In Glyfada, an upper-income suburb of Athens with palm-lined streets and a view of the Mediterranean, cosmetic surgeon Athanasios Athanasiou presents his latest accomplishment. A flawlessly beautiful woman wearing a tight-fitting tracksuit and sporting a bobbing ponytail walks into the room, dangling her car keys from her right hand. Athanasiou says: "A complete mommy makeover." He laughs, and the woman laughs along with him. She sits down and says: "Oh, Athi."
The woman prefers not to mention her name because she is a well-known TV personality in Greece. She says that after having her second child, she had Athanasiou perform many cosmetic enhancement procedures: adding new silicon to her breasts, a tummy tuck, liposuction, a lip enhancement, Botox and hyaluronic acid filler treatments and laser procedures. She adds that she has been going to a cosmetic surgeon for almost 20 years, but that the quality of the work has improved considerably in recent years. "I don't want it to be too extreme," she says. "It should look natural. Athi knows how to do that." And now she is looking forward to her birthday. She turns 45 in a week.
Despite this woman's cheerful approach to the future, these are tough times for her country. Greece is setting many sad records when it comes to unemployment, government debt and business failures. But the country is at the front of the pack in a different, somewhat unusual category: Nowhere in Europe do people have more cosmetic surgery procedures.
Every year, the International Society of Aesthetic Plastic Surgery (ISAPS) performs a survey of the number of plastic surgery procedures performed worldwide. When the numbers are compared to a country's population, the results are surprising for Greece. In 2011, 142,394 procedures were performed in the country, with its population of about 11 million. That means that, on average, one in 79 Greeks has had procedures such as liposuction, eyelid corrections and Botox injections performed on them. Worldwide, the Greeks rank only second to the South Koreans in terms of the number of cosmetic procedures performed per 1,000 inhabitants (see graphic). In Germany, with a population of about 81 million, there were 415,448 procedures in 2011, or one in about 200.
2011 was the year of the economic crisis, and yet Greece rose even higher in the international ranking. Looking good still seems to be important to the Greeks. But why now?
The country has cut costs drastically in other areas of medicine. In 2009, the Greek government spent €14 billion ($18.4 billion) on its health care system, while in 2012 government health care spending declined to only €9.5 billion. According to a study in the British medical journal The Lancet, hospital budgets in Greece have been slashed by 40 percent, and the country is also experiencing shortfalls in staff and medications.
Many hospitals have reduced their emergency room hours to only four days a week, resulting in longer waits for patients. Owing to cuts in government payments to doctors, many now expect patients to pay their bills in cash. Likewise, experts estimate that about 35 percent of Greeks have no health insurance. So how is it possible that the beauty business is still in full swing?
Finding Opportunity in Crisis
Dr. Athanasios Athanasiou, 42, is wearing a dark-blue suit and a green pocket square. He searches for an old photo of himself on his computer. He insists that he used to look awful, with deep wrinkles on his forehead and thinning hair. But he can't find the picture.
Then he points out the results of what he has had done to himself: a toned chin, a smooth forehead and a full head of hair. And soon, he says, pinching his hip, a colleague will remove his fat.
"You want to know why people are coming to me now, of all times?" he asks. "I believe that when people are not doing well, it especially important to hear others say: 'Wow, you look great.'"
After his training as a plastic surgeon in the United States, Athanasiou worked in Beverly Hills. In October 2011, at the height of the crisis, he opened his new practice, the Athens Beverly Hills Medical Group.
It was at the time when the Greek government had just approved its second large austerity package. Taxes were raised, and government employees were laid off. Thousands of protesters gathered on Syntagma Square, shouting "Thieves!" in the direction of the nearby parliament building.
But when Athanasiou launched his clinic, he did it with the spirit of optimism he had acquired in the United States. "I always saw the crisis as an opportunity," he says.
The investment has paid off. His practice works with 16 doctors -- surgeons, dentists and gynecologists. It has treated about 3,000 patients since opening. In addition to cosmetic surgery, Athanasiou offers urology and vascular surgery procedures. Business has been going well, and revenues are growing. He says that 80 percent of his customers are Greeks.
Dr. Athanasiou, who can afford this?
The doctor leans back in his armchair. "People are working," he says. "Maybe they're earning less money, but they are working. We adjust ourselves to the market." His prices have declined by 40 percent in the last two years, mostly because his costs have come down. Athanasiou performs his operations in private clinics. In the past, he says, a hospital charged €2,000 for the use of an operating room, but now the price has dropped to €700. An anesthesiologist, he adds, now charges €150 instead of the €400 he or she used to charge.
Athanasiou now charges between €2,500 and €5,000 for a nose correction or a breast augmentation. "That's a good price," he says.
