Most neuroses, he adds, are much more subtle and harder to detect, especially in patients who start with one small procedure, then have another and another. “People want to be perfect,” Pitanguy says, sighing. “In a healthy form, that means taking care of yourself, following a proper diet. But when they want perfection to an extreme, that’s impossible. This form of narcissism becomes self-destructive, pathological.”
But when it comes to unhappiness about aging, Pitanguy is quite sympathetic. “A lot of things can be done,” he says. “I believe that you should correct the [aging] process with elegance and distinction. You should not overdo, because if you overdo, you are only creating a mask without expression, a mask of death. That should be avoided. I try to bring naturalness.” Getting older, he notes, is often most difficult for beautiful women. “They don’t feel it is natural to age,” he says. “But if you help them with a distinguished proper operation, they will be much happier.” As for himself, Pitanguy insists he’s never had cosmetic surgery and doesn’t plan to. “I have a tolerant ego,” he says. “As long as you can tolerate yourself, you don’t need a surgeon.”
While the doctor’s private clinic caters to the elite, he also takes an interest in those at the other end of the spectrum. In 1960 he opened a charity wing at Santa Casa, which he still oversees. Every week, Pitanguy and his team perform free reconstructive surgeries on impoverished patients who suffer from birth defects or have been deformed by accidents. The team also performs cosmetic operations—from calf implants to breast augmentations—at low cost for middle-class people who could not otherwise afford them. In Rio, where the sun shines about 300 days a year and people practically live on the beach, such operations are viewed almost as necessities. Indeed, the Brazilian Society of Plastic Surgeons—the largest such association outside the U.S.—performed about 616,287 operations in 2004, the last year for which statistics are available.
No doubt this accounts for Pitanguy’s über fame in Brazil. In 1999 he received perhaps the ultimate accolade—he was the guest of honor of one of Rio’s most important samba schools in its entry to that year’s Carnaval. Riding atop its final dazzling float, Pitanguy served as the personification of beauty, the theme of the event. “This touched me a lot,” he say. “It was an homage paid to me by simple people.”
Simple isn’t the word for most of Pitanguy’s private patients, of course. When asked about the protocol of operating on a head of state or other such potentate, he quotes a scene from Marguerite Yourcenar’s Memoirs of Hadrian, in which the Roman leader visits his doctor, Hermogenes, and confides, “How difficult it is to be an emperor in the face of his doctor.”