Hundreds of beauty centres are performing operations that may be fatal. Holding them accountable is almost impossible due to the fact that they are owned by well-known personalities who have strong relations with officials and decision-makers in the state.

In a beauty centre in Baghdad, I met Souad (pseudonym) who was in a deplorable condition. The woman had undergone 10 different cosmetic surgeries between 2021 and 2022, most of which had been unsuccessful, nearly causing her serious illness, in addition to the disfigurements they left on her body. Her face, when we met, was taut on both sides. Her eyelids were barely blinking, her lips unnaturally shaped, and there was a large scar at the start of her hairline.

“I underwent a body sculpting operation in early 2021. Not long after, I discovered that the two sides of my body were uneven and the difference between them was obvious,” said Souad. The following year, she underwent a breast reduction operation. This time, they put a used silicone insert inside of her, which led to a serious infection.

Souad could not stop at that. Her obsession with having the most beautiful body prompted her to have a blepharoplasty (eyelid surgery). The plastic surgeon shaved off a small part of her hair and then patched the side of the head. However, the patch came apart, her eyelids drooped, and her face was disfigured.

Most cosmetic surgery operations are performed in private beauty centres. Government hospitals, including the Medical City in Baghdad, have opened similar departments, and their average prices range from $600 to $4000, depending on the type of operation. However, in many cases, these private centres are no more than beauty salons, and those who perform surgeries are people who do not have medical licenses to perform plastic surgery.

Specialist doctors point out that the problem lies in the demand for cosmetic procedures that are not needed. This was confirmed by Dr. Ghaith Al-Saadi, a specialist in plastic and reconstructive surgery. According to Al-Saadi, one in every fifteen people who visit his clinic every day does not really need surgery. Al-Saadi often tries to convince those who do not need cosmetic surgery to change their mind, but his efforts are rarely successful. “Snapchat filters, bloggers and social media influencers who promote plastic surgery have provided another incentive for young people to choose to undergo these procedures,” he said.

Psychologist Dr. Farah Abdel Salam attributed the high numbers of people, in particular young people, who turn to beauty centres to a psychological condition called body dysmorphic disorder, which makes people see non-existent physical flaws in themselves, fuelling their desire for plastic surgery.” Abd al-Salam agreed with the plastic surgeon, Ghaith Al-Saadi, that many of the patients at beauty centres are trying to achieve a perfect image as shown by the filters on “Snapchat” or to look like celebrities, “so we find that the majority now look like clones of each other.” This applies to both men and women, according to Al-Saadi.

Unforgivable mistakes

Obtaining the ideal appearance has become a popular market, to the extent that, as with any market, supply and demand is diversifying and increasing. This is despite the fact that what is at stake here is the life, health and safety of people rather than commodities. Cosmetic surgeon, Dr. Zainab Al-Shakarchi, who is the director of Majaz beauty centre where Souad had her cosmetic procedures, confirmed that major mistakes “which cannot be forgiven” were made during the operations that her new client underwent and which led to her unfortunate condition.

“Before performing any sculpting or breast reduction procedures, the plastic surgeon should have outlined the patient’s body and performed the operation themself, so that the outcome would match what Souad wanted. When they plan for the operation and leave the procedure to someone else, errors are inevitable,” said Al-Shakarachi.

There are numerous errors committed by unlicensed beauty centres as a result of the lack of medical specialization or to reduce the cost of operations, ultimately at the expense of the health and safety of individuals. It is common to see social media posts of people mourning their friends and relatives, mostly women, who died after undergoing weight-loss operations, in particular liposuction. This type of operation requires the person to go under general anaesthesia, but there are those who use topical anaesthesia, which is a big mistake, according to Dr. Zainab Al-Shakarchi.

Al-Shakarchi also said that the use of cheap materials is one of the main causes of mistakes that occur during cosmetic operations, and gave an example of the one of the most common filler injections used in the cosmetic world. “The price of a WHO-licensed injection consisting of pure hyaluronic acid that dissolves inside the lips over time and does not leave side effects ranges between $100 and $170. Unlicensed centres use cheap substances for less than $50, which is not safe.”

