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The beginning of summer was once characterized by the smell of cold watermelon and lemon ices at the beach. These days it has the smell of silicone. During the summer vacation, entire classes of high-school girls meet at the clinics of plastic surgeons. The big hits this summer? Breast and nose operations. And the parents and grandparents will also take advantage of the vacation for speedy recoveries from a variety of surgical procedures - upper eyelids for NIS 10,000, a face-lift for NIS 32,000; a neck for NIS 8,000.

During the past two years it seems that everyone is doing it, writing about it and talking about it; practically nobody is satisfied with how he or she looks. "I have expectations of being perfect," said Yehudit Landau, a participant in "Hamar'ah" ("The Mirror," a reality show on Channel 10) before embarking on a series of upgrades that took two months. At the expense of the show, she did breasts, face, tummy and teeth, liposuction, lifts and implants. During the final installment she looked like a 50-year-old who decided to go back to being 20: "How do you feel today?" asked the moderator, Orna Datz. "Twenty years old," replied Landau, without batting an eyelash.

Is Israel an empire of plastic surgery? It depends whom you ask. The 130 doctors who are registered with the country's plastic surgery association are overwhelmed with work. Although the organization does not keep statistical records, according to estimates there was a 10-percent increase in the number of operations between 2005 and 2006. In all, about 10,000 procedures are performed annually. But not all these procedures are performed by specialists registered with the organization; in effect, even physicians who are not plastic surgeons, such as skin doctors, eye doctors, etc., perform operations, so the number of procedures carried out is greater than the estimates. The financial turnover of the industry is apparently about half-a-billion shekels annually.

In Sao Paulo, Brazil, with a population of 12 million, there are 1,700 plastic surgeons - one for every 7,000 residents. In the United States there are 6,000 plastic surgeons for a population of 300 million, or one surgeon for every 50,000 residents. Exactly like in Israel. Indeed this craze was "imported" here from the U.S.: From American TV series it looks as though the whole world is one big clinic, and everything is reparable. A partial list: "Dr. Plastic" (broadcast in Israel on the E! channel), "The Swan" (on which "The Mirror" is based), "Nip/Tuck" and "Makeover Extreme." On local TV, too, the trend is picking up speed: Recently a second season of "Laredet Begadol" (the Israeli version of "The Biggest Loser") began, and Channel 10 is working on the second season of "The Mirror." Meimad, its producer, received over 3,000 requests from people who want to appear (13 were chosen).

It's no wonder. Surfing the Web sites of plastic surgeons reveals a glamorous gallery of models, actors, former beauty queens and society people - all of whom have undergone some kind of treatment. Women's magazines and gossip columns report extensively on these operations and also focus on the doctors, who have become celebrities themselves.

The names of the plastic surgeons do not reach these columns on their own; many doctors are represented by public relations agencies and consultants. One of them is Dr. Dov Klein, who used the services of consultants Aliza Zana and Nizan Ofir.

"When he came to us he barely had a room and a half at Ronit Raphael [Medical Cosmetic Center]," says Ofir. "We worked with him for six years. With our own hands we built him up and gave him an image. I myself ran to all the leading agencies and brought him models and trendsetters as clients. All of them are our work. It's no wonder that today [the volume of work in] his clinic has jumped by dozens of percentage points."

Dr.Plastic,superstar

Today Klein has a private clinic in the high-tech area of Ramat Hahayal in Tel Aviv; his logo, dK, is reminiscent of another fashionable Klein. Dr. Klein also has a line of cosmetics, a school for medical cosmetics and he's about to launch a line of underwear. He recently joined the Assaf Harofeh Medical Center, where he is running a new center for plastic surgery.

Not all plastic surgeons, incidentally, feel comfortable with the increasingly close connection between doctors and PR people. Dr. Michael Scheflan, a senior plastic surgeon and director and owner of the Atidim Medical Center (whose name is familiar from the "Jacuzzi affair," publicized here in 2003, concerning a microbe that was discovered in his clinic and infected 15 patients), recently wrote a biting critical article on the subject in the newsletter of the plastic surgery association: "For years there have been new generations of plastic surgeons who lack sufficient training in aesthetic surgery, who do not have the proper tools to deal with a competitive, not so say violent, market. What do they do to survive? They join advertising agencies and government or private aesthetic associations, and operate for a ridiculous salary and the payment of insurance premiums. They operate free of charge for public relations, pay commissions to patient contractors, collect bonuses from representatives of companies and manufacturers."

