João Carlos Stefani is not your typical plastic surgery patient. At 61 he decided to undergo a full facelift after decades of running his own company were starting to show. “I was looking old, very tired and my self-esteem had hit bottom,” he confesses. His local GP in the suburban town of Jaú recommended a consultation with a cosmetic surgeon.
Three months ago Mr Stefani agreed a R$12,500 (£3,400) fee and is now one of more than 180,000 Brazilian men who undergo cosmetic procedures each year. Growing demand from men is helping to make Brazil a leader in plastic surgery. Last year, 1.49m operations were conducted in total – for the first time a higher figure than that registered in the much more prosperous US.
Dr Carlos Uebel, President of the International Society of Aesthetic Plastic Surgery, who has undergone liposuction himself, says the main reason men seek surgery is to look younger and remain competitive in the job market.
Unlike women, where the average age for cosmetic procedures is falling – from 50 in 1980 to 35 in 2004 – plastic surgery in men is more popular when they hit middle age. Dr Prado Neto, head of Brazil’s Plastic Surgery Society: says: “Men are working in industries where appearance is very important. They no longer work the land or in factories, they’re gym teachers, salesmen, fashion PRs, all which depend more on image,”
Prejudice against men is still prevalent – a 45-year-old executive from Rio says at the time of his tummy tuck he told friends he had had a hernia operation – but in 2014 there are two and a half male to every 10 female surgeries, compared to one in 10 in the 1990s.
Driving Brazilian interest is growing demand from less well off people. Lower prices for an operation – known locally as uma plástica – and wider access to credit is bringing cosmetic surgery within the reach of working-class consumers. Danielli, 24, a secretary in a São Paulo bank, saved for two years for her breast implants. She says at least eight colleagues have done the same.
Prices in Brazil are certainly competitive. Ana Paula Silva, a London-based Brazilian banker, paid R$10,000 (£2,700) for liposuction, less than half of what it would have cost her in the UK. One reason is because of the number of trained cosmetic surgeons – the highest per capita globally. Ms Silva, 36, returned to her home town in southern Brazil for surgery this April after gruelling diets and expensive gym classes left her frustrated by disappointing results.
“I was literally working my arse off, but I just couldn’t get rid of these pouches,” she says squeezing the now non-existent saddlebags.
Ms Silva thinks that because Brazilians show their body 85 per cent of the year in the cooler southern states and year-round in the hotter northern region, they are more body conscious than their European counterparts.
Anthropologists say Brazilian interest in plastic surgery is deeply embedded in the national psyche, and closely linked to notions of appearance, ethnicity, status and social mobility. Alexander Edmonds, an anthropologist at the University of Edinburgh who specialises in the area, says plastic surgery has been popularised in Brazil, making it a coveted modern medical good.
“Some patients aim to correct [what they see as] ‘deformities’,” he says. Indeed, Mexico is ranked third globally but has less than half of Brazil’s annual cosmetic procedures (486,499 in 2013), while the Germans are fourth with fewer than 350,000 a year.
“Beauty is perceived as opening doors in Brazil and for many it’s a question of social inclusion,” says Alvaro Jarrín, another academic who specialises in the Brazilian phenomenon. He says that the industry is also a source of national pride, boosting procedure numbers.
Aesthetic surgery is coming to be viewed as a central element of healthcare, especially for women. Motherhood for example is blamed for thickened waists, Caesarean scars and bellies or breasts that have “fallen”. For years, a caesarean section has been the preferred means of giving birth and gynaecologists now routinely refer patients directly to plastic surgeons.
It is a trend that is worrying some people in the industry. Margaret Figueiredo, head of Silimed, the leading supplier of silicone implants in Brazil, is concerned about the number of procedures after childbirth. “Being a healthier, happier, more valued citizen comes at an ever heftier cost.”
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GlicOnLine promises to greatly improve treatment of diabetes
Mealtimes for Karla Melo, a Brazilian doctor and diabetes sufferer, used to be synonymous with nutritional charts and calculators, writes Samantha Pearson . By measuring her exact carbohydrate intake from a vast list of foods alongside her blood sugar levels, she could calculate her recommended insulin dose.
