Keeping Up Appearances | Verve Magazine
India's premier luxury lifestyle women's magazine
March 04, 2020

Keeping Up Appearances

Text by Shirin Mehta. Illustration by Aniket Ghorpade

The burden of achieving physical perfection existed long before filtered and Facetuned selfies became ubiquitous. But in this new normal of constantly putting ourselves on display, cosmetic practitioners are seeing an exponential increase in the number of patients, not to mention a broadening demographic. Verve gets four leading specialists to weigh in on the factors that affect the decision to alter the course of nature

In high school, many moons ago, I had a friend with a humped nose. We, her classmates, never really thought about it until, following a certain summer vacation, she returned to class with a perfectly chiselled muzzle. The offending bump had all but disappeared. And on her face was a smile that stretched from ear to ear. That was my first brush with the reconstructive results of cosmetic surgery. It had left us, students all, awed by our young friend’s gumption and just a little sorry that the transformed version did not have quite the presence of the original. A bit like Cleopatra’s long and pointy one in my favourite comic book of all time, Asterix and Cleopatra, that would turn my attention towards noses yet again, several years later. That appendage on the curvy cartoon queen made her so much more than, say, a Disney princess — all pretty and charming and sweet. It made her indomitable…memorable!

But in a cookie-cutter world that is reflected ever so much on social media platforms, everyone desires a perfect facade to face the mobile camera lens with, and that’s where plastic surgeons and cosmetic surgeons can change your life, hair, nose, chin, eyes, around. Whether it is sculpting any part of your face or body, sucking out offending body fat, imparting a dewy appearance full of natural-looking freshness or simply peeling back the offending decades, these specialists can make your beauty dreams come true. Enough to help you put your best features (among other body parts) on display, at all times. You could actually begin to look like the enhanced image on your Instagram filter…. And with technologically advanced, non-surgical treatments widely available today, by which zits can be easily zapped by lasers and sun spots and moles casually done away with, there has been a definite uptick in cosmetic processes and surgeries, especially of the non-invasive kind which are perceived to be safer. Worldwide, women, and men, are opting to look better, to feel better, to boost confidence and improve wellbeing, by changing what nature has endowed.

Interesting fact…. One of the founding fathers of surgery and plastic surgery, Sushruta, lived in India sometime between 600 and 1000 BC in the area that corresponds today to the city of Varanasi. His Sushruta Samhita (Sushruta’s Compendium) remains one of the most outstanding treatises of Indian medical literature. He is credited with the development of surgical techniques for reconstructing noses, earlobes and genitalia, many of which were apparently amputated as religious, criminal or military punishment. His forehead flap rhinoplasty procedure and otoplastic technique for reconstructing the earlobe with skin from the cheek remain forerunners of modern plastic surgery techniques so that even today, the pedicle forehead flap is referred to as the Indian flap.

Notwithstanding its august beginnings in this country, plastic surgery remains a taboo topic that no one will discuss. The stigma against admitting to going under the scalpel remains, and everyone is guarded when I broach the topic. I ask a colleague if she can suggest names of plastic surgeons that she may know of. “Why are you asking me?” she queries defensively. I speak to a top PR agent of Bollywood stars and she quickly gets off the phone with a “Don’t know, sorry.” Only a few in Bollywood will admit to having visited with a plastic surgeon. In a rare gesture, Shilpa Shetty openly admitted to a nose job. Vaani Kapoor could not hide her newly-crafted chin for long while Koena Mitra has publically bemoaned a procedure gone terribly wrong. Doctors, however, will not divulge the names of their patients, sworn forever to the utmost secrecy, leaving fans and industry watchers to merely conjecture and gossip for the most part.

I have never understood the adage ‘growing old gracefully’. Does it mean that one gives in to the rigours of age in a graceful manner, without trying too hard to play young? Or, does it mean the opposite? To do everything possible to look as gracefully young as possible, for as long as possible? I guess that, like beauty apparently, the meaning lies in the eye of the ‘beholder’. I visited a cosmetic dermatologist one time, to remove a cyst that was growing dangerously close to the eyelid. This was annihilated beautifully, leaving behind hardly a mark. But then, the doctor looked at the brown birthmark on my left cheek and offered to obliterate that as well. She was surprised at my immediate reaction, “Please do not touch that!” I said. I had grown to, perhaps unreasonably, love that blemish on my face but had I wished it, with the flick of a laser, she would have banished it forever. Right there and then.

