For the first time, Brazil surpassed the United States in the number of cosmetic surgical procedures performed in 2013, according to a report released by the International Society of Aesthetic Plastic Surgery (ISAPS) recently. Cosmetic surgeries performed in Brazil account for 12.9 percent of 11.6 million annual procedures worldwide.

The Brazilian surgeon Carlos Uebel, president of ISAPS, told a Brazilian daily newspaper cited the higher purchasing power of the middle class as the main reason behind the rise in plastic surgery in Brazil. “People now have more opportunities to undergo surgery,” Uebel told the newspaper.

Botox (made from botulinum toxin) was ranked top in numbers of overall cosmetic procedures performed worldwide.

More than 23 million cosmetic surgical and nonsurgical procedures were performed worldwide in 2013. The United States continues to lead with the most surgical and nonsurgical procedures performed combined, followed by Brazil, Mexico, Germany and Spain.

Countries by estimated number of plastic surgeons.

The report also showed that women received 87.2 percent of cosmetic surgical and nonsurgical procedures.