There is a need for regulations to be in place so that only qualified professionals perform these cosmetic and reconstructive procedures. In the current scenario, people generally get influenced by the advertisements and the low cost being offered, and they end up going to unqualified and untrained professionals. These places are not certified and are not hygienic or equipped to perform basic let alone complex surgeries. As a result, people end up with a lot of adverse outcomes and side effects, especially with respect to hair transplants which can be performed under local anesthesia and can be usually done in a small setup. These professionals are unqualified or not trained in this field, do not have a qualified medical degree to perform the surgeries, and are not aware of the intricacies of the same. There are regulations that have now been laid down by National Medical Council(NMC) which will help regulate who can and cannot perform these surgeries. If the professional performing these surgeries is not qualified, there would be punitive damages and the concerned people penalised for unlawful practice.

As of January 2021, the most popular form of cosmetic surgery in India according to search volume data was hair transplants with over 30 thousand results per month. Liposuction and Rhinoplasty followed with over 20 thousand and 19 thousand results respectively, according to a report by Statista. What are the possible reasons for this rise?

The possible reasons are that people have become more conscious of their baldness, thinning of hair, and bald patches (Zoom effect – these getting highlighted as people observe themselves more critically on a digital platform in selfie form). People have become more aware of how they look, and the role of digital media has played a very important role in making people look at themselves more critically and take the required surgical path to look more presentable.

In the last few years, especially during the COVID Pandemic, people have become more conscious of their diet, health, weight, and general fitness. Liposuction helps in the removal of the localised fat deposits in the body which are sometimes due to genetic susceptibility especially around the face, chest, abdomen, buttocks as well as thighs. These areas can be sculpted with liposuction and help achieve a better shape and aesthetic outcome.

According to you, how Reconstructive surgeries have advanced over the years in India?

There is a quantum leap in the last 10-15 years and most of it is related to the better training our plastic surgeons receive. We now have a greater number of trained plastic surgeons with ample experience in reconstructive microsurgery, which involves transferring large tissues from one part of the body to reconstruct the deficit caused by cancer, trauma, acid injuries, burn injuries, etc. More medical professionals are performing these advanced techniques and there are more centres doing these surgeries which were earlier limited to a few select centres some years ago. The globalisation, access to the latest information, and the transference of knowledge becoming more rapid have helped India’s surgeons/doctors to learn and master the techniques with advanced courses and training. India is now at the forefront of reconstructive surgery. There has been considerable improvement in the treatment due to technological advancements as well. Nowadays, we use CAD (Computer-assisted diagnosis) CAM (computer-assisted management) which helps us make 3D printed templates/prototypes of the defects and recreate the same in the body using body tissues. There are considerable advancements seen in tissue engineering which help recreate the affected area (nose, finger, ear) by prefabricating and prelaminating the same in the forearm/other areas of the same patient and transferring the 3D construct to the place where it is deficient or required.

What has been the impact of the ongoing coronavirus pandemic on plastic surgeries and the perspective of people towards them in India?

During the pandemic, cosmetic surgeries were put on a complete halt since the focus was to manage the covid cases. People chose to have the surgeries once the covid cases had settled and the pandemic was under control. We were all confined to our homes and got the chance to introspect and look at ourselves closely. And the fact that we were all on zoom and could see ourselves on camera, all the little flaws became highlighted. During the pandemic, it became apparent that the infection was more severe in unfit and diabetic patients. So besides taking of their health small nicks and tucks became more common as people want to look and feel good.

However, reconstructive surgeries on the other hand took a jump as there were cancer patients looking for reconstruction even doing the pandemic. We also saw large facial deformities because of black fungus (Mucor-mycosis) which resulted in patients losing a large part of the face. These patients required major reconstructive surgeries to integrate them back into the society

Do you think after the COVID-19 pandemic there has been a rise in cosmetic surgeries in the country? If yes, then why and how?

Most of the patients pursued their cosmetic surgeries post-COVID-19 pandemic which was influenced largely due to changes in lifestyle, digital media usage, and their perception of the face in selfie mode. The video conferencing (Zoom, Webex, etc) change in perception of one’s own facial aesthetics further motivated them to pursue the surgeries post-COVID.

During the pandemic, a lot of money was saved as we all stayed home and travel was also non-existent. Many chose to spend the savings on making themselves look and feel better.

There has also been a significant rise in make-shift cosmetic clinics in the urban parts of the country. What are the possible reasons for the increase in the number of such clinics?

This was largely seen due to the rise in demand for cosmetic surgeries. After COVID, as the demand for cosmetic surgeries increased, many unqualified and untrained professionals started their own clinics to earn quick money. And many of the patients were falling prey to these clinics because of the advertisements and low costs offered. For this reason, It is very important to check the credentials of the doctor performing the procedure, the degree of the doctor, the qualifications of the doctor, the number of surgeries that they have performed in their practice, years of experi,ence etc. before visiting a clinic or a hospital. The bigger and well-established hospitals screen and hire the doctors as a consultant after verifying the credentials. This provides a degree of safety when an individual goes to such a place. It is also very important to understand whom to go to for a particular treatment and to check if the person is qualified and trained enough to perform the same. As an example, a dermatologist can also do a hair transplant if he/she is trained for the same, as is the plastic surgeon. It is very important to check that the doctor has an MBBS degree, a Degree of specialisation (for plastic surgery one must get trained for 6 years post MBBS to become a qualified plastic surgeon). So, a doctor needs 12-14 years of training with the right degree to become a qualified and well-trained Plastic Surgeon. He or she is the right person to go to.

