Medical tourism in tango paradise: The internet ...

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Annals of Tourism Research 45 (2014) 116–131

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Annals of Tourism Research journal homepage: www.elsevier.com/locate/atoures

Medical tourism in tango paradise: The internet branding of cosmetic surgery in Argentina Anahí Viladrich ⇑, Rita Baron-Faust The City University of New York (CUNY), USA

a r t i c l e

i n f o

Article history: Received 8 October 2010 Revised 13 December 2013 Accepted 18 December 2013

Keywords: Medical tourism Cosmetic surgery Plastic surgery Argentina Tango Body capital

a b s t r a c t This article examines the online marketing literature that promotes Argentina as a rising destination for cosmetic surgeries. The surgical production of ‘‘body capital’’ is branded as an investment practice towards increasing one’s value in the global market economy. Online advertisers portray Argentina as a familiar place where foreigners can feel ‘‘at home’’ due to an assumed ‘‘cultural affinity’’ (i.e., racial, ethnic and cultural similarities) with their Argentine hosts. Argentines are depicted as surgically enhanced role models to be imitated by their foreign visitors. The notion of sensual exoticism is advertised via tango products—from taking lessons to watching tango shows—as a unique component of the cosmetic surgery package that brands improved physical appearance with enhanced sex appeal. Ó 2013 Elsevier Ltd. All rights reserved.

Introduction ‘‘Tango, European architecture, cultural places, historical tours, an exquisite cuisine and a wide array of comfortable accommodation facilities, along with tourist attractions unique to South America, will turn your health trip into a true tourist destination. There is a lot to discover, to know and enjoy. We invite you to try a different trip.’’ (AestheticUp, 2012). ‘‘Shopping, nightlife, restaurants, clubs, there is no shortage of things for the tourist to do. Argentina’s love of music (including the famously sexy tango), food (you won’t get a better steak ⇑ Corresponding author. Address: Departments of Sociology & Anthropology, Queens College of the City University of New York, Powdermaker Hall 233A, 65-30 Kissena Blvd, Queens, NY 11367-1597, USA. Tel.: +1 718 997 2784. E-mail address: [email protected] (A. Viladrich). 0160-7383/$ - see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.annals.2013.12.007

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anywhere) and general hedonism is well known! And of course, everything in Argentina is noticeably cheaper than you would expect to pay in the US or Europe.’’ (Cheaper Cosmetic Surgery Abroad, 2012). These quotes represent the standard pitches utilized by medical tourism companies to promote Argentina as a unique cosmetic surgery destination. Their shared themes aim to attract potential travelers to experience Argentina’s pleasures while receiving lower-cost, high-quality medical care—from breast implants to bariatric surgery. Whereas until recently so-called medical tourists were mostly the Third World wealthy journeying to developed countries for care, this route has largely been reversed (Merrell et al., 2008). Medical tourism is now a globalized industry aided by lower labor costs, advanced telecommunications, and an information revolution that allows the transmission of medical records to distant places in mere seconds (Bookman & Bookman, 2007; Connell, 2006; Whittaker, 2008). A spate of publications targeting potential health travelers reflects this trend—from handbooks offering advice on how to choose the best medical vacation to online cost-comparison charts. The social science literature has followed suit by addressing the ‘‘tour-and-cure’’ trend in articles and reports in social science journals such as Annals of Tourism Research (Clarke, 2010; Garcia-Altes, 2005; Joppe, 2012), with special issues devoted to the topic including Anthropology & Medicine (Naraindas & Bastos, eds., 2011), Medical Anthropology (Smith-Morris & Manderson, eds., 2010) and Signs (Mazzaschi & McDonald, eds., 2011). Much of this literature provides a critical lens to our understanding of offshore health services in tandem with rising global health inequalities (Smith-Morris & Manderson, 2010; Sobo, 2009; Sobo, Herlihy, & Bicker, 2011; Weisz, 2011). Despite the various terms used to define medical tourism practices—including cross-border travel, medical travel, and reproductive exile or travel (Kangas, 2007, 2011; Scheper-Hughes, 2000; Whittaker & Speier, 2010)—one thing is clear: Most commercial intermediaries, doctors, and clinics heavily rely on the Internet to advertise their products, recruit potential clients, and win new markets for their services (Lunt, Hardey, & Mannion, 2010). The growth in Internet-based medical advertising has reinforced the notion of patients as consumers free to buy any products (including specialized surgeries) in an increasingly mobile global marketplace (Smith-Morris & Manderson, 2010). This paper reflects the growing scholarly interest in the advertising strategies of the medical tourism industry as shown by studies on its Internet messages (Crooks, Turner, Snyder, Johnston, & Kingsbury, 2011; Lunt et al., 2010; Nassab et al., 2010; Whittaker, 2008). Aside from the literature on reproductive tourism and general marketing trends (Smith, Behrmann, Martin, & Williams-Jones, 2010; Viladrich & Baron-Faust, 2010, 2012) and recent works on medical and cosmetic practices (Masi de Casanova & Sutton, 2013; McDonald, 2011), there has been little research on medical tourism in Argentina. This article fills that gap by exploring the promotional pitches utilized by the online cosmetic tourism literature that advertises plastic surgery packages in Argentina. The cosmetic enhancement market represents a multibillion-dollar industry that caters to growing numbers of patient-consumers around the world (Lunt et al., 2010). While a handful of developing countries have become top destinations for aesthetic procedures, notably Thailand and India, most Americans and Europeans opt for shorter flights to Central and South America, particularly Brazil and Argentina, where cut-rate aesthetic surgery and fertility treatments are a major draw despite the lack of international accreditation of many health facilities (Burkett, 2007). An unprecedented devaluation of the Argentine national currency in the early 2000s provoked a tourism boom that attracted foreign companies to Argentina, eager to launch lucrative medical facilities in the cosmetic market (McDonald, 2011; Merritt, 2012). These investments ultimately paid off: Argentina ranks eleventh among countries with the most surgical and non-surgical cosmetic procedures (ISAPS, 2012) and fifth in demand for cosmetic surgery procedures in the Americas and the Caribbean (Parker, 2009). Over 300,000 cosmetic procedures (including 60,000 breast implant surgeries) are performed in Argentina annually at internationally competitive prices (InvestBA, 2012). Yet, price alone is not enough to lure medical tourists to a distant land for the purpose of undergoing potentially dangerous aesthetic procedures (Crooks et al., 2011). The combining of highly rated medical care with pleasure travel is no simple equation; savvy marketers know this and therefore

