BEIRUT: Dr. Imad Kaddoura inserts a speculum into his patient’s nose. The doctor squeezes the hinged instrument, spreading its blades laterally, and with the help of a large magnifying glass inspects the inner workings of the nostrils. “Look at this gentleman,” says the plastic surgeon. “Handsome face, small face, a triangular-shaped face and here is one structure that is not very appealing.

“So, we will do something to make it better looking,” Kaddoura says, with a smile.

“If I look in the mirror, nothing bothers me. But when I take a picture, I don’t like what I see,” says Kaddoura’s patient Hasan, 26, referring to his profile where the slant of his nose is particularly apparent.

Hasan also claims to have a breathing problem, after he fractured his nose some time ago. With him are photoshopped prints of what he would like his post-op nose to look like.

Three of his friends, all of whom underwent similar procedures, referred him to Kaddoura.

Hasan’s case typifies the Lebanese penchant for surgical enhancement and the overriding fact that appearances matter. In the past 40 years the country has experienced an astronomical 700 percent increase of plastic surgeons, reflecting a growing clientele.

While these numbers indicate that cosmetic surgery is not only available and on the rise but also socially acceptable, they have drawn criticism from some activists, mental health specialists and a disenchanted few who complain that Lebanese society is far too invested in unattainable standards of beauty, a detriment to individual self-fulfillment and the pursuit of meaningful relationships.

“There is going to be a lot of pressure on him,” Kaddoura says of his patient. “People will see him and make stupid comments, so he has to be aware that in profile he really doesn’t look good at all.”

In his experience, after surgery, patients become even more image conscious and return to his office with a renewed desire to go under the knife.

And while Kaddoura’s patient base expands, so does that of Dr. Antoine Saad, who has examined some of these patient’s troubled romantic lives.

“If you go through cosmetic surgery because you want either to accept yourself or to please others then it is the total opposite of what real love is. It only satisfies the first stage of love, which is infatuation and is usually short-lived,” he says.

This first stage of love has nothing to do with character, and everything to do with a personal image of what one finds attractive, he says.

In Saad’s clinical opinion, true love is a complex state of being that includes feelings of satisfaction and peace. “What people in society call love most of the time is nothing more than emotional addiction, rather than love per se,” he says.

“Love knows no rejection, is not possessive, accepts whatever is presented from the beloved,” he says. “This is the situation of real love. You can’t put conditions on it.”

He adds that the second state of love is characterized by intimacy, “where you transcend what is apparent physically and start to build up a relationship by sharing experiences and growing closer with time.”

He says his patients who frequently seek out aesthetic enhancements often find themselves in unstable and superficial relationships. Among them a good number suffer from obsessive-compulsive disorders, mood disorders and depression.

“At some point in their lives, they feel unsatisfied, whether with their families or uncertainty about the future, so they project it onto something and try to fix it,” Saad says, adding that many project their psychological instabilities onto their bodies and turn to cosmetic surgery to “fix it.”

“It is a problem because they are not able to sustain normal relationships, they just stay on the surface,” he says.

“They are easily frustrated when other people don’t meet their expectations. They are not able to accept themselves, either, and are constantly rejecting themselves, and by projecting their insecurities, can’t accept others either.”

Both Saad and Kaddoura point to competitiveness among women to secure a mate and Lebanon’s uneven male-to-female ratio as the prime cause for women seeking plastic surgery.

Specifically, the social connotations of beauty and social capital gained by being beautiful seem to be what some patients are after.

“You tend to get more of what you want in the marriage context [if you are perceived as beautiful] materialistically speaking,” Saad says, warning that these motivations only lead to superficial feelings of attraction.

Art therapist Myra Saad runs workshops with women who have body-image issues, but who chose not to turn to plastic surgery.

“They are looking somewhere inside themselves, and often people who go straight to plastic surgery have not gone through this process,” she says.

She found that many women felt unfulfilled and pressured by societal expectations. “Society expects women to get married at a certain age, to have a certain life pattern, to look a certain way, to be the ‘superwoman’ and deal between family and work,” the art therapist says, adding that similar pressures apply to men.

“Very often people don’t tend to do what they love, because they tend to think there aren’t any opportunities, so they just work to make money and think, ‘well, this is what I am supposed to do.’ As a society in whole we don’t question why we do what we do.”

For his part, LOVEanon blogger Michael Oghia, who studies the sociology of love remains cautious.

“Appearance is definitely part of attraction. So, it isn’t all a bad thing. However, appearances are only one part of the formula for attraction, and even less important when considering what is important in keeping two individuals together and happy,” the blogger explains.