All over the world, breasts are getting bigger, noses are getting smaller, waists are getting slimmer and faces are getting younger - all thanks to advances in plastic surgery. Though Israel often lags behind the current trends, Israelis are doing what they can to catch up, and the number of nose jobs done in Jerusalem this year is nothing to sneeze at. In the holiest city in the world, the meeting point of the three monotheistic religions and the site men fought and died for throughout thousands of years, fixing one's appearance is fast becoming top priority. "Human nature reigns," says Dr. Binyamina (Bianca) Rosenberg-Hagen, a plastic surgeon who runs a private practice out of Misgav Ladach hospital. "Our society has placed a lot of emphasis on looks, and people want to look young and beautiful." Rosenberg-Hagen estimates that more than 70 percent of her work as a plastic surgeon is cosmetic - meaning anything from breast augmentation and liposuction to face-lifts and rhinoplasty (better known to us as nose jobs) - and that the past five to six years have seen a dramatic rise in the number of Jerusalemites going under the knife. "When I was younger, I wasn't the prettiest girl," explains one 58-year-old who is recovering from a face-lift, "and I always said that when I got older I wouldn't let myself turn wrinkly and ugly. "So last year I went and got a face-lift. And yes, it was six hours of surgery, and I was very swollen for a couple of weeks, but now it's amazing. Everyone tells me how beautiful I look. "Just last week I ran into someone I hadn't seen since I was younger," she continues, "and he told me I look more beautiful now than I did then!" Despite the satisfaction of most of her patients, Rosenberg-Hagen says she won't perform every surgery requested of her, and made one patient wait eight years before giving her a face-lift. "I don't think that every girl with small breasts should get implants," she declares, and adds that she forces all of her clients to watch an in-depth video about cosmetic surgery before they go through with it. "We are seeing an exaggerated boom in aesthetic surgery," she states. "Years ago people were embarrassed about cosmetic surgery, but today, women show off their breasts to each other in the gym." Rosenberg-Hagen believes that the reason for the relatively sudden increase is mainly due to advertising. There was a time, she says, when Israeli law didn't allow doctors to advertise their services, but clever businessmen soon realized they could circumvent the law, advertise for the doctors and make a small fortune. "They developed many small machonim (institutes) for cosmetic surgery - which are usually very unprofessional places with inexperienced or unprofessional doctors," explains Rosenberg-Hagen. "While this drew clients away from the good doctors, it also did a great thing by drawing people's attention to the potentials of aesthetic surgery." Eventually, the Health Ministry changed the laws and allowed doctors to advertise their services, and the results are clear. "Years ago, I did more breast reduction than breast augmentation," recalls Rosenberg-Hagen. "But today it's the complete opposite - having big breasts became fashionable." Rami Neuman, the head of the plastic surgery department at Hadassah-University Medical Center, also attributes the staggering rise to the increased public awareness of cosmetic surgery, but says it's more than just local advertising. "Awareness grew because of the over-exposure to cosmetic surgery on television, on the Internet and people talking about it on the radio," he says, adding that better results as a result of better technology also contributed to its increased popularity. And Neuman has the numbers to prove it. This year, 250 breast augmentation surgeries were performed at Hadassah, while eight years ago saw only 50. Forty face-lifts were performed this year, compared to only 15 eight years ago, and 80 tummy tucks, compared to only 20 performed eight years ago. In fact, the numbers of almost all cosmetic surgery procedures done in Jerusalem have at least doubled, if not tripled, in the past eight years, according to data compiled by Neuman comparing the number of surgeries done in 1998-99 to those performed in 2005-06 [see box]. "It's going to keep growing," Neuman continues, "because we have excellent results, and the more people who do it, the more it will grow because everybody tells their friends." And contrary to popular belief, the phenomenon doesn't restrict itself to women. Rosenberg-Hagen estimates that about 10% of her clients are men, most of whom come in for nose jobs, blepharoplasties (eyelid surgery) or hair transplants, an increasingly popular procedure for males. Neuman gauges his male patients at closer to 