Forget face lifts or boob jobs -- in California the latest cosmetic surgery must-have is the buttock enhancement, whether higher, rounder or just smoother.
"I just knew that I was unhappy. And you know I did something for myself, something that did make me happy. And I feel great," said Kristina, 21, after going under the knife of surgeon Ashkan Ghavami.
He has carried out the S-Curve Buttock Lift operation -- which, instead of using implants, involves fat taken from the tummy and elsewhere and transferred to the buttocks -- on around 700 people.
Another of his patients, a 49-year-old accountant with no children, plumped for the operation because, after looking in the mirror, she knew there were "certain areas that no amount of dieting or exercising was going to touch."
"So, at 49, I finally said: why not? It makes you feel a lot better, it's esthetically nice, you look nicer in clothes," she said, asking not to be named.
Ghavami, an Iranian-American who is assistant clinical professor at the University of California Los Angeles (UCLA) David Geffen School of Medicine, said Hollywood stars had raised people's desire for a nicer "derriere."
"A lot of people focused more on breasts -- for the buttock to be a focus of body shaping is definitely very new," the medic, who pioneered the S-Curve and now teaches it to other surgeons, told AFP at his Beverly Hills clinic.
"Finally thanks to Kim Kardashian, Jennifer Lopez and all the media, now we are realizing this a much more natural way than butt implants."
He has performed the operation -- which typically costs $9,000-$16,000 -- for seven years, with the surgery most popular with black, Latino, gay and transgender people in Los Angeles, where the cult of the body is everywhere.
Ghavami's clinic is in the Zip code area "90210" -- the name of a coming of age TV show set in Beverly Hills, a city where dreams famously come true on the silver screen, especially if you look beautiful enough.
But achieving a better behind is not done without at least some pain.
"We do liposuction with small incisions, we go in with a canula and we suction the fat into a sterile container and then we wash the fat and put it into syringes and then inject it into the buttock," he said.
"When I'm injecting into the buttock, we do what's called the fanning technique -- it actually improves cellulite, because it fills the skin underneath," he added.
And contrary to some misconceptions, even prejudices, the operation is not necessarily anything to do with a patient being overweight.
"I never had a weight issue, but after I hit 40 I had 10 extra pounds. I actually gained 10 pounds just to have the procedure, so there would be more fat to transfer -- the more the better," said the accountant.
"My weight is really the same, it's just redistributed," she added.
According to the Association of Plastic Surgeons, last year some 13.8 million cosmetic operations were carried out in the United States -- five percent more than in 2010.
The most popular surgery is breast-enhancement, followed by nose jobs, liposuction and face lifts.
But the number of buttock enhancements has surged, with 38 percent more this year than in the same period in 2010. Ghavami says most of the 700 he has carried out were within the last three to four years.
"It's new for a lot of surgeons right now, that's why I'm invited to go lecture at meetings about it, because surgeons are very curious about it, it's trendy," he said.
For the patients the outcome can be life-changing. "They definitely save and invest to do it because when you're not happy with your body shape, there's something out there that can help you with it," said Ghavami.
"It's good for them, to their relationship, their husbands, their confidence."
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