Who is an ideal candidate for cosmetic surgery? Risks revealed and myths debunked

Between eight to 10 lakh cosmetic surgeries happen in India every year

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The Indian surgeon Sushruta (circa. 1000-800 BC) is considered the ‘father of plastic surgery’. The earliest form of such surgery was the use of skin from other parts of the body (arm, cheek, or forehead) to reconstruct amputated noses. The word ‘plastic’ in the term comes from the Greek 'plastike', or the art of modelling or sculpting. While originally used for restoration, it has now expanded to rejuvenation and enhancement. Between eight to 10 lakh cosmetic surgeries happen in India every year, and the country is one of the most popular hubs for such procedures. Surgeries which are considered medically necessary (like those for correcting nasal deformities which hamper breathing) are covered under insurance, while the rest might or might not be.

There is a rise in the desire to look more presentable, there is more awareness, and there is also the increased safety of cosmetic procedures. Social media has also played a vital role by making people more inquisitive about available procedures.

Dr Amit Gupta, MBBS, MS and DNB, is the founder and chief surgeon at Divine Aesthetics in Delhi. He has treated over 25,000 patients from the US, the UK, the UAE, Canada, Australia and Russia. When not wielding the scalpel, he likes to play the piano.

In layman's terms: Cosmetic surgery is the science of enhancing a person’s natural body aesthetics. It helps individuals attain bodily features that complement their body or face type better.

Difference from plastic surgery: Plastic surgery encompasses a broader scope, including procedures like cancer reconstruction, birth defect correction (like cleft lip), and accident injury reconstruction. It can be divided into two main categories: reconstructive and cosmetic. Cosmetic surgery does not have further subdivisions. It is optional in most cases since it enhances a person's appearance whereas reconstructive surgery is a medical necessity.

An ideal patient: One who understands what is achievable, recognises the importance of the changes, is emotionally stable and socially settled, and has realistic expectations from the procedure.

Post-surgery downtime: This varies depending on the procedure. While minimally invasive procedures like fillers and botox require no downtime, more extensive surgeries like breast implants may require a day while procedures like tummy tucks may require up to six days.

Make me look like a film-star! One of the most common misconceptions about surgery is that you can look like your favourite film star (Katrina Kaif being among the most popular). However, a surgeon cannot achieve a body shape or structure that replicates any other person. Therefore, the patient’s expectations are brought down to reality. What is achievable and what is not is clearly explained. Then it is assessed whether the patient is able to understand what we can create. If they have expectations beyond reality, then they are not ideal candidates for surgery. This is because most of the time these patients are not satisfied with the results, approach surgery in an obsessive way, undergo multiple surgeries and end up with botched looks which eventually bring a bad reputation to cosmetic surgeries.

The vital role of counselling: It helps us assess if the person can understand the results that are possible with surgery. It also helps to determine if a person is obsessed with looks, and is thus not a suitable candidate.

The changing age of patients: While the lower age range has come down to 18 or 19 years, the upper range has increased from 60 to 65. There is a rise in the desire to look more presentable, there is more awareness, and there is also the increased safety of cosmetic procedures. Social media has also played a vital role by making people more inquisitive about available procedures.

Dr Amit Gupta Dr Amit Gupta

What age is ‘too’ old: Generally, a person should be an adult to undergo cosmetic surgery. As for the upper limit, we don’t usually have a cap as long as the person is medically fit for surgery. Even a 70-year-old can undergo cosmetic surgery safely if the body permits.

Essential questions for the doctor to ask: Is the candidate medically fit for such a procedure or do they have contra-indications that could affect the surgery? If they are on blood thinners, for example, they cannot undergo a breast implant surgery immediately because of the risk of excessive bleeding. Does the patient have someone to take care of them after the procedure? Can the patient’s expectations match the results that are possible medically? Is the patient willing to adhere to the doctor’s post-operative advice? Is the patient in the right headspace to understand what is being done?

What you should ask your doctor: What are the results going to look like? What could be the procedure's possible side effects? How much rest is needed post-procedure? Is there any additional procedure that needs to be done? What are the possible complications of the procedure?

When would a doctor say no? Undergoing a procedure for purely cosmetic reasons is not a contra-indication as long as it is medically safe and the person understands the changes that are going to happen. If someone approaches the procedure without knowing or understanding the consequences, then it is a contra-indication for me.

Beware of:

* Medical complications: Undergoing a procedure without a prior medical test for conditions like diabetes, high blood pressure or heart disease that could cause a problem during the procedure.

* Choosing the wrong surgeon: Not every surgeon is qualified to perform all procedures.

* Under-qualified clinics: There are many clinics that are not recognised by the government and operate without adhering to proper guidelines, certifications, and standards.

* The low-cost trap: Many people fall for low-cost procedures which use poor quality consumables like Chinese and Korean breast implants.

* Poor post-surgery care: Many people don’t adhere to the recovery time that is suggested by the surgeon and start indulging in sports and physical activities sooner than they should. This often aggravates the scars and disrupts the healing process, thus impacting the desired results.

A one-time procedure: Every surgery is a one-time procedure, but the process may require management. For example, we can conduct a hair transplant on someone, but with time they are prone to losing more natural hair and would require hair fall treatment. In the case of facelift surgery, the results last for eight to 10 years, but the impacts of sun and pollution are ongoing. So the person might need additional treatment to preserve the quality of skin in order to reduce the signs of ageing.

Fads like the Brazilian butt lift (aka the Kim Kardashian butt): Every surgical procedure is to be approached with utmost caution. BBL is an extremely safe procedure, but has been criticised lately because of the poor technique used by some doctors. There are precautions and correct selections for every plastic surgery procedure. All procedures are completely safe as long as proper techniques are followed.

Procedures most in demand: For men, the most common procedures are hair transplant and gynecomastia treatment (male breast enlargement correction). For women, liposuction, breast implants and botox are the most common.

Top five myths: Plastic surgery makes you look unnatural. Hair transplant can cause migraine. Botox makes you look plastic. Breast reduction is very painful. Unmarried girls should not undergo breast implants.

How far is too far? Approaching cosmetic surgeries in an obsessive manner and doing multiple surgeries on one body part that creates an unnatural look.

Surgery makes one look unnatural: If done with realistic expectations, a skilled surgeon can deliver natural looks using modern cosmetic surgery techniques such as non-invasive procedures and second-generation dermal (skin) fillers. A skilled surgeon can use these tools to ensure you look like yourself, only rejuvenated.

Do breast implants break or tear? Average-sized breast implants used in today’s procedures can withstand up to 300 pounds of pressure before rupturing. It is unlikely that normal contact or force would cause your breast implants to rupture.

Migraines and hair transplants: There is no scientific evidence linking migraines to hair transplant procedures.

Botox equals plastic: The most common misconception is that botox makes one appear frozen or plastic. In reality, the enhancements made with botox injections can look exceptionally natural when performed by an experienced injector.

The pain of breast reduction: Usually, the patient is anaesthetised before the procedure so that they don't feel any pain. However, soreness can persist for two or three days after surgery. That is taken care of by mild painkillers and ice wrapping. Now, surgeons are developing methods to provide day-care surgery for breast reduction that will largely reduce the operation and recovery time.

Breast implants are a no for unmarried women: This notion stems from two concerns: breastfeeding and scars. There is, however, no evidence suggesting problems with breastfeeding after breast implant surgery. Breastfeeding is completely safe and possible after surgery. If done by an experienced cosmetic surgeon, there will be minimal bruising post the procedure, and the scars will vanish in due course. However, some patients who have poor healing and scarring tendencies must inform the same to the surgeon so that surgery can be planned accordingly.