I experienced it myself. Four hours of anesthesia and recovery along with a lethal pain caused by cosmetic surgery. But today I'm happy. I didn't suffer the post-surgery complications that many go through when I underwent breast augmentation, and my everyday experience of life has been transformed. Even the pain was somehow a delight, because I imagined how worth it it would be later, when I looked at my profile in the mirror.

Self-confidence and pride are probably the main reasons why people subject themselves to cosmetic surgery, which in Iran has long spanned a wide range of the body beyond the conventional nose.

Now you can enlarge or shrink any body part or make puffy eyelids open up. “Tear it down and build it up again,” a friend of mine likes to say, even though tearing it down and building it up again can cause a lot of trouble. In my case, I was lucky. After two months of convalescence, my bout of plastic surgery only changed my life for the better. But in Iran, many woman are plagued with problems, from the aesthetically trivial to the physically debilitating.

A number of my friends didn't even get to enjoy the new-found beauty of their post-surgical selves before calamities set in. Their conversation was not about the hump of their nose being gone, but about how their nose made hissing sounds when they ate, snoring when sleeping, unequal nostril sizes, the new crook that surgery had introduced. These are the many problems women suffer after rhinoplasty gone wrong.

Many of the friends who had to deal with such problems, however, did not ultimately regret the nose job itself. They were sorry because they had chosen the wrong doctor or had not been careful enough during convalescence.

Stickiness of nasal cavity, skewed nasal blade, shrinkage of the internal nasal vent, contraction of nostrils, continued thickness of turbinate bones (small curved bones that run along nasal passage), and damage to the tear duct, are known as “possible post-rhinoplasty complications”, according to Farhad Azad, ear, nose and throat surgeon who talked to Iranwire.

Make Me Taller

Rhinoplasty was among of the first cosmetic surgeries to arrive in Iran, and the country's women, and later its men, embraced it with gusto. But now there is far more to attend to, and nose jobs are almost the equivalent of a manicure.  One notable new procedure is “height lengthening,” which was originally performed for correcting deformities like the uneven length of  two feet.

Over the past couple of years it has became popular among Iranians who seek beauty with a few greater inches. But this procedure comes with some unavoidable and many possible complications: rigidity of muscles, damage to nerves in the leg, dislocation of pelvic joints, damage to leg tendons, infections in parts of the leg that must tolerate attached stretchers for up to a year.

These complications may plague the patient for one or two years, and can be very painful and make long-term physiotherapy necessary. The inability to walk is another possible complication, though one wonders how many who seek this out this procedure are warned of this when consulting with their doctors. Plastic surgery is now famously a cash-cow industry for Iranian medicine, with little and sufficient oversight by the government.

The Persian Nose, Flawed Appendage

The high cost of height-lengthening procedure means nose jobs remain the most widely pursued and popular cosmetic surgery in Iran. The physical attributes of Iranian faces makes rhinoplasty so sought after, says Dr. Azad, the same way that surgery to correct droopy eyelids is the most popular among young people in east Asia. He doesn't say so directly, but it would seem that Iranian noses, which tend toward the fleshy and the hooked, are not considered by Iranians themselves as especially attractive.  According to some research, Iran and Brazil top the world in the number of rhinoplasty surgeries.

The problems of weight is also sometimes referred to cosmetic surgeons: breast implants or even hip prosthetic parts for the thin, liposuction and breast reduction for the overweight.

Mandana had tried every diet, a variety of gyms and the various gadgets that are promoted day and night on satellite channels. But nothing worked until she entrusted herself to the cosmetic surgeon for liposuction, the removal of arm, leg and breast tissues. But not as much changed as she had hoped.

“After the surgeries, my life did not change that much,” she says. “As before, I'm always worried. I endured a lot of pain but I'm told that if I stop dieting I'll get fat again. The fear of growing fat again does not let me eat anything. Some places that were stitched still bother me. I am not feeling that great. Was it worth so much pain? Mentally I have become unbalanced and the smell of food makes me nauseous.”

The fear of returning to the old weight and its psychological consequences has plagued many, among them the 50-years old Sima, who eight years ago like Mandana underwent under a series of surgeries to become thin. Now she has reverted to her old weight. The aftercare did not involve a health program of eating that will help her transition and adjust her eating to her new body.

