If anyone had told the early plastic surgeons that buttock enlargements and vaginal rejuvenation would one day become a billion-dollar global industry led by Brazil, they would probably have been laughed out of the operating room.

But when the great and good of lasers and liposuction convened for the world’s biggest cosmetic surgery conference at the weekend, they did so in Rio de Janeiro. And the keynote speaker was a Brazilian.

“Even 20 years ago, there was a prejudice against aesthetic surgery and doubts about its importance,” Ivo Pitanguy, the country’s most celebrated plastic surgeon, told the Guardian. “I tried to show that it goes deeper than the skin, that it goes inside the soul.”

He may have succeeded. Pitanguy, now 90, is a celebrity on a par with Pele and Ronaldo. In Brazil, they call him the “the philosopher of plastic surgery” and simply “the maestro” – a man who has done more than any other to catapult Brazil to the vanguard of the nip and tuck. For the first time this year, Brazil overtook the United States as the world leader for cosmetic operations, according to the International Society of Aesthetic Plastic Surgery.

Facebook Twitter Pinterest Dr. Ivo Pitanguy, in colored surgeon’s cap, performs a face-lift at his Rio de Janeiro, Brazil Photograph: Bloomberg via Getty Images

With less than 3% of the world’s population, Brazil accounted for 12.9% of the cosmetic operations performed last year. This included 515,776 breasts reshaped, 380,155 faces tweaked, 129,601 tummies tucked, 13,683 vaginas reconstructed, 219 penises enlarged and 63,925 buttocks augmented. The growth of the latter category was particularly spectacular with a near doubling in the past four years to the point where almost one in five of all gluteoplasties (bottom boosting operations) are now performed in this South American nation – more than double the share of anywhere else.

It says a lot about Brazil that the country can celebrate being number one in the world for plastic surgery at the same time as it has to import more than 10,000 doctors from Cuba to provide basic medical care in poor and remote communities. But few seem to see this as a problem. Little over a year ago huge street demonstrations called for greater public spending on healthcare, but there was no backlash against private cosmetic clinics. In much of the media, they generate pride. Kiosks sell magazines devoted to the latest procedures and who is undergoing treatment, such as Plastica Beleza (Beautiful Plastic).

Facebook Twitter Pinterest Dr. Ivo Pitanguy poses at Ilha dos Porcos, Pigs Island, south of Rio de Janeiro, Brazil Photograph: Bloomberg via Getty Images

At Pitanguy’s clinic and hospital, he has trained 586 plastic surgeons as well as accepting thousands of others for short-term courses and visits. Many of his alumni have gone on to found their own schools and spread his philosophy, which emphasises that everyone has a “right to beauty” and that cosmetic surgery should be treated as an equal with remedial operations (for cleft palates, deformities, burns and the like) because both heal psychological ailments such as low self-esteem.

This is still contentious, but Pitanguy has steadily grown in influence and expertise. He learned his trade in the 1940s and 1950s from American, French and British surgeons, such as Harold Gilles and Archibald McIndoe, who honed their techniques on people who were burned or disfigured in the second world war.

“I saw the importance of saving lives and saving functions, but it seemed that nobody gave importance to the stigma of deformity and how people suffered with that,” he said in an interview in his clinic in Botafogo.

The argument is not yet over, but Pitanguy and his acolytes have won over many doubters by providing free cosmetic surgery to a limited number of poor clients at training hospitals. Even without this, more and more people can now pay for operations as a result of the rise of the middle class, the availability of credit and the high number – more than 5,500 – of trained surgeons, which has pushed down the price.

According to Prado Neto, the head of the Brazilian Society of Plastic Surgeons, a facelift in Rio costs about $8,000 compared to almost $15,000 (£9,000) in California, and about half of all procedures are now paid for with credit arrangements that spread the cost over a year or 18 months.

Among the recent customers is Thuanny Suckow Custodio, a Rio resident who paid more than 10,000 reis (£2,500) in instalments, for liposuction and for each breast to be enlarged by half a litre. “They were already a good size, but I wanted bigger. I wanted to go for the California look, the Barbie look,” she said. “I’m very happy with the results. I might get something else done.” She estimated that more than half of her friends had undergone some form of cosmetic surgery.

Facebook Twitter Pinterest Ivo Pitanguy attends Regine’s Brazilian Party on October 21, 1981 at Regine’s in New York Photograph: Ron Galella/WireImage

As the market has widened, cosmetic surgery has lost much of its exclusivity. Twenty years ago, facelifts were associated with a yacht-owning class that made films, own companies and ran countries. Today, it is within reach of the masses. Subtle tweaks have been replaced by ostentatious efforts to out do photoshop when taking “belfies” (buttock selfies). The increase in obesity has meant that the most popular procedure now is liposuction.

Pitanguy, who has mixed with Hollywood stars and reportedly commutes from his island home by helicopter, does not seem overly enamoured with all of the new trends. He stressed that the profession should not trivialise what is at stake. “What is important is being content with your own image. Plastic surgeons shouldn’t banalise that. It should be treated as a specialised field like any other field of surgery.”

In his speech at the congress, the doctor stressed the idealistic potential of his profession as “artists of the living form, dealing with body and soul”. One day, he said, “it will be clear that aesthetic surgery brings the desired serenity to those that suffer by being betrayed by nature”.

Despite this poetic idealism, outside in the trade booths, it was clear that beauty is now an increasingly mechanised industry, not just of sculpting, but of sucking, injecting, moulding and installing. Kiosks gleamed with rows of surgical scissors, forceps, pincers and other steel instruments. Silicon implants for breasts, calves and pecs wobbled on countless displays. But the most prominent business appeared to be liposuction machines, such as the $5,500 Viboplus which – salesmen said – can extract a gallon of fat in an hour.

One company was flogging a device that goes one step further by sucking out fat from unwanted areas and then injecting it back into cheeks, breasts or buttocks to compensate for sagging.

The promotional video, in which a thick needle-like instrument is repeatedly jabbed into the midriff of a client, makes for queasy viewing for a layman, but barely raises an eyebrow among the specialised audience. “It’s all done under local anaesthetic. There’s no bleeding or bruising. Patients usually leave the operating room on their own feet and go home the same day,” said the salesman, Larry Wagner.

In the future, cosmetic surgery as we now know it could disappear. “In 20 years, we’ll cut much less. We’ll have ways to shrink skin, to make it thicker and ways to remove fat without surgery,” said Fabio Nahas, vice president of the International Society of Aesthetic Plastic Surgery. “We may also become better looking as a species, but that will have more to do with genetic engineering, which raises ethical issues.”

Pitanguy, who has said he never felt the need for plastic surgery, sees other priorities in the future. As humans live longer, he says we will need to be more comfortable with who we are and how we look.

“The most important thing is to have a good ego and then you don’t need an operation,” he said.

• This article was amended on 26 September 2014 because an earlier version said there were 515,776m breasts reshaped in cosmetic operations in Brazil last year. This has been corrected to say 515,776.