Face value: An anti-ageing sheeted mask, used to improve the skin’s texture and clean the pores

Promila Roy (some names have been changed in this article) never gave that old adage ? about beauty being just skin deep ? much thought. Instead, when she responded to an advertisement by a skin clinic in Bangalore, she thought she had found the right place to get rid of “that irritating scar” below the chin. She sent an e-mail to the clinic and was assured that it would be removed through “laser therapy”. Little did she know that her desire to get the small pigmentation mark removed would leave her scarred ? mentally and physically.

Beauty may well lie merely in the eyes of the beholder, but that hasn’t stopped the queues outside beauty and cosmetic surgery clinics from burgeoning. And catering to the popular desire to look good are cosmetic surgeons ? the new-age gods who have taken up the scalpel on behalf of those seeking to improve their looks: by hook, crook or scalpel.

But, as Promila found, the end-result is not always gratifying.

“Her first shock came when she realised that they were performing some sort of a chemical ‘peel’ therapy rather than the promised laser therapy on her,” says her father, Paritosh Roy, a doctor. “But she persisted with the treatment in the hope that the scar would be removed. After a few sessions, each of which cost Rs 15,000, she realised that instead of the scar being removed, the pigmentation was spreading and it was looking worse,” says Roy.

The Bangalore-based clinic refused to take any responsibility for the mess-up. Promila spent more than a lakh on her treatment in Bangalore. She went from clinic to clinic till Roy took his daughter to Aniruddha Bose, a consultant cosmetic surgeon attached to hospitals in Calcutta, who referred her to a reputed hospital in Delhi. “It was quite unsettling to see the damage that had been done,” says Aniruddha Bose.

Promila is not an exception. Many others in Calcutta have faced similar situations. And doctors fear that unless steps are taken to check the credentials and expertise of those promising the earth to beauty-seekers, more and more people will end up with the serious side-effects of a botched-up job.

Beauty, clearly, is big business. There are no official figures on the number of beauty clinics, but it is believed that there are hundreds of such centres in the city. Every other street corner has a bill-board claiming a miraculous cure to a beauty problem. And gullible Calcuttans are falling for it.

Mahasweta Nandi is a case in point. She went to a beauty clinic in Calcutta to get her eyebrows shaped through laser rays. She wanted some extra hair removed ? but ended up with no eyebrows at all. She is now trying to raise enough money to get the corrective surgery done.

Wrong call

It’s not women alone who are at the receiving end of errant scalpels. Ashok Ghoshal, a consultant dermatologist, recounts the case of a man in his mid-twenties who had come to him with “nodulocystic acne” ? a severe form of acne that covered his face. He went to a city-based dermatologist with the hope of having a face without blemishes. The doctor performed a procedure called “dermabrasion”, which should only be done after the acne is cured through treatment to remove the acne marks. But the dermatologist didn’t follow the correct procedure, and the patient was left with a face full of angry red marks.

“In the first place, dermabrasion is a procedure which only a well-trained cosmetic surgeon can perform,” says Ghoshal. “Second, even if a dermatologist is performing it, he should at least know when to opt for such a procedure. He has to use his discretion.” Ghoshal rues the fact that some dermatologists ? or skin doctors ? have become “dermatosurgeons” and are performing cosmetology procedures for which they aren’t sufficiently trained. “As dermatologists, we don’t receive any surgical training unless we specially opt for it. Attending a three-day seminar or a workshop somewhere does not train one to perform delicate surgeries, even if you have a degree to your name.”

The reasons for this zeal for cosmetic surgery among some members of the medical fraternity is not far to seek. Says Bose, “The word cosmetology or cosmetic surgery sells. It has become the biggest money-spinner in recent times. Consequently it has attracted a host of self-appointed cosmetic surgeons and cosmetologists who don’t think twice before performing a cosmetic procedure for which they may not be trained.”

This, most doctors agree, is the crux of the problem. On the one side, there are snaking lines of people wanting to improve their looks. And meeting them headlong are knife-wielding doctors, without adequate training or qualification, who are laughing all the way to the bank.

“The only reason I can think of for this abuse of cosmetic surgery is monetary gain,” says Ghoshal.

Examples of sheer incompetence and negligence abound. Annie Samson, a career-oriented woman in her late 30s, was worried about her baggy eyelids. After much deliberation and consultation with a doctor she decided to go in for blepharoplasty (see box), to remove the bags under her eyes. But, to her horror, she discovered after the operation that the shape of an eye had changed with the stretching of the skin of her lower eyelids.

Kaushik Nandy, a consultant cosmetic surgeon who later performed the corrective surgery on her, says, “Performing blepharoplasty on the upper eyelids is relatively easy but when it comes to the lower eyelids, you have to be very careful and should have enough expertise to do it.”

Beauty is no longer what it was. The global beauty market props up images of what is beautiful, and what is not. Then, the media creates an awareness of good looks and aspirations. “As the visual media constantly bombards viewers with youthful images, even something as normal as ageing is seen as a disease,” says Bose. Many doctors point out that people in their mid-40s come to get wrinkles and a sagging skin removed just to look a little more youthful. And the young are seldom satisfied with their looks.