It was tedious and time-consuming but helped keep the disease under control.
Impressed with the results, she began to encourage her own patients to follow the same method, even though many were barely literate let alone adept at mathematics.
“Nevertheless people took it upon themselves to carry around all those papers and a calculator with them to work out how much insulin they should be taking,” explains her husband, Floro Dória. “When I noticed what was going on I thought, come on, there must be a way to automate this.”
That was more than ten years ago. Since then, Mr Dória and his wife have developed GlicOnLine, one of the world’s only Android applications that does all the calculations for a patient – a service that promises to greatly improve treatment of diabetes, especially among the poor.
With GlicOnLine, physicians and nutritionists prescribe patients medication and individual diets and levels of insulin – prescriptions which are then sent to the patient’s mobile phone. The phones then automatically issue alerts to remind the patient when to take the medication and tell them which foods they can eat. Diabetes sufferers who need to take insulin will also receive an alert telling them the exact dose they need to take to correct blood glucose levels and compensate for the stated meals. All of this data are stored in tables and graphs in a cloud-based medical record that can be read at any time by the patient’s doctors, allowing them to remotely change the patient’s dietary plans or medication prescription at any time.
The service is already being introduced to Brazil’s public health system and, after that, Mr Dória hopes to take the idea to the US and the rest of Latin America.
As developing countries such as Brazil turn their focus away from the leading infectious killers of the past to so-called first-world diseases such as diabetes, they are becoming an increasingly important source of new technologies to combat such conditions.
The Center for Health Market Innovations (CHMI), a global healthcare databank supported by the Bill & Melinda Gates Foundation among others, now lists GlicOnLine as one of the region’s most innovative healthcare projects.
However, developing a start-up in a country such as Brazil is never easy, says Mr Dória.
“It was a tremendous battle because there are very few financing options for start-ups in Brazil,” he says, adding that banks often refuse to give small companies credit because they cannot prove past cash flow or predict future income.
Their first big break, though, came in 2004 when GlicOnLine was officially established as a company under the name Quasar Telemedicina and received initial funding from the São Paulo research foundation (FAPESP). With the help of, Ricardo Pessoa, a third partner in the project, Mr Dória and his wife began developing the software for the application, which was tested in clinical trials a few years later at the clinical hospital of the university of São Paulo. The application’s positive effects on patients’ glycemic control and quality of life were clear.
However, the success of the application also relied on the development of Brazil’s own telecommunications market.
“When we started to develop the project in 2004 mobile phones here were just for making calls,” says Mr Dória. The first version of GlicOnLine therefore had to be voice-activated – a method that proved to be too expensive and essentially unviable.
It was only until about 2010 and 2011 that smartphones hit the Brazilian market on a large scale, making it much cheaper and easier for patients to use the service.
GAG Investimentos, a Brazilian fund focused on social entrepreneurship, has since backed the company but Mr Dória says he is looking for more investors to help build scale.
He estimates that 4,600 people used the former version of the application and now 700 people are using the smartphone version.
In the future, he hopes to launch an application for the iPhone and break into the challenging US market, he says.
“The application would be classified as a ‘medical device’ [in the US] so we would need to do a clinical trial to get the approval of the Food and Drug Administration (FDA) so we’re looking for someone to fund these trials,” says Mr Dória.
Adapting the application to the US market would require extensive work to adjust the nutritional tables, which are focused on Brazilian eating habits and food measurements.
In the meantime, though, Mr Dória says the company’s focus is on helping those his wife originally sought to treat: Brazil’s poor.
“Our vision as a company is to reach low-income people, those who have the most problems with making these calculations,” he says. “This is our responsibility at the moment.”
Given that Brazil has more than 13m people with diabetes according to the Brazilian diabetes society, making it the country with the fourth-largest number of sufferers in the world, it is certainly no small feat.
Texto escrito e publicado no Financial Times
