Chasing the perfect abs, men flock to plastic surgery

Bathers show off their six-packs on Rio’s Ipanema Beach. Photo / Marina Calderon for The Washington Post

Men are turning to ultra-high-definition liposuction, a plastic surgery procedure pioneered in Brazil, to sculpt six-packs and perfect abs.

In the spring of 2022, Junior Carvalho’s life came apart. His wife of 29 years asked him for a divorce. He moved into a Spartan one-bedroom apartment and saw less of his kids. He was eating too much, drinking too much, watching TV too much.

At 52, he already felt old. He didn’t want to die alone. But who would want him like this? He walked on the beach every day for hours, bereft and anxious.

As he walked, he started to lose weight. Then he lost more. He began visiting the gym. Found a personal trainer. Took supplements and testosterone. He grew stronger and more muscular, but came no closer to his goal. He wanted to look like all those impossibly fit men he saw strutting down the beach, six-packs gleaming in the Brazilian sun.

Searching online, he found his answer: ultra-high-definition liposuction. The treatment promises washboard abs for men who find them difficult to develop otherwise. Its surging popularity here is helping to remake the face of plastic surgery in a country that has produced many of the industry’s most renowned surgeons and each year notches some of the world’s highest plastic surgery rates.

Now, it’s not just women who are being wheeled into the operating room by the thousands. Six years ago, men accounted for just 5% of plastic surgery patients, according to the Brazilian Society of Plastic Surgery. By last year, their share had risen to nearly one-third. Over a similar time frame, surveys show, the number of liposuctions performed on Brazilian men soared by 46%.

Junior Carvalho, who had ultra-high-definition liposuction, displays the results at the shore in Rio. “When I see people looking at me,” he said, “the sensation is incredible.” Photo / Marina Calderon for The Washington Post

The results convey not only the culture’s shifting conception of beauty but also its idea of success. The cost of plastic surgery here is beyond the reach of most Brazilians. In a country of extreme economic inequality, the six-pack has become one more way to measure the divide.

In November 2022, Carvalho joined the movement. At his doctor’s office, he ordered nearly everything on the menu: facelift, chin job, ultra-high-definition liposuction and, perhaps in a quiet display of optimism, a vasectomy. The bill came to nearly $10,000.

Now, more than a year later, Carvalho was in a relationship - with a woman 16 years younger - and another perfect beach day had dawned in Rio de Janeiro. The sky was azure, the sea turquoise. From the balcony of his apartment, he could see people rushing the beach. He finished his coffee, slipped on his flip-flops. Once he hit the boardwalk, off came the tank top.

Tanned skin, flat abs: everything he’d wanted.

“I bought this belly,” he said. “When I see people looking at me, the sensation is incredible.”

He wished his ex-wife could see him now.

“Vanity,” he said, “is a virtue.”

‘We have created an evolution’

I moved to Rio in June 2019, Midwestern to the core, suitcase filled with plaid. The beaches here were unlike anything I’d ever seen: stunning, chaotic, filled with beautiful people in Speedos and thong bikinis.

To be sure, not everyone was buff. Not even most. More than half of Brazilians are overweight, according to the Brazilian Institute of Geography and Statistics, and one in five is obese. But the proportion of people who were extremely in shape - playing volleyball and lifting weights, sweating and flexing - was remarkably high.

Men work out with concrete dumbbells at a makeshift gym on Rio’s Arpoador Beach. Photo / Marina Calderon for The Washington Post

Then the rate grew. Soon it wasn’t just the CrossFit crowd that had six-packs. There were also guys who had no apparent right to them. They were pounding beers, eating whatever, some on the older side, others a bit soft - but their bellies, incongruously, studded with abdominal muscles.

I was baffled and, yes, jealous. What was their secret? It seemed to defy the laws of physiology.

And for some, I came to find, it did.

Men here are turning in increasing numbers to steroids, creatine, testosterone, protein supplements, nutritionists, procedures to grow hair, and procedures to remove it. There doesn’t seem to be a single cause, anthropologists and physicians say, but a combination: Social media. Pandemic isolation. Loosening stigmas against male care in a deeply conservative country.

“Men are hearing a social appeal,” said Erik Giuseppe Pereira, who researches masculinity at the Federal University of Rio de Janeiro. “And it’s for physical perfection.”

The phenomenon has coincided with innovation. Until recently, standard liposuction didn’t deliver the definition many men desired. To gain more, one possible solution had been to inject fat directly into the abdominal muscles to enlarge and enhance them. But performing the procedure without precision was seen as too dangerous. Then Rio de Janeiro plastic surgeon Alvaro Cansancao had an idea. In 2019, he began using ultrasound technology to pinpoint the exact location where the fat should be injected to inflate the abs.

“We have created an evolution,” Cansanção told the Washington Post. “Now they can have a six-pack without renouncing the pleasures of life.”