Public relations efforts focus on publicizing articles where surgeons are mentioned, and are camouflaged as consumer pieces or touching personal stories. Such a story is the breast-reduction operation of Orit Fox, 28, who still, even after the procedure, apparently has the largest chest in the country. Why a reduction? Because a few years ago Klein - at her request - inserted silicone implants in her with a volume of 1,300 cubic centimeters, on each side.

"In the army I decided to enlarge," said Fox in an interview with Einat Ehrlich on the Israeli entertainment channel. "My obsession is my breasts." Fox had a naturally large chest, and several doctors would not agree to enlarge it. "I continued to look for a doctor, and everyone told me: 'Dov Klein will operate on you.'" Fox's satisfaction did not last long. Adi Barkan, her agent, was also unhappy, and Fox volunteered to have a 500-cc. reduction. This surgery was followed in great detail by a film crew sent on behalf of TV presenter Guy Pines.

Who initiated the Fox news report?

Pines: "I think we were invited by that doctor, or it's possible that we read about it in the paper and we approached them. The doctors are very interested in doing such things, and Dov Klein most of all. It's quite common for doctors to employ PR people and publicize their operations."

Doesn't this seem to you like a voyeuristic activity that encourages plastic surgery?

"I don't feel that I'm leading a trend, but rather reflecting a situation. I don't talk about it either admiringly or critically. Although we show it, we also express our opinion ... I don't condemn the phenomenon as a phenomenon - not as a human being and not on the show. I think that if someone does it because it's his way of being a better person, that's his right, but I wouldn't want to encourage it. In the case of Orit Fox, the idea behind it was, 'God, what is this thing and who is this doctor who is so eager to be famous?"'

Klein himself is very eager to become famous, at any cost, it seems: "Orit did not have large implants. There are places in the world, in the U.S. or in Germany, where they make much larger breasts than that."

But it's not healthy, it damages one's back.

Klein: "There are patients who want that. I can explain the consequences of this operation, but they have to take responsibility."

There were doctors who didn't agree to do this implant for her.

"I can't take responsibility for the decisions of mature women."

In one case, three years ago, reporter Yasmin Levy of Rating magazine (today part of Yedioth Ahronoth) accompanied Naama Nativ, who became famous on the reality adventure show "Sof haderekh" ("The End of the Road"), to a breast-augmentation operation performed by Dr. Klein. The outcome was an extensive article.

"We weren't inside," says Levy. "We accompanied her to the operation and continued to speak to her after the operation. The idea was to reflect her thoughts, her considerations, the fears and the handling of the situation. We were not interested in the operation itself."

A few days after the operation Nativ went to the beach and was photographed with her new chest for the Internet TV channels, as a sign of appreciation to the surgeon. The photographers showed the bandages beneath the bikini top in close-up.

Guy Pines' staff has dealt with this subject more than once: A year ago they went to the Dr. Center Medical Center to follow up the treatments received by the members of the Diamonds band before the preliminary Eurovision Song Contest broadcast. During the course of the filming, one of the girls fainted. That was documented as well.

"We showed that not everything is wonderful," boasts Pines. "We also showed that people make a series of improvements and faint from it. Dr. Center approached us afterward and said, 'We invited you, so you can't show such things.' We told them, 'It's a shame, but it's part of the deal.'"

Tami Alon, one of the owners and the director of Dr. Center, recalls that "they had injections in their lips, they had dental work, they removed hair with laser treatments and one of them had a chest augmentation. That one fainted, apparently from the excitement."

Who paid?

Alon: "We did a barter deal. Some of them paid and to some we gave discounts. We pampered them. We also did [actress] Michal Zoaretz's teeth, and she didn't pay, but she gave us exposure. She agreed to let us publicize her."

Zoaretz refused to discuss the subject.

Nameofthegame

Barter is apparently the name of the game here: When it comes to people who are famous, regardless of the reason, not much money changes hands. Nine years ago, when murderer Hava Yaari was released from prison, she received a gift - with strings - from Dr. Center: a total makeover under wonderfully convenient conditions in exchange for an article in the "7 Days" weekend magazine of Yedioth. All the parties involved were satisfied.

