threaten to upset them. The point is recognized, oddly enough, in Pierre Bourdieus rigorous analysis of the class body. Bourdieu makes a conspicuous exception in his work, however, for physical beauty, which he calls fatally attractive because it threatens other hierarchies, and sometimes denies the high and mighty the bodily attributes of their position, such as height or beauty (1984: 193). Beauty, then, is an unfair hierarchy, but one which can disturb other unfair hierarchies. The class meanings of beauty become prominent in elaborations of the beauty myth in popular culture: a term which I use to refer not only to the commercial mass media (Williams 1983: 238), but also, following Latin American usage, to the (common) people, where the people are creators of an authentic national culture. The erotic and aesthetic ideal of morenidade (brownness) can be embraced as a tactic (de Certeau 2002) by the people, who embody authentic brasilidade in their capacity to seduce and provoke the elite. This is a trope that recurs in different spheres of both popular and elite culture: the maliciously innocent nudes painted by Brazilian modernists (Freyre 1986: 63); fables of mulata slaves who sexually dominate the master; fantasies of escaping the poverty of a shantytown by seducing an older man (Goldstein 2003: 108); stories of women from humble origins who through samba skills and recently considerable amounts of plstica make themselves into pop icons. And so even as it encodes some social hierarchies, beauty may have a kind of democratic appeal, perhaps especially during a time when authoritarian structures are losing their legitimacy while opportunities for social mobility remain limited. In such a situation beauty can function for girls as soccer does for boys. While boys living in poverty often dream of becoming professional athletes, many girls in poor communities have the equally impossible dream of becoming a fashion model. (NGOs and private instructors have responded by offering courses in modelling aimed at shantytown residents.) In both social fantasies, the invisibility of poverty is best negated by
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media visibility. When access to education is limited, the body relative to the mind becomes a more important basis for identity as well as a source of power. This theme is often portrayed in the dominant popular genre in Latin America, melodrama, in stories about passion that crosses class lines. While the rich girl may have all the advantages, the poor girls beauty (or, more rarely, the boys masculine appeal) is so strong that it threatens class barriers. Heroines in melodrama and fairy tales are invariably attractive. Perhaps this is because beauty can inuence the rich and powerful, becoming like the samba parade a popular form of hope.
NOTES I am grateful to the Social Science Research Council and Princeton University for funding this research. The Museu Nacional in Rio de Janeiro, Princetons Woodrow Wilson Society of Fellows, and a Woodrow Wilson Postdoctoral Fellowship at UCLAs Center for Modern Studies also provided nancial and institutional support for this project. I would also like to thank the JRAI reviewers and editorial staff as well as many friends and colleagues who have provided invaluable comments: Vincanne Adams, Kirsten Bell, Niko Besnier, Joo Biehl, James Boon, Peter Fry, Mirian Goldenberg, Chris Huston, Joana Lima dos Santos, Kirsty McClure, Pl Nyri, Vince Pecora, Kalpana Ram, Cristina Rocha, Thomas Strong, Gilberto Velho, Hermano Vianna, and Lisa Wynn. 1 I use pseudonyms for all patients and surgeons except those interviewed in an ofcial capacity (e.g. as director of a hospital ward) or quoted in the media. 2 Santa Casa charges patients having cosmetic procedures a fee that covers the cost of medical materials (in 2003 about R$1,700 for most operations) while reconstructive operations are free. At fully public hospitals, where I also conducted eldwork, there are no fees for cosmetic operations (though some patients still prefer to go to Santa Casa due to differences in waiting times or because they are drawn by Pitanguys name). Pedagogical techniques, hospital procedures, and patient demographics at Santa Casa are similar to those at public hospitals and so I generally include it in the category of public hospital. 3 Brazil subsequently lost its top place in the ranking to the United States. A survey of 3,200 women in ten countries found that 54 per cent of Brazilians (compared to 30 per cent of Americans) had considered having cosmetic surgery, the highest of the countries surveyed and more than double the average (Etcoff, Orbach, Scott & DAgostino 2004). A Brazilian study in 1988 found that a fth of women in So Paulo had had plastic surgery (O feitio do corpo ideal 1998). In 2004, 616,287 plastic surgery operations were performed, of which 59 per cent were cosmetic (SBCP 2005). With a reputation for quality surgeons and cheap prices, Brazil has also become one of the worlds top destinations for the growing business of cosmetic surgery tourism. 4 Faveret and Oliveira (1990) describe this situation of a two-tiered health care system as a kind of excluding universalism in which the elite and the middle class are excluded from the constitutional right to publicly provided health care (in Biehl 1999: 55). 5 Though it is now illegal to require a boa aparncia in a job announcement, I often heard service workers speak of how colour bars continue to be enforced in informal ways. 6 Surgeons are also responsible for poorly informed patients. During her fteen visits to the hospital, Dona Firmina was never told about scars, risks, or what aesthetic result she could expect. 7 For this reason, I prefer to use the emic word beauty (beleza) rather than the more neutral appearance, as a colleague suggested. 8 The term often used in scholarly and public discussions of racism in Brazil over the past four decades was probably rst introduced by sociologist Florestan Fernandes (1965: 205). 9 Patrcia Farias (2002) argues that this cultural logic is deployed among contemporary beach-goers in Rio de Janeiro. 10 There is a long history of black social movements that have in various ways challenged the encompassing paradigm of mestiagem and fostered a pan-black identity (Andrews 1991). A more recent black is beautiful movement has emphasized the aesthetic valorization of blackness, not mixture. The emphasis on aesthetics as a basis of self-esteem among some black activists and consumers has raised concerns among some activists, however, that an aestheticitized black identity would simply reect North American identity in a neoliberal mirror (Sodr 1999: 256; see also Fry 2005). 11 The concept of beauty as national patrimony is highly gendered in Brazil. The image of the male body as athletic, graceful, but also playfully dangerous (represented in the samba dancer, the soccer player, and capoeira player, for example) is, however, also a key symbol in brasilidade.

