Dr. Jason Diamond wasn't aware that his E! reality TV series Dr. 90210 was being aired on the other side of the planet. That is, until patients began arriving at his Beverly Hills office from all different parts of the Middle East. A facial specialist, Diamond was one of a group of prominent plastic surgeons featured on the show from 2005 through 2008. His new clientele included members of some of the most powerful and wealthiest Arab families in the world, including royalty from different countries in the region. They all wanted him to perform plastic surgery.
Diamond treated these patients in the United States initially. Over time, though, they began to ask if he'd be willing to travel to provide his services for them and their families at home. Eventually he decided to give it a shot. It took a year to get his license there and to settle on a medical facility where he could operate, but he eventually settled at The American British Surgical and Medical Centre in Dubai, founded by British plastic surgeon Mendy Kahn.
"It's my opinion, and I'm as a big an authority on this as anyone in the world, that they care more about their appearance than Beverly Hills' women."
Diamond was unprepared, though, for just how popular he was in Dubai. "It was ridiculous, there were people lined out the door to see me," he recalled of arriving there for the first time in October of 2009. "I was seeing people until one in the morning. I had never seen anything like it, so I decided to come back like a month later. And it was the same story, so I decided to make it a regular thing."
As a Beverly Hills plastic surgeon, Diamond was used to patients asking for Halle Berry's nose or Megan Fox's lips. He knew he could deliver on those requests, but he was unclear about the beauty ideals he'd encounter in a different part of the world -- if he would be able to translate them using his existing skills. It turned out he didn't have to.
In Dubai, about 60 percent of Diamond's current patients are Arabs who all speak fluent English. The remaining 40 percent are expatriates from Australia and Europe. Within the Middle Eastern group he sees local Emirati, as well as patients from other GCC countries like Saudi Arabia, Kuwait, and Qatar. He also has patients who fly in from India, Africa, and Russia. Across the board, though, he said, "They have very similar beauty ideals to what we have here based on the Hollywood influence ... that was a really big shock to me."
The first physician Diamond recruited into his new practice was Dr. David Matlock, who specializes in several procedures that he pioneered such as VASER Hi Def Liposculpturing (also known as "advanced surgical bodybuilding"), laser vaginal rejuvenation procedures, and Brazilian butt augmentations. "They say, 'I want a Beyonce butt, I want a J-Lo butt, I want a Kim Kardashian butt,' and it's amazing to think the same things I'm doing here, I'm doing over there," Matlock said.
There are small variations in taste, according to Dr. Marc Mani, the second surgeon Diamond brought into the practice. His patients in Dubai primarily consist of women in their mid-20s to mid-40s, mostly Arabs from Qatar, Saudis, local Emiratis, and Persians, 50 to 60 percent of whom dress in traditional robes. Breasts lifts and tummy tucks are the most common procedures that he performs there, with a fair amount of nose jobs and eyelids. "I think their beauty standards are more realistic in that they want to fit in with their own ethnicity," said Mani regarding his Arab patients."They are not denying their own ethnicity. They're somewhat influenced by Western standards, but in subtle ways. They want their nose to be refined a bit, but they don't want it to be a cute upturned, classic American nose. They don't want it to look fake."
It could seem counterintuitive for these women to invest so much in their appearances given that many are covered by traditional garments for much of the day. Diamond explained, "It took me a while to figure out, but in the Middle East many men are allowed to have four wives. The women want to be feminine and beautiful for their men. That is their job; they are not out working. There's no women's lib. Their job is to look good for their men, and that's all they care about."
"It's my opinion," Diamond added, "and I'm as a big an authority on this as anyone in the world, that they care more about their appearance than Beverly Hills' women."
"Their job is to look good for their men, and that's all they care about."
Though the women may indeed be very invested in looking good, the men are relatively uninvolved when it comes to the surgeries their wives undergo. On occasion, women have a mother or sister with them to see the doctors, but more often than not they show up alone. "I would say I see more often here [in Beverly Hills] men coming in with their wives saying, 'She needs to do this, or I really wish her breasts were bigger or smaller,'" said Mani. "The women are very self-directed there; they're very empowered over their own bodies and know what they want. Men are not driving their wives to have plastic surgery."
When the men do show up to the clinic, it's usually for their own surgeries: rhinoplasties, liposuction, breast reductions. Dr. Neal Handel, who has been practicing with the group for the last year, told me, "I've had a lot of male patients between the ages of 18 to 30 that when they get undressed and you see what their bodies look like, they've got the saggy tummies and the love handles. It's a lot of body contouring procedures."
They also spend a lot of time doing revision surgeries -- undoing prior work by other surgeons. Being a facial specialist, Diamond performs many revision rhinoplasties for his Middle Eastern patients. He cited Syria and Lebanon as places patients go for the original botched jobs that he then fixes in Dubai, and he seemed as interested by that trend as I was. Why would people with millions of dollars -- financial access to any health care in the world -- choose to go to such countries for cosmetic surgery?