Here, three cosmetic doctors speak to Verve of their practices….

Celebrity dermatologist, expert in aesthetic medicine

What led you into aesthetic medicine?
At home we have always been inclined, since my childhood, to everything aesthetic. My house always looked impeccable. My friends who came home would tell me how beautifully my mom kept the place. My mom is an artist so she used to paint a lot; my family has always been into painting and dancing and all sorts of art, so beautifying everything was something in the blood. Then when I joined medicine, post my MBBS days, I joined plastic surgery.

I worked under Dr K.S. Shekhar who did a lot of work with cleft palate children. We were part of an organisation called Smile Train which did free surgeries for them. That was where I realised just how much looks matter. Function matters as well; I am not trivialising that. But after the functional part of it was corrected, the kids used to be pretty traumatised with the way that they looked; there was always a scar on their lip or nose depending on how bad the cleft was. That’s when you started seeing how looks affected people. This was much more serious than having one acne here and there in our growing up years. So that’s what drew me towards aesthetic medicine.

What are your special areas of expertise?
My expertise has always been facial aesthetics, especially injectables. I am known for the most natural results and for trying to get the best aesthetic outcomes with the least intervention. And that’s what I enjoy doing most, injectable solutions for the face. Beyond that, of course we are really good at acne treatment, that’s something my clinic is known for. We also do innovative treatments for hair, and body contouring as well.

Is chasing youth the most prevalent factor driving people to undergo cosmetic procedures in India, today?
I think staying young is a big thing. Staying youthful, I would like to say, is something that people do come to me for — youthful and beautiful. Beautifying the face, beautifying their bodies, getting into the optimum best is what they want. And making them look fresh and youthful, is more important than just looking younger.

Where do you practise?
In Mumbai and Hyderabad.

Do men ask for changes as well?
Of course men do come in and ask for a lot. They have similar issues like all of us women do, wanting to look youthful. Hair, of course, is a major indication of why men come in. Other than that, there’s pigmentation, there’s oily skin, there’s acne, acne on the body; they also want to look less tired, more youthful; so all of the things that we women want, men want as well. Our practice with male patients has increased in leaps and bounds in the last couple of years; I must say that more than 30 per cent of our practice today is related to men.

There has been a rise in cosmetic procedures; is this linked to social media? Is it all about looking great on Instagram?
A lot can be credited to Instagram and social media, but having said that, also to awareness of these procedures which has really led to a lot more people seeking them. Also the knowledge that these are medical procedures, they are safe, they can be done — there’s nothing drastic, nothing scary. So these have been the reasons why people are now inclined towards wanting to do something to become the best that they can be, or to seek corrections of things that they don’t really like.

In India, are women with high media exposure like celebrities and influencers more likely to want to improve their appearance to get ahead? Do you know of any people who have opted for procedures for professional reasons but are in a line of work where you wouldn’t expect this to be a concern?
Of course! Fifty per cent of my practice must be film stars because I happen to stay in Mumbai and Hyderabad, and we have all the movie stars coming in. But having said that, the other 50 per cent of the patients includes just anyone and everyone. I have a lady coming from Pune who sells saris from home. She puts her money together every six months, arrives here and does what needs to be done to her face.

There are people from all walks of life who want to get treated. There are teachers, there are housewives, there are company secretaries, there are professors, I have had Phd’s, very well-educated professors who you would wonder at — I would not, but someone may feel that this is only a film actress’s prerogative — absolutely not! It’s the right of everyone to look the best that they can, to maintain what God has given them, and bring it to the best possible shape and size and tone. You need to work towards the best that you can be; it definitely is not any one profession’s prerogative or reach.

Can you name some of your celebrity clients?
I don’t believe in naming anybody because this is a very personal thing for everyone and it is up to them to say or not. We really believe in confidentiality and that’s very important.

