Zarina Saiyed is acutely aware of the fact that she looks much older than her 36 years. After 11 years of married life and two children, her weight has zoomed. Her relationship with a series of gyms and failed diets has only left her frustrated. That is why she decided to broach the subject of liposuction with her husband. She read about it in the newspaper. To her excitement he was equally interested. “She feels very odd because of the weight. When she discussed it with me, I didn’t have to think twice,” says her husband Asad, who works for an animation house in Mumbai. “We’ll end up spending about Rs 50-60,000, but money is secondary,” he adds.
Saiyed is neither a celebrity nor does she have a trust fund. The couple is, what one might broadly call, upwardly mobile. Of course, one could argue that this inclination towards plastic surgery is taking place only in Bollywood Central, appearance-obsessed Mumbai.
But people are giving up their inhibitions to go under the knife even in Kerala. Rehana Begum from Malappuram in north Kerala, a 62-year-old grandmother recently travelled to Kochi along with her husband Shamsul to meet cosmetic surgeon Dr R Jayakumar, head of the plastic, micro-vascular and cosmetic surgery department at Specialists’ Hospital. She told the doctor, “Every morning when I look at the mirror, I feel depressed.
“I have bags under my eyes, a double chin and my cheeks sag. I feel very old.” She underwent a facelift and thanked the doctor with her broadest smile.
Then there’s 70-year-old Karthiyamma, who requested breast reduction. The surgeon was intrigued. Karthiyamma said, “Throughout my life, men have been staring at my breasts. After the operation, I hope they will not stare at them on my deathbed.” Jayakumar obliged.
Karthiyamma is but one of the hundreds of thousands who seek surgical intervention for cosmetic purposes every year in India. According to an international survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS), India has been ranked fourth in the world with 894,700 surgical and non-surgical cosmetic procedures in 2010. And even though the industry remains unorganised, professionals place India somewhere in the fourth to fifth spot when it comes to cosmetic surgery tourism. People from the US, Europe, Russia and recently Africa have been travelling to India to knock years off their face and kilos off their body.
Though Goa remains an extremely popular choice for overseas tourists looking for a nip / tuck holiday, Mumbai is sought after too. Dr Manish Patel, a cosmetic surgeon at the Wockhardt Institute of Aesthetics in Goa says, “Earlier, foreigners would walk in to clinics out of curiosity. They’d see our work and find the prices lower and would give in. Lately people have been especially coming to India for cosmetic surgery.” Considering Goa’s rapidly growing tourist arrivals, it isn’t surprising that Wockhardt and Apollo hospitals both have separate cosmetic surgery units in the tiny state.
But tourists aren’t the only ones driving the cosmetic surgery revolution. Awareness, peer pressure and the now famous disposable income means that the massive Indian middle class is queuing up to shed weight. And inhibitions. If the aesthetic enhancement sector earlier attracted only the upper classes and celebrities, today’s client could be anyone from a homemaker to a middle-aged office-goer. But that doesn’t mean they aren’t nervous. For most cosmetic surgeons, the main problem is to allay the anxieties of their patients. Cosmetic surgeon Susheel Cleatus says, “The anxiety is that you are doing surgery. It is not like taking tablets. And, finally, it is not essential.”
So who are the people who come for these ‘non-essential’ surgeries to Kerala? “I have many non-resident Malayalis from the Middle East, USA, UK, and Australia,” says Dr KG Bhaskara, senior consultant plastic surgeon at the Medical Trust Hospital. “It is cheaper and they do it during their vacations.” Nurses who work in the UK and feel the need to look good also walk in.
Till just a few years ago, vanity in India was considered a sin, especially if you were married and had children. Why did you need to look good after you were ‘settled’? Awareness and peer pressure have taken care of that. Dr Milind Wagh, a plastic and cosmetic surgeon with a 20-year-old practice in Mumbai says, “Financial and emotional independence among women is also a huge factor. They know their mind, have the money and don’t see why they need to suffer with large breasts, which apart from aesthetic reasons also lead to acute backaches.”
Though plastic surgery clinics have been around for a very long time, the real growth has taken place in the last 7-8 years, say doctors. “Earlier it was only the upper class or celebrities that would come in,” says Dr Wagh, adding that though the ratio of women to men is currently 70:30, the number of men has also been increasing. “I recently did a nose job for a 60-year-old man who said he’d been too busy all his life. He said he could finally afford to look after himself and he didn’t only mean in terms of money,” adds Dr Wagh.
Interestingly, rhinoplasty is one of the few procedures that is equally popular among both men and women. Breast reduction is the other. “Many Indian men have the problem of large breasts,” says Jayakumar. The hair transplant market meanwhile is almost exclusively cornered by men.
From eyelid surgery to chin implants to lip jobs, there is very little that a surgeon’s scalpel can’t alter. However, in India weight reduction surgeries, breast-related treatments, nose jobs and hair transplants remain the most popular. Doctors say facelifts have been growing but not as much as the West. “One reason is that European women have thinner skins and age faster on their faces while Indians don’t,” says Zahabiya Khorakiwala, managing director of Wockhardt.
