Bold and Beautiful

Once labeled as a 'high class hangover', cosmetic surgery is reaching the middle class too and in fact it's the youth of our country who are ready to go to any extent to force the mirror to lie, finds out Sonal Vij

Traditionally, cosmetic surgeries in India have been associated with celebrities and people of the affluent class, but today, these surgeries are increasingly becoming popular and undertaken by the budding middle class. Also, more and more men and women from the upper middle class group are opting for cosmetic procedures to get attractive looks in order to grab lucrative jobs, best possible marriage partner and mainly get rid of any deformity that they feel impacts their self confidence and self-esteem. The industry is growing by leaps and bounds.

Size and Growth

Although cosmetic surgery has been practiced for a long time in India, the past five years have witnessed a considerable growth in the Indian cosmetic or aesthetic surgery market. The main factors driving this is the increasing demand for aesthetic procedures from urban cities' population like Mumbai, Delhi, Kolkata, Chennai, Bangaluru, Pune and Chandigarh. "The overall Indian aesthetic industry increased from $61.8 million (approximately Rs 268 crore) in 2005 to $110.7 million (approximately Rs 460 crores) in 2007," says Matloob Hasan, Research Manager, Koncept Analytics. He adds that in a period of last three years, 2005-2007, the Indian aesthetic industry (including both invasive and non-invasive cosmetic surgeries) has recorded a Compound Annual Growth Rate (CAGR) of 33.8 per cent in terms of revenue generation.

In the meantime, the number of people considering cosmetic surgery as a potential option to resurrect their beauty is on the rise, and the number of people undergoing multiple cosmetic surgery procedures is increasing at a pace of five to six per cent. Says Dr Rakesh Kalra, Cosmetic & Plastic Surgeon, Ashirwad Hospital, "There is almost a 20 to 30 per cent growth every year in the number of patients seeking cosmetic surgery. This surpasses the population growth in percentage terms as well as any practitioners' personal growing reputation contribution of about 10 per cent. While on the one hand, one does not work all 365 days a year, and on the other many patients get more than one procedure done at one go. On an average one major case is conducted everyday at our service, in addition to several smaller procedures/ minor surgeries, taking the total to about over a 1,000 per year at one single centre like mine."

Seconds Dr Sunil Choudhary, Director, Aesthetic and Re-constructive Surgery, Max Healthcare, "In the last three years, a phenomenal 300 per cent growth has been observed in Max Institute of Aesthetic Surgery. We do approximately about 500 such major surgeries in a year now."

The Divide

Aesthetic treatments are offered through two different categories of invasive (surgical) or non-invasive (non-surgical) procedures. Invasive procedures involve radical measures taken to alter the appearance of a patient. Some of the most sought after cosmetic surgical procedures are breast enlargement, rhinoplasty (nose surgery), surgical face-lifts, tummy tucks, and liposuction. "Surgical interventions, which largely comprise breast operations, liposuction, and rhinoplasty account for the remaining 21.6 per cent of all aesthetic surgeries," shares Hasan. In the invasive space, liposuction and breast augmentation are the two most important procedures which account for around 38 per cent of all the invasive procedures. The two procedures account for more than 44 per cent of the total revenues generated from invasive cosmetic procedures in the invasive market. Non-invasive procedures, on the other hand, do not involve breaking of the skin and holds attractiveness largely due to their lower cost, shorter time of procedures, and less recovery time.

Some of the main non-surgical cosmetic procedures are botox, skin resurfacing, and dermal fillers. "Minimally invasive applications or non-invasive cosmetic surgeries using laser and injectable products account for the largest share of treatments with about 78.4 per cent of all aesthetic surgeries carried out in India in 2007," informs Hasan. Also, in the non-invasive segment, Botox and chemical peels are the two major procedures which collectively account for approximately 50 per cent of the non-invasive market. In terms of total revenue generated from non-invasive surgical procedures, both the procedures account for 38 per cent of the total share.

Dynamics

In the last three years, the Indian cosmetic surgery (both invasive and non-invasive) industry has recorded a significant growth rate of 34 per cent in terms of revenue. As the number of people considering going for cosmetic surgery is increasing, the number of people undergoing multiple cosmetic surgery procedures is also on a rise. An extreme makeover or total body makeover consists of multiple cosmetic surgeries performed, in a short span, by a plastic surgeon to improve appearance and make one look younger.