Do you have clients that aim to look like their favourite Bollywood stars? Priyanka Chopra’s lips, for instance. What are the most common requests?
We did get requests from people who came in and said, ‘This is the lip I like’, or whatever. Then it’s up to me to explain to them why it might suit that person and not them. If I think that it might suit them, I go ahead and create exactly that. But when I think it doesn’t, I sit down to analyse and tell them why I don’t think it would. So Priyanka Chopra’s lips might look great on her face because she has a face as such, nose as such, eyes as such, attitude as such. It probably would not suit another person without those extra things.

What do you consider the right motivations for cosmetic procedures? What happens when a patient’s requests are unrealistic or unhealthy?
The motivation for cosmetic medicine should be to maintain what you have, look the best that you can, take care of yourself, that’s it! There are a lot of patients who have unrealistic expectations — ‘unhealthy’, I wouldn’t say — perhaps sometimes. There are patients who bother a lot about their looks, one pimple can drive them towards depression. But I am no one to sit here and judge why they should or shouldn’t feel like they do. They come to you, it’s up to you to counsel them, and steer them towards doing only what is necessary and only what is safe.

Where: Ra Skin and Aesthetics, Mumbai;
Reva Health and Skin, Hyderabad.


Aesthetic laser specialist

Cosmetic dermatologist, laser specialist, founder at Skinsense Skin and Laser Clinic

What led you to become a cosmetic surgeon/dermatologist? What do you hope to achieve by it?
Dr Abhijit Desai (AD): While graduating from T. N. Medical College and B.Y. L. Nair Medical Hospital in the field of dermatology, I was interested in bringing Advanced Aesthetic Medical treatments to India for the treatment of Indian skin types. I endeavoured to use only those treatments and aesthetic medical devices like LASER (light amplified stimulated emission of radiation) which have proven to be absolutely safe for our Indian skin. To achieve this, way back in 2000 and 2001, after graduating as a dermatologist, I learned about the then-emerging field of aesthetic or cosmetic dermatology. Since we didn’t have any formal courses or curriculum of cosmetic dermatology and its newer treatments at the time, I travelled to Singapore to learn from doctors who specialised in the field. I started one of the first aesthetic laser clinics in Mumbai, in 2002.

Dr Gauri Desai (GD): While my Post Graduation (M.D.) from T. N. Medical College and B.Y.L. Nair Medical Hospital, has not been in the field of dermatology, I have observed Dr Abhijit’s practice from its inception and been a part of the general running of the clinic. My entrance into the field of LASERs for aesthetic and lifestyle procedures was due to existing patients! Many of them insisted that I carry out their treatments as they wanted a female doctor, but wanted to follow up with Dr Abhijit. It was for this reason that I underwent training in the theory and practice of LASERs in Aesthetic Medicine in Slovenia in 2010.

What are your special areas of expertise?
AD: Though I am a dermatologist, I have focused my clinical practice in the field of aesthetic/cosmetic dermatology. I have had a special interest in the field of Aesthetic LASER. Using LASER which are noninvasive, nonsurgical modes of treatment for various aesthetic and non-aesthetic conditions, has always been a passion. The Indian skin type is very different from the Caucasian skin type. So using only those lasers which are suitable for Indian skin and customising the treatments which are safer for Indian skin has been of great interest for me.

GD: My expertise lies in the use of LASERs in the field of aesthetic medicine and also in the treatment of age and lifestyle related issues like LASER assisted reduction of snoring and reduction of vaginal laxity.

Can you tell us something about the 4D facial rejuvenation and face lift and its effects? What are some of the non-surgical procedures that are gaining popularity today? What are women looking for? Are they more concerned with their faces or bodies?
GD: Women are concerned with both their face and body. Depending upon individual factors, they sometimes give more importance to one over the other. Non-surgical procedures are gaining favour these days, as they usually have lesser downtime, no anaesthesia requirements, no need for hospitalisation or recovery time and lower risk. People prefer these for cosmetic and body shaping needs as they do not want to spend time in hospitals or indoors, given their busy schedules.