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shape their promotional pitches by concocting exclusive branding for their specific destinations (Bookman & Bookman, 2007). Within the globalized trend of product differentiation, countries strive to make their services as both attractive and unique. In their study of medical tourism in the English-speaking Caribbean, Chambers and McIntosh (2008) observe that the region could not easily compete in the global medical market, given the wide international availability of cheap, top-notch health services paired with appealing natural resources. The Caribbean region consequently brands its distinctiveness in special ways, by advertising alternative healing therapies and eco-resorts nestled in rain forests that purposely target tourists’ demand for adventurous experiences (Chambers & McIntosh, 2008). While nations such as Jamaica (with low-grade technology) offer eco-friendly health accommodations, Barbados (a traditional niche for a well-off population segment) has fashioned for itself a blossoming fertility health market (Ramírez de Arellano, 2011). In an effort to develop its own signature brand, Argentina has rapidly marketed its uniqueness by combining the advantages of a proto-European country that offers outstanding natural beauty and exceptional sophistication with top-tier cosmetic medicine. While cardiovascular and orthopedic surgeries are readily available to foreign patients in Argentina, medical tourism companies typically promote elective enhancement procedures—labeled as low risk and with quick recovery time. In this article, we argue that the online marketing literature promotes the cosmetic surgery journey to Argentina as an exciting experience that takes place in surroundings familiar enough for foreigners to feel at home. We term the concept ‘‘cultural affinity’’ to define an alleged familiarity shared by Argentine providers and their foreign patients on the basis of their racial, ethnic, and cultural similarities. The notion of sensual exoticism is constructed through the promotion of tango products, from tango lessons to tango shows, as a singular component of the Argentine plastic surgery package. We argue that the Argentine medical tourism literature delivers its own tangoized version of beauty—spiced with sensuality and charm—as a singular product of the Southern Cone. Medical tourism marketers strategically address the ontological tension between seeking medical treatments abroad and having a vacation by advertising Argentina as both a sophisticated and exciting destination. In the conclusions, we revisit the main findings of this study and call attention to the potentially deleterious effect of Internet messages that mostly stress the benefits of the cosmetic surgery trip and downplay its potential health risks. We begin with an analysis of the surgical production of body capital as an investment practice aimed at increasing one’s value in the global market economy. Cosmetic tourism and globalized body capital Conceptual tensions in the literature on cosmetic surgery underscore positions that assert its practice as liberating and empowering, versus those that consider it a form of subjugation to the globalized beauty industry (for a critique, see Holliday & Cairnie, 2007). This paper seeks an alternative middle ground by conceiving aesthetic surgeries as a vehicle for capital investment, with the body being a main site for its transactions. Unlike previous modernity projects that sought progress through social and political institutions, enhancement technologies have turned the body into a main instrument for social and political advancement (Hogle, 2005). The exponential growth of the cosmetic industry, which has gone hand in hand with the commoditization of health care, involves conscious efforts to change one’s physical traits for the sake of social and material gains (Aizura, 2009). Recasting the body as a capital investment allows us to see it as a means for either restoring or improving normalcy while creating a ‘‘natural’’ look with a scalpel (Blum, 2003; Gimlin, 2000). No longer only focused on repairing physical flaws (Pitts, 2003; Pitts-Taylor, 2007), cosmetic surgery has become a widespread leisure activity that seeks to improve one’s appearance in a capitalistic economy. The notion of the changeability of capital (Bourdieu, 1985) is particularly useful here to address the convertibility of one form of assets into another. Cheap surgical vacations allow quick investments in one’s body parts that are then turned into social capital (connections and access to upper-level

