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RIO DE JANEIRO — A machine purrs as it delivers electrical pulses deep into the saggy skin on Barbara Penha's jawline, a high-tech treatment used first to tighten her jowls and then to sculpt her tummy.
The technique is all the rage at the chic dermatology clinics that cater to legions of wealthy women here who invest serious time and big bucks into looking their bikini best.
But Ms. Penha isn't a socialite, nor did she fork out the $450 that a single radio-frequency session typically runs in Rio de Janeiro. The struggling housewife got the treatment free of charge at a clinic that provides the poor access to the kinds of pricey cosmetic treatments that have become almost de rigueur among Brazil's moneyed elite.
Free Botox and laser hair removal, free chemical peels and anti-cellulite treatments may at first seem shockingly frivolous in a country such as Brazil - which, despite phenomenal economic growth in recent years that has lifted millions out of extreme poverty, still battles with diseases such as tuberculosis and dengue fever.
But the philosophy behind the more than 220 clinics across Brazil that treat people such as Ms. Penha and thousands of maids, receptionists, waitresses and others is simple: Beauty is a right, and the poor deserve to be ravishing, too.
The Brazilian Society of Aesthetic Medicine's Rio clinic has performed free procedures on more than 14,000 patients since its founding in 1997, said Dr. Nelson Rosas, who heads the Rio branch.
Good looks, doctors argue, are more than skin deep, and by treating what patients view as physical flaws doctors are often also healing their psyches.
"What's a wrinkle? Something minor, right? Something with precious little importance," Dr. Rosas said. "But when we treat the wrinkle, that unimportant little thing, we're actually treating something very important - the patient's self esteem."
The notion that beauty treatments can act in much the same way as psychoanalysis, helping free patients from crippling neuroses, was pioneered in past decades by celebrated Brazilian plastic surgeon Dr. Ivo Pitanguy .
Nicknamed the "philosopher of plastic surgery" for his intellectual and psychoanalytical take on the vocation, Dr. Pitanguy, 85, is largely responsible for Brazil's reputation as a world leader in the field and a top destination for cosmetic surgery tourism.
His skill with the scalpel catapulted him to international fame - the surgeon is arguably Brazil's second-most famous person after soccer legend Pele. It's made him the go-to man for A-list celebrities, international statesmen and royalty seeking a quick fix to their esthetic woes. Dr. Pitanguy's long and illustrious patient roster is said to include such luminaries as Zsa Zsa Gabor, Francois Mitterrand and Brigitte Bardot, although the discreet doctor has rarely named names.
Dr. Pitanguy's handicraft on the world's rich and famous allowed him to join their ranks - he commutes to Rio by helicopter from his own private island. But he has remained attentive to the less privileged.
More than half a century ago, he founded a surgical wing to help treat the poor. While the wing at Santa Casa de Misericordia Hospital in Rio focuses on reconstructive operations for burn victims and people with serious deformations, it also provides discounted cosmetic procedures.
Other hospitals have since followed suit. Now, at least two dozen hospitals, mostly public, in Rio alone offer discounted or sometimes free cosmetic surgeries to low income people, according to a website aimed at informing potential patients.
With more than 11.5 million operations a year, Brazil is the world's second-biggest consumer of plastic surgery after the United States, but here there is none of the stigma that still clings to the practice in the U.S.
Local celebrities appear on the cover of glossy magazines with titles like "Plastica e Beleza," or "Plastic [Surgery] and Beauty," and wax poetic about their latest face-lift, breast implant or round of Botox. Actors on the prime-time soap operas that captivate the public here regularly get surgical makeovers, as do the characters they play as part of the soaps' high-drama story lines.
Silicone, on prominent display at the beach here year round, takes center stage during Carnival, when samba queens wearing only a sprinkling of sequins and feathers flaunt their pumped-up bustlines and gravity-defying rear ends at Rio's extravagant Sambadrome parade. (Breast and buttock implants are among the most popular plastic surgeries here, along with liposuction, face-lifts and procedures to flatten prominent ears.)
The Senate is debating whether the government's national health service should fully cover breast reconstruction for cancer patients. The state-funded health service already pays for gastroplasties for the morbidly obese and some surgeries to repair serious deformities or injuries, including correcting cleft palates in children.
"In Brazil, plastic surgery is now seen as something of the norm," said Alexander Edmonds, an anthropology professor at the University of Amsterdam and author of "Pretty Modern: Beauty, Sex and Plastic Surgery in Brazil." "In a way, surgery is becoming the standard of care among middle-class and wealthy women, and so it's not surprising that lower-class people aspire to it, too."
While he acknowledges the potent psychological benefits that sometimes result from plastic surgery, Mr. Edmonds warns that Brazil's overwhelmingly pro-"plastica" attitude can be dangerous.
"The word 'beauty' in Brazil kind of obscures the fact that you're talking about real surgery," he said. "The problems and risks of surgery are often minimized, and these operations tend to be seen like a 'beautification' like any other, which of course they're not"
Still, worries about risk don't appear to be holding many here back. On the few days a year when low-income people can apply for free or cut-rate cosmetic surgeries, the lines snake out and around the hospitals. Once their case has been approved, patients often spend months or even years on the waitlist before the actual surgery.
The free surgeries are widely seen to benefit the hospitals, too, as they allow young doctors to hone their skills.
Nilcea Furtado said she waited three years for her first free laser treatment there. Though the clinic, which is also a private training institute for doctors, doesn't perform surgical procedures that require anything more than local anesthetic, Ms. Furtado says she's experienced the kinds of psychological benefits described by superstar surgeon Dr. Pitanguy .
"Since I was a teenager, I had lots of horrible hairs on my chin and I tried everything to get rid of them but nothing worked," said Ms. Furtado, 48, a secretary whose entire monthly salary is less than a single laser hair removal treatment session. "I had heard that lasers were effective, but they're so expensive they seemed like an impossible dream for me."
Six free laser hair removal sessions later, Ms. Furtado's chin is silky smooth, and she says she's a new woman.
"I never knew what it was to look into the mirror and like what I saw," she said. "It's an amazing feeling."
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