"It's weird. I mean, maybe in that part of the world those are places that you think of, but when I hear people say, 'Oh, I went Syria to have a rhinoplasty,' I'm thinking, what were you thinking? As a Beverly Hills guy that is the last place that I'd want a rhinoplasty," Diamond said. "I can just tell you they are very far behind in technique and knowledge. Very, very far behind in what they know compared to what we know, so there are a lot of very amateur mistakes and a lot of disastrous mistakes, just the worst stuff I've ever seen in my life. And I see a lot of bad stuff here in L.A. that comes out of Tijuana and Mexico, and that stuff is nothing compared to the bad stuff I see coming out of these other countries."
Matlock described a case where he consulted with a male patient about whether he had ever undergone cosmetic surgery. He was told no. Then in the operating room he encountered fresh silicone seeping out of the man's butt and thigh. "Unbelievable," he said. "Bad jobs. You couldn't do that over here."
Diamond explained, "Some of these people will go and try and get it fixed and fixed and fixed, so you may think it's a plastic surgery addiction although they're just on a lifelong quest to correct a bad problem."
There are some financial incentives for these doctors to travel to Dubai, but surprisingly most told me they do better financially in their practices here in the United States. Some just have a passion for travel and use Dubai as a launch pad to see other places in the region, like Mani, who has visited Erbil, Iraq and Petra, Jordan. Others love the cosmopolitan feel of a city like Dubai and the exposure to international patients.
Dr. Diamond told me that his favorite parts about practicing in Dubai is the way he's treated as a physician. "In America back 30 or 40 years ago, doctors were respected and revered, and it's not that way anymore," he said. "But there you feel that huge degree of respect. People say, 'Thank you doctor. Bless you. Please come to my house. I'd be honored to have you come to my house.' I'm invited to people's houses for dinner 10 to 15 times a day, all the time." Matlock likened the physician/patient relationship there to that of a "father and child."
American doctors in particular seem to be on a pedestal. Every surgeon I spoke with described how their patients tell them that they only want American doctors, because they feel they have the best training in the world. Handel told me, "A lot of them will say to me, 'I came to you, because I want an American plastic surgeon.' I was trained at Yale. Marc Mani went to Harvard. I don't think they care about that. It's that we're Americans."
"When your job is to meet different people and take care of them, you see them on a fundamental level that has nothing to do with their culture and more to do with them as human beings."
Still, Dubai is a long way from Beverly Hills, culturally. "The very first time, I went I was very scared [to go] and the month leading up to the trip, every day I seriously considered hiring a bodyguard detail to come with me. I didn't. I know everyone over there knows I'm Jewish because on the TV show, they saw my son's bris and my wedding with the Rabbi," said Diamond of his initial reservations. "Actually it was very interesting, one of the very first patients I looked on the chart before I went in the room, and it says they're from Palestine, a husband and wife. And then they said something to me in Hebrew, and I haven't spoken a word since Hebrew school, since I was bar mitzvahed, and I didn't even understand what they said. It turned out that they were husband and wife doctors that practice part-time in Dubai and part-time in Palestine. The woman ended up booking surgery with me. They ended up inviting me over to their house for dinner."
"I feel genuine respect when I'm there with these people who know I'm Jewish. It really opened my eyes. You know, we are all just people; we all want the same thing. Maybe on some level Muslims hate Jews, Jews hate Muslims; maybe it's not really in our DNA. Maybe it's man-made stuff that there should be a way around," Diamond said.
"In a way I think it's been a good education for me about being more open-minded about Arabs," said Handel, "because here in the United States there's not a lot of positive press for Arabs." He described his patients as "polite, gracious and respectful."
"I've traveled a lot, but when you travel for vacation it's a lot different than when you travel for work," added Mani. "When your job is to meet different people and take care of them, you see them on a fundamental level that has nothing to do with their culture and more to do with them as human beings. It's a lesson. It shows you how much we have in common with everyone else."
When Diamond set out for what was supposed to be his first and only trip to perform surgery in Dubai, he had no idea that he'd keep coming back, or that he'd recruit his colleagues and set up an entire team there. His doctors from Beverly Hills now include a hair transplant specialist and a cosmetic dentist. There are eight of them who alternate traveling there every two to three months for about a week at a time.
Diamond and his group now have their sights set on a brand new facility in Riyadh, Saudi Arabia. In a country that is far more conservative than the United Arab Emirates, in which women are not allowed to vote or drive and where non-Muslim Americans would be prohibited from entering certain areas, it seems like a stretch to imagine how these Beverly Hills plastic surgeons are going to work there. But maybe it isn't. "There's this common thread among all human beings in all our DNA," said Diamond. "What beauty is. It's proven in the animal kingdom, too. Beauty and symmetry. Everyone knows what's good. You know beauty when you see it, and it's similar from culture to culture, with slight variations, very slight."