PHOTOS: The Distressing Worldwide Boom in Cosmetic Surgery

In ancient China, where foot binding was invented, a stunted foot signified a prized comeliness. In modern Manhattan, the pursuit of beauty has led some women to surgically shorten their toes and secure them with metal pins to fit more easily into three-inch Jimmy Choo stiletto heels (Kristina Widmer’s foot, post-surgery).

For his new book, Love Me, photographer Zed Nelson traveled to 18 countries over five years, documenting extreme measures undertaken in the quest for cosmetic perfection. Nelson’s unsettling images of plastic surgeons, beauty queens and bodybuilders underscore the seduction of narcissistic compulsion. “Beauty is a $160 billion-a-year global industry,” he says. “Body improvement has become a new religion.”

In Nelson’s book, plastic surgeons are particularly potent emblems of the global obsession with beauty (Ox, a Brazilian plastic surgeon, and his wife Angela). “Plastic surgery and beauty industry professionals are an inevitable part of the phenomenal obsession with body improvement,” he says. “If you can sell the idea of one prescriptive ‘look’, then you can sell people the products and services to help them attempt to achieve this ideal.”

Nelson’s project began when he noticed, while travelling internationally, that global standards of beauty had become eerily homogenized: He saw skin-lightening products in Africa and surgical procedures to “Westernize” eyes in Asia. The popularity of rhinoplasty in Iran was especially apparent (Elham, 19, of Tehran, after her procedure).

“When I arrived in Iran, I was amazed,” Nelson says. “My interpreter had had a nose job, as had her mother, her sister, and her two best friends. People were proudly walking in the streets with bandaged noses, excited to be the new owners of small, chiseled, American-style noses.”

“Beauty pageants are an outdated and yet still very present manifestation of the creation and enforcement of a beauty ‘ideal,’” Nelson says (Miss Essex, a losing contestant in the Miss England competition). “They are terrifying, hilarious, bizarre, and absurd.”

While exploring the world of cosmetic surgery, Nelson was amazed by how ubiquitous it has become in modern culture (Laser face resurfacing, Bare Necessities clinic, London). “Banks now offer loans for plastic surgery. American families with annual incomes under $25,000 account for 30 percent of all cosmetic surgery patients,” he says. “Americans spend more each year on beauty than they do on education.”

As cosmetic surgery has become more common, new uses for established procedures have emerged. In China, the Ilizarov procedure—which was originally developed to lengthen the legs of dwarves—has become popular for people who simply want to be taller (an Ilizarov procedure in Beijing). By severing the shinbones and stretching them apart with an implanted metal frame, up to three new inches of leg bone can be grown, but the operation comes with risks of deformation and weakened muscles.

For Nelson, the fact that the elaborate hairstyles and makeup that define “beautiful” in pageants are forced upon young children is something truly astonishing—and overlooked (Katie, age 9, winner of the Universal Royalty Texas State Pageant). “The work is a reflection on cultural brainwashing, and a reminder that our behavior has become quite extraordinary without us really noticing it,” he says.

Nelson sees the never-ending pursuit of youth as a driving cause behind the worldwide trend of appearance modification (Sally Walker, age undisclosed, at the Cosmetic Enhancement Expo in Dallas, Texas). “As our role models become ever younger and more idealized, we are so afraid of aging that the quest for youthful preservation generates an almost pathological obsession with our bodies,” he says.