In the year 2007, around five per cent of the total cosmetic procedures done were multiple procedures, where an individual receives more than one aesthetic treatment.

Driving Factors

The economic growth has largely contributed to increase in the number of cosmetic procedures. "The growth story of the Indian cosmetic surgery industry is broadly based on the growth of the economy that has seen an annual GDP growth rate of seven to nine per cent in the last five years," shares Ritu Sharma, Research Editor, Koncept Analytics. So, does economic slowdown affect this industry? Most surgeons believe that aesthetic surgery is not independent of the economic situation of the country. For only aesthetic surgery to survive the inflation has to remain low and the economic rate has to grow.

Cosmenomics

The economic factor that is driving the growth is the improved purchasing power and standard of living of the Indian populace. Indian population represents 16.9 per cent or 1.1 billion of the global population, the increasing per capita income of which is expected to make India the eighth largest wealth centre by 2017, according to the Economist Intelligence Unit (EIU). According to the annual Cap Gemini/ Merrill Lynch wealth report, the number of millionaires in India was 50,000 in 2002, and has reached 1,00,000 at present, which amounts to a CAGR of more than 20 per cent. India represents 1.1 per cent of the worldwide number of millionaires, which is 9.5 million.

Medical Tourism

The growing sector of medical tourism is also adding to the growth of the Indian cosmetic surgery industry. An increasing number of foreigners, mainly from the European countries, the US, Middle East, Asian and African countries are visiting India for getting their cosmetic surgery done because of lower costs and satisfactory services provided here. In India, the cost of cosmetic procedures is on an average one-third to countries like the US and the UK. As Dr Kalra says, "About 25 per cent of clientage at my centre is of foreigners." In the meantime, several practicing plastic surgeons have started doing cosmetic surgeries. The growing interest of plastic surgeons to enter into the field of aesthetics market is evident through the increasing membership of the Indian Association of Aesthetic Plastic Surgeons, which has reached 200 from just 10 around a decade back.

The Players

"There is almost a 20 to 30 per cent growth every year in the number of patients seeking cosmetic surgery" - Dr Rakesh Kalra Cosmetic & Plastic Surgeon Ashirwad Hospital

"The overall Indian aesthetic industry increased from $ 61.8 million in 2005 to $ 110.7 million in 2007" - Matloob Hasan Research Manager Koncept Analytics

One of the leading non-invasive aesthetic clinics is Kaya Skin Clinic. Marico one of the leading FMCG companies ventured from products to services. A single clinic, started as a prototype in Bandra in September 2003, Kaya has grown at a fast pace. Kaya currently has 76 clinics spread across 23 cities in India. The group has over 5,00,000 customers across the country. Kaya's turnover grew 57 per cent in the financial year 2009, through growth from established clinics and new additions. The Kaya business now stands at a turnover of Rs 160 crore. Kaya Skin opened its 100th clinic in Guwahati. Shares, Rakesh Pandey, CEO, Kaya Limited, "This is the first clinic in Guwahati and is in line with our effort to extend world-class skincare solutions to smaller cities and non-metros as well."

Discussing expansion plans he says, "Kaya is the world's largest cosmetic dermatology chain. In line with our aggressive growth strategy, we aim to open 15 to 20 Kaya Skin Clinics every year, depending on economic conditions. We see a good opportunity both here in India and in the Middle East to penetrate and grow the pioneering Kaya concept. It is important to note that all our clinics are owned and not franchised so 100 owned clinics in seven years is a significant milestone for us."

Another leading player is VLCC. Today, VLCC is the single largest player in the organised sector with a pan-India presence of nearly 225 outlets across 75 cities, one in Kathmandu, nine locations in UAE, two in Oman, one in Bahrain and one in Al Ain. The VLCC Group, a 'Superbrand', serves as an umbrella for all its other brands - VLCC Health Care Limited, VLCC Personal Care Limited and VLCC Institute of Beauty, Health and Management. Another emerging player is New Look Laser. With 17 centers pan-India, 10 are concentrated in Delhi. "Since we keep getting clients from other states, we shall be glad to replicate the module to other cities through franchisee mode too. We plan to reach a target of more than 40 centres by 2012," says Parichay Upadhyay, President, New Look Laser Clinic.

