On her 13th birthday, Tanya Sharma* asked her mother if she could get a nose job done as a gift. She wanted her eyebrows and side profile to look better in photos; her mother didn’t have an answer. “She was worried about a stubby little hump that looked perfectly normal to everyone but herself. I didn’t know that she had taken photos from various angles, fed it into an image-correction software and decided she needed a ‘real-life’ photoshop,” says her mother Richa. But just as she was wondering if her daughter’s extreme self-image absorption is an aberration, she found out that Tanya was actually inspired by her classmate’s 18-year-old sister, Alia. The young adult had sunk into depression because her breasts were asymmetrical, which she felt disqualified her from wearing t-shirts or posting social-media reels. Things were so bad that Alia’s parents had to consult a cosmetic surgeon.
But being self-conscious and having a low self-esteem about one’s body is not only a teen problem. Diksha Parekh*, 22, wanted eyelid curl uplifts to enhance her eyes, and genitalia correction to avoid embarrassing wedge lines in her trousers before she applied for a new job. Since CV formats for top jobs now require a mention of social-media profiles, she wanted to make a good impression; Samantha Suri*, 45, got a facelift because she didn’t want to look tired on her date; Amit Pant*, 52, opted for body sculpting because he wanted the senior vice-president’s post badly and had to look right for the top job — lean, agile and dynamic.
Cosmetic surgery to enhance body image has been around for decades, except it was more prevalent in appearance-conscious industries such as films and fashion. “Now the flaws are imagined and self-imposed. It is not only about looking good anymore. Most people seeking a cosmetic makeover (and this is completely separate from reconstructive or gender reassignment surgery) are actually suffering from a body dysmorphic disorder (BDD). It is a mental-health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others but bothersome to those concerned that it interrupts their normal lives,” says Dr Richie Gupta, director and head of department, Plastic Surgery, Fortis, Shalimar Bagh.
“People of any age can have BDD, but it’s most common in teenagers and young adults. Patients usually worry a lot about a specific area of their body (mostly the face), and spend a lot of time comparing their looks with others. BDD can seriously affect their daily rhythms. Some even attempt self-mutilation,” adds Gupta.
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Dr Anup Dhir, a south Delhi-based plastic, cosmetic and reconstructive surgeon, who calls it “Facebook Facelift”, says, “This is the worst manifestation of the desire to be noticed on social media. There’s no physical deformity, just a perceived one. It is about enhancing the normal and seeking copybook perfection, almost equivalent to an Obsessive Compulsive Disorder (OCD).”
While there may only be informal studies of cosmetic surgery in India, and little hard data, both Gupta and Dhir believe there has been at least a 20 to 30 per cent jump among young people, caused by BDD in the last two decades. “In fact, the non-invasive procedures have gone up by almost 10 times,” says Dhir, while Gupta estimates, “Invasive procedures have gone up by about 150 to 200 per cent in the same period.”
Over the years, they have seen their patient profiles become younger, Tanya being a case in point at Gupta’s clinic. “Rhinoplasty or a nose job is the most common cosmetic procedure requested by teens. Yet, the nose should have reached its adult size before surgery can be considered. The nose finishes growing by age 16 in girls and age 18 in boys. I don’t use the knife in such cases. One has to go with what is scientifically acceptable. I refuse tummy tucks, liposuction and body contouring in young people. Instead, I recommend that they achieve that ‘ideal body’ through diet and exercise. Young girls requesting abdominal sculpting or fat suction do not even know that it can only be done when they have lived through a pregnancy and had a family,” says Gupta.
Of course, he does a risk-benefit analysis for his patients and even tells them how much an intervention can improve their look. “That agreement has to be there. Even if you raise the skin of the nose, redirect it and raise the bony structure around it, there are risks of bleeding and laceration,” he says. At the end of the day, invasive body surgeries are surgeries and one must prioritise safety. For example, healing is delayed in patients with diabetes and thyroid issues while the results are not good enough for long-time smokers.
Dhir, who feels that people are using their bodies as a toolkit for self-confidence, says societal perception still drives much of the “business of looking good”. “Most of them are still driven by the marriage market. I have had persistent parents seeking the weirdest cosmetic corrections. A mother wanted her younger daughter to look like her prettier older one so that she could easily find a match. I have had parents requesting facial reconstruction so that their children look suitably ‘Bollywoodish.’ Of late, young men are requesting breast reduction surgeries and full body sculpting for that gym-toned look,” says Dhir.