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circuits); symbolic capital (status); and even financial gains (better jobs and upward mobility through marriage). The body capital framework critically examines the conversion of patients into self-reliant agents who choose surgical fixes as a way of gaining autonomy, decreasing age anxiety, and improving self-esteem (Fraser, 2003). In this view, investing in reshaping one’s belly and buttocks is no longer a symptom of conspicuous consumption but rather a long-term strategy that, along with obtaining advanced university degrees, promises to increase one’s value in the hierarchical market of symbolic goods (Gilman, 1999). Elective surgeries are thereafter framed as a choice, with appearance no longer being determined by genetic destiny but rather by market competition and cultural mandates (Gilman, 1999; Hogle, 2005; Lee, 2008). By realigning individuals’ self-perception with an image that conveys radiance and youth, aesthetic surgery has the potential to change how society values one’s persona (Holliday & Cairnie, 2007). The inauthentic or surgically modified body then becomes synonymous with a younger individual and the antithesis of the aging and degenerative self (Ackerman, 2010). The new technologies of the body have also contributed to deepen social inequalities by favoring individuals who display improved physical features (Goldenberg, 2010). As noted by Holliday and Cairnie (2007), even small surgical changes may have dramatic consequences in the ways people are perceived by potential employers, friends and colleagues—leading to varied degrees of success in different fields. The surgical makeover is utilized as an individualistic and normative project that allows women and men to regulate their own appearance and even strengthen their gender identity through discipline (e.g., gyms, competitive sports) and/or body modification, from rhinoplasty to gender reassignment (Aizura, 2009). Cosmetic surgery tourists represent a growing group of transnational patients who visit distant locations to improve their bodies while enjoying recreational activities as members of a growing leisure class (Masi de Casanova & Sutton, 2013). Such travelers are increasingly being recruited among those who cannot afford cosmetic practices in their countries of origin, epitomizing a lower- and middle-class strategy by which to become (and remain) competitive in the labor market. Edmonds (2007) shows how cosmetic surgery in Brazil’s public hospitals delivers promises of upward mobility to the working class by treating aesthetic imperfections according to the mandates of the beauty industry. In her study on women’s marriage prospects, Schaeffer-Grabiel (2006) describes how Mexican and Colombian women endure cosmetic surgery hoping to improve their chances of marrying well-todo foreigners. The medical industry makes good use of the promotion of body capital by advertising the mediumand long-term benefits that cosmetic alterations bring to the medical traveler, for whom a surgically improved body turns into a souvenir of the tourist experience (Jones, 2011). Contrary to other forms of medical outsourcing that are considered lifesaving and more serious, plastic surgery is framed as an elective holiday journey described as relaxing, pleasurable, and restorative (Bell, Holliday, Jones, Probyn, & Taylor, 2011). The body ultimately becomes both the medium and endpoint of the cosmetic surgery trip, eventually leading to professional advancement and individual success within a consumer-market-driven economy (Hunter, 2011; Yang, 2011). The beauty industry, both East and West, abounds in depictions of practices to enhance one’s body capital, largely by framing cosmetic surgery as the new ‘‘fountain of youth’’ for the emerging middle classes. The motto ‘‘being good looking is capital’’ (Wen, 2009) is more than a metaphor; it symbolizes a well-planned upward mobility stratagem. In South Korea (Orbach, 2011) and China (Yang, 2011), the double-slit eyelid operation to Westernize the Asian eyelid has become synonymous with social advancement. This practice is publicly advertised on the Miss Plastic Surgery Pageant, a competition first held in Beijing in 2004 to crown the country’s best ‘‘artificial beauty.’’ In China, cosmetic surgeries have become family projects to secure a young woman’s success by improving her marriage and employment options (Lindridge & Wang, 2008; Wen, 2009). Similarly, in Argentina, teenagers are increasingly turning to cosmetic enhancements (including Botox and fillers) mostly due to social and parental pressure (La Nación, 2012). Breast implant raffles are a staple at ‘‘sweet fifteen’’ parties, with breast augmentations being one of the most popular birthday presents sought by young Argentine women (Balch, 2006). As further examined in this paper, the online medical tourism industry widely advertises Argentines’ use of plastic surgery as a trend to be admired and even followed by prospective medical travelers.

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Methods This study is based on a content analysis of the online marketing literature—namely, Internetbased advertisements and promotional articles and blogs—that brand Argentina as a top destination for medical travelers seeking cosmetic enhancements abroad. Online searches were conducted for a period of four years, from May 2009 to May 2013, during which we tracked the websites of Argentine and U.S. medical tour providers and online advertisers that promote cosmetic surgery services in Argentina. Keywords systematically utilized to conduct the searches included ‘‘Argentina’’ and ‘‘medical tourism,’’ ‘‘plastic surgery,’’ and ‘‘cosmetic surgery.’’ This led to the compilation of a broad directory of English-language websites. Periodic visits to these websites via search engines (e.g., Google, Yahoo) allowed us to gauge the direction of cosmetic tourism marketing and replicate the information that English-speaking medical travelers may easily find on the Internet. An initial search conducted by the second author led to more than 400 hundred websites that served as the original corpus for this research project. After deleting duplications and discarding sites that were not significantly related to Argentina—as in the case of global agencies that only tangentially mentioned this country—we ended up with 98 websites that advertise Argentina as an aesthetic surgery destination. In agreement with the typology of medical tourism websites proposed by Lunt et al. (2010), these open portals represent three categories: cosmetic and medical tourism companies (65 sites); articles promoting cosmetic surgery travel (22 sites); and blogs posted by travelers and doctors (11 sites). In order to assure inter-coder reliability, the authors worked independently of each other, searching for the most salient and frequent themes on the selected websites. Rather than relying on prescriptive content analysis (based on pre-coded sets of close parameters), open categories were used to identify the most frequent and distinctive frames within the texts (McKeone, 1995). The analysis of the materials was done manually by recording the materials’ manifest content (e.g., quotations) as well as their latent meaning, as in the case of words suggesting a particular theme. For example, the use of phrases such as ‘‘European-like atmosphere,’’ ‘‘familiar,’’ and ‘‘comfort’’ were linked with the concept of Argentina as a destination that is comfortingly familiar to travelers. Most of the conceptual analysis (e.g., the meaning of ‘‘body capital’’ from a cosmetic tourism perspective) was developed by Viladrich, the first author of this paper. Viladrich is a sociologist and medical anthropologist, originally from Argentina, whose long-term research deals with the cultural dimensions of health and illness in her home country. In a second stage, the authors worked together to check for the amount of agreement between their respective coded materials, as well as to refine the most salient themes found in the texts. From the 98 websites, they selected 200 promotional materials that included 136 advertisements, 53 excerpts from articles, and 11 excerpts from blogs. Together, these materials provided three main themes by which Argentina (and its inhabitants) is construed as distinctive from other medical tourism destinations. The first theme, cultural affinity, was found in 80 of the 200 online materials and portrays an alleged racial and cultural similarity between Argentines and their foreign visitors. This theme was represented evenly among advertisements, articles and blogs in about forty percent of the 98 websites. Quotes in this group highlight the European and cosmopolitan qualities of Argentina (and particularly, Buenos Aires) that present the country as both exotic yet comfortable for Western travelers. The notion of having European origins is indicated via photographs of predominantly white women and men, as examples of typical cosmetic surgery patients. We particularly identified 147 images of Caucasian plastic surgery patients (mostly posted on advertisements of medical tourism websites). A second theme, found in 69 out of the 200 materials, highlights Argentines’ investment in their body capital through plastic surgery and the concomitant high quality of their plastic surgeons. This theme was represented evenly in advertisements and articles in one-third of the 98 sites. A third and final theme, found in 51 of the 200 materials (distributed uniformly among advertisements, articles and blogs in about one-fourth of the 98 sites) introduces the Argentine tango through two distinctive and convergent frames. The first frame depicts tango as a hands-on activity that medical travelers are enticed to learn and practice, either before or after cosmetic surgery. A second frame