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12 More recently, the reaction to the sudden popularity of silicone breast implants reveals how the female body is discussed in a national register. In the United States, implants provoked an ongoing debate about their safety and led to the largest class action lawsuit in American history against a silicone manufacturer. In Brazil, implants elicited instead a controversy over whether yet another aspect of Brazilian culture was losing ground to American fashions. 13 The surgeon-patient interaction is also gendered, as senior surgeons are typically male, though rising numbers of women are now entering plastic surgery residency programmes. 14 Sixty-nine per cent of all plastic surgery operations are performed on women, but this percentage would be higher if reconstructive operations were excluded (SBCP 2005). 15 For example, the minimum age for surgery is calculated by counting back years from the rst menstrual period. While there is almost no upper age limit to surgery, menopause is perceived by some patients as an acceleration of ageing that can be reversed through surgery. 16 Plstica & Beleza reports on a rise in intimate plsticas, claiming that cosmetic surgery on the genitals ... offers the modern woman the freedom to improve her performance (Cirurgia plstica ntima 2000-1). 17 Maria Joss comments are taken from an interview in a plastic surgery guide (Ribeiro & Aboudib 1997: 148-52).

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Faveret, F. & P.J. Oliveira 1990. A universalizao excludente: reexes sobre as tendncias do sistema de sade. Dados 33, 257-83. Fernandes, F. 1965. A integrao do negro na sociedade de classes. So Paulo: Cia. Editora Nacional. Figueira, S. 1996. O moderno e o arcaico na nova famlia brasileira: notas sobre a dimenso invisvel da mudana social. In Uma nova famlia? (ed.) S. Figueira. Rio de Janeiro: Jorge Zahar. Freud, S. 1961. Civilization and its discontents (trans. J. Strachey). New York: W.W. Norton. Freyre, G. 1956. The masters and the slaves: a study in the development of Brazilian civilization. New York: Knopf. 1986. Modos de homen & modas de mulher. Rio de Janeiro: Record. Fry, P. 2000. Politics, nationality, and the meanings of race in Brazil. Daedalus 129, 83-118. 2005. A persistncia da raa: ensaios antropolgicos sobre o Brasil e a frica Austral. Rio de Janeiro: Civilizao Brasileira. Gilman, S. 1999. Making the body beautiful: a cultural history of aesthetic surgery. Princeton: University Press. Goldenberg, M. 2004. De perto ningum normal: estudos sobre corpo, sexualidade, gnero e desvio na cultura brasileira. Rio de Janeiro: Record. Goldstein, D. 2003. Laughter out of place: race, class, violence, and sexuality in a Rio shantytown. Berkeley: University of California Press. Haiken, E. 1997. Venus envy: a history of cosmetic surgery. Baltimore: Johns Hopkins University Press. Hanchard, M. 1999. Black Cinderella? Race and the public sphere in Brazil. In Racial politics in contemporary Brazil (ed.) M. Hanchard, 59-81. Durham, N.C.: Duke University Press. Hasenbalg, C. & N.V. Silva 1999. Notes on racial and political inequality in Brazil. In Racial politics in contemporary Brazil (ed.) M. Hanchard, 154-78. Durham, N.C.: Duke University Press. Jeffreys, S. 2005. Beauty and misogyny: harmful cultural practices in the West. London: Brunner/Routledge. Kaw, E. 1993. Medicalization of racial features: Asian American women and cosmetic surgery. Medical Anthropology Quarterly 7, 74-89. Kleinman, A. & A. Becker 1998. Sociosomatics: the contributions of anthropology to psychosomatic medicine. Psychosomatic Medicine 60, 389-93. Kottak, C. 1990. Prime