According to Dr Mohan Thomas, when he moved to Mumbai in 2003 after studying and practicing in the US for 30 years, he’d spend days without a single consultation. However, the Cosmetic Surgery Institute, his clinic, now sees a steady stream of clients every day. In the last few years, there has been a 400 per cent increase in the number of patients, he says. “In fact the biggest jump has been in non-surgical procedures, which also contributes to the aesthetic enhancement industry,” he adds.
Like Dr Thomas, a number of experts believe that it’s the non-invasive procedures that are in fact leading to the opening up of the market. Laser hair removal, Botox, cosmetic fillers and pigmentation removal are used as nonchalantly as threading. “Since these are non-invasive, people are more open to them. We believe this is the first step and people who try there will in a few years be ready for invasive surgery,” says Khorakiwala.
Girls as young as 16 are aware of unsightly hair growth and aren’t scared of getting lasered. “We don’t go below 16 years unless it’s a rare case. Also, all young adults below 18 have to be accompanied by their parents,” says Suvodeep Das, marketing head of Kaya. According to Das, the non-invasive procedure segment is growing at 27 per cent and is worth almost Rs 380 to Rs 400 crore in India. “People would earlier think of their skins if they had a problem like pigmentation. They are now increasingly thinking of enhancement. That’s the big change,” he says.
Two days after her engagement, Chandni Nayyar, 28, walked into a skin clinic for laser hair removal. Marriage was a good excuse and she wanted to get rid of waxing forever. Four months later not only was she mid-way through her hair removal, she had also decided to give Botox a try. But not in its traditional avatar. “I always thought Botox was for older women who wanted to get rid of their wrinkles,” she said. Nayyar, however, was told that a tiny prick and a small vial could soften her angular face features and give her a more oval shape. She promptly said yes.
While the non-invasive market also remains dominated by women, the number of men has been increasing too. Pigmentation remains their major worry. However, beard shaping via laser, to ensure that hair growth on the face remains restricted to certain areas is also becoming popular.
Clinics like Kaya are also the reason why the business of aesthetics has reached smalltown India. Towns like Guwahati, Vizag and Kanpur are suddenly rethinking their monthly facials for a shot of Botox that costs anywhere between Rs 5,000 and Rs 8,000 and lasts about four months.
Juvederm, a cosmetic filler used to smoothen out laugh lines that deepen with age has also caught people’s fancy. Used as an injection, the treatment, just like Botox, doesn’t take more than half-an-hour. If it accounted for 8-10 per cent of the market earlier, today Juvederm corners about 15-18 per cent of the share. “The fastest growing segment is anti-ageing comprising women between 28 to 30 years. Overall, it’s 23- to 40-year-old women that form the largest customer base for non-invasive,” explains Das.
But Dr Thomas has a warning. “In the excitement of looking younger without going under the knife, people are overdoing it,” he says. According to him as well as Dr Wagh, people want maximum gain with very little pain. “Women end up spending insane amounts on fillers and Botox when after a while what they need is a facelift,” says Dr Thomas, adding that he even advises women against liposuction when he realises that their problem can only be solved with bariatric (stomach stapling) surgery.
Doctors also insist that a patient has to be in a stable emotional state before undergoing any procedure. “I have two counsellors at my clinic for pre- and sometimes post-operation,” says Dr Thomas. He adds that he’s often refused women who’re going through emotional turmoil. They’re in it for the wrong reasons, he adds.
Similarly, Dr Jayakumar says he is very careful in his choice of patients. He always does an extensive interview to know the reasons why a person wants to do cosmetic surgery. “If the person is doing it for himself, I feel satisfied,” he says. He remembers a case of a newly-married couple where the husband wanted a nose job for his wife. But the wife told the surgeon she was happy with her nose. He said no.
“Unfortunately, we live in a society where a man can dictate how his wife should look. I often get couples where the man wants his wife to get a breast lift. They’ll never look at themselves in the mirror, of course,” says Dr Wagh.
Though nowhere close to its US counterpart, the cosmetic surgery industry in India is on an upward path. A 2012 report by McKinsey pegs the Indian beauty industry (including surgery, spas and salons) at $2 billion and doctors say this could well be over $5 billion by 2015.
While the trend will slowly shift toward procedures that are less invasive and leave fewer scars, doctors say that stem cells will be the next big thing for this industry. Instead of implants, sizes are already being increased with a person’s body fat. The limitation for now remains that the size can only go up by a few cups. Similarly, doctors soon plan to start using body fat instead of commercial fillers. “Since its the person’s fat, there can be no reaction or allergy. It’s the safest. It just takes time to harvest,” says Dr Wagh.
It may be a while before India goes up from 5,000 breast augmentations a year to lakhs like in the US. But driven by costs that are roughly a quarter of global rates, the rising quality of services and an opportunity to combine cosmetic surgery with vacations, India’s cosmetic future looks very full.
■ Non-invasive anti-aging procedures will become more popular
■ Botox treatment and skin rejuvenation techniques will explode
■ Cosmetic filler injections are set to be the fastest growing sector
■ Body contouring will remain popular as new techniques appear
■ Breast augmentation will become bolder and more common
■ Men will be an increasingly larger part of the cosmetic future