20%, most of whom request nose jobs and rectifications of gynecomastia (enlarged breasts on a man caused by hormonal imbalance). But more than gender differences, it is the makeup of Jerusalem's population that renders the trend so remarkable. "People here are more religious, more spiritual and definitely more conservative," admits Rosenberg-Hagen, "but at the end of the day, people are people wherever you are. People want the same things out of life wherever they are - to be loved and appreciated." The haredi and Arab populations are no exception, and Rosenberg-Hagen claims the number of clients from these communities has tripled in the past few years. "There is still secrecy in the haredi community," says Rosenberg-Hagen, "but they get special permission from their rav for the woman to undergo cosmetic surgery either to get a shidduch [match] or to make her more appealing to her husband." Most often, that surgery is a nose job or breast implants, says Neuman. But according to Rosenberg-Hagen, Arab and haredi women are increasingly undergoing another type of surgery, one they definitely prefer to keep secret - hymen reconstruction, a procedure that rebuilds the membrane covering the vagina so no one can detect that the woman is not a virgin. But there is nothing wrong with cosmetic surgery halachically, says Rabbi Shlomo Vilk, a high school principal and rabbi who lives in Baka. "Beauty has its place in Jewish thinking," admits Vilk, "and no one would ever say that beauty and how you see yourself is not important." While taking care of yourself doesn't always include putting yourself through surgery or at an unnecessary risk, Vilk maintains that because there have been so many advances, it's not as risky and is therefore permissible, even in the holy city of Jerusalem. "Anyone who lives in Jerusalem can't just view it as a holy city - it's also a place where they live, a city, like any other, and its holiness isn't derived by detaching from reality," asserts Vilk. "Jerusalem has nine out of 10 parts of beauty that God gave the world," he continues. "The Holy Temple was beautiful architecturally, people came from all over the world to see it, and it's important that when people come to Jerusalem they see people are nice on the inside and on the outside - it's holistic and pleasant." The challenge, he says, is for people not to focus on outer beauty alone. "Beauty can't be the most important thing," he explains, "and should be used as a tool to be a better person and to positively influence one's inner beauty - to improve security and self-confidence." Superficiality is dangerous, he warns, because if people only care about themselves and how they look, society will eventually collapse. "Becoming beautiful isn't bad," Vilk concludes. "It's how we use it that can be bad or good." Compared to Tel Aviv, those undergoing cosmetic surgery in Jerusalem are significantly more modest and conservative, insists Rosenberg-Hagen. "Tel Aviv is more hedonistic," she says, citing as an example the fact that women in Tel Aviv ask for larger volumes of breast implants than women in Jerusalem. "It may only be 50 kilometers away, but it's very different. Here, women don't show off as much." Keren Azo, a 28-year-old Jerusalemite who received breast implants and a nose job this year, agrees. "Tel Aviv is like Las Vegas, it's the city of sin, so to speak, and people there are more provocative than people in Jerusalem," says Azo. "In Tel Aviv, women get breast implants because they want men to look at them, they want to get more calls on their cell-phone, but in Jerusalem, women do it more for themselves." Azo, a happily married mother of two children, got her breast implants because she was tired of spending hundreds of shekels a year on padded bras. "I was always self-confident, but I wanted bigger breasts - my chest was very small and I always had to buy expensive padded bras to look good in clothes," explains Azo, who says she went from a small B cup to a C. Though she says the procedure was more painful than childbirth, three months later, she is thrilled she went through with it. "It was horrible for a few weeks, but then the pain went away, and now I am so happy. It's unbelievable. It's amazing. I have this deep happiness inside - my dream was fulfilled," gushes Azo. "Any woman who loves herself and wants to do cosmetic surgery to make herself more beautiful should know that it's worth it." And though she loves her new breasts, Azo loves her new nose even more. "My breasts didn't make me prettier, they made me happier," she says. "The nose, on the other hand, is the center of the face. It's the first thing people see when they look at you. And I think I'm so beautiful now."

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