If it’s not marriage, then there’s the dating market. “Most post-40s women and men are signing up for genital corrective surgeries,” he adds. As Dr Amrinder Bajaj, senior gynaecologist at Fortis Memorial Research Institute, Gurugram, and author of Live Your Best Life, Understanding Menopause (Penguin, 2022), says, “Apart from vaginal tightening, young women are getting their ‘virginity’ restored through hymenoplasty. Many are opting for labiaplasty and fat extraction from the genital region so that they can look good in tights. All of these procedures are extremely delicate, risky and can cause infections, leading to permanent damage,” says Bajaj. In the end, is a perfect date or reengineering youth worth the risk?
Not when you have the money for it, says Dhir, an 18 per cent GST on cosmetic surgery procedures notwithstanding. “Each of these procedures costs anything upwards of Rs 40,000 till about Rs 5 lakh. Previously, patients would depend on parental and family resources. Now the young earn well enough to fund the procedures themselves,” he adds.
Older women, too, who usually top their careers in their mid-40s and have some sort of economic heft, feel insecure. New Delhi-based Cynthia Campetto, vice-president, business development, of a top communications company, felt the need for face rejuvenation. She had bits of fat from her belly extracted and injected into her face to plump up her sunken contours. “At 45, I was stressed at work, had lost weight, was low on energy, didn’t feel like myself anymore. Now I look five years younger, have regained my self-confidence and can match up to younger colleagues at work,” she says.
But a surgery is still a means to a mere approximation of one’s desires, it’s not mind control. So, most BDD patients are dissatisfied with their results and seek repeat treatments for reassurance and approval. Most surgeons keep a healthy gap between surgeries of no less than three months. “This is necessary for scars to dissolve and the skin to regain some elasticity,” says Gupta. “Most people have a misconception around fillers distorting the face over time. Repeated fillers are not harmful but results depend on various factors. What matters first is how you look after the first injection and the effect it leaves behind. That’s an aesthetic judgment. The second question is how you age and your lifestyle management. I can ensure that the skin lift remains and does not hollow out, but just like any other health problem, you must change your lifestyle to prevent damage. Besides, what people do not understand is that you are just delaying the ageing process, not reversing it,” he says.
There is a chronic appetite to look good but an equally chronic ignorance about health hazards of procedures. “The problem is people run to anybody who can feed their fantasy than go with the advice of a specialist surgeon. And there are several high-end clinics which prey on the gullible, advertising general skincare experts as cosmetic surgeons. A real surgeon will not hide even a five per cent chance of a surgery not going your way. There is full transparency. But these fly- by-night clinics will promise you the moon,” says Gupta. Dhir recalls how a breast augmentation patient, who already had a smaller (250 cc) silicon implant, wanted a bigger (350 cc) replacement after three months when one should wait for six months to a year.
One of the reasons for this adventurism is the absence of cosmetic surgery regulations and guidelines on the basis of which you could penalise violators. “As per the National Medical Council, which governs branches of allopathic medicines, only an MCH or DNB (qualified surgeons) in plastic surgery and an MD in dermatology can practise cosmetic procedures. But I have come across dental practitioners, ENT and even general surgeons carry out these surgeries in the name of healing,” says Gupta.
Any cosmetic surgery would go bad in the wrong hands. The classic example of this is botox. “If done by a trained physician, it can yield very aesthetic and natural-looking results. The crucial knowledge concerns how much botox is required for what tissue and for what purpose. When injected in the wrong muscle, a botox procedure can go bad. For example, when done on the forehead lines, an inexperienced hand could inject it into the muscle that is supposed to lift the eye brow. In excess amounts, that can lead to a lip spasm,” says Dr Sonali Kohli, consultant dermatologist and venereologist, Sir H. N. Reliance Foundation Hospital and Research Centre. Botox is under a shroud because of certain over-injected faces. “It is actually a clinically proven procedure with minimum to no downtime for the patient,” she adds.
Kohli is seeing more and more younger people use very small unit injections called micro botox, which are injected into the muscle to decrease activity and help define and enhance contours of the face. They are also used to treat smokers’ lines, peri-orbital wrinkles, and lips for a more youthful pout. “No genuine practitioner would ever recommend a procedure without checking the patient’s age, medical condition and purpose. One certainly shouldn’t go for it at a young age,” says Kohli.
*names changed for privacy
Top procedures and their approximate costs per session:
Liposuction: Rs 2 lakh
Angioplasty: Rs 2 lakh
Eyelid lift: Rs 1.5 lakh
Hair transplant: Rs 80,000 to Rs 1.5 lakh
Tummy tuck: Rs 3 lakh
Fat grafting: Rs1 lakh
Breast implants/ reduction: Rs 2.5 -Rs 3 lakh
Female genitalia correction: Rs 75,000 to Rs1.5 lakh
Male breast surgery: Rs 80,000 to Rs1.2 lakh
Face rejuvenation: Rs 80,000 to Rs 2 lakh