To get abs like those, a man undergoes ultra-high-definition liposuction at Hospital Gloria D’Or in Rio. Photo / Marina Calderon for The Washington Post

The procedure has swept Brazilian social media and spread to the United States and Europe. Here, plastic surgeons have made it central to their marketing, attracting in some cases millions of followers - and a new, international clientele. Celebrities trumpet their transformations. “Awaken your self-esteem,” one reality TV star told his six million Instagram followers in March as he flexed a surgically forged six-pack.

The commenters on such posts rarely criticise, or advocate for “natural” beauty. Many offer only a lament: They’d do it, too, if only they had the money.

“My dream,” several people responded to one post.

“Perfection,” another added.

Anything for a six-pack

As I spoke with men in Rio who’d had the procedure done, it became immediately clear that no one undergoes it on a lark. Each of the eight men I interviewed described internal deliberations that in many cases spoke to the most fundamental emotions and insecurities.

One man, Paulo Pellegrino, 48, said he worried that the growing chasm between his wife’s and his physical appearance would harm their relationship. Eric Stephan Hamers, 36, a triathlete who once struggled with obesity, spoke of how uncomfortable he was when comparing the taut forms of other competitors to his own comparatively flaccid physique. Higor Caldato, 39, a psychologist who specialises in eating disorders, said his work has taught him that appearance is fundamental to self-worth. And Magide Murgy, 37, said it was vanity, pure and simple: “Who doesn’t want a perfect body?”

Then there was Thiago Matos Pinto. Listening to him was like unpacking Rio de Janeiro’s many inequalities.

In working-class northern Rio, where Pinto grew up, a long bus ride from the city’s famed beaches, there isn’t the same competition for physical perfection. Many people commute long distances to work. More struggle with obesity and diabetes.

Thiago Matos Pinto, 40, who underwent liposuction last year, works out on Rio’s Leblon Beach. Photo / Marina Calderon for The Washington Post

None of Pinto’s friends there had defined abs. But in the wealthy oceanside enclave of Leblon, where Pinto moved five years ago, almost all of his friends did.

“It’s difficult to find someone who doesn’t,” he said.

Some of his friends trained and dieted obsessively. Others had the surgery. Many used steroids and supplements.

If he had stayed in northern Rio, or lived in the clouded gray of Sao Paulo, he said, he doesn’t think he would have dwelled on his appearance. But after several years on the beaches, he decided to just do it - and schedule the surgery.

Within months, he was back out there in a blue Speedo, doing pull-ups on public exercise equipment in the morning sun - one more man with toned abs in the city of the six-pack.

Dreams of the beach

“I’m anxious,” the barrel-chested man said.

Cleiton Cirilo, 38, had spent eight years thinking about this moment, ever since he had first spoken with Rio surgeon Alexandre Charao about sculpting his core to remove abdominal flab. But the technology hadn’t yet advanced, and he hadn’t been ready - “scared of knives”, he said. So he delayed and mulled until he could think of little else.

“I see other men of my age with better bodies than mine,” he said. “And I kept thinking, ‘I have to improve my body.’”

Surgeon Alexandre Charão marks Cleiton Cirilo’s chest and belly before his operation in June at Hospital Gloria d’Or. Photo / Marina Calderon for The Washington Post

Sitting in a room at Hospital Gloria d’Or, his mother at his side, Cirilo clasped and unclasped his hands. He fidgeted with his bracelet.

His mother, Neuza Garcia Soares, had questioned whether surgery was necessary. She’d told him he already looked great - healthy, muscular even. But he’d said he wanted more.

“He’s always been vain,” she said.

Both were bemused by my presence. They didn’t understand why plastic surgery here would be of interest to an American newspaper. I explained that Americans like plastic surgery, too, but there’s a difference. In America, people are usually demure about the work they’ve had done, but in Brazil, I found, few people were shy about it. Quite the opposite: It was a source of pride. Many boasted of their treatments. No one had requested anonymity.

I wasn’t sure that would have happened in the United States.

Cirilo shook his head in disbelief.

“I’ll talk to anyone who asks about it,” he said.

The door opened. Charao, coifed and confident, looking far younger than his 50 years, whooshed into the room. The surgeon directed Cirilo to take off his shirt and trousers. He grabbed a handful of midsection flesh.

“Your problem is the flaccidity,” he told Cirilo. “You’re not fat.”

With multicoloured markers, the surgeon drew the outline of a far more muscular man across Cirilo’s chest and belly.

Surgeon Alexandre Charao holds a patient’s belly during a liposuction surgery at Hospital Gloria D’Or. Photo / Marina Calderon for The Washington Post

“What grade of definition do you want?” Charao asked.

“Low definition won’t do anything,” Cirilo responded.

“I think you want medium,” Charão said. “With your form, high definition would look really fake.”

The surgeon handed his patient a sedative. He told him there would be swelling, draining and then a long wait of six months to see the final result. Cirilo nodded, lay down on the bed and closed his eyes.

Cirilo had never been a beach person. He’d always been most comfortable at home, playing video games, shirt firmly on. “Discreet,” he called himself. But maybe, he thought, when he opened his eyes again, he’d see the beginnings of a new life. One of beaches and Speedos and sun.

He didn’t know if he’d like it. But he enjoyed thinking about it.