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Fig. 1. Tango and Medical Tourism in Argentina. Source: http://www.aestheticup.com/buenos-aires-argentina-medicaltourism.php.

turns medical travelers into voyeurs of the Buenos Aires tango spectacle. Combined, these two frames draw attention to the charms of the Argentine tango as an intrinsic component of the culture of Buenos Aires and its people. With the exception of two big tourism companies (GoSculptura and Plenitas), which each posted more than one tango advertisement throughout the period, we identified one reference to tango per website. Although the tango theme was the least frequent found in the materials analyzed, it has a visual impact that highlights its larger relevance (Fig. 1). Furthermore, we identified two dozen images (mostly as part of advertisements in 24 of the 98 websites) that included photos and drawings of sensuous (white) female and male tango dancers. The occurrence of the tango theme also correlates with the growing importance of ‘‘tango tourism’’ in Argentina, which has been increasingly reported by the scholarly literature (Dávila, 2012; Merritt, 2012; Savigliano, 2005; Viladrich, 2013). Finally, we acknowledged two additional themes: the low cost of cosmetic services and doctors’ high professional reputation. These are largely found in the marketing materials of most touristic destinations and are widely discussed in the medical tourism literature (see Bookman & Bookman, 2007). In order to save space, and avoid reiterating what is already known on the topic, this paper does not discuss these last two frames. The next section explores why reputed high-quality medical technology at low cost is not enough to entice foreign travelers to visit Argentina for aesthetic procedures. A whitening niche: the construction of cultural affinity ‘‘Buenos Aires, the ‘Paris of South America’ is a truly cosmopolitan city bursting with culture, architectural landmarks, fine dining, street life, tango, great wine, meat and shopping. Come alone, as a couple or with your family and prepare for this lifetime experience!’’ (GoSculptura, 2011)

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A main feature in the portrayal of Argentina’s exceptionality rests on the promotion of its sophistication and the cosmopolitanism of its citizens, who are portrayed as being closer to the developed world than to their Latin American peers. As noted in the quote above, the capital city of Buenos Aires is widely considered the Paris of South America with its beautiful, wide boulevards and lavish shops, along with intellectual and artistic sophistication (Nwosu-Hope, 2010). Medical tourism companies represent Argentina as being wealthier, in terms of gross national product per capita (Workman, 2007); more literate, with a 97% literacy rate (Populstat, 2009); and whiter, with 85% to 97% of Argentines identifying as being of European descent (Europa World Plus, 2012) than other Latin American countries, and more developed than Thailand and India—despite the latter’s booming technology industry. In the same way in which European health clinics brand their services as being located in developed countries (Whittaker & Speier, 2010), Argentine medical facilities distance themselves from their Latino neighbors, including Brazil, a country known not only for its fabulous beaches and annual Carnival but also for being a ‘‘scalpel paradise’’ for Americans (Edmonds, 2010). The online medical tourism industry constructs an image of Argentine urbanites as European descendants who are better off than their Latin American peers: ‘‘With its heavy European influence (mainly Italian and Spanish), Buenos Aires, Argentina is known as the ‘Paris of South America’ and is the largest city in Argentina with 33% of the population. Argentina is the 2nd largest country in South America and the 8th largest country in the world. . . Argentina is referred to as a secondary emerging market or an upper middle-income country’’. (Medical Tourism.com, 2012) Plenitas (2009), a leading medical tourism company in Argentina, presents a comparison chart (Table 1) with a few social indicators among selected countries that underscore Argentina’s advanced social status. Curiously, this chart selectively ignores Brazil and Mexico, which offer stiffer competition for Argentina than countries in South Asia or Eastern Europe. Plenitas’ comment at the bottom of the table—noting that Argentines are ‘‘mainly white and from European descent’’—stresses the similarity factor between foreigners and their Argentine hosts. A key feature in the construction of cultural affinity involves depicting familiar environments where medical travelers will feel ‘‘at home,’’ as suggested by the following quotes: ‘‘Many tourists that have come to Buenos Aires claim that they did not feel foreign at all when walking down the streets of the city; they felt ‘at home.’’’ (PlacidWay, 2012)

