Not many indians know that rhinoplasty or nasal reconstruction, one of the most in-demand forms of plastic surgery today, was actually first performed by the renowned ayurvedic surgeon Sushruta in the 6th Century BC. The procedure, which has been described in detail in Sushruta Samahita, involved taking a flap of skin from the forehead and using it to reconstruct the nose.

Sushruta evolved this procedure to treat soldiers who had had their noses chopped off during battle. Today rhinoplasty or the ‘nose job’ is an elective procedure, which entices hundreds and thousands of men and women to voluntarily go under the knife. These, however, are not people with disfigured noses. They are people who perceive their noses as disfiguring.

Once upon a time, not so long ago, people guiltily whispered to each other about nose jobs, tummy tucks and face lifts. No more. Body contouring is not just in, it’s actually flauntable. People are happy to show off their contoured bodies, their chiselled features, perfect smiles and returfed scalps. They openly discuss the best place to get your regular dose of botox or boob job done. And they display their tucked tummies, sculpted arms and legs with pride.

Rakhi Sawant, India’s most high profile item number girl, who has often admitted that she has had various parts of her body sculpted, once memorably said on a TV talk show, “Jo diktha hai woh biktha hai.” And that’s the key to the whole issue.
For, it’s not just item number girls who need to have perfect bodies to sell their talents. Aspiring brides, models, actors, TV anchors, Page 3 personalities, ordinary job seekers, politicians — you name them and they could be likely candidates for the knife. Because in today’s lookist world, no one is bothered about the inner self. Beauty is much more than skin deep; it is flesh deep. Or even deeper. Huge gobs of fat are sucked out, other body parts are sewn together, plumped up, lasered and toned in search of perfection.

Procedures like tummy tucks, liposuctions, breast lifts and reductions or augmentations, eyelid tucks, face lifts, microdermabrasions, hair weaves, aesthetic dentistry, botox injections and silicone implants are available for the asking. And these are just a few of them.
A couple of years ago, Franz Gsell, one of Germany‘s most celebrated plastic surgeons picked up Tatjana, a plain, dumpy girl from a backwoods Bavarian town, performed more than 20 operations on her and turned her into what he called the perfect woman. Franz enlarged her breasts from A to C-cup, slimmed her bulbous nose and thickened her lips to a Hollywood pout. Then he dumped his first wife and married his ‘creation’ who was less than half his age. She in turn willingly bared her silicone enhanced breasts to visiting pressmen, and her botoxed face with its plastic smile was on every society page.

But her story doesn’t end there. Eight years into their marriage, she left him for a used car salesman. One year later Franz was killed by some intruders who broke into his flat. The needle of suspicion pointed to his wife, who inherited his huge fortune. Finally, however, she was cleared. Today, she is still floating around, making headline news in the European papers for all the wrong reasons.

So, obviously in the hands of a skilled plastic surgeon anything can happen. Men can be turned into beautiful women. Indeed, in countries like Thailand where this operation is in demand, plastic surgeons have perfected the technique.

In fact, Thailand plastic surgeons have also perfected the art of selling their skills to such an extent that they now offer plastic surgery holiday packages. On such a package, American or Japanese clients, for instance, can have body sculpting done for a fraction of what it would cost in their own country and then recuperate in a beautiful seaside resort for a week. Rhinoplasty or eyelid lifts can be done in an hour and don’t require hospitalisation. Lengthy procedures like liposuction, tummy tucks and face lifting take a couple of hours in the operation theatre, a day or two of hospitalisation and at least a week to recuperate.

Once upon a time, mommies were comfortable creatures with soft bodies and blurred contours. Often they didn’t even bother to look in a mirror because they were mommies who just had to look motherly.

But that was in a different era. Today it‘s Mommy Makeover time. Mommies these days take part in beauty contests and TV shows and dance competitions. They also hold jobs, seek promotions and face clients. Grooming is essential. Also, they have to look good in order to feel good. Dowdy moms are just not cool anymore.

Take a look at this ad put out by a plastic surgery centre in the US. It says: ‘Today’s mommies are like no other generation before — they are on-the-go superwomen who juggle hectic schedules while trying to give their children the time and attention they deserve. And as most moms know, your body is never quite the same after childbirth... Your post-childbirth body contour is another issue. What about a wonderful Mommy Makeover, a combination of procedures designed to help you regain a more youthful contour?’
The Mommy Makeover is a personalised combination of contouring procedures targeting ‘weak’ areas which got stretched and pulled out of shape when she gave birth to her little ones and fed them. So, a mom could choose to go in for a breast lift and a tummy tuck. She could also have a facial rejuvenation with an eyelid lift, botox injections to get rid of the laugh lines, lip augmentation, chin and cheek implants, a forehead lift, a mini-incision face lift, rhinoplasty, laser hair removal and laser skin resurfacing. And if she really wants to have the works, she could also have other contouring procedures like liposuction, thighplasty, buttock implants and brachiaplasty or arm reduction.

