Image by Getty (A still from ‘Grey’s Anatomy’)

You would be forgiven for thinking that Hollywood is the cosmetic surgery capital of the world, but a new survey undertaken by the International Society of Aesthetic Plastic Surgeons shows otherwise, The Business of Fashion has reported.

The Global Aesthetic Survey for 2016 identifies the top five countries in the ranking as America, Brazil, Japan, Italy and Mexico. These five spots are responsible for almost half the cosmetic surgeries performed globally. While none of the countries come as a particular surprise, the table shifts dramatically when you consider per-capita figures.

While the United States has the highest number of procedures overall (at 4.2 million), when you compare this to their population data, it comes to 13 people for every thousand, which is significantly less than any of the other cosmetic surgery hotspots identified. Compare this to Italy and Lebanon which sit at 16 per thousand, Taiwan and Belgium at 17 people for every thousand and South Korea – for which 2015’s data had to be used as too many surgeons chose not to participate again – which is by far the highest at 20 people for every thousand.

“It is mainly culture that makes some countries more susceptible to surgery,” ISAPS president Renato Saltz told The Business of Fashion. “In certain cultures, people are more concerned with how they look than others. France and Italy have always been leaders in beauty in Europe and their plastic surgery figures are high. Or in Colombia, television is hugely popular and almost exclusively shows beautiful people, so no wonder people are susceptible.”

He went on to highlight a number of other factors too. For example, proximity to the ocean must be considered as a reason why so many people in cities like Rio de Janeiro choose to go under the knife, as they spend so much time on the beach. In places like Utah, where the state is dominated by the Mormon church and many women have had five or six children by the age of 30, tummy tucks are prevalent.

For countries like South Korea, surgically-enhanced K-pop stars are said to wield a huge amount of power where fans see their success as determined by the work they have had done. Girl group Six Bomb even released a single called ‘Becoming Prettier’ which was a celebration of the plastic surgery the band underwent. As well as this, medical tourism is big business (worth almost £400 million annually) as people from across the continent, and indeed the globe, flock to Seoul for procedures, making the country’s stats much higher.

This article originally appeared on Harper’s BAZAAR UK.