When Santa Monica resident Sara Shahpouri returns home from her annual trips to Iran, she usually has a suitcase full of saffron and pistachios and a Persian carpet. This year, she came back with a new face.
In Los Angeles, Shahpouri's home since she fled the 1979 Islamic Revolution, a face-lift would have cost her several thousand dollars. Instead, she bought round-trip airfare to Tehran, put her face in the hands of the city's preeminent plastic surgeon and had money left over to spend on jewelry.
An incongruous growth industry in the land of Ayatollah Ruhollah Khomeini's revolution, cosmetic surgery is thriving in Iran. Skilled doctors master the latest procedures practiced in the West and acquire the newest tools, from lasers to wrinkle-busting serums.
Because image-conscious Iranians, earning local salaries, make up the bulk of the doctors' clientele, procedures are cheap by Western standards. Iranian expatriates such as Shahpouri, who is in her early 50s, have caught on, and are being lured home by more than aging parents and cultural nostalgia.
"My relatives are too old to travel, to deal with visas, so I need to come every year anyway," she said, crossing her pedicured feet as a nurse injected her with anesthetic on the way to the operating room. "I'm a single mom. I deserve beauty treats once in a while, and here it's affordable."
Diaspora beauty tourism has become so prevalent that Tehran-based doctors are advertising on Los Angeles-based television channels, booking appointments well in advance by phone and refashioning their offices and bedside manner to cater to expatriate expectations.
Sheherezade, 50, a homemaker who lives in suburban Washington, visits Iran twice a year to maintain the complexion of a 30-year-old. While her two boys play with their grandparents, she gets bargain Botox injections at the stylish offices of Tehran dermatologist Fariba Ghalamkarpour.
On her latest trip, she sipped cappuccino in an airy waiting room, not unlike the clinically elegant medical spas popular in Beverly Hills and Manhattan. Japanese calligraphy prints hung on the textured walls, and slender orchids in stylish vases covered the spotless tables.
Sheherezade, who didn't want her last name used, wore a lilac slip dress underneath the black robe mandated by Iranian law, and played nervously with the doctor's business cards, printed in Farsi on one side, English on the other.
"Needles scare me," she said, with the serene expression of women who cannot move their facial muscles. "I considered doing Botox in the States, but the doctor was so brusque, I didn't feel comfortable. I wanted to know if my eyelids would droop, whether my smile would be affected. He just said, 'Yes, it might,' and tapped his foot."
In addition to being affordable, Ghalamkarpour has mastered a soothing approach that puts her expatriate clients at ease. For middle-aged Iranian women who live in enclave exile communities, buffered from assimilation, the often harried manner and rapid-fire English of U.S. doctors is off-putting.
"Cosmetic procedures are intertwined with psychology, a woman's body image. You need to build a mental connection with people," said Ghalamkarpour, who wore a designer suit underneath her white lab coat and sprinkled her Farsi liberally with English expressions.
In between explaining the possible side effects of microdermabrasion and chemical peels, she remembered the names of Sheherezade's sons and chatted about her hair color.
Although a reverence for beauty has run through Iranian culture for centuries, the demand for cosmetic enhancement surged after the revolution made it illegal for women to reveal their hair and their bodies.
This left the face as the sole canvas for public self-definition, and turned ordinary women toward procedures -- such as tattooed makeup and colored contact lenses -- usually reserved for the aesthetically intrepid.
The boon encouraged a new generation of Iranian doctors to specialize in cosmetic medicine, the most reliably lucrative practice in a country where corruption and patronage networks infiltrate even the smallest hospitals.
Surgeon Majid Navab, known in Tehran as "Dr. Goldfinger" for his magically discreet face-lifts, practiced in Paris for a decade before moving to Iran in 1988. The move made sense because, as he put it, "French women take care of their bodies, Iranian women their faces."
His reputation is such that if a woman walks into a dinner party appearing refreshed, the women in the room will exchange knowing looks and whisper "Navab."
Shahpouri was in his office the day after she arrived in Tehran. There, Navab spoke the language of flattery. He stepped into the waiting room, the air heavy with mingled perfumes, the endearments slipping off his tongue in Farsi, French and English -- "Joonam! Cherie! Honey!"
Expatriate women form a core clientele for Navab's face-lifts ("one goes back and brings two, two go back and bring four"), whereas his local Iranian patients shift according to the cosmetic trend. These days, he said , it's nose jobs. For men.
"For years, there was this ruthless competition between young and older women. Now, the competition is for older men, struggling to keep up with the looks of their 20-year-old girlfriends. Otherwise, when they go out, they'll look like they're dating [their] daughter."
The legacy of the Islamic Revolution -- a youthful, restive population and economic decline -- has made it remarkably common for the very mature to date the very young.
One of the worrisome aspects of the cosmetic tourism boom, Iranian doctors say, is the growing number of general practitioners who do a brief specialization in cosmetology and promote themselves as plastic surgeons.
They underestimate postoperative recovery time to encourage expatriates to undergo procedures during brief visits, and often fail to check for health problems that could complicate plastic surgery, said Hamid Rasti, a U.S.-trained doctor who advises European airlines on whether sick or recovering passengers should fly.
"Apart from the very top surgeons, most doctors who call themselves plastic surgeons are extremely careless," he said. "Medicine here is business. They want to maximize profit." He said he advised an Iranian woman from Sunnyvale, Calif., not to have her eyes done, after one plastic surgeon told her she could "go to the bazaar after two days and fly home in a week."
For her part, after her face-lift, Shahpouri heeded Navab's advice and convalesced for three weeks, before heading back home to Santa Monica.