The Brazilian plastic surgery market is certainly a case that deserves being studied. The encounter between a tropical climate and a Latin culture has favored its growth within a very receptive client base in an aesthetically oriented society. According to the most recent study on aesthetic procedures from the International Society of Aesthetic Plastic Surgery, Brazilian plastic surgeons performed almost 7 surgical procedures per 1,000 persons in 2016. This is surprisingly high, especially if compared with the 4.6 procedures per 1,000 persons performed by our American colleagues in the same period. This highly demanding and competitive market has always pushed Brazilian plastic surgeons to finer results and more concealed scars. No wonder Brazilian plastic surgeons are world renowned for having great aesthetic results.That is just about as far as good news goes for Brazilian plastic surgeons. With a number of aesthetic procedures per surgeon slightly higher than the American market (264 vs 224) and given that the average American produces more than 6 times what an average Brazilian does (Gross Domestic Product (GDP) per person: $57.400 vs $8.600/year), fees are certainly not the same, and the average income of a Brazilian plastic surgeon is considerably smaller than that of his American peer. Furthermore, an unprecedented economic recession and an increasing competition have accelerated the saturation of the Brazilian plastic surgery market.In the United States, 159 match positions for plastic surgery were offered in 2017, representing a 2.4% increase in the plastic surgeon population. The projected GDP growth in the same year is 2.6%. Brazilian economy is slowly recovering from one of its biggest crises ever recorded. Consecutive corruption scandals and the inability of our political system to overcome an ethical crisis involving parties from the entire political spectrum threaten a faster recovery. With a growth projection of 0.3% for 2017, it will certainly be challenging to accommodate a 4.7% growth in the total number of plastic surgeons next March, when 260 new plastic surgeons will graduate. These young surgeons will face a very difficult beginning of their careers. There are not so many opportunities out there for them. Moving away from the big cities is probably an easier way to start, but most will choose to stay close to where they grew up or where they were trained. This historical lack of planning has increased the offer of aesthetic surgery in the major Brazilian cities, where prices have dropped considerably in the recent past. Entry prices for aesthetic surgery have dropped to unreasonable values and forced newcomers into a series of unjustified risks to kick off their practices. Unfortunately, most of these new specialists will depend on jobs not related to plastic surgery for a few years, maybe decades, before they can rely exclusively on what they were trained to do. Redesigning the current model of plastic surgery training in Brazil is a challenge the next leadership of the Brazilian Plastic Surgery Society (SBCP) will have to face sooner or later.Competition comes not only from inside the ranks. Other medical specialties have incorporated aesthetic procedures into their surgical practice and are now active players in the aesthetic surgery market. As unfair as this may sound to someone who devoted years of training to become a fully certified plastic surgeon, this is a phenomenon we have very little governability over. This is a form of competition we will have to learn to deal with. Litigation might be able to slow this process down but, in the long run, we will need a different strategy to compete and expand into new markets. This is especially important if we consider that more than half of the 5,500 active plastic surgeons in Brazil are now under 50.Less than 10 years ago, things looked very different. Although our American colleagues were battling against the effects of the 2008 financial crisis on the aesthetic surgery market, Brazil was in the spotlight and was preparing for 2 major sports events. Interestingly, many of the solutions used then can help us in these troubled times. In 2016, Brazilian plastic surgeons performed less than half the number of nonsurgical aesthetic procedures that our Americans colleagues did (1.1 vs 2.7 million). In fact, there has been an increasing interest in these procedures by both Brazilian consumers and the plastic surgery community. There is a lot of money being made with the teaching of these less-invasive techniques. However, this is not a new market, and it is certainly not an easy one to go into. Dermatologists have been leading the supply for decades and, as the procedures and indications get simplified by refined objective analysis of the aging face, other paramedical professionals have also decided to compete for these patients. In a head to head competition, pricing will certainly favor dentists and other nonmedical “estheticians.” The same is happening in the United States, and it does not feel like it is something that will be going away any time soon. Although most patients still can perceive a difference between the plastic surgeons and their competitors, we need to understand the forces that will drive this market and learn how to add value to these procedures for our potential customers. This is not an easy task. Ultimately, it will require most Brazilian plastic surgeons, and especially our regulators, to understand that the aesthetic market lies in a gray zone between health care and beauty, 2 of the biggest industries in global economy. In these 2 distinct segments, pricing, marketing, competition, and the customer buying decision follow totally different logics. As aesthetic surgeons, we are exposed to the advantages and disadvantages of both industries.The reconstructive path, however, has traditionally been ignored by Brazilian plastic surgery. In the United States, more than 3 quarters of the procedures performed by plastic surgeons are reconstructive. In Brazil, the SBCP estimates that reconstructive surgery accounted for only 43% of the procedures performed in 2016. Most Brazilians will never get access to complex reconstructions, like free flaps or craniofacial surgery, if they ever need it. Despite the recent reinforcement of the right to breast reconstruction by Brazilian legislators, the number of breast reconstructions performed in the public health system in 2014 corresponded to only 29.2% of the women getting a mastectomy in the same period. Yet, many of the candidates to a breast reconstruction fellowship at the Hospital Sirio Libanês, one of the largest private institutions in Latin America, receiver very little training in the field during residency. A considerable number have never seen a latissimus dorsi flap. This is a troubling reality.In terms of potential market growth, this is certainly the problem over which our actions, as an organized professional class, could have the highest impact. This does not mean that the required actions are simple. It certainly implies an evolution of the traditional private office, out-of-pocket payment model most plastic surgeons are used to. In complex plastic surgery reconstructions, high performance and proper teaching can only be achieved in centers that concentrate a certain case volume. There are very few of these available in Brazil. Most plastic surgery residents rotate briefly as observers in settings that depend very little on their presence. There is no real commitment, from either part, with the training of reconstructive surgeons. As the “fee-for-service” model gets further challenged by the stakeholders involved in the health-care industry, institutionalization of care and more focus on patient-related outcomes should help accelerate the creation of more of these specialized centers. In cancer centers around the world, plastic surgery normally has one of the largest case volumes among specialties, as they collaborate in cases from most of the other groups. As complexity increases, most oncological surgeons will need the support of a reconstructive plastic surgeon to perform an adequate resection and optimize rehabilitation. Yet, very few of these cancer centers in Brazil have a fully dedicated plastic surgery staff. In some, there is no one with basic microsurgical training. We have recently heard rumors of head and neck surgeons doing their own free flap reconstructions in some major cities in Brazil.Plastic surgeons who wish to go into reconstructive surgery will also need to understand our role in the multidisciplinary care of these patients. In this market, our colleagues from other specialties are not only recruiters but they are also our clients. Fostering a good relationship and making them aware of the benefits we can bring to their patients through good reconstructive plastic surgery are important challenges. Most of them have never had any contact with high end reconstructive surgery. Finally, we should also be doing a bigger effort to renegotiate the fees paid for reconstructive procedures in the public and private systems. This would certainly motivate more of the younger surgeons to get the additional training they need.As the country’s economy slowly recovers, new opportunities for meaningful change in the Brazilian health-care system will appear. Although plastic surgery will always find a strong clientele among Brazilians, the restoration and maintenance of a healthy and inclusive marketplace for all plastic surgeons in Brazil will require a deep discussion on the real challenges we face and the changes we need to do.