In a kingdom torn between the rise of Islamism and always-connected digital world, more and more women are undergoing invasive operations, sometimes risking their lives.
CASABLANCA — The dress code is strict: thigh-length evening dress, plunging neckline, fifteen centimeter-high stilettos. It is essential to carry a designer bag (if not a knock-off), to wear sunglasses with rhinestones and a watch wider than your wrist, preferably gold-plated. Fadela* adds a last coat of mascara to her false eyelashes before getting out of the cab. The driver took care to drop her off a few meters from the main entrance to the exclusive restaurant and club La Corniche.
In front of this new meeting place for the Casablanca elite, customers arrive in luxury vehicles and large 4×4 cars with tinted windows. But Fadela prefers to walk the rest of the way rather than be spotted getting out of a taxi, a cheap means of transportation in Morocco. She is willing to walk despite being in pain. Fadela is recovering from a surgery called "BBL," Brazilian Butt Lift.
Popularized in Brazil, this procedure involves taking fat from another part of the body, usually the stomach, and transferring it to the buttocks. In Morocco, the BBL, or its derivative, "MBL" (Moroccan Butt Lift), is one of the most popular surgeries for young women who dream of an impressive buttock with an hourglass waist. "In short, all Moroccan women! " smiles Fadela.
Since she bought her impressively proportioned new buttocks, this 28-year-old woman has abandoned her former life. No more waking up at 6 a.m. to commute to work from the suburbs, full of financial hardships and ordinary people. Fadela now frequents only nice neighborhoods, except when she visits her family. "I said I took vitamins to make me bigger. I help them financially, so they don't ask questions."
Her procedure cost 4,000 euros, the equivalent of a full year's salary from her work as a beautician. "The doctor spread the payment over two years," says the young woman. But above all, this tool for seduction is a profitable investment.
"Since my operation, I met a guy who is renting me an apartment in the city center. He takes care of me, gives me gifts, takes me to restaurants. Soon, I'll be able to stop working altogether," she says, sipping her cocktail, her eyes glued to her iPhone XR. "I wasn't born with a silver spoon in my mouth. If you want to stay thin, you have to work hard. But it pays to have these buttocks. Some people are able to support their whole family with them!"
The sun is setting, it's time for a selfie break. The terrace overlooking the ocean is soon invaded by half a dozen young women. Each face bears an unsettling resemblance to those of Instagram stars, cloned as if to erase any sign of individuality. They have been rendered undistinguishable by their protruding cheekbones, thin noses, lips swollen with hyaluronic acid, silicon breasts, facial muscles paralyzed by Botox injections and, of course, their disproportionate buttocks.
Fadela swells her chest, swings her hips to reveal the curve of her buttocks and adds a phone filter to further smooth her skin texture. The photo will be shared to her 10,000 Instagram followers. "Without my buttocks, I would never have been able to come to a place like this."
More and more women are going under the knife to comply with the new beauty standards of the Instagram era. The democratization of internet access and the dazzling success of social media influencers have transformed the relationship Moroccan women have with their bodies.
"We are witnessing a ‘Kardashianization" of society. It is even stronger in Morocco where the influence of appearances is very important. Patients arrive with photos of Instagram models that they want to look like, convinced that this will enable them to escape their social status or to climb the class ladder," says a dermatologist in Casablanca, who wishes to remain anonymous.
Middle Eastern satellite channels rebroadcasting American reality TV programs has played a significant role in this quest for beauty. Yet it was these same channels that helped to import the puritanical Wahhabi doctrine to Morocco during the early 2000s.
"We are witnessing a ‘Kardashianization" of society."
In Morocco, the paradox is disturbing: society oscillates from one extreme to the other. It swings between a conservative majority and young women who are obsessed with their image, which innovations in cosmetic medicine have dramatically morphed.
Meeting the growing demand, cosmetic surgery clinics have sprung up in the North African kingdom. It now has more than 120 plastic surgeons for its 36 million inhabitants, though this is still eight times less than in France. They mainly perform BBL, tummy tucks, breast implants and rhinoplasties. "There is no official register, but in the last 10 years or so, the numbers have exploded. Morocco has made exceptional progress," says Wafaâ Mradmi a surgeon and president of the Moroccan Society of Aesthetic and Plastic Surgeons (SOMCEP).