Table 1 Plenitas: ‘‘Destination Argentina’’. Source: Plenitas, Destination Argentina accessed on 10/07/10 at http://www.plenitas.com/en/ destinoargentina.asp. Argentina

Colombia

India

Poland

Thailand

$12,400 $6,600 $2,900 $12,000 $8,100 GDP per capita (international dollars) Industrial production 16.2% 4% 6.5% 10% 8,5% growth rate Airports 1,334 980 333 123 109 Television Broadcast 42 (plus 444 60 (includes 7 low562 (480 have less than 179 (plus 256 5 (plus 131 Stations repeaters) power stations) 1 kW of power) repeaters) repeaters) Internet service 33 18 43 19 15 providers In the last two years, Argentina has experienced an important growth in the economy, especially in agriculture and industry. The values related to services show the quality of life of the inhabitants who, due to their high educational level, demand more access to information and culture as well as better quality. Literacy rate 97.1% 92.5% 59.5% 99.8% 92.6% (>15 years old) Argentina’s population has a high level of literacy, is mainly white and from European descent. In Argentina, many nationalities live peacefully, without any racial or religious conflicts.

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‘‘Argentina is a traveler’s paradise due to its gorgeous landscapes, beautiful cities, lively culture and its stunning natural wonders. Unlike the Andean nations where North Americans and Europeans are obvious tourists, in Argentina you can travel while feeling at ease and blending in with the peoples of European descent.’’ (MediMundi, 2012) While in nations such as South Africa, the promotion of urban safaris to Soweto (also described as ‘‘poverty safaris’’) tends to highlight travelers’ sense of being elite (Mazzaschi, 2011), online advertisers describe Argentine hosts and their foreign visitors as convivial members of a first-class citizenship. In contrast, the popular representations of many South Asian countries (including India and Thailand) emphasize luxurious medical infrastructures that are removed from disadvantaged children and adults living in poverty (Bookman & Bookman, 2007; Warf, 2010). In an analysis of promotional materials for medical tourism in India, Crooks et al. (2011) observe marketers’ tendency to highlight the great quality of India’s medical care, in order to combat the perception of India as a third-world country. Online advertises emphasize India’s cutting-edge medical services, which are branded along with its touristic sites and holistic vacations (Gupta, 2008). However, the experiences of tourists in India and in Argentina, as publicly constructed, clearly differ. Citing an article from the Argentine newspaper Clarin, Masi de Casanova and Sutton (2013: 67) note that Argentina is generally regarded as a better location than India—a country seen as ‘‘known for its dirtiness,’’ which becomes a serious concern for potential medical tourists. Salomon’s study on medical tourism in India (Solomon, 2011: 110) details the experiences of an American couple who travel to India for orthopedic surgery, by stating that the advantages in medical care and costs they experienced ‘‘had to be put alongside the challenges of their first visit to India, including their responses to crowds, poverty, and a different set of sense stimuli.’’ The couple Salomon interviewed were as satisfied with India’s medical services as they were shocked by their cultural encounters: ‘‘Some of the smells are really horrific, and it’s hard to get past the smell to eat. . . We’re just some Southern people, we’ve never been outside the United States, and we were kinda scared stark.’’ Whatever Argentina lacks in terms of India’s diverse and high-tech medical options, it makes up for with its alleged cultural resemblance. McDonald (2011) observes that the use of postcolonial racial idioms intend to make Argentina a European niche in contrast with India, Thailand, and Mexico. Rather than warning foreigners to avoid Argentine locals, the former are invited to embrace their hosts’ cultural practices. ‘‘Being among friends’’ becomes an online vaccine against the culture shock that medical tourists may experience elsewhere, but not in the company of porteños (people from Buenos Aires), as advertised in a blog post (Tanaris, 2008), entitled ‘‘Argentina: Nightlife, Tango, Plastic Surgery’’: ‘‘Modern medical tourism not only offers affordable plastic surgery but also the once in a lifetime chance of experiencing the beauty of your destination country. Porteños [people born in Buenos Aires] are not only renowned with their expertise inside the operating room but because of their culture. You will never be in a culture shock if you decide to get affordable plastic surgery in Argentina. Family and friendship ties are generally valued more than in North America and the best thing about Buenos Aires is being surrounded by incredible people who you can call family.’’ Leonardo Boto, executive director of the National Institute of Touristic Promotion in Argentina (Ríos, 2009), stresses the cultural resemblance that makes Europeans and Americans more comfortable in Argentina than in other countries, including India: ‘‘There is also a cultural closeness with the U.S., Europe and other Latin American Countries—Botto added. For an American, for example, it is a delicate situation to get medical attention in a country like India, for example, where you won’t be sharing the language and the religion, nor will they have the same vision regarding the mysteries of life.’’ Shared language is another important aspect in the branding of cultural affinity. One factor that has enabled India to successfully market its services to medical tourists is that Indian professionals speak English (Bookman & Bookman, 2007). Although Mr. Botto (in the quote above) seemed unaware of this