Additionally, it is important to check if they are affiliated with any national body. We have national associations which give membership to qualified Plastic Surgeons. The IAAPS (Indian Association of Aesthetic Plastic Surgeons) is such a body that credentials Plastic Surgeons who also specialise in Aesthetic/Cosmetic surgery. Their qualifications are vetted before being made a member. The inducted members are entitled to display the logo of the association in their clinic and on letterhead. This authenticates that the surgeon is qualified to perform aesthetic/cosmetic surgeries and gives confidence to the lay person to undergo the aesthetic procedure under their care.

As the Vice President of the Indian Association of Aesthetic Plastic Surgeons (IAAPS), my endeavour is to streamline the training and skills of our members. This is done with the help of workshops and regional conferences (with participation of local trained faculty). This helps in spreading knowledge and the latest techniques to our members. The association also invites local and international experts for talks on various aesthetic/cosmetic procedures.

This help upscale our practice as well as impart knowledge on the latest techniques. We also conduct many workshops and didactic lectures to train our young plastic surgeons.

When and how do cosmetic surgeries go wrong? What steps should be taken to prevent them?

It is imperative to understand that no qualified doctor would want his/her patients to have an adverse outcome after the surgery. There are certain risks associated with any surgery but the risk is very minimal if done in a correct manner by a qualified surgeon in an accredited facility with ready backup in case of any emergency. From my experience, minor complications can happen in 1-2% of the patients who undergo cosmetic procedures and major complications are far less in number. Major adverse outcomes may require in-hospital or ICU admission and can be life-threatening. Given the nature of the surgeries, a bad outcome can happen with even when getting treated by a qualified doctor as well.

In a well-equipped facility, adverse outcomes can be managed more efficiently and prevent loss of life. The doctor should be qualified enough to address the side effects and minimise adverse outcomes.

In hospital settings where we have ready backups, such cases can be easily managed but in a small clinic with the inadequate facility, these patients can end up losing their life. In my practice, I see about 10% of patients who have been operated on outside and have had some adverse outcomes. We can correct most of them but will involve one or more surgeries and added expense. Most of the minor corrections can be done under local anesthesia, but the additional surgery is traumatic for the patient besides the cost.

What are the most common procedures that are opted by people in India? Do such people really need these surgeries? What are the possible reasons for their decision to go under the knife?

Cosmetic surgeries are the personal decisions of the patient. Sometimes, the patient has very unrealistic expectations, in such cases, it is very important for the doctor to educate the patient about the risks involved, and guide them through the process, the post-surgery care, and the lifestyle modifications required to have a good and consistent result. In some cases, we refuse the surgery as the patient has unrealistic expectations or undergoing the surgery at the insistence of family or partner.

What are common myths and misconceptions related to Aesthetic and Reconstructive Surgeries in India?

The common myth that we come across especially with liposuction is that it is a method to lose excess weight. The fact is that liposuction is more for body contouring in people who are otherwise fit and struggling to get rid of the stubborn localised fat deposits rather than a weight loss procedure. The other fact is that there is a limit to how much fat can be removed in one sitting (about 5-8% of body weight) Excessive fat removal in one go can lead to blood loss, major body fluid shifts causing pulmonary oedema, kidney failure, loss of life, etc

Another myth is that one can get along with a regular lifestyle immediately post plastic surgery. Except for some minor procedures, there is a convalescence period. One can resume regular activities after some recovery period, which may vary from 7-10 days after a hair transplant to almost 6 to 12 weeks after major surgeries.

Myth: Only women opt for liposuction or breast surgery

This is a myth because we observe that many men undergo liposuction surgery as well. Men with localised fat deposits as well as large breasts (gynecomastia) often opt for liposuction and gland excision if weight loss does not help.

Myth: Liposuction gives permanent results

The fact is that there is nothing permanent if one does not work towards maintaining the weight, diet, and lifestyle modification. The results are there till the weight is maintained. Weight gain will result in loss of shape and loss of results achieved with liposuction

According to you, what will be the status of Aesthetic and Reconstructive Surgeries in the country in the coming years? Do you think, in the post-pandemic world, these procedures will become more popular?

Aesthetic and reconstructive surgeries are on the upswing in India, as we and the general public have become more aware of the subject. In India, we are growing exponentially on this front and we have more trained professionals in both aesthetic and reconstructive surgery. The addition of CAD-CAM technology, 3D printing of templates helps us in creating the exact size and shape of the defect which can then be used as a guide to recreate the lost part using body tissues and alloplastic implants. This can help in correcting the deformity and create an exact shape of what it was before the trauma, accident, or cancer. The best example is of recreating a lost jaw using CAD-CAM technology and giving the patient the ability to speak and eat normally (with dental implants in the reconstructed jaw)

Complex reconstructive surgeries can help recreate a lost nose or an ear. Additionally, tissue engineering and advancements in stem cell technology can help create a body part in the laboratory (like the recently bio-engineered ear for a girl with a congenital absence of the ear).

There is tremendous scope for growth and with the help of cutting-edge technologies and awareness, the patients undergoing these surgeries have also risen.

Additionally, reconstructive surgeries play a very important role in rehabilitating patients, especially patients with severe acid burns and mutilating injuries. The availability of Dermal Matrix has simplified many of the surgeries in such patients. Surgery helps them to integrate back into society and live productive life.

India is already on the world map in Composite Tissue Allotransplantation (CTA) wherein hands have been transplanted from brain-dead individuals. We are not far from transplanting a face. The improvement in immunosuppression will further open up the possibility of transplanting other organs and parts of the body.

Technology and surgical skills will be amalgamated to bring out the best possible outcomes in the near future and Plastic, Aesthetic and Reconstructive Microsurgery will be at the forefront of it all.