“I N THE GULF the ladies want a big butt and a big vagina. Not the Lebanese. They want smaller vaginas. They are more like the Europeans: they want the labia inside.” So says Dr Hussein Hashim, a plastic surgeon in Beirut, as he sits behind a desk scattered with buttock implants. He and his colleagues perform surgeries with names like “The Barbie Look” or “The Beverly Hills Rejuvenation”—operations that trim the inner labia, tighten the vagina or reduce the fold of skin covering the clitoris.

Labiaplasty is the fastest-growing cosmetic surgery in the world. Lebanese women, who have a penchant for biological improvement, are particularly keen on it. Only Spain and Brazil do more vaginal procedures per head. “Beauty used to be all about the face. Now it’s about the body. Buttocks and vaginas are the big thing,” says Elie Abdel Hak of Lebanon’s plastic-surgery society.

The rise in women who want so-called designer vaginas has confounded researchers. Some say the Brazilian bikini wax has made women more conscious of their vulvae. Others blame online pornography for idealising the vagina and depressing women who think their genitals are abnormal. They don’t want their vaginas showing through their shorts or bikinis, says Mr Hak. “They’ve become ashamed.” Tighter clothes, childbirth, irritation during exercise and insults from men also play a role, studies suggest.

In Lebanon women are often influenced by magazines featuring slim yet voluptuous women. A nip and tuck is relatively cheap (a labiaplasty costs about $1,500). Girls as young as 14 have nose jobs, often brought to the clinic by their mothers. But a labiaplasty carries risks. America’s Food and Drug Administration has warned that some of the tools used to destroy and reshape vaginal tissue are dangerous. Lasers used to “rejuvenate the vagina” may cause burns, scarring or pain during sex.

More study is needed, but in general the satisfaction rate is high and the complication rate low. Lebanese women who have undergone the procedure certainly seem happy. “It’s amazing,” says one. “I’m like a baby now.”