The Sweet Life of the Scalpel

Imagine Fantozzi in Capri: the Faraglioni, Via Camerelle, and then the legendary Hotel Quisisana, the one from “Waiter, how’s the water in the pool?”. “What water!?” – followed by the dive and the splash as he hits the bottom. Fifty years on from that legendary film – Il secondo tragico Fantozzi was released in 1976 – this time the water is there, gushing, and at the Quisisana the early October sun shines in the endless Italian summer, and the Fantozzi visiting the grand hotel is not the accountant, employee number 7829/bis, who asked for the ‘royal suite’, but a distinguished plastic surgeon.

Professor Fabio Fantozzi is, in fact, organising a major cosmetic surgery conference, ‘When Science meets La dolce vita’. The invitation features the very Faraglioni rocks against which his namesake crashes whilst water-skiing in a desperate attempt to win over Miss Silvani, only to be smashed to pieces and sold as grouper at the fish market. But today, Fantozzi (the accountant) could count on Fantozzi the surgeon and his followers, because this international event is taking place at the Quisisana: The event will feature 85 speakers from 27 different countries and 4 continents, covering every specialty of cosmetic surgery with the finest minds and the sharpest scalpels of a generation or more. From breasts to necks to eyes to abdomens, with specialists from all over the world: Saudi Arabia, the UAE, Lebanon, Romania, Serbia, Spain, Mexico and Turkey (particularly well represented).

“We wanted to bring together the world of surgery with that of the Italian imagination – cinema, La Dolce Vita to be precise,” he tells Il Foglio. “The Quisisana Hotel is perfect because it was originally built as a sanatorium.” But today, beneath the fluttering flags of every nation, here is the conference – “held entirely in English; we have the presidents of the French, Italian, Brazilian, Kuwaiti and Dubai societies of plastic surgery. We’ve managed the miracle of getting them all to come to Capri.”

Well, Capri is better than Cinisello Balsamo or Lignano Sabbiadoro. “But these are intense days, because from 7 am until 6 pm we have only short breaks; each speaker has roughly 12 minutes to present their idea on a specific area,” says Fantozzi. His area is one of the most difficult of all: the neck. “It’s a very complex area, and the scars are visible, so even a successful operation can still end up being a major failure.”

Another key protagonist – and the most obvious one – is the nose: how to make it smaller, straighten it, smooth it down or sculpt it. Under the guidance of Professor Paolo Persichetti of the Campus Bio-Medico in Rome, as early as half past seven in the morning, the following, amongst others, are performing – or rather, expressing themselves: Dr Volney Pitombo (Brazil), a leading authority in the field and a founding member of the Monegasque Academy of Plastic Surgery, who, under the mottos ‘Rhino in Rio’ and ‘there is no such thing as an ugly person with a beautiful nose’, discusses ‘secondary rhinoplasty’ – that is, surgery for those who, dissatisfied with the results, have it redone a second time.

Dr Saed Kaldari, on the other hand, a leading figure in the field of rhinoplasty in Qatar, credited with over five thousand nose jobs across the Middle East – who knows how Middle Eastern rhinoplasty is faring these days amidst the Houthis and the Strait of Hormuz – operates at the prestigious Surgi Art Hospital in Doha and, in an elaborate AI-generated animated video, depicts himself alongside Pinocchio, who is looking in the mirror and is very unhappy with his nose, as the caption suggests. The puppet is then entrusted to the professor’s expert hands, who sculpts a delicate French-style nose for him, and Pinocchio becomes the city’s darling. “Don’t let anyone else’s opinion dictate how you should see yourself. Not every word you hear about yourself is the truth… even if they repeat it a lot,” reads the caption, in Arabic, complete with a big-nose emoji.

It’s clear that AI is set to transform the entire sector. Between filters, avatars and deepfakes, nobody on Instagram shows their true face anymore. Does anyone ever come to you with an AI-retouched photo and say: ‘Do you have to make me look like this?’ ‘Every day. But the problem already existed with Photoshop,’ says Fantozzi. “With Instagram and mobile phones, however, we’re now bombarded with a volume of images that simply didn’t exist before. People notice more flaws in themselves – especially young people – then they exaggerate them, and someone with a weak personality ends up undergoing procedures that aren’t even necessary.” Well, that’s good for you, isn’t it? “I turn away loads of potential clients, but if someone’s set on it, they’ll just go to someone else.”

