There can be few more disconcerting experiences than being closely - very closely - scrutinised in this fashion. I am standing next to a window, daylight streaming in so as to show my make-up-free face in the best (and, for best, read worst) possible light. Dr Maurizio Viel's face hovers inches from my own. His eyes are dispassionate as they scan my skin, searching out every little crease, every asymmetry of feature, every imperfection of proportion. Everywhere, in short, where there is room for improvement. It is very odd to be looked at so intently with a complete absence of eye contact.
After a flattering guesstimate of my age he makes his diagnosis.
"I could give you a little light Botox here," he says, fingers hovering over my brow, "and here," he says, touching the corners of my eyes where the skin crinkles when I smile and increasingly the imprints linger. "Perhaps a little filler in the lips," he adds as an afterthought. "Otherwise, I am happy."
Well, that makes one of us.
Dr Viel is extremely charming and has a reputation as one of the best in his field but, truth be told, I'm feeling a tad deflated - something Dr Viel's keen eye notices later and which, he assures me, can be rectified with a small augmentation.
Let's face it, what did I expect walking into a cosmetic surgeon's office and asking him, by way of research, what he would "fix"? For him to tell me everything was fine just as it is? In the world of cosmetic surgery nothing and no one is as good as it gets.
It may have its origins in reconstructive surgery - in patching back together victims of devastating illness or injury - but today cosmetic, plastic or aesthetic surgery has evolved into something quite different. New techniques mean that practitioners can do far more while appearing to have done far less. It is more subtle and more socially pervasive than ever, with increasing numbers of us viewing the prospect of undergoing cosmetic procedures not so much in terms of "if" but "when."
Last year consumers in the UAE alone spent Dh300 million on treatments, both surgical and non-surgical (Botox, fillers, skin peels and the like). According to the latest figures from the Emirates Medical Association, 47 per cent of those who opted for some form of cosmetic treatment were men, with the most popular male procedures being hair transplants and abdominal liposuction. Back in the 1990s male patients represented just 8 per cent of the total treatments.
Today, clinics in the UAE such as Dr Viel's Dubai branch of the London Centre for Aesthetic Surgery (founded with his brother and fellow surgeon Roberto in 1990) and Aesthetics International, also in Dubai, bear witness to the burgeoning popularity of cosmetic procedures and their "routinisation" across both genders.
According to a spokeswoman for Aesthetics International: "Aesthetic surgery is on the rise in the Middle East and there is no question about that. So far this year we have carried out 180 major surgeries and over 4,000 non-surgical procedures which include Botox and fillers. The company recently expanded its stable of surgeons from nine to 11 in response to the growing demand."
Dr Viel has no doubt that the increase is a direct response to what he describes as the "rapid evolution in surgery".
"If we consider what we have today and what we had 20 years ago," he says, "there were only drastic or dramatic procedures back then. Developments mean that we have fewer and fewer invasive operations and the non-surgical side has grown. There is much more available with much better results. It means patients can start doing treatments earlier and earlier."
In the process trends have become more pronounced, with certain regions and ethnicities favouring particular procedures.
"In Europe people ask for more facial surgery," Dr Viel says. "In the Gulf they ask for more body surgery. In northern Europe ladies have very delicate skin which tends to be overexposed to the sun and which damages more clearly. In the Middle East the local ladies have stronger skin and they avoid the sun so sun damage is less important and ageing of the face less of an issue. But lack of exercise and a rich diet means that the body doesn't hold out so well. Liposuction is the number one procedure here and breast augmentation is the second."
In Lebanon, rhinoplasty has practically become a right of passage for teenage girls. Egyptian women favour facelifts. And in India the demand for the non-invasive option of skin whitening cream is such that it has been identified as symptomatic of the "Snow White syndrome". The market in such creams is expanding by nearly 18 per cent a year and stands at an estimated US$432 million (Dh1.587bn).
Yet, though the fashions may be regional, the general growth in the practice, acceptance and active expectation of cosmetic surgery as part of the "natural" ageing process is global.
The American Society of Plastic Surgery reports that the number of cosmetic procedures carried out in the United States has increased by 228 per cent since 1997. As the population ages, prices drop and younger people opt for surgery or some form of treatment, those figures will surely rise. In the UK, the government recently announced plans to capitalise on the growth witnessed there by extending Value Added Tax on cosmetic procedures. At the moment, only minor treatments such as Botox and chemical peels carried out by high street salons are eligible for the tax, which is levied at 20 per cent of the purchase price. According to the Chancellor George Osborne, taxing surgical procedures could raise up to £500 million (Dh2.935bn) a year.
