Healthcare is a critical factor in the health, happiness and well-being of people around the world, but most of the attention paid to healthcare focuses on what can best be called "medically necessary" procedures. However, what about people who choose to indulge in elective cosmetic procedures? Plastic surgery is a major global enterprise and some of the biggest indulgers in cosmetic surgery may surprise you.

SEE: Top 10 Most Expensive Medical Procedures

Who Gets the Most
The list of countries where the largest number of plastic surgery procedures are performed is not likely to surprise too many readers. According to a global survey by the International Society of Aesthetic Plastic Surgery (ISAPA), The United States is ranked first, while China, Brazil and India follow closely behind. It makes sense that four of the five largest countries in the world would top the list, particularly as these are also countries with relatively good healthcare infrastructures (at least for those who can afford to access them). That would perhaps explain, then, why Indonesia does not even appear in the top 25, though it is the fourth-most populated country on Earth (though religious and cultural influences may also have a major role).

On a per capita basis, though, the numbers get a little more interesting. The U.S. falls to sixth in the world on this basis, while China and India fall out of the top ten entirely. Colombia, Brazil, Italy, Greece and South Korea (ranked from fifth to first respectively) lead the world in per-capita plastic surgery procedures.

What Gets Done
By far the most common procedure done around the world is botulinum toxin injection (Botox), which is done over 3 million times around the world every year. Lipoplasty (liposuction) is a somewhat distant second, at almost 2.2 million procedures - with hyaluronic acid injection (HA, which can reduce wrinkles and plump up soft tissue) close behind in third.

It is likewise interesting to see how procedure frequency breaks down across national lines. Brazil, often associated with exceptionally fit-looking people in barely-there swimsuits, leads the world in liposuction, with the U.S. close behind. Curiously, China, India and Japan are the next countries in order of frequency, but at rates almost one-fourth that of the U.S.

The U.S. is number one in breast augmentation and abdominoplasty ("tummy tuck"), but Brazil is number one in blepharoplasty (surgical modification of the eyelid) and rhinoplasty ("nose job"). The U.S. is also number one in four of the five most common non-surgical procedures (botox, HA, laser hair removal and laser skin rejuvenation. Brazil, though, is number one in procedures that remove fat from parts of the body and move it elsewhere within the body to plump or bulk up features.

There are a few other curious trends here. South Korea and China are among the world leaders (per capita) in blepharoplasty, and apparently many South Korean women undergo the procedure to achieve a more "Western" look. On the stranger side of things, there are roughly seven times more procedures performed on buttocks in Brazil than the average.

Follow the Money
There is a definite economic angle to plastic surgery. As these procedures are not medically necessary in most cases, it is uncommon for national healthcare systems or traditional private healthcare insurers to pay for them. Certainly different countries have different standards for "necessary" procedures (Sweden tends to be fairly liberal in this regard), and there are countries such as Brazil that actually allow for tax deductions for elective plastic surgeries.

There's even a tie-in here to the ongoing sovereign debt troubles in Europe; although it's hard to prove conclusively, access to cheap debt (and/or the threat of it disappearing) likely played a role in how countries like Italy and Greece appeared on this list (as the surveys were taken just as the crisis started).

Because plastic surgery can be expensive, it has created a thriving business in "medical tourism." Simply defined, medical tourism is when a resident of one country travels across national borders to take advantage of lower costs for a particular medical procedure. While it has always been somewhat common for wealthy and powerful individuals from less-developed countries to travel abroad for medical care, it has now spread to a more mainstream customer base.

Medical tourism likely explains the surprisingly high position of many countries on the procedure lists, as surveys tend to look only at raw procedure counts and not the identities or nationalities of the patients. South Korea, Brazil, Colombia and Thailand, for instance, are all famous as destinations where patients can receive quality care at substantially lower prices - while a surgeon in the U.S. might charge $2,400 for an eyelid procedure or $3,600 for a breast augmentation, those fees drop to about $1,800 and $2,900 in Brazil and are even lower in Thailand and Colombia. Not only can patients save money this way, but they can recuperate in pretty pleasant surroundings (and many stars reported doing so to avoid media attention).

SEE: Medical Tourism: Are The Savings Worth The Risk?

The Bottom Line
Vanity is part of the human condition, and where there are ways of changing a person's appearance, there is usually someone with the will to have it done. Plastic surgery is not the most economically significant activity in global healthcare, but looking at which countries have the highest number of certain cosmetic surgical procedures can offer some interesting cultural insight.

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