In Iran, a country where the veil is mandatory and make-up is considered un-Islamic, cosmetic surgery is now commonplace. Several years ago, I spent 18 months taking before-and-after photographs in a hospital-based cosmetic surgery clinic in Iran. This article is about my impressions of this industry and my perspective on the enigma of why so many women are seeking cosmetic surgery.
I was working on a project about professional women in Iran, and spent eight months shadowing a doctor as she did her job, taking a series of photographs. It was a whole new world in which I saw so many unfamiliar things and many sick women. I got to know the issues that preoccupied the women, and their worries over even two hairs out of place. I wore a doctor's coat and was present in the operating theatre for numerous procedures. I witnessed births – the first tears, the emotions – and hysterectomies. I met all kinds of women. I was also working on a concurrent project on make-up so I became completely immersed in their world too. When I walked along the street and saw a woman approaching, I would try and imagine what she was thinking. I had developed a new awareness and my respect for women grew.
During the sessions I attended at the hospital, there was plastic surgery regularly underway in the adjoining operating theatre. I became curious and wanted to photograph the women for my project on make-up. I asked the doctor to mention this to the surgeons on my behalf. She said they wouldn't agree, but told me that she had had her breasts done, so why not photograph her. So I photographed the doctor and I eventually met one of the plastic surgeons. In fact, he was very keen to collaborate. He worked with two female assistants and I soon joined them as a full-time photographer – photographing his patients.
The first appointment a patient has with the surgeon is for an appraisal. Part of this involved my photographing the relevant body parts. I was staggered by the number of cases. The waiting room was always packed, some people sat there for six hours before seeing the doctor. Appointments ran late into the evening, often until midnight. Patients were shown different breast prosthetics. Then the surgeon would suggest other procedures as they were going to be under an anaesthetic anyway. He would say things like: “We can also fix your stomach while we're at it.” His tone would become comforting and his whole manner more endearing and affectionate. As far as the photographs were concerned, he explained that they were a necessary documentation for their operation – to show the before and after. The patients paid for the photographs and I received about a third of the fee.
The clinic was carrying out about 500 breast operations each year. One woman had her stomach, breasts, legs, even her feet done. She said she wanted to feel good when she looked in the mirror. She was 40 or so years old. She said: “I want to die beautiful.”
About two out of ten women needed reconstructive plastic surgery on genuine medical grounds, following an accident, say. These patients were generally refused on the grounds that such cases were too serious and time-consuming.
When they examined and consulted, the surgeon (sometimes with someone from his team) would stand over the patient and discuss all the “faults” of the woman's body. There was no discretion or sensitivity towards the patient's nudity either. There was a noticeable difference between the male and female doctors in this respect. In the time I had spent previously with the woman doctor, I noted that during an examination or treatment she kept areas that were not pertinent covered and moved the cover accordingly. There was no such consideration from the male cosmetic surgeons. As doctors, who should have been concerned with well-being, they seemed completely oblivious to this, or perhaps they didn't care.
There were many young women with nothing “wrong”. They all had scenarios to “improve” their bodies; stories and histories that they thought could be fixed with these operations. It was all to do with lack of self-esteem. Often their partners were against it, but the doctors were very aware that it is a self-esteem issue. I was particularly upset by the young women. But my compassion for all the women and my anger at how they were being treated grew stronger the longer I worked there. Breast augmentation or reduction surgery costs around three million tomans (UK £2,000). How much would a therapist cost? It was astounding.
However, it's the fashion. Everyone is watching satellite television, they see photos on the internet. I met a woman who came to have a breast reduction just so that she could go without a bra to a party. In a climate such as this, if you don't have something done, there's something wrong with you. They see that they differ from Europeans. Some were bored, with nothing to do but focus on their bodies – for example, the new moneyed women from expensive urban areas. One woman was there so often that the plastic surgeon did not know what else to do for her. Eyebrows were lifted with thread positioned under the muscle. That cost 600,000 tomans. Cheekbones were created with careful repositioning and the addition of muscle. Of course this would eventually droop. There was a prostitute who had spent seven million tomans. Actually, the work on her was paid for by wealthy clients. She regularly came for vaginoplasty – vaginal tightening surgery.
I'll never forget the tearful faces of many of those who had been operated on. The results were never as people imagined. For every five patients, three would come back unhappy after surgery. That is a lot of unhappy people. I was witness to tears every day. These women were confronted with a whole new reality. One woman came in screaming, scaring all the new patients in the waiting room. On occasions like this they would quickly usher her into a room and close the doors. The surgeon would calmly tell her that her body had clearly not been receptive to a common procedure. That it was an outcome of the individual bodily constitution. He would explain that it was early days, that the body needed time to adjust and allow the changes to take proper shape. If patients remained unconvinced he would, for example, return two million tomans of a five million toman bill, explaining that the other three million had gone towards hospital fees. He was one of the better-known surgeons; I wondered what the others were like.
The patients guessed that I was not part of the clinic, that I was an outsider. I couldn't hide what was in my eyes. The nurse, too, was obviously very uncomfortable about the way things went. She often made distressed eye signals at me as the results of the latest operation were revealed. Worst of all was the secretary. She encouraged or controlled waiting room conversation as appropriate. She would create familiar names for newly operated on patients – “Ah here comes the lady with the perfect nose”, or the “beautiful-breasted one” and so on.
I have never been as angry as I was working there, made worse by the knowledge that I was helping the surgeon to make more money. From the start, when patients first came for a consultation, to the end, when the bandages were taken off, was like witnessing someone's suicide. I wanted to stop them but there was no opportunity to speak, and I knew they were too determined to go ahead, that they would think I was crazy. I've heard that elsewhere in the world you need a letter from a psychiatrist to qualify for some of these procedures. But in Iran there is nobody to monitor what goes on and the surgeons are not accountable to anyone. At the clinic they were always wary of me as a journalist. I'm not sure if I would have lasted any longer in that environment. My anger was beginning to show.
This is a terrible phenomenon that befalls our women, but it is not political so it is ignored. Yet it is there, under the skin of the city. Slowly but surely these women are destroying themselves. Beauty is not – or should not be – dependent on the shape of your nose.
Acknowledgements
This is a slightly edited version of an article that will appear in Index on Censorship No.1, 2010, and is reprinted here with their kind permission. The copyright remains with Index on Censorship. Negar Esfandiary conducted the interview and translated the text into English.