India is considered to be a hub for cosmetic surgeries. Dr Mohan Thomas, Senior Cosmetic Surgeon with Breach Candy Hospital, Mumbai speaks about the growing market, the opportunities and challenges in the industry and laws associated with the practice in India, in conversation with Raelene Kambli
What is the current size of the cosmetic surgery market in India?
Indian cosmetic surgery market is anticipated to witness remarkable growth in the coming years. The reason being increasing consumer awareness, direct marketing and advertising campaigns and technological advances in surgical and non-surgical procedures, resulting in high growth of cosmetic surgery market in India. Growing disposable income of middle-class households and a gradual shift in people’s desire to look presentable and more beautiful for a longer period of time is the driving force behind the cosmetic surgery industry. Today, anti-ageing surgeries and cosmetic procedures are rapidly gaining popularity in India.
The estimated size of the overall cosmetic surgery industry is worth $110 million (around Rs 460 crores) with the maximum revenue by invasive or surgical procedures as their costs are comparatively higher than the non-invasive procedures. With the growing anti-ageing industry, that is three per cent of the entire skincare segment in India, offering solutions to large numbers of women, it’s never been easier to eradicate the lines and wrinkles that make you look older than you actually are. This has given rise to the growth of non-invasive procedures in comparison to the invasive procedures.
What are the new trends in this field?
Due to the rising obesity epidemic, men are increasingly getting breast reductions. Dermabrasion, a type of skin polishing, has nearly doubled. Among other things, the procedure helps people get rid of acne scars. With an increasing number of people going in for weight loss on their own or aided by bariatric surgery, deflation syndrome causing very loose skin has become very common. The procedures that have gained popularity are the ones that snip away excess skin, such as arm lifts, breast reductions and tummy tucks. Buttocks have also gained prominence among females with many of them wanting perky butts.
Newer entrants in cosmetic treatments include:
Botox therapy: The therapy is considered as an alternative to botulinum toxin to treat wrinkles. Rather than causing temporary paralysis of muscles with botulinum toxin, the nerves to the muscles are frozen causing a similar effect. Research shows that the treatment lasts for several months and has similar effects to botulinum toxin.
Vampire facelifts: Another innovation in cosmetic treatment is the use of a patient’s own plasma (the protein rich liquid component of blood) to enhance facial features. It is said to reduce wrinkles, improve facial volume and rejuvenate the face. The procedure is said to be at a very nascent stage and there is no substantial research to prove the benefits gained from reinjecting a patient’s own blood products into their tissues and any effect is likely to be temporary.
Fractional laser: Many talk of the ideal treatment that lessens the time of the procedure. Fractional laser can resurface the skin to rejuvenate the areas such as the face or hands. Although recovery is much quicker, this is because a small total area has been treated as compared to conventional lasers and repeat visits are often needed.
Non surgical fat loss: Use of radiofrequency and magnetic therapy to help shrink the skin and destroy the fat cells to achieve good results.
What are the opportunities and deterrents for the industry?
Cosmetic procedures in India and across the world are treated as a commodity. False and misleading promotions flourish in conventional and online media in the fight for a share of the market and the patients’ welfare becomes secondary as gimmicks are promoted in the name of scientific development. Such kind of promotion leads to commercialisation of the speciality and is contrary to the efforts to make the discipline a legitimate medical practice.
To maintain the ethics of the speciality, it is quite essential that the cosmetic procedures and methodology should be subjected to rigorous research protocols before they are used on patients. Any surgical initiative in cosmetic surgery must adhere to the highest standards of research for subject protection. It is quite essential to safeguard the health and welfare of the patients opting for cosmetic procedures.
What about regulations?
There is very little regulation of the use of specific products for cosmetic purposes. There is relatively very little monitoring of the efficacy and safety of cosmetic procedures and treatments. Use of limited mechanism makes it difficult to prevent the use of demonstrably harmful procedures. Use of injectables, applicables and the technology should be FDA approved, preferably US FDA approved.
What are the current laws for cosmetic surgeries and aesthetics procedures in India?
A plethora of surgical and non-surgical treatments are provided in the aesthetics industry. Surgeries are usually performed by well-trained cosmetic and plastic surgeons. However, the number of cosmetic procedures performed in India is rapidly on the rise. What is alarming is that the legal regulations surrounding the use of cosmeceuticals are surprisingly lax. The problem with the cosmetic industry is that in terms of laws and regulation, it is not at all treated like a separate branch of medicine. It is important to make people understand the need to choose the right premises and practitioners, both private and public, that are directly involved in the performance of a procedure. For e.g. It is not possible to have control on sex to prevent AIDS but the only way forward is to educate and sensitise people about AIDS.
Similarly, the end user needs to take an educated call on the procedures that are good and apt for his or her concerns. He or she should not fall prey to dreams in a bottle. The centre he chooses should have adequate facilities and the practitioner should be well qualified to carry out the procedure.
People should understand that these are medical procedures and should be conducted with the same care and diligence in an adequately equipped facility.
The demand for cosmetic surgery is on the rise, and it is an industry that can possibly generate profits. However, the profit motive should never be allowed to interfere with the delivery of healthcare and the trust that patients place upon the practitioners.
Currently who certifies these procedures?
The American Board of Cosmetic Surgery along with the American and International Board of Aesthetic Plastic Surgery and American Academy of Dermatology is the certifying board devoted solely to examining a surgeon’s skill in cosmetic procedures of the face and body. It is an independent sub-speciality board that examines and certifies physicians in general, facial and dermatological cosmetic procedures.
In India, individual societies that are under the medical board control and grant certifications in broad based specialities. The surgical procedures performed are all standardised and part of published literature in the peer reviewed journals and no experimental surgery is conducted.
The government intends to introduce regulations for cosmetic surgeries. What is your opinion about this? How will this impact the industry?
Currently, it’s important to regulate the poor and unsafe practices carried out in the cosmetic sector and particularly, the non-surgical interventions that are almost entirely unregulated. The requisite medical boards and authorities are already present to have checks on the extent of this practice and they do have regulations to improve the quality of training and patient care. I would like to point out that this is a significant area of medical practice which has grown enormously in the recent years. We need to make sure that patients are protected and that the doctors and others undertaking cosmetic procedures have the training and skills needed to undertake this work. Not newer regulations but adequate education is going to help in that direction.
How can we curb malpractices in this field?
The medical community needs to initiate steps to improve the ethical practice of cosmetology in India. Scientific evidence of the safety and efficacy of cosmetic procedures and devices is needed to assure the public that the interventions being offered have been evaluated properly. Hands-on training of medical practitioners and non medical personnel should be carried out and certificates provided.
The procedures initially should be carried out under the guidance of an expert and patients should insist on having a qualified, experienced professional conduct the procedure in a medical facility which has been certified for the requisite purpose.
Instead of policing cosmetic practitioners it is advisable to bring them to the same standard by adequate education and hands-on training and workshops.