The trend, then, is undeniable. But does it mean we are getting more beautiful or that are we simply losing sight of what true beauty is? Are people feeling more comfortable in their skin? Or is this the pursuit of something "more perfect", an infinite process more likely to engender dissatisfaction in those who embark upon it? Most people who have one cosmetic procedure return for a second and, for many, those first bee-like stings of Botox mark the beginning of an escalating succession of treatments.
As Christine Rosen, a resident fellow at the Ethics and Public Policy Center in Washington, DC, says: "The greatest boon to modern cosmetic surgery was not the development of any particular technique or the creation of a miracle product. It was an import from psychology: the inferiority complex. The inferiority complex provided a crucial link: it joined individual mental health with physical appearance and thus psychologised cosmetic surgery."
The New Yorker Alexander Edmonds is an assistant professor in anthropology at the University of Amsterdam and the author of Pretty Modern: Beauty, Sex and Plastic Surgery in Brazil. There, he explains, this process is so complete that cosmetic surgery has become almost entirely blended with therapeutic medicine. In the same way that orthodontic surgery - teeth whitening and veneers - is routine to the point of being considered simple oral hygiene in the US, breast augmentation, liposuction and so on are provided on the public health system in Brazil.
This notion of surgeons as psychoanalysts with scalpels is a tricky one. After all, according to one doctor interviewed by Edmonds: "The psychoanalyst knows everything but changes nothing. The plastic surgeon knows nothing but changes everything."
The result, Edmonds says, is that aesthetic surgery "no longer occupies the moral arena of vanity. It is considered a kind of psychotherapy - something that really has to do with mental well-being. It is marketed as a kind of empowerment, but to actually measure whether it delivers on that is quite difficult".
What is clear, he says, is that with the rise of cosmetic surgery, beauty - or whatever version of it is favoured by a particular culture or person - is "becoming part of a consumer capital in that it's really a kind of property of the self that has value and that people believe they can exchange in the job market or relationships, or whatever field in which they're competing".
To some extent that is nothing new. The power of beauty has never really been in question - though the nature of it always has. Dante's Beatrice inspired The Divine Comedy. Helen of Troy's beauty was so irresistible it started a war. Cleopatra - a potent leader - was lauded as much for her beauty as her politicking. Children are raised on tales of transformation - the Ugly Duckling, Cinderella, Beauty and the Beast - that equate beauty with goodness and happiness.
The difference now is that beauty need not be a gift with which you are simply blessed. It is something you can buy, and that changes everything. In France, for example, where cosmetic surgery is far less popular than in the US, the UK or the Middle East, there is an appreciation of "une femme d'un certain age" - an older woman who looks her age and whose appeal is undiminished, even heightened, as a result. But aesthetic treatments put a premium on youth - or at least the appearance of youth. In regions where those treatments are prevalent, signs of ageing are viewed with less tolerance. Those who opt not to embrace treatments may find themselves judged accordingly and found less competitive in both professional and personal spheres.
Advocates of treatment argue that surgery stops you being misjudged because of your appearance. Critics argue just the opposite: that surgery breeds unrealistic expectations and that misjudgment and intolerance of ageing and perceived imperfections follow in its wake.
But, according to Dr Viel, if the end result is achievable then any expectation bred by the evolution in aesthetic medicine is, by definition, realistic. People should not be sold dreams but they should not be discouraged from wanting to be themselves "only better". Even if the definition and desirability of that "better" is a matter of taste and therefore not one that he necessarily shares.
"If I have a patient who wants something that I think would be too excessive then I will very gently suggest that I don't think the work would suit them," he says. "At the end of the day the patient walks out of my clinic and it's like they bear my signature. They are an advertisement for me.
"I do have some women coming to me asking for Botox and wanting the frozen face look and of course I can do that. Some women want their breasts to look fake. It's a status thing to some to have surgery that is clearly surgery. But increasingly, as procedures are more affordable, people want a more subtle look - what is known as the European rather than American style.
"You see, there are two main ways to go," he smiles. "Total transformation or subtle rejuvenation and enhancement. If one operation can make somebody feel much better, what is wrong with that? What is wrong with enhancement?"
What indeed? I ponder this thought as I leave Dr Viel's clinic, and his advice to start the process (that light Botox, that subtle filler) before it is "necessary". Prevention, after all, is better than a cure. But a cure for what?
"Think about it," he half-jokes. "Take your time, think about it - then do it."
I'm still thinking.
Case Study No. 1 - breast augmentation
NAME Debbie*
NATIONALITY Australian
SURGERY COST Dh29,000
SURGEON Dr Maurizio Veil, London Centre for Aesthetic Surgery Gulf, Dubai, www.lcas.ae
It is now a year since I had my boob job and I can't imagine life without them. They don't feel fake at all. I went for a smallish size (220 grams to be precise), basically just to get back what I lost through four pregnancies and months of breastfeeding.
