Drawing on ethnographic fieldwork in hospitals that offer cosmetic surgery to the poor, this article examines the causes of a rapid growth in plastic surgery rates in Brazil over the past two decades. It argues that problems with diverse social origins manifest themselves as aesthetic defects, which are diagnosed and treated by the beauty industry. But plastic surgery also incites the consumer desires of people on the margins of the market economy and mobilizes a racialized 'beauty myth' (a key trope in national identity) in marketing and clinical practice. Beauty practices offer a means to compete in a neoliberal libidinal economy where anxieties surrounding new markets of work and sex mingle with fantasies of social mobility, glamour, and modernity.Only intellectuals like misery. The poor prefer luxury.João Trinta, Carnivalesco, Carnival parade designerIn the universe of beauty In contrast to the calm and comfort of the private clinics where I begin my fieldwork, Rio de Janeiro's public hospitals have a hectic environment. Lines of patients sprawl through the narrow corridors that serve as waiting rooms, while young residents in surgery bustle past with stacks of medical files in their arms (Fig. 1). The patients, mostly women and children, span the full range of colours celebrated in Brazil as the hallmark of the povão, 'the common people' . For some it is easy to tell what the complaint is, as the residents say. A cleft palate, a chest burn, a mangled ear. But most patients come for cosmetic surgery, what they call simply plástica.On most days when I visit Santa Casa hospital, housed in an old convent in downtown Rio, the patients are eager for their operations and there is an excited buzz in the hallways. They have been waiting anywhere from a few months to several years. Strangers strike up conversations about their breast surgeries or discreetly lift up their blouses to compare results. Upstairs relatives crowd the corridors waiting to visit patients recuperating in shared rooms, while a team of forty surgeons perform the full range of cosmetic and reconstructive procedures. A Japanese television crew shoots a story one day. On another, former residents come to pay their respects from Europe. In the midst

Brazilian plastic surgeons have successfully promoted a psychotherapeutic rationale for cosmetic surgery. This article critically engages with this 'philosophy' of health, analyzing how it is deployed in busy teaching hospitals. I show how a tradition of intimate hierarchy and class dynamics in medical institutions informs the experimental ethos of clinical practice as patients internalize a psychotherapeutic notion of health and management regimes of female reproduction and sexuality that are becoming normalized among upper social strata. In the process, cosmetic and healing rationales become blurred as patients pursue an expansive, qualitatively defined state of wellbeing that I call 'esthetic health'.

ObjectivesTo elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.MethodsOverall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.ResultsStudy participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers’ awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become ‘gate-openers’ to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts.ConclusionsTo improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Along with a handful of other nations in the developing world, Brazil has emerged as a top destination for medical tourism. Drawing on the author's ethnographic fieldwork in plastic surgery wards, this article examines diverse factors - some explicitly promoted in medical marketing and news sources, others less visible - contributing to Brazil's international reputation for excellence in cosmetic plastic surgery. Brazil's plastic surgery residency programs, some of which are housed within its public health system, attract overseas surgeons, provide ample opportunities for valuable training in cosmetic techniques, and create a clinical environment that favors experimentation with innovative techniques. Many graduates of these programs open private clinics that, in turn, attract overseas patients. High demand for Brazilian plastic surgery also reflects an expansive notion of female health that includes sexual realization, mental health, and cosmetic techniques that manage reproduction. Medical tourism is sometimes represented as being market-driven: patients in wealthier nations travel to obtain quality services at lower prices. This article ends by reflecting on how more complex local and transnational dynamics also contribute to demand for elective medical procedures such as cosmetic surgery.