time society: an anthropological analysis of television and culture. Belmont, Calif.: Wadsworth. Kulick, D. 1998. Travesti: sex, gender and culture among Brazilian transgendered prostitutes. Chicago: University Press. Lehmann, D. 1996. Struggle for the spirit: religious transformation and popular culture in Brazil and Latin America. Cambridge: Polity Press. Mello, J.M.C. & F. Novais 1998. Capitalismo tardio e sociobilidade moderna. In Histria da vida privada no Brasil, vol. 4 (ed.) L. Schwarcz, 96-122. So Paulo: Companhia das Letras. Morgan, K.P. 1991. Women and the knife: cosmetic surgery and the colonization of womens bodies. Hypatia 6, 25-53. ODougherty, M. 2002. Consumption intensied: the politics of middle-class daily life in Brazil. Durham, N.C.: Duke University Press. O feitico do corpo ideal 1998. Veja, 2 April. Os exageros da plastica 2002. Veja, 6 March. Parker, R. 1991. Bodies, pleasures, and passions: sexual culture in contemporary Brazi. Boston: Beacon Press. Pitanguy, I. 1983. Aspectos loscos e psicolgicos da cirurgia do contorno facial. Sociedade Brasileira de Cirurgia Plstica Regional So Paulo, 24-5 September. 1992. Aspectos loscos e psicolgicos da cirurgia plstica. In Psicosomtica hoje (ed.) J.M. Filho. Porto Alegre: Artes Medicas Editora. Rankin, C. 2005. Prescribing beauty: women and cosmetic surgery in postmodern culture. Body Modication: Mark II Conference, 213 April, Macquarie University, Sydney, Australia. Reis, E. 2000. Modernization, citizenship, and stratication: historical processes and recent changes in Brazil. Daedalus 129, 171-94. Ribeiro, C. & J.H. Aboudib 1997. Voc e a cirurgia plstica: tudo o que voc precisa saber sobre cirurgia plstica. Rio de Janeiro: Record. Ribeiro, C.A.C. & M.C. Scalon 2001. Class mobility in Brazil from a comparative perspective. Dados Revista de Ciencias Sociais 44, 53-96. Ricoeur, P. 1970. Freud and philosophy: an essay on interpretation (trans. D. Savage). New Haven: Yale University Press. SBCP 2005. Brazilian Society of Plastic Surgery, press release obtained by personal communication.

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Les pauvres ont le droit dtre beaux : chirurgie esthtique dans le Brsil nolibral
Rsum En sinspirant dun travail de terrain ethnographique dans les hpitaux proposant de la chirurgie esthtique accessible aux revenus modestes, lauteur tudie les causes de la diffusion rapide de la chirurgie esthtique au Brsil sur les vingt dernires annes. Il avance que les problmes lis la diversit des origines sociales se manifestent sous la forme de dfauts esthtiques, qui sont diagnostiqus et traits par lindustrie de la beaut. La chirurgie esthtique suscite cependant aussi les dsirs de consommation de la part des citoyens qui se trouvent en marge de lconomie de march et fait intervenir dans le marketing et la pratique mdicale un mythe de la beaut racialis qui est un grand thme rcurrent de lidentit nationale. Les chirurgiens esthtiques offrent un moyen de devenir comptitifs dans une conomie nolibrale de la libido, o les angoisses lies aux nouveaux marchs du travail et du sexe se mlent aux fantasmes de mobilit sociale, de sduction et de modernit.

Alexander Edmonds is Lecturer in the Department of Anthropology at Macquarie University in Sydney, Australia. He has conducted extensive ethnographic eldwork in urban Brazil and is currently writing a book on Brazils culture of beauty. He has a particular interest in understanding the intersection of race, sex, and markets in capitalist peripheries.

Department of Anthropology, Macquarie University, NSW 2109, Australia. alexander.edmonds@mq.edu.au

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