"Plastic surgery is part of my preparation for coming back to life," Yaari told interviewer Anat Meidan. "My wrinkles are wrinkles of suffering and I want to erase that. Look at my nose; it really grew during those 12 years. It reminds me of Ehud's nose, and that bothers me." (Ehud Yaari is her ex-husband).

Hava Levy, 56, Israel's beauty queen in 1969, had a face-lift three years ago. Two years ago she revealed her experiences in Olam Haisha magazine, to journalist Sarit Yishai, who is also a close friend. A year later she repeated this with a similar interview in Zmanim Moderni'im magazine. "I wanted to compliment my doctor," she says. The doctor, Dr. Meir Cohen, got two articles praising him and his handiwork, seen in the glamorous photographs of Levy - who was also properly compensated: For the past two years she has been running his clinic.

Did you pay for the surgery?

Levy: "Why is that important? I won't go into those details. I saw many doctors before him, and I didn't connect with them, and I connected with him immediately, I felt comfortable with him, and I was happy to tell other people, because I thought it was a pleasant experience to do something for yourself."

The limits of barter arrangements become even more flexible when the patients are journalists. A year ago, Meirav Batito-Fried of the daily Maariv volunteered her face for the benefit of the newspaper, and agreed to receive a Botox injection. She documented her experiences before, during and after the treatment in a revealing article. "It abused me," she wrote about the deepening furrow between her eyebrows, "and I went crazy."

"None of the other journalists was ready to do it," says Lisa Peretz, the editor of Signon, a Maariv supplement, who assigned Batito-Fried to do the article. "I asked them 'Why?' and they said it was embarrassing. If there is anything the media have done for the field of plastic surgery, it's to take it out of the closet. They not only reported, but also confirmed that it's all right. From that point of view the shame has been removed, and that is the great contribution of the media."

Why did you initiate such an article?

Peretz: "I imagined plastic-surgery reality like on television. It's shown on all the channels in prime time. I, as an editor, was not ashamed to ask for such a thing either."

Doesn't it bother you to be part of the exaggerated preoccupation of the media with the female body image?

"It's true that in recent years the media have praised women who expose silicone breasts. Ten years ago if you dared to ask someone about plastic surgery, you did it in private; today young female celebrities like Miri Bohadana talk about it freely. There are people who brag about it. It's a dilemma for women's magazines. With every cover and every article, I deliberate its legitimacy once again."

Do you understand that the message that is conveyed is that women are not important because of their achievements, but because of their chests?

"It's true, an entire age group is gradually disappearing. There is no longer any possibility of growing old gracefully, of being the tribal elder; in the next generation there won't be any smart, wrinkled women with knowing eyes. That's what I regret most. All the women will become mutations. The body inside ages and outwardly you are constantly ironing and polishing it. If once someone who did four or five operations was considered mentally disturbed, today it's self-evident. Everything has become terribly vulgar. Thanks to the medical centers. A girl finishes her army service and as a gift on her discharge she gets new breasts."

Dr. Haim Kaplan, who injected Batito-Fried: "I did it for her and for the article," he says. "She received the Botox from the importer and I injected her free of charge."

Did that bring you patients?

Kaplan: "I don't know. After all, how much did it cost? No more than NIS 800. I did it gladly. The idea is that your name will be mentioned all the time in the media, like Coca-Cola. But I usually don't operate on celebrities because they don't want to pay and I don't work for free."

Exposureandcoverage

One of the first patients who documented herself in the media was journalist Bruria Avidan-Barir in Laisha women's magazine, 12 years ago. She underwent neck and lower jaw surgery with Dr. Haim Resner, a well-known plastic surgeon. "When the time came, I decided to tell other women and to convey a positive message to them," she says.

"The responses were amazing, and I felt wonderful. Hundreds of women turned to me from all over the country. It wasn't a free operation. At the time, a very well-known doctor offered to do the operation in exchange for an article, but my husband objected and said, 'We'll do it in a place and at a time that suits us."

What do you think of the increasing exposure of the patients?

Avidan-Barir: "It's the most realistic expression of the commercial and marketing world. They are marketing breasts, ears, lips - everything is marketed. After all, people do free operations in exchange for exposure. I didn't do it as a marketing campaign, but described fears and sensitive processes, pain. It was an intelligent mix and was therefore fascinating, but I admit that it was revealing."

In early 2002 writer Nir Kipnis, who writes for the men's magazine Blazer, published by Yedioth, decided to embark on a campaign of self-improvement. He shed 50 kilograms during one year through dieting and exercise, under the guidance of nutritionist Tzahi Canaan. He documented his experiences in his newspaper every month.

