Plastic Makes Perfect

 IT CAN TAKE NEARLY SIX HOURS TO COVER THE OVER 300KM distance that stretches between Itanagar and Guwahati on a bus. It is a journey that many in Arunachal Pradesh take every time a major illness befalls someone in the family. Guwahati, with its many private and government hospitals, is often their first port of call. Early September, Lishi Tania, a police constable in Arunachal Pradesh, boarded one such overnight bus. A nervous energy followed the 28-year-old as he made his way onto the bus, and remained with him throughout the journey, even when he stepped into the clinic in Guwahati the following day.

It wasn’t however a major ailment that had brought him so far from home. Tania was here to get a hair transplant. “I had told myself about four years ago that I was going to get it done,” Tania says. “And now I decided it was time.”

Tania had spent his early 20s in alarm observing the same baldness that had prematurely ravaged the heads of his grandfather and father now creeping up on him. For the last four years, he had started squirreling away money for the procedure, even as he searched for a hair transplant clinic. He had budgeted  ₹1.5 lakh in all for a treatment in Delhi, but instead found one in Guwahati that, including travel and ac­commodation, would cost him under  ₹1 lakh. “The way I see it, I saved the money,” he says.

Tania is part of a body transformation phenomenon sweeping through the country today. Cosmetic procedures, once seen as the reserve of the ultra rich or celebrities and always undertaken in secrecy, oftentimes on a secret trip abroad, whether it was a Botox jab, a new nose or hair transplant, are being sought after by Indians from all walks of life and across the country. Middle-class Indians from both metropolitan cities and smaller towns and cities in far-flung areas are getting hair transplants and eyelid surgeries, new noses and jaws, getting their eyebrows lifted and their faces tightened, augmenting their breasts and sucking out fat from their bodies—sometimes even carving out six packs into their abs—lasering out hair or zapping out fat, scheduling Botox jabs and dermal fillers as if it were part of a skincare routine, and undergoing myriad surgical and non-surgical procedures, sometimes even documenting their journeys of transformations on social media, and with many even funding these procedures, when there is a cash crunch, through easily payable equated monthly instalments (EMIs).

“There is a lot of change going on in our social culture,” says Dr Rachana Tataria, a consultant in plastic and reconstructive surgery at Fortis Hospital in Mumbai’s Mulund area. “It is also a generational change. Gen Zs and millennials are more body aware, and then there is the influence social media has over our daily lives. People are looking for self-confidence. They want to feel good about how they look.”

This boom is borne out in numbers. India is today said to rank in the top 10 countries where the most cosmetic aesthetic (surgi­cal and non-surgical) procedures are carried out. More nose jobs (after Brazil and Turkey) and liposuction procedures (after the US, Brazil and Mexico) are done here than anywhere else in the world (according to the International Society of Aesthetic Plastic Surgery or ISAPS figures for 2023.) According to ISAPS, India accounted for 7.4 per cent of the global aesthetic surgery procedures market in 2023, generating a revenue of around $4.2 billion which is expected to nearly triple by 2030.

THERE ARE TWO aspects to this growth. Not only are more Indians getting procedures done, the competence of Indian plastic surgeons and the relatively cheaper rates of procedures here are also attracting a growing horde of international patients. Dr Ajitkumar Borkar, a consultant in plastic and cosmetic surgery in Mumbai’s SL Raheja Hospital, likens this phenomenon as an extension of India’s status as a ma­jor hub for medical tourism. “Not only is the cost of procedures here much lower than what it will cost in the developed world, you also have to remember that many cosmetic procedures are not covered under insurance policies in most countries,” Dr Borkar says. “So, many are increasingly coming to India. We have equally talented plastic surgeons, the procedures are cheap, and you can club a holiday and go see the country too.”

In Delhi, Handa Aesthetics and Plastics, a popular plastic surgery clinic run by the husband-wife plastic surgeon duo Dr Arjun and Shruti Handa, has a clientele that comprises about 20 per cent from foreign countries. Comparing India to other established hubs of cosmetic procedures like Turkey and South Korea, Dr Arjun says that while most procedures in India cost about one-tenth the price in countries like the US, it is only slightly cheaper than South Korea and on par with Turkey. “Plastic surgery today is basically a global market. People, in India and outside, are looking at plastic surgeons from across the world, and today everybody [plastic surgeons] is putting up their work and their results on social media, on their websites, and on YouTube. So, information is readily available… And people from all across the globe are looking at us as well, search­ing us,” Dr Arjun says. “The price is a factor... But that’s not the only factor. Nobody will get their surgeries done unless and until they are satisfied with the work that is being done.”