My doctor, Dr Maurizio, said I was the ideal candidate because it was just like "filling two air pockets" to get my boobs back to their former glory. I suppose that's another reason they don't feel fake; I was a B-cup before the kids, and growing up in Australia, I spent my life in a bikini. After the kids I had to wear a padded one. I felt I'd been robbed, and having the boob job was just taking back what childbirth had stolen.
I won't pretend it was the easiest thing to go through with. The morning of the operation I was terrified. I thought about how bloody stupid I would feel if something went wrong and I left my children motherless all because I wanted bigger boobs. Can you imagine? "Oh my mum died having her boobs enlarged." What a prat. Anyway, Dr Maurizio assured me that the op was an easy one and less complicated than an in-growing toenail. On the big day he was all smiles when I told him how nervous I was. "I'm not," he said. Which I guess is the right way round.
Afterwards, I woke up feeling really groggy and saw these two pyramids on my chest. I had no idea what they were for about an hour. I was all strapped up and I have to say that was almost the worst part. The recovery period is, realistically, four to six weeks. The first week is the worst. You are strapped up with really strong tape, which made me itch like crazy, and of course you can't lift your arms over your head, so things like washing your hair become difficult.
I had the implants over the muscle as opposed to under it, which is a lot less invasive. I can honestly say there was not one single moment where I experienced excruciating pain, but there was discomfort. My boobs were really sore basically, for at least four weeks, and wearing a bra hurt at times (and you have to wear a support bra, even at night). But it got better with every week. By week three I was almost back to normal and by week six I was doing everything I had done before, just with bigger boobs!
They have "settled" now - at first they were a bit Angelina Jolie - they are just part of me and I defy anyone to tell me they look fake. It was one of the best decisions I ever made; it changed my self-perception at a time when my body image was really low and inspired me to look after myself so the rest of me looks as good as my new boobs.
As told to Helena Frith Powell
* All names in these case studies are pseudonyms
Case Study No. 2 - rhinoplasty
NAME Bronwyn
NATIONALITY South African
SURGERY COST Dh15,000-plus
SURGEON Dr Imran Tahir, British Lasik and Cosmetic Surgery Center, Jumeirah, www.britishlasikdubai.com
It's been nearly seven years since I had my nose done and I haven't really thought about it again until now. As a small child I was always aware that big noses were part of my family; the men had large, strong noses and the women's were very long.
I never thought about it until I grew up and noticed that I too had inherited the dreaded appendage. No one in the family said anything because we all looked the same. My mum was teased by her brothers that the first thing they could see coming round the corner was her nose and the last her bottom. They called it "duck's disease". If I sneaked a peek at my profile out the corner of my eye I could always see that I had a little "too much" nose. I was always conscious of it. I didn't think I could do anything about it until I came to Dubai. Some people I knew were having breast augmentation and there were many surgeries to choose from. I thought it couldn't be that serious. I had saved up enough money so I thought, "It's now or never".
I did my research by watching copious amounts of Dr 90210. I looked at hundreds of "before" and "after" photos, stared freakishly at people's noses and of course read the local and international reviews on the doctors in Dubai. I also ensured that they were recognised by the international medical boards. I visited two doctors before I made my decision. The first surgeon had a fancy computer program that could give me the impression of a new nose with the help of a mouse; I wasn't convinced. The second, I read, was and still is a reconstructive surgeon. Anyone who could sew a leg back on in my opinion could obviously be perfectly capable of slicing off a bit of my nose. After looking at photos of his handiwork, I felt confident he was the one. I booked the operation straight away so I didn't have time to mull over my decision and before I knew it I was sitting in my hospital gown with ink lines on my nose. I was a little nervous the night before but not enough to change my mind.
My husband was the only one I told about the operation. I'm shy and don't like a lot of attention so I was very quiet about the whole story. People I didn't tell didn't really notice the change (that is what I wanted); others were surprised but supportive. I was very surprised that I was not in much pain after the whole ordeal and the dark bruising lasted about a week.
I can honestly say it was the best thing I ever did. What people don't realise is that I didn't do it to get a perfect nose, I wanted a normal nose. My nose is now just a part of my face - it's not tiny, it's not big, it's normal. It is even slightly askew after someone bumped it while it was still healing. I didn't do this for vanity; I did it so that I didn't stand out.
I think plastic surgery is more widely available in the UAE but only through demand and an awakening that we can change things about ourselves. No longer do we have to be grateful for what we have, especially if what we have makes us deeply unhappy. Living in Dubai does enable you to do it maybe because of more disposable income but also because the plastic surgery and cosmetic enhancement boom is taking place everywhere. The procedures are less invasive and less costly, giving more people access to them.