At Skinsense, most of our treatments are ‘lunch-time procedures’, which means that individual sittings are short with so little post-procedure discomfort, that one can get back to work as soon as the session is over. The 4D Laser Face Lift helps in tightening the skin and in simultaneously stimulating new collagen formation to delay the signs of aging in the younger age group and to reduce existing signs in the older population. It helps to eliminate fine lines, prominent folds and wrinkles. We use multiple laser wavelengths in a combination of modes to achieve this. It also helps in improving the texture, appearance and function of the skin. People can start this treatment in their 40s or sometimes in the late 30s.

Is chasing youth, the most prevalent factor driving people to undergo cosmetic surgery in India, today? Are men asking for change too?
GD: Yes, both men and women are asking for change today. However, most of the aesthetic discussions till date have revolved around women and fewer men are aware of the options available to them. This is slowly changing over time. As medicine has advanced, life span has also increased. This fact, coupled with a change in lifestyles and available options has led people to aspire for youthful looks as well as fitness. People in certain professions feel the pressure for maintaining physical appearances more than in others.

There has been a rise in cosmetic procedures, is this linked to social media? Is it all about looking great on Instagram?
AD: While there is no one reason, it is linked to social media and the media in general. Information is more easily available thanks to the media, and a single photograph can reach millions in seconds due to various social media platforms. This has changed people’s mindsets and aspirations.

In India, are women with high media exposure like celebrities and influencers more likely to want to change their appearance to get ahead? Do you know of any people who have opted for procedures for professional reasons but are in a line of work where you wouldn’t expect this to be a concern?
GD: Yes, women (and men) in areas with high media exposure are more likely to opt for treatments to enhance or alter their appearance. For some, like actors and models, this could be related to betterment of financial prospects. They may opt for invasive procedures as well as surgeries (slightly higher risks). For others, it is just related to becoming aware of advances in the field of aesthetics across the globe and having access to options. Urban women from all walks of life as well as a variety of ages do come to our clinic to ask about cosmetic concerns and do undergo non-invasive procedures. They would probably not accept ‘going under the knife’ that easily. Also, non-surgical treatments are more cost effective and hence not a deterrent for the middle class.

How far do you find that problems, perceived or otherwise, can be solved by cosmetic surgery? Do the insecurities remain?
AD: It is very important to make a distinction between perceived problems and visible ones as that sets the stage for planning. There is definitely a limit to how much change should be expected by a client and what can be offered and actually delivered by a professional. It is very important therefore to have a detailed discussion about these during consultation. The doctor and patient need to be on the same page regarding what end-point needs to be achieved. Insecurities often remain when there is a mismatch regarding the same. However if realistic expectations are set, there is usually no reason for dissatisfaction.

What do you consider the right motivations for these procedures? What happens when a patient’s requests are unrealistic or sometimes unhealthy?
AD: Individual motivations can differ. However it would be wrong to opt for change to look like someone else or to conform to another’s idea of beauty. Each person has a different genetic make-up, lifestyle and environmental exposure. When these are taken into consideration, the optimum expectations can be set. As mentioned earlier, unrealistic requests cannot be delivered. This can lead to a lot of stress and frustration after the procedure has been carried out. The body will change and age as time passes and this has to be kept in mind while planning the treatment…both, by the doctor and the patient.

Where: Skinsense Skin and Laser Clinic, Mumbai.


Plastic and cosmetic surgeon

What led you to become a cosmetic surgeon? What do you hope to achieve by it?
Having parents who are surgeons themselves, I have had a childhood with a medical background and have always been a surgeon at heart. The field of plastic surgery intrigued me since the days that I was doing my residency to become a general surgeon. As I worked my way through the plastic surgery training, I was exposed to cosmetic surgery as a subspecialty. What led me to become a cosmetic surgeon was the challenge one faces when you have to actually deal with healthy people who want to look or feel better by improving some part of their body. As a female cosmetic surgeon, I understand the shyness of a woman when she is concerned about her body. I hope to make women feel comfortable when they come to me with their problems, I hope to encourage them to undergo procedures which are safe, I hope to be a hope of light when they think some things are impossible to correct, I hope to give them the right perspective in terms of results, safety and expectations.

What are your areas of expertise?
Cosmetic surgeries for the breast, tummy, and post-weight-loss, body contouring procedures.