Solidarity for Those without Insurance
There is a facility called the Medical Social Center in Ellinikon, half an hour from Glyfada. Doctors there treat people who no longer have health insurance. A woman named Natasha is currently waiting for her appointment.
Natasha, 48, is a housewife with two children. She is at the center to have someone look at an enlarged thyroid gland. A month ago her husband, a self-employed craftsman, realized that he could no longer pay the family's social insurance premium of €425 a month. "And now I'm sitting here," she says.
The doctor, Giorgos Vichas, tall, graying and with wrinkles on his forehead, works as a cardiologist by day. In his free time, he offers free treatment at the center, which is now staffed by 120 volunteers and 80 doctors. There are specialists in most fields, including pediatricians, dentists, orthopedists, psychotherapists, neurologists and cardiologists. "None of us can bear to see people living without medical care," says Vichas.
The 51-year-old doctor describes cases of cancer patients who were refused treatment because they were unable to pay for medication, and of pregnant women who don't know how they'll pay the costs of delivery.
There are no paid jobs at the center, but it also doesn't accept monetary donations. It does, however, accept items like diapers, powdered milk for infants and medications.
The center opened in December 2011, and 4,000 patients were treated in its first year. Doctors there have already seen 4,700 patients in the first three months of 2013. Vichas hopes that what he and his fellow volunteers do there will soon no longer be necessary. At the moment, however, it doesn't seem like demand for their services is declining.
Dr. Vichas, given the shortages you experience here, how is it possible that so many cosmetic surgeries are performed in this country?
Vichas thinks about the question for a moment, before saying: "We Greeks were not always saints before the crisis. To a certain extent, many of us played a role in what has happened here."
Vichas talks about corruption in the country. Of course, he says, he suspects that many who can afford these types of procedures are among those who exploited the old system. "But that's the old, ugly Greece," he adds, noting that the country is different today. He says that he believes in the solidarity, the community and the social renewal he experiences daily at the Medical Social Center.
In one respect, Vichas shares the sentiments of cosmetic surgeon Athanasiou. "I also see an opportunity in the crisis," he says.
The Greek Aesthetic
How many contradictions can Greece endure? Matthew Josafat is someone who can provide answers to this question. The 76-year-old psychiatrist is one of the country's most popular analysts. He writes books and speaks to packed halls. After working in his profession for 50 years, he has acquired a unique ability among his countrymen to comprehend the hopes, desires and abysses of the Greek soul.
Josafat is a short man who has put on a little weight with age. He sits down in a large armchair at one end of his therapist's couch. A full bookshelf occupies one wall of his office, and the others are decorated with modern art and a portrait of Sigmund Freud. Josafat worked in the UK for a long time, which, as he says, has given him insights into the Northern European as well as the Southern European psyche. Josafat doesn't find the boom in cosmetic surgery surprising and says that he has to agree with Athanasiou's assessment that, especially in a crisis, people sometimes do special things to feel good about themselves. It's true, he says, that some people simply feel better after a facelift.
This is also, and especially, applicable to the Greeks, says Josafat. After all, he notes, beauty also played an important role in antiquity. "Beauty has always pleased the gods. Even Plato glorified youth and the body," says Josafat. "We have always had an aesthetic view of life."
Then the psychiatrist talks about the differences between northern and southern Europe. In the north, he says, people derive much of their enjoyment of life from work. "In England, the men on my couch usually talked about their jobs," but in Greece, he adds, this doesn't happen as often. Instead, he explains, the patients on his couch are more likely to talk about romance, love and eros.
This view of life also affects the position of women in society, Josafat explains. "In antiquity, women were second-class citizens. Their appearance was their currency," says Josafat. The notion of the emancipated companions that women have become in the modern age hasn't taken hold in Greece as quickly as it has in northern Europe.
Indeed, many things have changed in Greece in the last few decades, says Josafat. But now, he fears the crisis and the lack of jobs could force women back into their old role: being attractive and getting married. Perhaps this explains the link between eros and poverty, he says.
Lifting Bodies and Spirits
Greece isn't the only country where the beauty business thrives in times of crisis. In the United States, too, many people have had cosmetic procedures despite the poor economic situation. After the 2008 recession, Americans spent less on food, rent and clothing, but more on breast augmentations, liposuction and gluteoplasty.
"The economy may be a shambles this holiday season, but you wouldn't know it from looking at the cosmetic-surgery business," the US magazine Newsweek wrote in December 2011.
At the Athens Beverly Hills Medical Group, Dr. Athanasiou explains how he envisions his future. He wants to expand his business and boost medical tourism. He also hopes to attract customers from Great Britain, Germany, Russia and the Middle East. "Greece can compete internationally," he says.
He plans to make €2 million in revenues in 2014, and he believes in the rules of the market. And, he adds, repeating something he said earlier: "For me, the crisis is an opportunity."