Priya (name changed upon request), who got a procedure to cor­rect breast asymmetry in Mumbai last month, is a good example of why many choose to get plastic surgery procedures done in India. Having been born and raised in India, although she now lives in the UK, where she works in data science and AI, she is aware of how advanced private healthcare in India is, while also having family support to help her through the recovery. Plus the costs were a consideration. “The same surgery would cost me almost three times [what it did here] in the UK,” she says.

Priya, who is now 35, hadn’t undergone any procedure earlier, because although she had consulted doctors in her 20s in India, most of them weren’t supportive of her getting breast implants and correctional surgery. “I couldn’t do it before due to a lack of guidance and direction from gynaecologists and a general feeling of taboo around plastic surgery…. This majorly hampered my self-confidence and sex life,” she says. Moving to the UK and meeting friends who had similar conditions, she says, helped broaden her mindset about plastic surgery. Since the procedure (under Dr Tataria), Priya says she has found a new confidence in herself. “Getting this surgery done… gave me the assurance that it’s not being conceited or self-centred to enhance what nature may have missed to work on slightly,” she says.

Indians, however, make up the vast majority of people getting procedures done in the country today. And while people in their mid-30s and older getting anti-ageing procedures, plastic surgeons say, make up a large section, the young are said to be especially keen. Ritu (name changed upon request), a 30-year-old fitness entrepreneur in Mumbai, has been visiting plastic surgeons regularly since she turned 27. She likens the dermal fillers she gets injected once every six months or so (to make what she feels is a rounded jaw more prominent and chiselled) and the Botox injections once every three to four months (to help what she believes is increasing evidence of faint wrinkles on her forehead) to something like a skincare routine. “I don’t use them in a way to change myself. Just a subtle way to enhance what is already there, and to look better,” she says.

Ritu felt the need to get her first set of jabs when a photo-shoot had been lined up, and has continued getting them since, she says, because her profession often requires her to face the camera for social media. “It’s not about changing my appearance. Nobody hates themselves. It is really something you do which is minimal, and kind of like part of a skincare routine,” she says.

These jabs every few months aren’t cheap. Ritu spends some­where between  ₹25,000 to  ₹30,000 every time she visits her doctor for a Botox jab, and between  ₹50,000 to  ₹1 lakh for her dermal fillers. Surgical procedures that many others undergo are even costlier. The prices may not have pinched Ritu, but for those in their 20s, only just starting out in their careers, it probably does. In recent times, however, several fintech firms have begun offering a new class of wellness loans that makes financing Botox jabs or liposuctions as easy as buying the latest iPhone.

One such firm, Fibe, has tied up with a number of well-known clinics like VLCC, VCare and Olivia to offer EMIs on a broad spec­trum of procedures from hair and skin treatments, body contour­ing, and traditional wellness therapies, apart from some dental and orthodontic treatments.

This category of financing, Fibe’s co-founder and group CEO Akshay Mehrotra says, is growing rapidly, and they currently wit­ness over 3,000 such loans disbursed each month. “Our customers are primarily younger, mostly in their 20s and early-30s, reflecting a growing trend of elective spending on self-care and aesthetic treat­ments. While metro cities currently account for the majority of loans, we are witnessing rapid growth in regional areas…. highlight­ing rising demand from Tier 2 and Tier 3 cities as well,” Mehrotra says. “We expect wellness and cosmetic loans to continue gaining popularity as more people view self-care and aesthetic treatments as an important part of their lifestyle rather than a luxury.”

While cosmetic treatments have been slowly going mainstream for a while, plastic surgeons noticed a big uptick during the time of the pandemic. It is easy to understand what happened. People trapped in endless Zoom and Microsoft Teams video-conferences observed their thinning hair and their sagging cheeks, and the many other blemishes that would have earlier never distressed them enough to visit a plastic surgeon.

Dr Vaibhav Shah, a plastic surgeon in Mumbai who only performs facial and hair procedures, sees many such patients. According to him, the growing cosmetic industry is shifting from one catering predominantly to middle-aged and elderly individuals who want to stem the appearance of ageing to increasingly younger individuals. “Among Indians [for facial procedures], the two things they are after most are procedures for the nose and fuller lips that pout more,” he says.

