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Cosmetic surgery is used for anti-aging, but young people are increasingly resorting to it to alter their looks in a beauty revolution which is being described as unprecedented.
The trend is clear in Spain, where about 400 000 cosmetic operations are performed annually, more than in any other European country.

Surgery no longer serves just to improve a person's natural looks, but to change them and even to make them deliberately artificial. Most recently, Crown Princess Letizia, 35, had her slightly aquiline nose straightened in an operation which many saw as modifying her looks in an indefinable, but undeniable way.

Young girls are also "going mad" for breast implants, according to plastic surgeons interviewed by the daily El Pais. Many of them do not even seek a natural look, but round-shaped breasts that reveal the operation, surgeon Jose Mallent said.

Beauty becoming a duty
Latin American and Asian immigrants are meanwhile resorting to surgery to adapt their facial features to the Western beauty ideal.

"The constant (media) stimulation of our senses with views of beautiful individuals is something totally new in the history of our species," expert and author Ulrich Renz told El Pais.

In the past, being beautiful was something exceptional, but advances in cosmetic techniques, increased money power and media pressure have turned beauty into a perceived duty which ordinary people can and feel obliged to pursue, according to analysts in Spain.

The number of cosmetic surgery operations increases 10% annually in Spain, where the market turnover is an estimated 800 million euros (1.2 billion dollars) a year.

About 40% of surgical and non-surgical aesthetic treatment is given to people who are under 21 years old. The most common types of surgery on an overwhelmingly female clientele include eye and nose fixes, face-lifts, liposuctions, breast augmentation and tummy tucks.

People want to look like celebrities
The operations are not cheap, but large companies promote them with aggressive publicity and payment facilities. Spaniards also practise "scalpel tourism" to Mexico, Colombia, Brazil or Argentina, where the medical guarantees are more difficult to control than at home.

The Spanish patients' defence association ADEPA received some 800 complaints about operations that went wrong in 2006, but that does not deter people seeking such procedures, some of whom arrive at clinics with pictures of celebrities whom they want to look like.

The royal palace cited breathing difficulties as the reason for the nose operation on Letizia, wife of Crown Prince Felipe and Spain's future queen, but commentators linked it with image concerns as well.

"I thought she was a self-confident woman, but she did not like herself," royalty-watcher Jaime Penafiel commented.

Cosmetic surgery not linked to low self esteem
One US study, however, showed that people undergoing cosmetic surgery do not usually suffer from low self-esteem. Beauty is now seen as something necessary, available, and increasingly artificial, with many cosmetic surgeons describing themselves as artists who mould human flesh.

Breast implants have become "just another consumer product," Antonio Porcuna of the plastic surgeons' association SECPRE said. Girls seeking such operations may be as young as 14, and it is up to the surgeons to decide whether they follow the association's recommendation not to operate on minors.

Who is beautiful is defined by the Western media, which tends to exclude most of the world's population from that privileged category.

"I had clear Inca features," said Orly Cuzco, a 28-year-old Ecuadorian immigrant who had his aquiline nose straightened. Other immigrants get jaw implants or reshape their slanted eyes in attempts to Westernise their facial features.