In other words, she could have herself re-engineered to end up looking like her teenage daughter. In the process, would she end up looking like a plastic stereotype? Do women all over the world want to turn into skinny, long-legged, big-breasted creatures with large eyes, flat bottoms and sculpted noses? Or is that a western ideal?
According to an article in the Time Magazine, the number one procedure by far in Asia is a form of blepharoplasty or eyelid surgery, in which a crease is created above the eye by scalpel or by needle and thread. This is done to change the shape of the eye. Strangely enough, in the US too, blepharoplasty ranks near the top, but there it involves removing bags and fat from around the eyes. Similar procedures but different goals. Westerners use botox to diminish wrinkles, but in Korea, Japan and Taiwan, it is injected into wide cheeks to shrink the cheek muscle in order to get the same ideal Caucasian look.

And then there are some Asian ‘cultural’ requirements. In China, Korea and Indonesia, where virginity is highly prized, young women go in for hymen reconstruction in time for their wedding night. In fact, hymen reconstruction is offered at special student concession rates in some countries like China. In Japan, Indonesia and Korea, men ask for penis enlargement procedures to avoid ‘shame’ when bathing en masse.
I remember watching a Phil Donahue show on ‘recycled virgins’ about 10 years ago. These were American women talking about hymen reconstruction. With them however, it was a fad rather than cultural requirement.

On a similar show, I watched with horror as woman after woman talked about failed silicone implants. I learnt then that silicone implants which were mainly used for breast augmentation could fail in many disastrous ways. Silicone breast implants were first introduced in 1962. Before this, plastic surgeons attempted to enlarge the breast by inserting foam and other materials directly into it. Over the years, the silicone breast implant became one of the most popular forms of cosmetic surgery. Silicone gel contained in a silicone envelope was used for the implant.
But silicone implants were banned for general use in the United States in 1992 after thousands of women reported serious side effects from leaking silicone, including brain, nervous system and connective tissue disorders such as arthritis or lupus. Saline implants were offered as an alternative. Users, however, claimed that the saline devices were not as natural in appearance and texture. Eleven years later, the ban was lifted but with a lot of cautionary advice.
By then breast enlargement and silicone implants had become increasingly popular across the US. Though some women got the surgery for medical reasons, many more had the procedure for cosmetic reasons. According to the American Society of Plastic Surgeons, in the US alone, that number grew from 32,607 in 1992 to 225,818 in 2002. An in–crease of 593 per cent.

Then there are the silicone injections, which are strictly regulated in the US but are widely used without any control in Asia. Silicone is used to plump up noses, breasts and even sex organs. Although the plumped up body part looks great at first, gradually the part begins to droop and has to be redone. More alarmingly, silicone can also cause swelling and tissue decay. If it leaks into the bloodstream it can even result in death.
India is also now becoming a destination for plastic surgery, though it still has a long way to go before it can catch up with Thailand. The problem over here, as in other Asian countries is the lack of proper regulation. In Indonesia, for instance, there are only 43 licensed plastic surgeons, yet apparently about 400 illegal procedures are performed each week in the capital alone. In China, 200,000 law suits were filed in the past decade against plastic surgeons most of whom did not even have a proper degree.

So what can go wrong when you go in for a nip and tuck? Plenty. And you are not always warned about it.
The most common side effects of botox injections around the eyes and in the face include temporary bruising, eyelid drooping (ptosis), dry eyes, double vision (diplopia). A facial droop can occur with injections into the cheek. When injected into the face or neck, there can be some difficulty in swallowing (dysphagia), upper respiratory infection, neck pain, and headache. These complications usually occur when too much toxin is injected or when the right amount is injected but into the wrong muscle. However, the good news is that this rarely happens in the hands of experienced specialists.
Similarly, though liposuction is considered one of the safer forms of plastic surgery, it has its own risks and complications especially in the hands of an unskilled surgeon. In the US for example, more than 50 per cent of the adults are overweight. Although liposuction is not considered a treatment for obesity, not surprisingly, it has become the most frequently performed cosmetic surgery procedure in the country.
Liposuction has evolved over the last 15 years, with the introduction of tumescent and super-wet techniques, ultrasonic liposuction, and power-assisted liposuction. These advances have made the removal of larger volumes of fat with less blood loss easier. However, unless the surgeons are experienced, there can be problems like scarring at the puncture points and unsightly folds.
Going under the knife can also become addictive. Experienced plastic surgeons and dermatologists would be able to counsel would be-clients on what can work for them and what won’t. But ultimately it’s a very personal decision which when taken could transform not just your looks, but also your life. It could be for better or for worse. But it is certainly forever.