Since he is based in Mumbai, Dr Shah also tends to get a lot of aspiring actors and social media influencers. “They usually come to me for a little work on their faces. A little work and they feel they will have a better chance at their careers, or in the case of influencers, will lead to more followers and better opportunities to earn money,” he says.

A few years ago, Dr Shah performed a complete facial sculpting on a 23-year-old aspiring singer who had recently moved to Mumbai. This involved a host of procedures from buccal fat removal that involves surgically removing fat from the cheeks to create a slimmer face, Botox injections into the sides of the jaw to cre­ate a V-shape, a chin implant, dermal filler jabs, and a thread lift, of­ten also called a “lunchtime lift” because of its quick nature, wherein medical-grade threads are used to lift and tighten sagging skin on the face and neck. She later went on to star in one of the seasons of the popular reality TV show Bigg Boss. “Later when I spoke with her, I asked her about her singing. And she said, ‘No, no. Because I now look good, I’ve become a model [and actress] instead’,” Dr Shah says.

THE BOOM IN cosmetic procedures in India, as it is said in the rest of the world, is particularly in the sphere of non-invasive or minimally-invasive procedures. And here, the growth is particularly noticeable away from the clinics of plastic surgeons and in the many shiny new dermatology and wellness centres, where you can fit in your Botox jab with the latest facial, that are mushrooming across the country. Dr Chiranjiv Chhabra, a dermatologist and the founder and medical director of Alive Wellness Clinics, a string of centres that provides aesthetics and dermatology services across Delhi NCR and Punjab, points out that when she first started what she calls cosmetic medicine back in 1997, many doctors were puzzled by what she was up to and even looked down upon her choice of practice. “Also, earlier, these procedures were considered a luxury, and people would get them quietly because they felt others would judge them for it. But today people perceive it, not as luxury, but as part of self-care and wellness,” she says.

The change, she says, is because today many of these procedures are packaged as part of wellness and skin health. Non-invasive or minimally invasive options are also viewed as safer than surgical ones, can often been performed quickly and with little or no time re­quired for recovery, and are also much cheaper. “It’s very reasonable to the pocket. In my clinic, there are treatments that start for some­thing like  ₹2,500 and then go on up from there,” Dr Chhabra says.

There is also a lot of innovation going on in this space. Newer types of anti-wrinkle injections are emerging that claim to be as good or better than Botox. There are new types of dermal fillers, too, and treatments that use the body’s own tissue to enhance the skin. And then there are a number of new types of machines that use radio frequency, ultrasound or lasers, to correct blemishes or target fat.

Clinics, such as Dr Chhabra’s, also tend to be ahead of the curve on the latest trends in medical health. Her Alive Wellness Clinics for the last nine months have been offering a Mounjaro management programme, where this weight-loss drug is provided in a planned manner and where the patient is constantly monitored, and any evidence of skin laxity is treated

 through a number of procedures. “These drugs give incredible results and a person can easily lose 10 to 12kgs, but if it is not managed properly, this rapid weight loss can also lead to a hollow [gaunt] face, and baldness,” she says.

Rapid weight loss from drugs like Ozempic and Mounjaro are known to lead to sagging skin, even leading to terms like the “Ozempic face” and “Ozempic butt”, and many plastic surgeons believe that as these drugs become more popular, demand for procedures like tummy tucks will also go up.

Just like technology has given a big boost to less-invasive proce­dures, new tech innovations are also transforming the way plastic surgeons go about their jobs. Dr Arjun gives the example of two of the most common cosmetic procedures in India, liposuction to reduce fat and rhinoplasty to reconstruct noses. “In liposuction, earlier, we used to do a very crude form, where we just sucked out the fat, which is very traumatic and had a very long downtime. There was a lot of swelling, increased chances of complications. Then came power-assisted liposuction, then ultrasound-assisted liposuction and laser-assisted liposuction. They’ve essentially allowed us to do a more precise job, with less trauma and faster re­covery. Similarly, for rhinoplasty, earlier we remodelled the bone manually by using an osteotome and a mallet, which is essentially a fine chisel and hammer. But these days, we use a piezotome, which is an ultrasonic scalpel that precisely cuts the bones of the nose or of the face, allowing us to do a lot more precise work with minimal trauma,” Dr Arjun says. “So these technologies are all focused on increasing the precision and decreasing the trauma to the patient as a result of the process of the surgery.”