These increasingly inexpensive, sometimes credit-paid operations are reaching women from almost all classes of Moroccan society. "A woman remains a woman whether she is rich or poor," says Mradmi, who is based in the coastal city of Agadir. "This is especially true today when there are non-invasive procedures that cost as little as 100, 200 or 300 euros."
Once seen as a way to delay the effects of aging, cosmetic surgery today attracts younger and younger women. However, fans of going under the scalpel are facing increasing risks of complications. "We have patients aged 14 and 15 who want to have their breasts or buttocks reshaped. But since there has been a significant increase in the practice of BBL, accidents are happening more often. Before, we used to throw away liters of fat, now we re-inject almost everything. Imagine a liter of fat per buttock! It is a heavy and long operation that aggravates the risks of pulmonary embolism," says plastic surgeon Taleb Bensouda from his discreet clinic in Casablanca.
Last June, the death of 32-year-old Imane Bensmina caused a stir in the Moroccan press and on social media, where she was followed by a community of bloggers. The clothing designer had gone to a private clinic in the capital for a standard liposuction procedure. She died from fat embolism.
"We don't really know what happened. She was very pretty, maybe she was a couple of kilos overweight," says her cousin, Aïcha Zaimi Sakhri. "The operation lasted eight hours, which is strange for a liposuction. Did she want to have Kim Kardashian"s buttocks? She didn't tell us anything."
The announcement of her death came as a bombshell to the small world of Instagrammers. Frequently solicited by clinics to promote cosmetic procedures and treatments, these influencers were then targeted and accused of encouraging surgery without mentioning the risks.
"It's true that Imane had issues. But she was influenced by bloggers who advertise the procedures like they sell perfume," says one of her friends. "On Instagram, female Moroccan influencers show an illusory world in which if you are not rich, if you are not reconstructed, you are nothing. They forget that they have an audience of very young girls, sometimes poor, and that this creates disappointment."
Several women have died under similar conditions in recent years. Imane Bensmina's family and others have filed complaints, but the doctors involved have not faced any convictions.
"Plastic surgery has become commonplace even though it is a very complex specialty that requires special skills, years of practice and training. But when you go to Instagram, it's like getting a haircut. You have to remember that it's a long and painful process, requiring touch-ups in 30% of cases, and that with general anesthesia you can die on the table," says Dr. Bensouda.
The Brazilian-trained plastic surgeon, who has been operating for almost 30 years, says that 40% to 50% of his surgical procedures are to fix operations that have failed or resulted in complications. "Unfortunately, patients always want more and the clinics operate on this chain reaction."
Three months after Imane's death, the scandal which had shaken influencers seems to have already fallen into oblivion. In the basement of the modern building housing Guess Clinic, Dr. Mohamed Guessous, known as "Guess," is bent over the body of a patient still asleep on the operating table, with his smartphone in hand.
The finger strokes on his phone are as meticulous and fast as those during the rhinoplasty he has just performed. He takes a close shot of the patient's face, sticks the letter "I" on her eyes so that she is not recognizable, adds the hashtag #rhinoplasty and then a GIF with star patterns. "That's my little trick: if I use a video effect, the post has 100 times more views!"
In a few seconds, the photo collage appears on Instagram. The patient is not yet awake when Dr. Guessous's 300,000 subscribers start clicking. "You know, most of them absolutely want to be featured on my social media, otherwise they feel like it's a failure."
His surgeries are filmed and broadcast live on Snapchat, where plastic surgeons from around the world share their medical prowess. Instagram, on the other hand, is more of a "before and after" snapshot, which patients eager for spectacular results follow very closely. "Let's see how it looks," the surgeon says to the nurse during a facelift. "I've become a professional photographer! " she says, juggling between a tablet and a smartphone throughout the procedure.
Trained in France, the 54-year-old star surgeon opened his clinic in 2008. "Since then, we have made extraordinary progress. We are operating at the same level asthe United States and Brazil. We have surpassed the French, they still use the term ‘liposuction" when we talk about ‘liposculpture,"" says Guess. In addition to its surgery department, the establishment has a slimming center, a spa and a whole array of machines and lasers that can regenerate skin, graft hair and even shrink a vagina in a few minutes. "In two or three sessions, it can save a couple!" says the doctor, climbing the stairs at top speed.