Nandy recalls a 16-year-old school student who went to him recently because he thoughts his lips were too thick. “I thought he looked fine but he seemed to have developed a feeling that because of his lips he couldn’t make friends with girls.” Nandy rues that there are any number of cosmetic surgeons in the city who’d be willing to cut his lips to size. “But cosmetic surgery,” he warns, “is an unforgiving branch where even a minor deviation can ruin the surgery.”

Many believe that since cosmetic surgery is largely seen as a “non-essential” service in the medical community, it lends itself to abuse by unscrupulous medical practitioners and quacks alike. And unlike other streams in surgery, there are no checks and balances on cosmetic surgery. There are, for instance, no official complaints on any botched-up operation in the city.

“We will act if we get any complaints. In fact, we have a grievance cell where anyone can lodge a complaint,” says the president of the Calcutta branch of the Indian Medical Association (IMA), Ashok Ghosh. But the IMA, he stresses, cannot act on its own.

Even the Medical Council of India (MCI) pleads helplessness when it comes to suo motu action. According to Indrajit Ray, chairman of the ethics committee of MCI and principal of Calcutta Medical College, the MCI can act only on complaints against registered medical practitioners. “Quacks or non-medical people don’t come under our purview, and the MCI has to receive a complaint in order to act,” says Ray. He adds that while the MCI has dealt with over 2,000 complaints in the last four years, it has not yet come across a charge of negligence against plastic surgeons.

Cause for concern

But, says Anupam Golash, a consultant plastic surgeon who specialises in microsurgery, there are grave reasons for concern. “Certain beauty and skin clinics in the city run by so-called professionals conduct procedures for which they are neither equipped nor qualified,” he says. “They attract people through commercial advertisements and end up providing unscientific treatment.”

A patient had come to Golash with severe burns on his nose caused by laser rays administered to remove a mole. The person had visited a well-known skin clinic where he was treated by an “untrained” person, and he ended up with a burnt skin that needed rectification.

Prabir Basu, working president of the Bengal Federation of Consumer Organisations, however, says that a patient can always take the issue to a consumer court. “One can file a case of medical negligence and deficiency of services in a consumer court where the complainant has to prove his case,” he says.

Cosmetic surgeons are aware that steps must be taken to stop the abuse of this “beautiful profession” but claim to be helpless. Lokesh Kumar, who performed the corrective surgery on Promila in Delhi, strongly advocates “some legislation” to control the abuse. “We are trying to create awareness among people about going to the right place for cosmetic procedures. We are also in the process of creating a media cell to create more awareness,” says Kumar, who’s also secretary of the Association of Cosmetic Surgeons in India.

Till then, the doctors hope that the people themselves will take care ? and check the surgeon’s credentials before subjecting themselves to his care. If Promila had done that, she would have had another story to tell.

All you need to know before the nip and the tuck

Rhytidectomy: Commonly known as face-lift, it needs considerable training even for a very experienced plastic surgeon. Besides, it should not be looked upon as a permanent means to halt the ageing process. It is not possible to do a face-lift through a non-surgical procedure. Cost: Rs 60,000 (approx). Risks: Common post-operative effects are bruising, temporary numbness or tightness in the face or neck and loss of skin sensitivity. In rare cases, it may also result in nerve damage, leading to facial paralysis.

Rhinoplasty: Popularly referred to as a nose job, it is an operation which requires a lot of skill as the operation can be done only by feeling the features. The surgeon performing it must be conversant with the ethnic characteristics of the individual. Otherwise, a few millimetres’ difference can change the aesthetics of the nose. So it is important to check whether the surgeon performing rhinoplasty has done a significant number of such operations. Cost: Rs 25,000 – 30,000. Risks: If a nose job goes wrong, corrective surgery can only be done after at least nine months. Subsequent rhinoplasties are difficult to perform and the results may not be as good as the first one done correctly.

Blepharoplasty: This surgery is performed to remove excess skin and fat around the eyes. It is an operation where few millimetres here and there can mar a face. Even experienced plastic surgeons can make mistakes. A glaring example of blepharoplasty gone wrong is Michael Jackson. Cost: Rs 35,000 (approx). Risks: Bruising and discolouration. It can also result in the dry eye syndrome and drooping of the lower eyelid. In serious cases, bleeding in the eye socket can lead to blindness.
nAbdominoplasty: Tummy tuck — where excess sagging skin and underlying fat is removed — can only be performed surgically. Cost: Rs 30,000 – 35,000. Risks: It leaves behind a scar. If excess skin is removed, it may cause the skin to stretch.

Collagen and Botox: Both are temporary injectables used to treat facial wrinkles and should be injected by plastic surgeons. The person giving it should also be conversant with the surgical alternatives. Botox injections are a temporary alternative to endoscopic brow lift. Cost: 0.5 cc of Collagen costs Rs 10,000 and a Botox injection costs Rs 13,000 - 15,000. Risks: Some people may be allergic reactions to collagen. And Botox applied to a wrong muscle may cause temporary muscle paralysis.