Is chasing youth, the most prevalent factor driving people to undergo cosmetic surgery in India, today? At what age are women most commonly looking for change? Are men asking for change too?
Yes, there are those who want to look younger and choose procedures to reshape their body and physical features. But there are also those who have never liked a particular feature and want to change that about themselves. Most importantly, there are other issues like developmental issues such as under-developed breasts in a woman needing breast augmentation; post-traumatic deformities for example deformity of the nose needing a rhinoplasty or a nose job; functional problems such as large breasts causing severe neck and upper-back pain requiring a breast reduction; image issues for example post-weight-loss severe sagging of loose skin requiring a body contouring procedure.

Just a decade ago, the most common age group looking for cosmetic procedures was between 25 and 50 years. With changing times, this has expanded to include women from 18 to 65 years.

More and more men are now also choosing to undergo cosmetic procedures. Most common in men are gynaecomastia (male breasts) correction, liposuction, post-weight-loss body contouring and anti-aging procedures for the face. Research has shown that men choose plastic surgery primarily to either look better or to gain an advantage in their professional life.

There has been a rise in cosmetic procedures, is this linked to social media? Is it all about looking great on Instagram?
A decade ago, reconstructive plastic surgeries were still most prevalent in India. These are procedures performed to help correct deformities. Cosmetic surgery was a luxury only the rich could afford. Now, with a growing economy and therefore a growing middle class, there are more people with increased disposable incomes who can choose to have cosmetic surgeries performed. With increased demand, the cost of performing surgeries has also reduced, which further encourages patients to choose to have certain surgeries. Of course, social media also has an influence as there is an increased awareness among people who aspire to look better or their very best. It has also helped to create increased acceptance of cosmetic surgery amongst people. But it is not always about looking good on Instagram, it is sometimes about looking and feeling normal.

Which are the most commonly asked for requests today? Are women concerned more with their face or body? Why so?
The most commonly asked for procedures are liposuction, breast augmentation, tummy tuck and anti-aging procedures for the face. Women are more concerned with their faces because blemishes cannot be hidden, and the face reveals a major part of your personality.

In India, are women with high media exposure like celebrities and influencers more likely to want to change their appearance to get ahead? Do you know of any people who have opted for procedures for professional reasons but are in a line of work where you wouldn’t expect this to be a concern?
Film stars, models, social media influencers, do influence the younger generation as they try to emulate them but the desire to look good is natural, and that desire may be just to feel good about oneself. More middle-class people are also opting for cosmetic surgeries nowadays. Everyone has different motivations and this is no longer limited to the entertainment industry. Even in the corporate world, looking young and attractive seems to be a criterion when hiring people.

How far do you find that problems, perceived or otherwise, can be solved by cosmetic surgery? Do the insecurities remain?
If the problem perceived by the patient is the same as perceived by the cosmetic surgeon, the chances of it being solved is higher. There are situations where the patient points out a certain problem which the surgeon may not perceive to the same extent, or the problem is such that it cannot be solved by a surgical procedure, or solving that problem will not be as beneficial to the patient as he or she thinks, in terms of improvement. The patient needs to trust the cosmetic surgeon and have realistic expectations regarding the procedure. Insecurities remain only when there is lack of trust or the consultation has been inadequate in terms of risk-benefit ratio.

What do you consider the right motivations for these procedures? What happens when a patient’s requests are unrealistic or unhealthy?
Even the desire to look good is the right motivation provided the expectations are realistic.

Are genital rehabilitation and hymenoplasty common? Why do Indian women opt for these procedures? Are designer vaginas a fashion?
Genital rehabilitation and hymenoplasty are common procedures; it’s just that women are shy talking about them. Indian women may opt for a hymenoplasty as they don’t want their future partners or spouses to know about a previous relationship. A vaginoplasty is desired by women who have had multiple pregnancies and have a lax vagina which hampers their sex life.

Where: Shah Superspeciality Clinic, Breach Candy Hospital, Wockhardt Hospital, Bhatia Hospital, St Elizabeth’s Hospital and Apollo Spectra Hospital. All in Mumbai.

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