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fact, his remarks reveal the construction of cultural familiarity between Argentina and its foreign guests—despite the fact that Spanish (and not English) is the language spoken in Argentina. Online marketers typically de-emphasize the fact that Argentina is a Spanish-speaking country. Fear of a foreign language, which may make potential travelers hesitant to undergo surgical treatments in Argentina, is counterbalanced by the country’s alleged European flavor, along with the availability of English-speaking providers and personal assistants. In the end, much of the manufactured affinity discussed here is orchestrated by an advertising industry designed to make patients ‘‘feel at home’’ even in unfamiliar and foreign surroundings. These findings coincide with the work of scholars who point out the public representation of Buenos Aires as a haven for American and European expatriates and a locale that combines familiarity with a sexy urban vibe (Dávila, 2012; Merritt, 2012). Next, we explore how medical tourism marketers go one step further by depicting Argentines as savvy consumers of cosmetic surgeries and, therefore, as role models to be imitated by their foreign visitors. Looking like an argentine ‘‘Argentine women are the most beautiful because they are obsessed with their looks and use plastic surgery in Argentina to reach their objective.’’ (GoSculptura, 2012). ‘‘. . .Buenos Aires is considered a perfect aesthetic surgery destination due to porteños’ body image obsession. In a country where 1 in 30 of the population has gone under the knife, Dr. [Guillermo] Blugerman believes: ‘many feel comfortable recovering in a place where surgery is less taboo.’’’ (Nwosu-Hope, 2010) As suggested in the quotes above, Argentines are described as ‘‘obsessed’’ with their body image (Fig. 2), a trait that reinforces their stature as savvy consumers of cosmetic surgeries (Forbes et al., 2012; Meehan & Katzman, 2001). In a promotional interview, Dr. José Juri (billed as the most famous plastic surgeon in Argentina) points out that Argentines’ obsession with beauty is rooted in the fact that most do not consider themselves Latin American but rather European, and even dress according to that image (Carlin, 2006). While in Brazil cosmetic surgery is defined as a ‘‘tactic of the weak’’ (Edmonds, 2007, 2010) in order to escape poverty and stigmatization, in Argentina it is framed as a middle-class conscious effort to assure one’s upward trajectory. The normalization of the surgery trip is reinforced by the self-determination of European-looking Argentines in investing in their bodies. In Dr. Juri’s words: ‘‘A pretty face has more power and will get you more than 20 letters of recommendation’’ (Galetto, 1996: 6). The cosmetic surgery web pages prominently feature photographs of beautiful white individuals, especially in ‘‘before and after’’ photographs of plastic surgery. In these figures, the archetypical Argentine female is portrayed as a fair-skinned, sexy woman encased in a form-fitting tango dress slit to the upper thigh (see figure). As noted by Ballve (2006): ‘‘There is a strong pressure for [Argentine] women to adhere to a European look, and if they don’t fit the mold, they suffer harsher judgment, personally and professionally, than in many other cultures.’’ Physicians’ competence is among the main factors influencing the choice of destination for medical tourism (Gill & Singh, 2011). Concomitantly, medical marketers tend to impart a sense of professional reassurance to foreign travelers by pointing out that Argentine physicians have plenty of local patients who, as summarized by cosmetic surgeon Dr. Raul Banegas, ‘‘are obsessed with physical perfection. . . So we have to be the best at what we do. . .’’ (The Week, 2007). The portrayal of Argentine women and men as devoted caretakers of their own body images becomes a surrogate warranty for finding a good plastic surgeon: ‘‘Argentina’s plastic surgeons are skilled because domestic demand for breast implants, laser surgery and nip-and-tuck treatments is sky high in this fashion-conscious country where looking good is always in style. One in 30 Argentinians are estimated to have gone under the plastic surgeon’s

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Fig. 2. Argentine women’s ‘‘obsession’’ with beauty. Lbmsl. Source: Excerpt from GoSculptura’s website: http:// www.gosculptura.com/info/newsletter/ofArgentineWomen.php).

knife, making the population the most operated on in the world after the US and Mexico.’’ (MediMundi, 2012) The ethnographic observations and media analysis of McDonald (2011: 487) and Merritt (2012: 96–97) agree with our findings regarding the branding of Argentines’ European traits along their fondness for cosmetic enhancements which, together, make cosmetic surgery more appealing to foreign patrons. In her study of cosmetic tourism in Argentina, McDonald (2011: 487) notes the following: ‘‘Assertions of a ‘white’ and ‘European’ identity are underwriting broad claims to biomedical expertise, and in particular, the kind of expertise needed to operate upon foreign, ‘First World’ patients. It

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is not by chance that Buenos Aires markets itself as a safe place for surgery while simultaneously selling the idea of Argentina as an island of European culture in a sea of ‘tropical’ Latin America.’’ The concept of becoming a ‘‘surgical junkie’’ (Blum, 2003) is crucial in the construction of changeable bodily parts that can be improved all at once. In a promotional article, Carlos Robles, commercial manager of AestheticUp.com (La Razón, 2010), explains the advantages of this approach: ‘‘In most cases we don’t just do one surgery but a mix; it is customary to take advance to travel abroad to get several surgeries all at once. Typically, the idea is to combine a breast implant with a liposuction, because it is convenient from the perspective of cost differentials.’’ Now we turn to the last key ingredient in the recipe for marketing Argentina as a special medical travel destination, which relies on tango imagery to make body capital more accessible (and sensual) to the medical traveler. Tango in Buenos Aires: branding sensual difference