"It has become a business: Doctors no longer have nurses but community managers."
He is called upstairs, where young women wait in silence for their consultations. They could be mistaken for the ungracious Instagrammers seen at La Corniche. The blindingly white teeth, the smooth, long hair down to the buttocks, the designer bag, the watch — everything is there. "Our patients come from all walks of life, some wear the hijab. We even have young secretaries, women with very low salaries," says the clinic, which has signed an agreement with a credit company specializing in aesthetics.
"To feel well in one's own body is a human right. That's why I allow for installment payments and I give discounts to the most needy. This has been my credo from the beginning: democratize access to aesthetic medicine because it is an essential need," says Dr. Guessous.
There's something hypnotizing in the way he talks about surgery. Fear fades away, the act becomes harmless, inoffensive. "That's all you want to do?" he says with a charming wink to a Tangier woman dressed in a Balenciaga trench coat, a silk scarf camouflaging her hair.
She came to this Casablanca clinic with her 20-year-old daughter for injections of platelet-rich plasma (PRP), the famous "vampire lift," a technique to regenerate facial skin with its own plasma that was popularized by Kim Kardashian. Her daughter, who has already undergone rhinoplasty, has opted this time for a lip filler. "My husband doesn't know about it. Even though it has become commonplace, it's not something you can say. If the neighbors notice a difference, we'll say we've just come off bed rest," says the mother in a burst of laughter.
Dr. Guessous is also famous for having invented the "Ferrari" silhouette. "It's a BBL to which we added a lateral curve for more femininity compared to the buttocks of Brazil, where sporty figures are preferred."
Sizes range from "S" to "XL," but the bigger it is, the better it works. "There are often excesses, but I don't judge. What is shocking today may become commonplace in a few years. I'm only responding to this demand," says the surgeon, who performs the operation three to four times a day. "At the same time, my patients look at images like this it all day long on social media platforms. So they say, ‘Why not me too?""
Clinics partner with influencers who promote their personal surgical experiences on Instagram. Blogger Sofia Guedira Benzakour was elected as the official ambassador for Guess Clinic. "I had a nasolabial fold filling done by Dr. Guessous that I shared with my community. In Morocco, it's normal, all women want to re-do something," says the 32-year-old mother from her elegant Casablanca apartment. Benzakour has 62,000 social media followers.
But this over-sharing of images is not favorably viewed by the entire profession. Other Instagram accounts of surgeons show pictures of naked bodies covered in bruises, incisions, blood, fat containers and lots of "before and afters." "It's a disgrace to the profession," says Dr. Taleb Bensouda. "It's unfortunate to see this race for Instagram posts. We have a respectable profession that they are making vulgar."
Medical advertising is prohibited in Morocco, but digital advertising is not regulated. Clinics take advantage of this legal vacuum to recruit patients on social media, especially through influencers. Some even sponsor their Instagram page. "Things have gone too far. It has become a business: Doctors no longer have nurses but community managers! Yet the National Council of the Order of Physicians does nothing. You would think that all Moroccan doctors are now corrupt ," says a practitioner on the condition of anonymity.
The Moroccan Society of Aesthetic and Plastic Surgeons does recognize this abuse of the legal loophole. "But the train of digital communication runs at high speed, and we must not go against progress. Let's not forget that it is the patients who ask for content," says president Mradmi. "What must be fought above all is the scourge of unqualified beauty practioners operating and these are multiplying, even in small towns in Morocco. In these centers, it is non-professionals who perform medical procedures, especially injections. This can have very serious consequences for patients, who risk complications, such as blindness, and they can even lead to death!"
Last year, videos showing "Botox parties' in Marrakech sparked outrage. During these evenings, guests were injected with hyaluronic acid between petits fours and champagne.
The frenzy seems unstoppable. Influencers are growing in number, with two million Instagram pages according to digital marketing specialist Mohamed Elghazaoui. "In Morocco, we are still fighting illiteracy and, until recently, there were very few media outlets. Suddenly, we gave a people who had never expressed themselves before unlimited access to social media platforms. This new media audience is not prepared, they believe in the perfect life that influencers sell them to monetize their content." The outings to La Corniche, the luxury car, the bag, the watch, the husband. And, in order to obtain that, they need a constantly updated body.
*The name has been changed.