In Brazil, Beauty Is a Right. Are They On To Something?

Every person with a toddler knows that her child is in constant imminent peril. Trying to prevent the next near-death or disfiguring accident is a parent’s unending occupation.

I was doing my best as I stood on one end of a shower in our hotel in Rio de Janeiro, trying to get the water temperature right before going to comfort my then 2-year-old daughter, Anika, who was trying to escape bath time on the other end.

But I was too late. Anika fell on the slippery tile, her face landing on the sharp ledge. I didn’t think it was serious until I saw streaks of blood on the floor. I shut off the water and picked her up to see the wound, a gaping hole in her cheek. She was so shocked she wasn’t even crying. I grabbed a towel and yelled to my husband that we needed to see a doctor immediately.

Because I was in Brazil at the time, instead of at home in Virginia, I was given a new vantage point on the way that society treats the desire for beauty as a sign of human flourishing and not mere vanity. The differences I observed in Brazilian society’s relationship with beauty —compared with what I’d grown up with in the United States — forced me to reflect on my past and reconsider what I wanted for my daughter.

The next half-hour was a blur of trying to stop the bleeding, struggling to find an emergency room that would take a 2-year-old, trying to communicate with cabdrivers with my nonexistent Portuguese skills and sending texts to a Brazilian friend who apparently wasn’t checking his phone, asking for help. Finally, we got Anika to a hospital.

While the bleeding had stopped, the flesh around her cut lay open, like it had been filleted. I could see that her injury was about as deep as it could be without exposing bone.

My first thoughts were about her future, about her chances of being a news anchor or an actor or an influencer, if that’s what she wanted, or of finding a partner, which immediately embarrassed me.

When I was younger, one of my most intense yearnings was to be beautiful, and I don’t mean naturally. I was OK-looking, just the normal amount of insecure about my appearance. Yet I knew that the way I presented myself through my hair, my face and my clothes said something about my taste, my ability to take in the world and interpret it for myself. It was a way to exert my sense of self.

The problem was that I wasn’t allowed to. To my immigrant parents, who moved to the United States from India when they were in their 30s, beauty was frivolity. The important things were to work hard and study hard. Everything else was a distraction. We were middle-class — both of my parents trained as engineers — but they had arrived in this country with barely any money and knew what it meant to be poor. To them, my aesthetic concerns must have seemed very foreign.

It wasn’t until I was in my late 20s — when I finally had the confidence to do what I really wanted, which was to experiment with nice makeup, high-end hair products and more stylish clothes — that I developed a healthier relationship to how I looked. I realized then that wanting to look good wasn’t a sign of my superficiality. It was normal and human. And as I’d always expected, it was more than that; beauty itself was an investment that could lead to more success.

This is what I was thinking about when a nurse in the emergency room said that in some cases, they brought in a plastic surgeon. We agreed that was what we wanted, and within about an hour, the surgeon turned up. Calmly, he instructed a nurse to hold my daughter’s head still and had me pin down her arms as he applied local anesthesia and got to work on the stitches.

“I want to get it out!” Anika shouted as she saw the needle go in. I whispered that it wouldn’t take long. Meanwhile, I watched, amazed at the surgeon’s skill. There was a deeper set of stitches that was meant to hold the wound together to relieve tension on the surface. Then there were the running locked intradermal stitches just beneath the top layer of the skin to prevent the typical railroad-track lines from forming.

“Don’t worry,” he told me after. “Brazil has the best plastic surgeons in the world.” He reassured me the scarring would be minimal. Our total bill for the plastic surgery was just $500.

Brazil, I learned, prides itself on its huge number of skilledplastic surgeons. The country recognizes a “right to beauty,” which in practical terms means subsidizing nearly half a million surgeries each year, according to Carmen Alvaro Jarrín, the author of “The Biopolitics of Beauty: Cosmetic Citizenship and Affective Capital in Brazil.” In the 1950s, a famed plastic surgeon convinced the president that ugliness can cause painful psychological suffering and that treatment should be covered. While at first he was referring to those with congenital deformities and burn victims, most procedures covered today are purely aesthetic.

This philosophy has significant drawbacks. In a public health system that’s strapped for resources, it’s certainly arguable that this is the wrong kind of spending. Everyday differences in bodies end up being pathologized by the medical establishment, defining attractiveness in a limiting way. Small breasts, for instance, might be diagnosed as “hypotrophy of the mammary glands.” Finally, because plastic surgeons gain practice at government hospitals, poor patients are basically guinea pigs, Jarrín says.

For all its failings, however, what Brazil’s policy does create is an acceptance that beauty is a form of self-care and that there’s nothing embarrassing about wanting to meet society’s standard for how we should look, no matter our social class. There’s no denial that small changes we can make to our surfaces have profound influence on our quality of life and that beauty is often a means of gaining power.

When I got back to Virginia after my daughter’s accident, I kept wondering what her treatment would have been had it happened here. Most countries’ health coverage applies just to reconstructive care, not aesthetic. Brazil, an outlier, sees more continuity between the two, “likely a means to push their own agenda, but that they also have a point,” says Alexander Edmonds, the author of “Pretty Modern: Beauty, Sex, and Plastic Surgery in Brazil.”

Our system in the United States makes the kind of hospital treatment my daughter received a matter of privilege. While her procedure might be considered reconstructive rather than cosmetic, whether she got a chance to see a plastic surgeon would depend on where she was getting treated. For example, hospitals visited by patients on Medicaid are less likely to provide the option of a plastic surgeon, and Medicaid does not cover cosmetic surgery unless the procedure is medically necessary — which, in my daughter’s case, it was not.

Beauty standards continue to rise, yet access to cosmetic care is rarefied.

When I went to my daughter’s pediatrician’s office to get the stitches out, the nurse hesitated at first. She’d never seen stitches like hers, with the thread visible only at its entry and exit points. She brought in two doctors just to check she was doing it right. None of them knew for sure, but when pulled from one end, the thread came out easily. I asked about what the care would need to be like going forward to minimize scarring. Sunscreen, they all said.

I inquired about lasers and stem cells and any other tools that might be in a plastic surgeon’s toolbox. Their nonresponses told me that this was overkill, which made me defensive. I wasn’t asking because I was going to go out and get them. I just wanted options. We tend to romanticize scars. “The lessons of life amount not to wisdom, but to scar tissue and callus,” writes Wallace Stegner in “The Spectator Bird.” But the benefit of having money is to not face consequences.

It’s been months since my daughter’s fall, and her scar is healing, along with my anxiety about it. My daughter is still processing the shock of what happened to her.

If the scar doesn’t completely go away on its own, when she’s older and if she wants it, we can get her more treatment, which we’ll have to pay for out of pocket. Luckily, we can afford it. I won’t need to lie to her about what I know to be true, that controlling how we look is a big part of how we exert our power in the world. To do so isn’t superficial any more than to be uninterested is a mark of moral superiority. She won’t need to wear her scar as a badge of toughness, and her inability to live with it won’t be a failure of personality. She’s allowed to want to feel beautiful.

Sushma Subramanian is the author of “How to Feel: The Science and Meaning of Touch.” This story was supported by the journalism nonprofit the Economic Hardship Reporting Project.

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