I support and respect what plastic surgery can do. What I don't support is what plastic surgeons allow to be done. There are limits. I respect the doctors who can say no. We put our faith in these surgeons to give us sound advice and to advise us on the limits of their profession.
Are we "fake" because of it? Compared to what? What original form are we comparing ourselves to? When we have our hair dyed is it fake? It temporarily changes our appearance, and so do some of the new procedures. If that is the case then we need to stop brushing our teeth, cutting our hair, cancel the waxing, the pedicures and doctor's appointment to remove that hairy mole and return to our original prehistoric hairy unkempt selves. I'm happy we have choices.
As told to Jemma Nicholls
Case Study No. 3 - breast augmentation and facelift
NAME Lucy
NATIONALITY British
SURGERY COST 1997 breast augmentation price can't be exactly recalled; Dh50,000 for facelift
SURGEON Dr Jaffer Khan, Aesthetics International, Dubai, www.aesthetics.ae
I first contemplated plastic surgery about 20 years ago; I subsequently had my breasts done in 1997 and I've just had a facelift.
In 1995, we moved to the Middle East and I spent most days at the pool. The problem was (back then) I was a AA bra size and could never find a bikini that would fit my small frame. My gynaecologist highly recommended Dr Khan, and as I trusted her opinion more than any advertisement I'd seen, I promptly made an appointment. I remember describing my breasts as small and saggy, to which Dr Khan replied; "No they're not, they're just empty". At that point I knew he was the surgeon for me. We then discussed the size - that was the hard part. I come from a family of large-breasted women so I decided on a C cup. The day of the surgery I was very nervous and scared; I don't think anyone likes the idea of going under the knife. As it turned out though, it really was a non-event: I was home the day after surgery and had very little pain by the following day. I know I had some discomfort for a while, but it's 14 years ago and the (only) wonderful thing about pain is that you forget the way it felt.
The second time I contemplated plastic surgery was after the birth of my fourth child (a menopause baby). I was 45 years old with a newborn again. When my son was around 5 years of age he began asking about age and death; children have such uncontrollable imaginations. I can't count the number of times we had tearful conversations about how old and, in his eyes, close to death I was. My husband suggested a birthday present to restore my youthful appearance and, at age 53, I decided to go for round two.
Given my first experience, and in light of Dr Khan's reputation, I didn't even consider another surgeon. I very recently had the facelift and was home again the next day. There was very little pain and only a bit of bruising around the eyes and cheeks. I stayed in the house for two weeks and then I was out in public. I'm very happy with my new look and cutting my hair short has fooled most of the people I don't see often (they just think it's my new hair style that makes me look 10 years younger).
Plastic surgery isn't for everyone, but I'm very happy with the results I've had and what's it's done to help me look and feel younger. I'm still me, and judging by the reaction of those I've shared my secrets with (I've referred a few friends) they think so too. The lifestyle and opportunities in Dubai definitely make plastic surgery more accessible and available than in many countries, and for me, that's great.
I'm certainly not addicted, and this next one will definitely be my last, but I'm quite sure that I'll get my breast implants redone sometime next year as the recommended "life" of breast implants is around 15 to 20 years.
As told to Jemma Nicholls
Case Study No. 4 - hair transplant
NAME Dave
NATIONALITY British
SURGERY COST Dh20,000
SURGEON Dr Sajad Khan, Aesthetics International, Dubai, www.aesthetics.ae
I lost my hair at a relatively young age and had never really thought much of it, but then my wife became pregnant with our first child and although I am only in my mid-30s, I felt like an old dad because of my receding hair line.
I spoke to a few friends who have had surgery here in the Middle East and listened to their recommendations. Aesthetics International was recommended by a friend of my wife so I decided to go along for a consultation. Dr Khan appeared really professional and I immediately felt comfortable with him and his team.
During the weeks leading up to the surgery, I was quite cocky and confident about it all and didn't think it was too big a deal, yet when the actual day of the surgery came round, although I wouldn't admit it to anyone, I was really anxious and almost backed out!
After the treatment, as expected I was in a fair amount of pain and also experienced some itching on my head but when this passed and the effects of the surgery started to become apparent, I felt like a new man; with my new head of hair I immediately felt much more confident, especially in business meetings, and was also able to look forward to becoming a dad and forgetting about feeling old.
There is no doubt that plastic surgery today has become much more widely available and mainstream. Due to its accessibility, I think that some people have surgery just for the sake of it as opposed to someone who has spent a long time thinking about it and finally doing it - like I did - because they think it could change their life. Here in the UAE I feel there is a certain level of vanity that doesn't exist in the UK. Here people can indulge in surgical procedures like others would a spa treatment. In my case, it's certainly much more acceptable for a man to be well groomed and have plastic surgery than perhaps anywhere else in the world.
As told to Jemma Nicholls