At present, the company has 23 outlets in the country, including Delhi, Mumbai, Bangalore, Jaipur, Srinagar, Ahmedabad, Surat, Hyderabad and Dehradun. "With people becoming conscious of the way they look and health and wellness becoming a major area of awareness today, we see tremendous potential in India," Upadhyay added.

As for invasive procedures, hospitals dominate the market. The popular trend is that of smaller clinics referring patients to hospitals. Well, looking at growth opportunity one can witness that what used to be only a reconstructive department is today different from the cosmetic and aesthetic surgery department. Today, nearly all major hospitals have now started this department. At Delhi-based Sir Ganga Ram Hospital, the Department of Plastic and Cosmetic Surgery was established in 1965 by Dr Suresh Gupta. It is manned by 11 fully trained plastic surgeons, one clinical assistant, two DNB students with a team of three registrars and a fully equipped microvascular lab.

It offers state-of-the-art tertiary level care in all disciplines of plastic surgery. The department has an outstanding team of specialists covering all aspects of plastic surgery such as aesthetic surgery, craniofacial surgery, hand surgery, reconstructive microsurgery, burns and general plastic surgery. Approximately, 2,000 major surgeries are done per year and emergency services are available round-the-clock. Says Dr Suresh Gupta, Emeritus Consultant, Sir Ganga Ram Hospital, "We are one of the centres of excellence in microsurgery, aesthetic surgery and also one of the few multidisciplinary craniofacial surgery centres in India."

In Delhi, a popular clinic is Delhi Aesthetic Clinic, which has been established and managed by doctors who are experts in the areas of cosmetic medicine, cosmetic surgery, body aesthetics and anti-ageing medicine. All these areas are interrelated and require comprehensive approach to deal with the problem. The doctors are trained in all aspects of aesthetic medicine, surgery and anti aging medicine. All the surgeries are performed at Indra Prastha Apollo. Since patients want to maintain secrecy while they undergo cosmetic procedures, stand alone clinics/ hospitals definitely play a vital role. Opines, Dr Kuldeep Singh, Senior Consultant - Plastic & Reconstructive Surgery, Indraprastha Apollo Hospital, New Delhi, "Stand alone clinics is the need of the hour. When a patient comes in for a cosmetic procedure he does not want the whole world to know. S/ he wants privacy." One such setup is-Ashirwad Hospital in Dehradun. It was established in the year 1995 with the idea of creating a cosmetic surgical facility in an area out of town, far from its hub and pollution, yet within straight and easy reach of the people. Shares Dr Kalra, "The hospital is a well managed one with excellent nursing care, and, in fact, it's a home away from home." This centre caters to medical tourism patients. Dr Kalra adds, "We give very economical facilities at par with international standards. Cosmetic surgery procedures are done with a high degree of patient satisfaction."

Growth Forecast

The Indian cosmetic surgery market is likely to retain its tremendous growth pattern. There is a significant contribution of the media in making consumers aware about the need to look beautiful and restore their looks. It could be considered as one of the major reasons behind the industry growth. The growth will further be driven by more and more plastic surgeons entering the aesthetic surgery domain. It is already visible with plastic surgeons' growing attendance in aesthetic workshops. In addition, the trend of taking cosmetic surgical treatment among Indians in foreign countries is in the downslide. In the wake of an increase in the number of cosmetic surgeons in India, the influx of foreign patients in the country has also increased.

Furthermore, growth will also continue with the growth in the national economy. Though the economy is not likely to sustain the growth path in the next two-three years, which it achieved in the last five years, it still managed to generate the momentum. "On the basis of all these factors, it is projected that the overall Indian cosmetic surgery industry will grow by 45 per cent - from $110.7 million (approximately Rs 460 crore) in 2007 to $272 million (approximately Rs 1,130 crores) in 2010. In terms of revenue from non-invasive procedures, growth will be around 42 per cent whereas revenue growth in invasive or surgical procedures will be around 30 per cent," concludes Hasan positively.

sonal.vij@expressindia.com