‘‘The Worldwide Dancing Festival that is part of Tango Buenos Aires will take place in the city [of Buenos Aires] from August 13 to 31 and it is the tango event that enjoys the broadest international repercussion. Thousands of dancers and international attendees get together for this event’s activities making it a total success. However, tourists not only take advantage of the milongas, shows, classes and exhibitions, they also get information that allows them to remain a few more days to take care of their own beauty needs. What it is expected are the consultations for surgical enhancements since having a surgery in Argentina is cheaper and our professionals have an international reputation. All of this makes Argentina one of the preferred worldwide destinations for plastic surgeries.’’ The quote above comes from an excerpt of ‘‘Tango Buenos Aires,’’ posted on the promotional website of a cosmetic surgery clinic in Buenos Aires (Clinica Robles, 2010). It provides a direct link between foreigners’ opportunity during a single stay in Buenos Aires to dance tango and seek affordable surgical enhancements. The medical tourism industry in Argentina builds such advertising on frames that either invite medical tourists to take classes and practice tango, or become tango spectators. The first frame is best exemplified by Plenitas, a leading medical tour company coupling cosmetic surgery with tango tours in Argentina. For one all-inclusive fee, a prospective patient can reserve four-star accommodations and meals, tango lessons and nightclub shows along with a face-lift, liposuction, or tummy tuck (Plenitas Press Release, 2004). Among Plenitas’ most popular tours in 2009 was the ‘‘Breast Implant & Tango Trip,’’ a seven-day package that included both Spanish language and private tango lessons and FDA-approved silicone implants. In its marketing, Plenitas promises the unveiling of ‘‘a new you’’ at a tango dinner dance at Buenos Aires’ famed Gardel’s Corner (Plenitas, 2009). Following Plenitas’ lead, other tango tour providers (e.g., Freegate Tourism, Explore Argentina, and Tour y Tango) soon began offering full tourist and hotel packages with tango classes and shows, all for around $2,310 per person (ExploreArgentina.com, 2009). In the promotional article ‘‘Tango & Cash: Argentina’s secret weapons against fat thighs,’’ Healism.com states: ‘‘The low cost of thigh lift surgery should be enough to entice most cosmetic surgery shoppers out there, but medical tourism brings other advantages to the table as well. How about adding a luxurious vacation where you travel to exotic sites, eat delicious food, meet amazing people, and learn a few tango steps along the way? Argentina is an amazing country in its own right and would be a great destination to visit even if you didn’t need any health care.’’ (Healism.com, 2012) Tango offers a new pleasure for the cosmetically enhanced body, as the following excerpt illustrates: ‘‘Tango is the sensuous and passionate dance of Argentina. All Argentines know tango. You can experience the culture of Tango anywhere in Buenos Aires. Opening days and times of Tango halls change regularly so you will want to check before going. Your Personal Assistant will help direct

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you to Tango halls. . . Señor Tango is considered one of the hottest Tango Halls in Buenos Aires.’’ (Medretreat.com, 2012) The practice of tango in Buenos Aires has skyrocketed in recent years, fueling a growing foreign interest in the manufacture of tango products from thematic restaurants to tango stores, simultaneously turning the city into the ‘‘Disneyland of tango’’ (Dávila, 2012). It was only a matter of time before the medical industry would bundle its services with the growing Argentine tango industry. In her ethnographic study on first-world expatriates, Dávila (2012) observes that foreign travelers, whose original goal in Argentina was to learn tango, would end up buying cosmetic surgeries after being lured by the country’s widespread aesthetic surgery advertising vis-à-vis its relative cheaper prices. Argentine tango guides combine glossy color images of tall, slim, beautiful and sensual dancers with tourist excursions and commercials for aesthetic surgery clinics, paralleling the performative ritual of watching and being watched at tango parlors (Merritt, 2012; Viladrich, 2013). Interestingly, breast augmentation and liposuction—the two most internationally advertised cosmetic procedures—rank as the top practices promoted by big city magazines that convey sexual themes by showing partially naked white women (Hennink-Kaminski & Reichert, 2011). In his study of gender reassignment surgical tourism in Thailand, Aizura (2009) points out that foreign patients are not only subjected to surgical corrections but also to Thai culture, which together inform their own subjective transformations. In similar fashion, by making tango an essential part of Buenos Aires—and even assuming, erroneously, that its inhabitants all know about tango, as in the quote above—the medical tourism industry promotes Argentina as a destination where bodily changes can also be sensually enhanced. In one of its online promotional materials, entitled ‘‘Of Argentine Women,’’ GoSculptura (2012) quotes a plastic surgeon for the purpose of stressing Argentines’ obsession with beauty and femininity and their influence, along with the role of Argentine tango, in enhancing foreigners’ sensuality: ‘‘And interestingly, this obsession on looks is contagious. Says a plastic surgeon in Argentina: ‘I got three women patients who are company presidents,’ she says. ‘One of them is foreign. When she arrived she looked rather severe. Today, three years on, she is a lot more feminine and sensual. Another example: at the tango club I go to, we have a number of French women who come over year after year. And year after year I see their look softening, their hair getting longer... Coquetry is the essence of it all,’ she says.’’ For those unfamiliar with the relatively fast expansion of tango tourism in Argentina, the typical question that arises is how medical tourism companies are able to advertise cosmetic surgeries—with their potentially dangerous effects that demand postoperative care—hand in hand with tango lessons that require a significant amount of physical activity. As noted earlier, a second marketing frame turns medical travelers into spectators of the tango’s flair at dancing parlors and restaurants. Aware of the limitations of promoting tango dancing while recovering from surgery, online marketers stress the ‘‘tango spectacle,’’ as in the following online advertisement: ‘‘For a big, festive night of tango, try El Querandí in San Telmo. The elaborate nightly show, featuring dramatic dancing and some of the best Argentine crooners you’ll ever hear, includes a traditional three course dinner.’’ (GoSculptura-Argentina, 2012) By adding tango to the cosmetic surgery equation, the commercial marriage of medical and tourist excursions is heightened by the coupling of improved appearance with enhanced sex appeal. In a recent content analysis of cosmetic surgery tourism and its media representations in Argentina, Masi de Casanova and Sutton (2013: 67–68) also observed that Argentina fits the fantasy of achieving a beautiful and youthful body through enhanced technologies, in places where the sexiness of the experience is enriched with tango attractions. In the end, it is not enough to surgically alter one’s body; it is through the company of Argentines that travelers may get to experience ‘‘a new you’’ (per the Plenitas advertisement quoted above). The fleshly charisma of tango appeals to men, as well. In a promotional article, entitled ‘‘Tango with the Dentist,’’ a Canadian medical tourist (Shirley, 2012) muses about his personal experience in the office of a female dentist in Buenos Aires: ‘‘Is it normal to fantasize about dancing a tango with your