Like many Iranians who undergo liposuction for weight reduction, most are left to handle the management of eating and exercise themselves.The surgery is an expensive and sometimes dangerous one-off procedure, with the patient left to fend with a recuperating body and often misguided attitudes about how to maintain her new weight.

And I'll Have That Surgery Too, Please

“After surgery I became sick,” Sima says. “I was feeling very bad and my stomach would reject whatever I ate. I felt like my nose had started to droop down, so I had a nose job too. Then my eyelids became droopy, so I had them fixed too. It seems that I had become addicted to surgery. In the end, after months of suffering from mental disorders, I went to a psychologist who helped me to find myself again. I overcame my obsession and I no longer think about my weight. The only thing that those surgeries left me are the stitches.”

Liposuction is one of those cosmetic surgeries that is not only dangerous, but has psychological complications as well, such as fear of regaining the lost weight.

Injection of gels and Botox, surgery of droopy eyelids or the stretching of skin, popular among the middle-aged and old people is also popular in Iran. “I am not against such injections,” says Manzar Shamsai, a dermatologist practicing in Tehran, told IranWire. “But due to fact that they are done on the spot and seem simple, they end up in a vast amount of problems and complaints. A little mistake can lead to a lifetime of regret. Paralysis of muscles, their deformation and many other complications cannot be concealed because they happen to the face.”

These days, she points out, many unqualified general practitioner doctors are offering Botox and gel injections. As a result more and more patients are suffering from infections and other complications, and end up having to seek out a specialist doctor.

Shahla describes a friend who works at a beauty salon on Mirdamad Avenue that holds “Botox days.” It is becoming increasingly common to see Botox and other medical procedures in salons. Shahla has tried to convince her friend that a salon is no place for such procedures, that it is unclean and that the woman who performs the injections has no qualifications beyond having worked as a doctor's assistant.

“The owner herself developed an infection, but she continues offering the procedures out of greed,” Shahla says. “And in the end, they have lots of clients because a salon is cheap compared to a medical clinic.”

A Culture That Likes to Mock

According to a study by the Sociology College of Tehran University, the main reason women cite for having cosmetic surgery is a desire for enhanced self-confidence. The study maintains that age, employment, social status, happiness with life and religious beliefs bear no relation to the attraction of women to cosmetic surgery. The attraction comes primarily from the search for self-confidence.

The question inevitably arises, given the considerable pain and possible complications, especially in Iran where practice by inexperienced doctors and amateurs is rampant, is it worth it? The Persian adage about undergoing some discomfort – “kill me but make me beautiful” – seems to have taken on much more literal meaning today.

Friends and acquaintances made fun of me for the procedure I chose to have. But the reality was that there was a part of myself I didn't like, because it wasn't the way I wanted it to be. With time, though, I've thought a great deal more about who determines what the 'right' look is after all?

The fact is, Iranian culture is brutal when it comes to appearance. Much recrimination is disguised as either humor and candidness, and while many cultures the world over take looks seriously, in Iran the attention has turned extreme. The teasing begins at school, where children are merciless, and continues, many say, into old age.

“I pretended to laugh when friends and acquaintances jokingly called me fatso or fatty,” says Mandana. “But every day I saw that I hated myself. I was envious of thin people. Maybe without these jokes, I would not have tortured myself to death.”

“In school the students laughed at my large nostrils,” says Neda, who has had rhinoplasty. “They would tell me that the war is over but I was still carrying two mortar shells in my nose. Now, of course, I'm not unsatisfied with the shape of my nose and have more self-confidence.”

It was only after emigrating to east Asia that I saw how subjective and specific is our conception of beauty. Many Asian friends told me repeatedly, “What beautiful eyes you have. You Middle Eastern girls are so beautiful.” It seemed that I was looking at myself for the first time. I was looking at some part of me that I had grown accustomed to as ordinary, and saw it as original.

Some people surrender to cosmetic surgery to remedy physical defects and some do it to come close to ever-changing standards of beauty. One day pouty lips are in fashion, the next day it's big breasts. Perhaps one day small and droopy breasts will even become fashionable. It is a wheel that never stops turning. But I am not going to be judgmental about those who choose to remedy their looks. How can I? “Judge not, lest ye be judged!”