Canaan was not paid. The compensation was the exposure. The project was funded by the Maccabi health maintenance organization together with a fitness club in Tel Aviv. In addition to losing weight, Kipnis had hair removed from his back and shoulders with laser treatments at Ronit Raphael's medical-cosmetics center. "There, too," he says, "the deal was a mention in the text in exchange for the treatment."

Blazer's editorial staff had no ethical problem with this arrangement?

Kipnis: "No, nor do I have an ethical problem with it. I think that even the readers already understand that today there is nothing free in the press, and we don't pay money for anything."

Journalist Sarit Yishai, of Olam Haisha, also underwent various treatments at the expense of her plastic surgeon, Dr. Meir, and reported them in her magazine. According to the magazine's editor, Mary York: "More and more women are aware of their external appearance, and Olam Haisha reports on innovations in all the areas that interest women, but refrains from taking a stand. Over the years we have also published many articles that discuss the dangers of these operations. The magazine distinguishes between plastic surgery and treatments that do not involve invasive surgery. None of the female journalists at the paper has had plastic surgery for the purpose of writing, at the expense of a doctor, but in the context of the treatments a number of articles were done, always with reservations about after-effects. Sarit underwent various treatments and wrote about them afterward and she didn't pay for them."

'Uniformformat'

Plastic surgery penetrated our lives as a consumer item in the late 1980s, with the opening of many centers specializing in it. These centers encouraged doctors to work there for a lower-than-average salary, which created competition, lowered prices significantly and put an end to the elitist image of plastic surgery. Ronit Raphael was the first to open these medical-cosmetics institutions; afterward, many others were opened with the same format, spawning a flood of operations with convenient payment conditions.

Dr. Dean Ad-El does not think the media or the opening of medical centers are the reason for the large number of plastic surgery procedures. Ad-El, the head of the department of plastic surgery at Beilinson Hospital and Schneider Medical Center, and a leading doctor at Clalit Aesthetics (a network of clinics for plastic surgery operated by the Clalit health maintenance organization), claims that the pressure comes from below: "There is a great deal of pressure from young girls, and also from the middle and lower classes. This is the social class with the most plastic surgery. Women for whom their external appearance is very important break open savings plans. Women in crisis after a divorce, who don't have much money, save their pennies and believe that an operation is a key to success."

Dr. Miri Rozmarin, of the philosophy department at Tel Aviv University (TAU), thinks the situation is more complicated: "The uniform image of the body affects all the women; they all have to look the same. They say that women are victims of the media, [but] in my opinion the truth is more complex. When someone says she wants [such operations] for herself, I believe her. The complexity is in the fact that we live in a culture where even our will is a built-in social phenomenon, and this leads to a constant need to improve our body so it will resemble some unattainable ideal."

Dr. Roni Halperin, of TAU's women and gender studies program and literature department, says with respect to the book by feminist Naomi Wolf, "The Beauty Myth," that society punishes women for their achievements. "The more power you have achieved in the public arena and the more opportunities have opened to you, the more the obsessive preoccupation with your body puts you in your place, and that teaches you that you can be a successful CEO, but still a slave to your hair color and your wrinkles.

"Feminine beauty is a matter of culture and of economic and political interests. I'm not issuing a sweeping condemnation of operations; I am critical of the dictatorial culture that embraces these values. They place you on a treadmill of endless, frenetic running, in order to enforce domination over you once again.

"The man who does the same thing, the ultimate metrosexual, does not achieve self-esteem through the weight loss; it's always just a bonus. It's an 'extra,' in order to celebrate success, not a sign of success, while for women to have breasts of a certain size is success. For men the Mercedes is not the status, the status exists before the Mercedes. When younger girls increasingly become models for mature women - that's far from beautiful, it's grotesque, and the joke is on us. This is a long-standing masculine culture; only the means of domination change."

"The whole idea is that we have to give birth to ourselves anew all the time," says Dr. Sigal Gooldin, of the department of sociology and anthropology at the University of Haifa. "The format of the various plastic surgery procedures and diets replicates the size and shape of the body, creating a certain pattern to which we must aspire. A uniform pattern. There is cultural totalitarianism here, because in real life there is a range of different body sizes and shapes. The media are involved in that and they also glorify the models that they themselves create." W