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dentist? During a root canal?’’ While dental work is fairly standard no matter where it is performed, the tango is branded as authentically Argentine thanks to the image of sexy dancers (even dentists). Medical tourism in Argentina is then entwined with sexualized imagery, with the implied promise of transforming oneself and returning home with a surgical souvenir enhanced by the tango mystique. Conclusions The field of cosmetic surgery in Argentina provides a window of opportunity to explore the ‘‘tourwith-a-cure’’ global trend led by medical travel companies offering all-inclusive packages for offshore aesthetic care. While many features of the Argentine medical tourism industry can be found in other countries (i.e., low-cost, top-notch medical technology), cheap, expert services alone are not enough to convince foreigners to seek cosmetic surgery in the Southern hemisphere. We have argued that the emphasis on plastic enhancement treatments portrayed alongside sensual pleasures in alleged familiar environments is key to promoting Argentina’s medical tourism industry. Argentina differs from Brazil, with its beautiful beaches and wild Amazon jungles, and Mexico, with its Aztec and Mayan wonders. By the turn of the twentieth century, Argentina had already embraced a seemingly European modernity by importing British-designed public transportation, Italian cuisine and French architecture. Therefore, medical tourism’s Internet pitches emphasize the proto-European, first-class glamour of Buenos Aires and its inhabitants as a comfort factor offered to Western tourists. For Internet marketers, the branding of the similarity factor between locals and visitors, based on racial and cultural features, is ultimately aimed at normalizing cosmetic surgery. Contrary to other destinations where locals and foreigners are phenotypically and culturally set apart, the online cosmetic tourism literature emphasizes racial and cultural resemblance. Rather than inviting travelers to venture into potentially ‘‘dangerous’’ territories, the caring aspect of curing is spiced with exciting and sensual experiences. In this vein, the tango component of medical packages is more than a dance; it is a ticket to out-of-the-ordinary practices different from one’s own daily routines. Internet messages help create new shades of body capital that feed on Argentines’ alleged fixation with their own ideals of beauty that highlight their sensual charisma and self-confidence. Certainly, Argentines are pictured as architects of their own body capital, not as mere copies of the archetypical Anglo-Saxon thin body type. The slim, fairly white Argentine women and men portrayed in tourism vignettes must be followed and mirrored, both in their tango moves and physical appearance. No longer designed in the developed world, globalized body ideals are now concocted in the developing one. Tours that combine tango (both as dancing practice and spectacle) and thigh lifts endorse the image of Argentina as a place where porteños are not only sexier and more beautiful, but also whiter and more sophisticated than their Latin American and Asian peers. In the end, the medical tourism sales pitch ‘‘sea, sand and surgery’’ (Bookman & Bookman, 2007; Connell, 2006) is turned into ‘‘touch-up tours,’’ with tango imagery deployed as a powerful advertising tool. This paper’s results agree with an emerging literature on medical and tango tourism in Argentina, which underscores the racialized discourses (mostly emphasizing Argentines’ whiteness) that have largely framed the global advertising of cosmetic surgery practices in this country (Masi de Casanova & Sutton, 2013; McDonald, 2011; Merritt, 2012). Since our study focused on the medical tourism messages and not on their impact, future work should determine if the growing volume of medical travel to Argentina is due (even partially) to the effect of Internet advertising. Cosmetic surgeries are highly invasive and potentially hazardous and require delicate post-operative follow-ups (Bookman & Bookman, 2007). Therefore, forthcoming research should also address the potentially deleterious effect of marketing messages that give emphasis to the pleasurable aspects of the cosmetic surgery trip and minimize its potential dangerous effects. As noted by Sobo et al. (2011), the general inconsistencies in the Internet’s selling of medical tourism packages to Americans reveal unresolved issues, such as the lack of international certification of many foreign medical facilities. Cosmetic tourism in Argentina can either address these issues (by further developing rigorous standards of quality and safety) or continue to deepen the tensions found in the patient-tourist equation, such as promoting tango dancing while recovering from surgery.

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