Afghanistan's growing demand for plastic surgery

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Media captionTreatments range from eyebrow lifting to reducing the look of wrinkles and removing unwanted hair

There is a growing demand for cosmetic surgery in Afghanistan, where just 10 years ago such procedures were mainly used to deal with injuries caused by decades of conflict.

Even though it may come as a surprise to some that looks can count for so much in a country where war, poverty and corruption have been commonplace, plastic surgery has a relatively long history in Afghanistan.

It was the conflict itself which gave medics the specific medical skills required to become plastic surgeons. Used to carrying out burn re-construction and other trauma surgery, they have been able to adapt their skills accordingly.

And the market seems to be growing all the time. Cosmetic surgery is especially popular among a younger generation of Afghans.

'Not qualified'

Women tend to visit plastic surgeons for facelifts, nose reshapes or liposuction. Eyebrow tattoos and hair transplants are more popular among younger men.

Image caption Adverts extolling the 'before and after' effect can be seen all over Kabul

Representatives of both sexes often request a specific look based on photos of Bollywood actors and actresses.

While most recipients hail the benefits of cosmetic surgery, critics are concerned that the growth in demand has resulted in a skills shortage, with some surgeons not sufficiently qualified to carry it out.

Kabul private hospital plastic surgeon Dr Najibullah Najib is a prolific plastic surgeon, on average dealing with two or three patients every day.

Surgeons like Dr Najib cut their teeth treating the victims of war for more than 20 years - thereby gaining the skills required for such delicate operations.

"Many girls want their eyebrows shaped in a new Chinese style or they want their eyelids done. Sometimes they want their noses to be narrower and higher," he said.

'Nicer then I expected'

Housewife Sheba, 40, is typical of the kind of patient who Dr Najib treats. She has already had three operations.

Image caption Demand for plastic surgery has surged in recent years

"First I removed fat from my abdomen, then I removed the bags under my eyes and also reshaped my eyebrows," she says.

"When I was laughing, I suffered by looking at my wrinkles. Now some friends even say I look 14 years younger.

"I love my body and my clothes fit a lot better."

Another client, Sahar, has had a nose operation.

"Now it is narrower and higher. I didn't expect such a change. When the dressings were removed, I was so surprised: it was nicer than I expected."

Most of the cosmetic surgeries that have sprung up in recent years are based in Kabul, with specialists trained in Iran and Pakistan.

All over more affluent parts of the city, it is possible to see adverts promising better looks and better hair, juxtaposed with classic "before and after" shots of apparently satisfied clients.

Skin 'destroyed'

So successful in fact has Afghanistan's cosmetic surgery business become that people have even started coming to the country from abroad for the comparatively low cost of treatment.

Image caption Cosmetic surgery has spiralled in what is traditionally a conservative country

A basic nose alteration in Afghanistan costs in the region of $300-$600 (£187- £375), doctors say. A similar operation in the West can cost up to 10 times more than that.

Bahador Shirzad, who works as an assistant at a hair enhancement centre in Kabul, says that surgical and non-surgical methods are used.

"We recommend non-surgical methods for those whose side hairs are weak or where the skin is destroyed," he says.

"With the surgical method, we take hair from the back of head of the patient and implant it onto the balding area."

But with the increase in demand, so the criticism of the quality of treatment on offer has grown.

Shafi is a patient unhappy with the treatment he received and who claims to have suffered unpleasant side effects.

"Doctors polished my head with some oil and then they implanted artificial hair on my head and joined it up with my own hair," he recalls.

"After a couple of hours I got a bad headache and my eyes were itching. I understood that these were [expected] side-effects of the implant procedure.

"But then I removed the hairs and my scalp had completely lost its colour."

Abdul Ghafar Ghayoor, a plastic surgeon in a hospital in Pakistan, says that some Afghan doctors lack the necessary experience to carry out such highly technical surgery.

"I have seen a number of Afghan doctors who have [only] worked for less than a year in Iran, Pakistan, India or Russia... This is why their work is usually not perfect."