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French Version

Lebanon assumes position as region's cosmetic-enhancement capital

Countless mideast visitors arrive in search of physical makeover

Lebanon earns its reputation as the Middle East's playground in the summer months, as countless visitors from across the region flood into the country in search of fun, sun, and lately, cosmetic enhancement.

In keeping with the international trend, Lebanon's plastic-surgery market has been steadily growing over the past decade, but what was a local, nonlucrative, reconstructive industry during the war has mushroomed since the Israeli withdrawal of South Lebanon in 2000.

As nose-jobs, liposuction, and facelifts become more ubiquitous across the Middle East, so have the number of practicing plastic surgeons in Lebanon-from seven in 1980 to more than 60 now - turning the country into the go-to regional destination for cosmetic procedures.

"The world used to be survival of the fittest but now thanks to the media, its survival of the cutest," said one of the country's more reputable surgeons. "But it's not just limited to Lebanon. In England the industry grew by 40 percent last year, it's really happening everywhere."

Lebanon's "international school of plastic surgeons" - so designated by one source since most of the doctors were trained abroad in different locations - are reaping the benefits of this global quest for physical perfection thanks to the combination of reasonably priced procedures and well-trained doctors. "It's a cash business", Lebanese surgeon Dr. Ibrahim Melki told The Daily Star.

"Surgeons can charge whatever they want, and they don't have to deal with insurance or national health care since elective procedures are not generally covered."

He added that though Lebanon's market has grown precipitously recently, like other local industries its fortunes are influenced by domestic politics. One Beirut surgeon said the surgeons were hit briefly by Harriri's assassination, but quickly rebounded after three months.

"If the political situation were better, the market would be better. Don't get me wrong we're not complaining and a lot more Canadians and Americans are coming now, but some are still scared," he said.

On average most Lebanese surgeons estimate that between 10 to 20 percent of their clients are foreigners of Arab descent and the remainder are local, but during the summer season and religious holidays the number of regional customers swells. Dr. Nizar Chehab, estimated that up to 40 percent of his clients come from abroad.

"The business is seasonal," Chehab explained after having just performed an abdominal liposuction on a male Kuwaiti patient.

"During Muslim holidays our clients are almost 50/50 (proportion of local to foreign), we get a lot from Saudi Arabia, Kuwait, and Dubai and Christians come during their holidays."

The most popular procedures for local and regional patients alike include, Rhinoplasty ("especially before the school year to fix the oriental nose" in the words of one surgeon), breast augmentation (most in demand before beach season), as well as liposuction and increasingly popular liporestructuring procedures - where fat from a patients' body is injected into lips and wrinkles. The main clients are women between the ages of 20 and 40, though men are starting to embrace cosmetic enhancement as well. Most surgeons estimate that about 10 percent of annual aesthetic procedures are performed on male patients.

Rising demand has fueled another dynamic in the local surgery market, price-gouging. Chehab said he has heard rumors of doctors overcharging Gulf clients, though he denied taking part in the "inappropriate" practice and other surgeons said they had not heard about it.

Not only are foreign patients coming to here to have work done, but Lebanese doctors are increasingly traveling to Gulf countries to preside over medical conferences, lectures, and more and more to operate. Another surgeon said the latter phenomenon was problematic for both doctor and patient, because surgeons cannot monitor the recovery process and are often paid unfairly.

The Kuwaitis pay more money for procedures than those performed in Lebanon, but the surgeons get from a third to two-thirds of the amount billed to the patient. "They'll charge $6,000 for a rhinoplasty, but only give the doctor two or three thousand of that. Or they might pay the doctor $6,000 for a days work, but have him do 3 or 4 surgeries in one day," said the source.

Most are reluctant to divulge specifics about their rates, but according to one doctor the average cost for rhinoplasty performed by a certified surgeon costs $1,500 in Lebanon, a third less expensive than in Kuwait. Dr. Melki said he charges between $500 and $3000 for liposuction, depending on a host of variables including the depth of a procedure and where it is performed. While cheaper price tags can certainly be found elsewhere in the Middle East, with lower costs come higher risks.

Many Lebanese are traveling to Syria for aesthetic procedures, where costs are significantly lower. Two Lebanese women aged 26 and 27 went to Damascus for their nose-jobs, both of which were performed by a Syrian surgeon. One of the patients said she paid $250 to have her surgery in the doctor's clinic under only local anesthesia - meaning she was awake for the entire process, and can vividly recount the crushing sound made when the hammer-like instrument broke the bones in her nose. The other patient opted to have her procedure performed in a hospital, under general anesthesia (meaning she remained unconscious), and with the assistance of three trained staff members at an additional cost of $200.

Both are happy with the results, but others have not been so lucky. All four of the surgeons said they have had to correct many botched surgeries by unqualified doctors, though fearing the possibility of political ramifications, they were reluctant to pinpoint Syrian surgeons as the culprits.

"I had to drain an abscess in a woman's implants for three months because it was so infected," said one Lebanese doctor. "The Syrian surgeon had just given her antibiotics and not removed the source of the infection."

According to the source the patient said she had paid $800 for an operation that costs $500 alone to administer. He said it is impossible to pay the remaining hospital and doctors fees with only $300.

Paradoxically this effort to save money by going elsewhere for surgery often ends up worsening the financial burden on the patient who is forced to turn to local surgeons for revisions that are often more expensive than the surgeries themselves.

"If you have a nose that is deformed during surgery, it requires much more work than a virgin nose and ultimately the patient spends a lot more money," another doctor explained, "and I've seen some deformities that cannot be easily corrected."

Beirut,04 18 2006
Lysandra Ohrstrom
The Daily Star
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