Blepharoplasty, which is what caused Souad’s disfiguration, is performed in such centres and salons at a price of 200,000 Iraqi dinars ($137). In licensed professional centres under the supervision of specialized doctors, the same procedure costs between $340 and $500, said al-Shakarchi. What happened with Souad was that the person who performed the operation cut out twice as much of her eyelids than needed. However, she is lucky to have escaped a greater danger. According to Al-Shakarchi, “Most doctors do not test their patients before surgery, and this sometimes leads to surgical site infections such as hepatitis C, which is transmitted through the blood.”

Al-Shakarchi investigated the many deaths that have been recorded in Iraq over the past two years as a result of such operations. “If doctors had examined these patients properly before the operations, they would have survived. Instead, they simply had them sign waivers that released them of any medical liability. This is a universal measure used to forego pre-examinations of the patients.”

Well-known public figures and officials prevent the closure of hidden centres

In March 2022, Jassem Al-Azzawi, the head of the Doctors’ Syndicate in Iraq at that time, cited the same reasons for the increase in deaths. He said that there are 400 unlicensed beauty centres, some of which are linked to political figures. According to Al-Azzawi 190 violating centres had been closed in the second quarter of 2021. Al-Azzawi stated that the remaining unlicensed centres were mostly located in Baghdad, with the Karkh side housing more unlicensed centres than the Rusafa side.

“Some of these centres are nothing more than salons inside houses and alleys,” which, according to the head of the doctors’ syndicate, means they are difficult to access. “We cannot locate them unless they are reported by residents of the area.”

Even when gaining access to these centres and salons, the possibility of closing them down and holding them accountable remains difficult. Some of the centres and salons are associated with political figures and celebrities who have influence. This saves them and their centres from closure and any chance of accountability.

Last September, a video of Hamsa Majed, a controversial figure who posts videos on social media, but also owns businesses including a beauty centre, went viral.  Sitting in a restaurant, Majed talked about the fact that there were more than 5,000 plastic surgeons who did not have a license to practice. She also pointed out irregularities at her own centre.

Majed accused one of her workers of leaking the video, and had that worker interrogated by five officers in the security forces. The reaction to the video clearly showed a close relationship between famous people and security forces who provide protection to centres that do not have licenses or trained medical professionals.

In centres such as Majed’s, people, some of them nurses or people posing as doctors, perform plastic surgery at lower prices. Their mistakes are sometimes fatal. Souad was one of these victims, and similar cases have been documented by the Doctors’ Syndicate, which is also responsible for granting licenses to beauty centres. The president of the syndicate, Dr. Jassim Al-Azzawi, stated that there are no official figures for the number of deaths caused by plastic surgery errors. On June 14 of this year, the head of the Doctors’ Syndicate, Jassim al-Azzawi, was dismissed from his post for reasons that were unclear, but he confirmed to Jummar that part of the reason was his speaking up about unlicensed beauty centres.

In May 2022, the Doctors Syndicate issued a statement which said that it had received an increasing number of complaints about women and men who had been harmed as a result of cosmetic surgery performed by illegal centres and by people who are not specialists, which endangers the lives of citizens. Some of the families of victims of failed plastic surgery choose to remain silent. Others resort to filing a formal complaint against the owners of the centres and those who performed the operation. There are some who seek revenge through their tribes.

However, even if the union receives a report, the next step is not easy. “Some unlicensed beauty centres belong to celebrities such as bloggers or artists who are in contact with influential people in the country. We tried to close them in cooperation with the Ministry of Health, but we were unsuccessful,” said al-Azzawi, who has now been reinstated as president.

Before leaving the beauty centre of Dr. Zainab Al-Shakarchi, I took one last look at Souad. Her mouth was smeared with anaesthetic ointment and the doctor was preparing to inject her with filler to correct the shape of her lips.