Even surgeons have now become influencers: stories from conference attendees are all the rage on Instagram. Here is Dr Ahmed Abdelaziz, an Egyptian and director of Clinic Z in Cairo, who previously took part in the panel on breast reconstruction (Tuesday, 9.40 am). He is posting photos of the Faraglioni and, feeling the strain of the journey, has even published a poll: guess how many modes of transport I had to take? 1, 2, 3 or 4? The correct answer is 4: car, plane, hydrofoil and even a tuktuk (or perhaps Capri’s local taxis, as tuktuks are not known to operate on Capri). Later, he reappears looking more relaxed in his tuxedo, enjoying a candlelit dinner at Tuesday evening’s gala dinner.

These surgeon-influencers are wildly creative: Abdelaziz in a reel: ‘when you’ve finally found the right plastic surgeon’, where he appears looking professional in the operating theatre, followed by beaches, starry skies, a blossoming flower and a galloping horse, all set to inspirational music. The scene then cuts to a patient lying on a treatment bed, already sedated, with his abdomen marked in preparation for surgery: the doctor is also an expert in male liposuction, and his profile features numerous “before and after” images of abdominal transformations. flabby and sagging, then sucked in and tucked away; and, of course, he also has a podcast, because these days nobody can do without a podcast, so here is the podcast on ultrasound in plastic surgery, followed by a photo of him thoughtfully savouring a large mug of coffee (and then he also posts from Marina Grande, enjoying a Capri coffee before boarding, and then the hydrofoil and then the plane…). 

At this UN-style gathering of cosmetic surgery, this G20-style summit on the war on fat, ample space is reserved for what we might call the non-aligned nations. The Turks, of course, are held in high regard. There is Dr Cemal Şenyuva from Istanbul, and Dr Hüseyin Kandulu, who practises not only on the Bosphorus but also in Dubai and Doha. On his Instagram, another patient lies on a treatment bed, covered in marker pen doodles in a style reminiscent of Cy Twombly. His motto is ‘Aesthetic Art’, and the word ‘art’ recurs obsessively among these special body artists: the Surgi Art Hospital, for instance, and Abdelaziz, who describes himself as a ‘plastic artist’.

The lives of these maverick surgeons are mad: Dr Kandulu dashes from one conference in Pakistan to another in Paris, yet still finds time to record a video in which he explains that he is a follower of the Italian concept of ‘sprezzatura’, or ‘effortless elegance’, a concept he illustrates by showing off his calves (which perhaps could do with a bit of work) in a pair of smart espadrilles, rather than Fantozzi’s dreadful Capri clogs, and then answers fans’ questions: “There is no evidence that salmon sperm injections – also known as polydeoxyribonucleotide (PDRN) – are actually effective for facial skin regeneration”. Even salmon sperm! Forget Fantozzi’s grouper. 

And then there is the Imcas (International Master Course on Aging Science) ‘grand tour’ – one of the world’s most important medical and scientific conferences dedicated to dermatology, plastic surgery and anti-ageing science – with upcoming stops in Paris (January), followed by São Paulo (May) and Bangkok (June).

I am becoming somewhat disoriented; I am beginning to hallucinate: here is Dr Juliano Pereira (Brazil) discussing HD liposuction – high definition – will it be any different from the standard version? The one interrupted by adverts? However, his colleague Augusto Valente (also Brazilian) is instead discussing ‘HP’ liposuction (with a printer? No, High Performance!).  

Interlude featuring breast implants: on Tuesday at 12 noon, a small room is reserved for a ‘workshop’ hosted by Silimed, a leading manufacturer of breast implants (Brazilian, of course); on stage, Dr Mariagrazia Moio will outline their features (there are various types: the giant fake-boob manufacturer produces the Enhance model, with an oval base; the Natural, with a round base; the Maximum, with a round base and spherical profile; and finally the Advance, which points sharply upwards, ‘round base, conical profile’, like Aphrodite A’s missile-like breasts in ‘Mazinga Z’).

These prostheses are available in a range of surface finishes: polyurethane with a ‘Velcro-effect’, micro-textured ‘true texture’ (“open-pored surface for greater stability”), matt smooth or standard smooth – the matt smooth version shines, out of scale, in the video presentation on the hotel stage, illuminated by a celestial light, and looks like a huge jellyfish, or a soft alien spacecraft that has just arrived on planet Earth.

Speaking of aliens: is it true that politicians are increasingly resorting to cosmetic surgery? Some have taken on strange, extraterrestrial features. Others seem to be undergoing procedures that may contravene international conventions: who are the most heavily enhanced? Fantozzi doesn’t name names, but notes that “they used to be generally elderly men (and women), out of shape, perhaps bald. Today they’re younger and want to be attractive”. But can you spot them? “On TV it’s impossible. The lighting on television programmes is a cosmetic procedure in itself; people illuminated so intensely are unrecognisable”.