The innovations in this field and the faster recovery time are drawing in more customers, many of whom tend to be quite up to date with the latest advancements. Often, these patients will show up at consultations with photographs of themselves altered through image-editing apps and ask the doctors to replicate these transformations on their faces and bodies. Dr Arjun commonly gets such patients, and he tends to be particularly cautious when he gets those who ask for procedures that will give them looks more common with other ethnicities. “In India itself, a person from Kashmir will look very different from a person from UP, and that person will look very different from somebody from Tamil Nadu, or West Bengal or the Northeast….. If someone from let’s say Tamil Nadu says he wants to get a nose like someone from the Northeast, neither will the result be possible, or match the [rest of the] face,” Dr Arjun says, as he mentions how the popularity of K-pop and K-dramas has led to many Indians asking him to give them facial features similar to Koreans.

Internationally, Kim Kardashian with her tumescent derriere and swollen lips has long been a poster-girl for her cosmetic en­hancements. Her enhancements became a rage as many women sought out what is known as Brazilian butt lifts, which involves sucking fat out of one part of the body and inserting it into the bot­tom, and breast enhancements that looked unnaturally large for their frame. This look is now no more in fashion, and many women who had undergone these procedures are said to be removing their implants and getting dermal fillers in their lips dissolved, to achieve a look that looks ‘cleaner’ and less unnatural.

Dr Arjun tends to be wary of fads. He says a vast majority of those who opt to go under the knife come to improve their looks and not radically transform themselves, while around 10 per cent will come chasing the latest fad. A few years ago, a 25-year-old woman from Noida who worked in a corporate office, but was also trying to build her Instagram profile, got Dr Arjun to give her a Brazilian butt lift. “We took out the fat from her tummy and lower back and put it into her buttocks, and she was very happy. But then 18 months down the line, Kim Kardashian herself [who had popu­larised the procedure] underwent a butt-reduction procedure, and that look went out of fashion. So this person came back to get a butt reduction,” he says. In another case, a 27-year-old whose boy­friend wanted her to get a breast augmentation, ignored Dr Arjun's advice and opted for implants that were too large for her frame. “I told her that your body will not be able to support this implant and you will come back after three or four years asking for a revi­sion…. And then I’ll have to not only replace the implants, but I’ll also have to do a correction procedure because the breast will sag as well…. And she came back after three years saying, ‘What you said has happened…. and I want to go back [to my earlier size],” he says. “People who are chasing fashion trends or doing procedures from peer pressure or some kind of impulsive behaviour, those are the people who are usually not happy. And as plastic surgeons, we have to filter out these patients and talk straight with them.”

Then there are many who now get procedures done because they believe it will give a boost to their career or marriage pros­pects. Recently, Dr Tataria performed a breast augmentation and liposuction around the hip region of a 27-year-old in the hospitality sector. She had to wear a uniform to work, and these procedures, she felt, would make her look better in them. “People in professions like hospitality, or stewards or stewardesses, or those who go to the gym, even trainers, many of them seek out plastic surgery quite a bit. These procedures give them the confidence to be in that profession essentially,” Dr Tataria says.

There is of course an argument to be made against an industry that thrives on the insecurities of the body. Women’s bodies (still the primary target of the industry, although many men are also now opting for these procedures) and their insecurities have long been lucrative sites of commercial gain. A variety of external fac­tors have historically shaped the ideal female face and body, from the latest clothes and diets to the cosmetics industry. Instagram filters and plastic surgeries are now the latest addition.

BACK IN ITANAGAR, Tania is far removed from these conversations. Every day, he observes the transplanted hair growing on his head with a reserved excitement. He might have beaten back what he calls the curse of 85 per cent bad genetics and 15 per cent regrettable habits like the unrestrained use of hair gels in his early youth, but he doesn’t want to celebrate for now. “It will take at least six months or more for proper results to come,” he says, as he explains how this current transplanted crop will fall and in its stead will, hopefully, grow a new crop of hair.

Tania had to overcome not just his early fears of a hair trans­plant, but had to assuage his mother’s unfounded ones too, es­pecially when someone told her that hair transplants lead to cancer. Tania has also been documenting his journey with this transformation on social media, which has led to a growing fol­lower base. “I’ve heard some people in Arunachal have also got hair transplants done. But it is always a secret. I wanted to break that and let people know about it,” he says.

“When I was going bald, it hurt my self-confidence a lot,” Tania goes on. And then after a long pause on the phone, where I imagine him running his hand through his newly transplanted hair, he says, “The final results will still take time. But I am already feeling better.”