Iran has long been known as a centre for cosmetic surgery, with tens of thousands going under the knife annually in pursuit of perfection. But a sharp increase in the numbers in recent years has alarmed senior doctors who are fearful of the impact on patient health, and even Iranian identity.
“The authentic Iranian face is being distorted through invasive procedures,” Babak Nikoumaram, chair of the Iranian Society of Plastic and Aesthetic Surgeons (Ispas), told the Financial Times. “Incongruous western beauty standards are forced upon Iranians.”
Iran ranked 12th globally in terms of the number of cosmetic surgery procedures performed in 2022 — the most recent figures available — according to the International Society of Aesthetic Plastic Surgery (Isaps), up from 18th place in 2016.
Rhinoplasty remained the most popular procedure, followed by liposuction, eyelid surgery, abdominoplasty and breast augmentation. In total, some 320,000 cosmetic procedures, both surgical and non-surgical, were performed in the country in 2022, compared with 151,000 in 2016, said Isaps.
But the figures were just “the tip of the iceberg”, because few of Iran’s surgeons provided Isaps with data, said Nikoumaram. Doctors were also not obliged to file records with Iran’s health authorities. The true number of procedures was much higher and was likely to put the country in the top five, he said.
In a sign that multiple cosmetic procedures have become mainstream in Iran, interior minister Ahmad Vahidi said late last year that people who had radically changed their appearance in this way would need to apply for new ID documentation.
Women, who account for 80 per cent of demand for plastic surgery in Iran, according to industry figures, cite a range of reasons, from the perception that people seen as prettier gain advantages to the rise of social media.
Hundreds of thousands of Iranians follow the country’s beauty bloggers and there are around 6,000 accounts on Instagram and other platforms promoting Iran’s cosmetic surgery services, according to Isaps.
“It’s the new social norm, and people feel pressured to conform,” said Iranian personal trainer Maryam, 34, who has undergone several cosmetic procedures including rhinoplasty and jawline contouring. “The dominant view in our society is that beautiful women get approached with better marriage proposals and land better jobs.”
Neda, 25, a fitness instructor who has also had rhinoplasty, added: “Iranian women want to be like foreign models who have married rich men or made fortunes and become famous. No one wants natural looks anymore.”
Pressure from men for women to look a certain way had also intensified, according to Maryam. “Guys started comparing girls to those on screen. Some pick whatever features they like from different women and ask their woman to look like that.”
Taraneh, a 34-year-old architect who has had a rhinoplasty and Botox treatments, said: “Girls feel insecure and inadequate compared to what they see on social media. They do this to boost their looks in a way that would be appealing to guys.”
Cosmetic surgery in Iran was once largely confined to the affluent and middle-aged. But it has become mainstream among the young and people from all walks of life, said surgeons.
Alireza Mesbahi, a facial plastic surgeon and secretary of the Iranian Rhinology Society, said many patients, lured by “misleading advertisements and fake Photoshopped images on social media”, were still in high school.
Demand remains strong despite a crippled economy as Iran grapples with runaway inflation and western sanctions imposed over its nuclear ambitions. Some clinics and financial services companies offer instalment plans for those struggling to fund procedures.
“I’ve worked in gyms where most women came from poor families but getting lip fillers was all that mattered to them,” said Maryam. “The prices are still affordable for people on a budget.”
Iran’s low costs and surgical expertise also lure patients from abroad, mostly from Arab states as well as Iranians living in Europe and the US. According to Isaps, about 8.5 per cent of plastic surgery clients in Iran came from other countries in 2022.
The average surgeon’s fee for rhinoplasty in the US is around $6,000, with additional costs for anaesthesia and other expenses, according to the American Society of Plastic Surgeons. In Iran the total price is between $800 and $2,000.
Rapid industry growth, unbridled advertising and a rising number of unqualified practitioners have worried senior plastic surgeons. According to Ispas officials, there are some 430 accredited plastic surgeons in Iran but an estimated 2,000 doctors offer cosmetic procedures.
“Professional and ethical standards will be sacrificed for financial gain”, Nikoumaram said, alleging that some surgeons were stamping their signatures on medical notes to authenticate operations conducted by technicians.
The “destructive tsunami of cosmetic surgery” also risked undermining the wider health service by swallowing up financial and medical resources and causing a labour shortage, he said.
A rise in malpractice claims and weak regulation were further concerns. The number of medical commission sessions convened to examine malpractice cases had more than doubled in the past five years, he said. Surgeons were not obliged to report complications, while victims were often “offered money not to file lawsuits”.
Mesbahi also expressed worries for patient health, warning that the trend for small noses “not only violates aesthetic principles and modifies racial features, [but] can also cause breathing problems and damage the sense of smell”.
Senior plastic surgeons have called for better regulation of the industry and adoption of international best practice, including a minimum age for surgery, mandatory professional training and requiring doctors to disclose mistakes made by peers.
“There are rules for changing a building’s configuration,” said Nikoumaram. “Why shouldn’t transforming people’s faces be regulated?”