Then there are those who take Ozempic and its derivatives – in short, the slimming injections that are all the rage these days – and their faces sag. “They lose weight very quickly – 30 kilos in just a few months; in the United States, even 50 or 60. Afterwards, it’s clear that the face sags, the breasts sag: and so do the arms, abdomen and legs, so skin removal is inevitable.” This is where Gustavo Ghiglione comes in – an Argentine with a practice in Buenos Aires – who discusses ‘cruroplasty’, which, I learn, is the reduction of the inner thighs following significant weight loss. There is no event, circumstance or physical transformation for which you cannot find a specialist in Capri. 

An entire panel is dedicated to Latin America. On Monday at 12.30 pm – appropriately at equatorial time – the ‘Latam table chair’ took place, featuring Dr Rafael Silva de Araujo (Brazil), Dr Enriquillo Clime (Dominican Republic), Dr Humberto Uribe (Colombia) and Dr Stefan Danilla (Chile). Brazil is always well represented: “It is the country with the highest number of plastic surgeons per capita,” says Fantozzi, who trained there as a pupil of the legendary Professor Ivo Pitanguy, who died in 2016 – ten years ago – and who, it is said, had performed cosmetic surgery on all the world’s celebrities, starting with Sophia Loren.  “But also presidents such as François Mitterrand. He had his chin—which was too pointed—touched up, and had an excellent facelift. Mitterrand was so enthusiastic that every year he wanted to award him a new Legion of Honour, but after a while he ran out of them. Pitanguy spoke a host of languages and had invented the Erasmus programme before the Erasmus programme existed; as far back as the 1960s, 50 per cent of the places at his school were reserved for foreign students. He was also very passionate about Italy and Dante.”

Excuse me, Dr Fantozzi, but how did you end up at Pitanguy’s? “I was in my fourth year of surgery at La Sapienza, on holiday in Rio, and so I went to see this Pitanguy. I discovered there was a competition to get in; the deadline had passed, but a kind secretary told me that if I wanted to, something could be arranged. But I had to send all the documents straight away. I was absolutely determined to stay in Rio – bear in mind this was the 1990s, there was no internet – so I rang an acquaintance of mine at Alitalia and asked him if he could arrange for all my papers to be sent on a Rome–Rio flight. ‘OK,’ he said, ‘but in return I’d like a few cosmetic procedures.’ I ended up staying in Rio for five years; I’m now an associate professor at Unirio and I also have a practice in the city.” 

That Alitalia executive appears to have been a pioneer of cosmetic tourism as well. These days, there is considerable interest in medical tourism: to Turkey for hair transplants, to Albania for dental work, to Dubai and Sharm el-Sheikh for a full range of procedures… “Yes, it’s true, each destination has its own speciality; in Lebanon, for example, they are highly skilled. I recently attended the Lebanese National Congress of Plastic Surgery”. Admittedly, they do go a bit over the top in those countries, with those thick lips, those prominent cheekbones… “In the Middle East, women’s facial features are different from ours – more pronounced. And then, if they wear a veil, how shall I put it, they need to be a bit more visible.” It’s a different story when it comes to low-cost options. “You have to be very careful, because it’s not just about the operation itself; there’s the whole aftercare process. You might be able to have the operation anywhere, but if complications arise, what do you do? Do you go back? Do you stay for two or three weeks? In the end, the costs aren’t actually that cheap, not to mention the risks involved.”

“In fact, we have a panel dedicated specifically to this”: Carolina Mynssen, a lawyer from Brazil, discusses “medico-legal considerations regarding medical tourism”, because in reality the patient is not protected at all. “The patient must understand that the operation may be cancelled or postponed – and what then?”, explains Ms Mynssen. She is also active on Instagram, posting from the Quisisana’s ground-floor suites where Paolo Villaggio stayed while filming Fantozzi, according to the hotel’s former manager; she could have advised him and offered legal assistance regarding those monstrous promissory notes – including those for the damage to the swimming pool and the bill for the royal suite (“one hundred thousand a day”: he thought “a month”). In the present day, Fantozzi would likely have chosen Istanbul instead: an all-inclusive weekend, a hair transplant for him and a rhinoplasty for Silvani, no promissory notes but three convenient instalments. And perhaps things would have turned out even better for him – oh well.