A young girl recently told popular writer Jeffrey Archer, ‘I want to be famous.’ She had no clue how she was going to achieve that – no skill would be required, no hard work was needed – fame was, according to her independent of such trivial issues. Today, young women (and men, but we shall stick to our own kind here) are thinking very differently from the way we ever did, or do. It is a generational change in mindset, a greater desire (under all costs) to look wanted and be perfect for prospects – both career-wise and partner-wise. Carrie Bradshaw’s statement to an oversized Samantha in Sex and the City: The Movie, is: ‘You would be fabulous at any size, but are you happy?’ Size, then, does matter, in more ways than one.

And so begins the trend for younger and younger girls willingly going under the knife for beautification treatments. Whether it’s laser surgery to remove scars, blemishes or hair, acne control treatment or serious cosmetic surgery like rhinoplasty, liposuction, breast augmentation and tummy tucks, you would easily find teenage girls (think 14 or 15 years of age) lining up for a piece of the action. Even before their bodies have finished developing, the fear of not being good enough, or not ‘fitting in’ engulfs these young girls – because their mental target is hugely unrealistic. It is like the Barbie dolls they once played with – Barbie’s figure is not humanly feasible – in fact it has been noted that were she to be a real woman with those measurements, she would not even be able to stand straight! In much the same way, girls are chasing a mental image of the ‘perfect’ woman – one who is super thin, super curvaceous (think a big bust size) and has flawless skin. This woman cannot come to life without a good amount of artificial work done on her, and is more likely than not to be an unrealistic image. If she is an image from glossies, she has definitely been photoshopped and airbrushed to look as close to perfect as is possible.

As Mumbai-based cosmetic surgeon, Dr Mohan Thomas, points out, girls who come in don’t even understand their own frame and figure. If they are big-boned they cannot, by definition have a modelesque or Bollywood-inspired size-zero figure. BMI indexes are all fine when working out, but they are not what should be solely under consideration when looking at cosmetic surgery for weight loss or body contouring. These 14-15 year olds, who come in with their parents, “are trying to extrapolate their relationships not functioning to the fact that there is something lacking in them from the physical angle.” Body contouring and liposuction among young girls is also increasingly common – as post weight-loss treatments and even bariatric surgery, women are left with loose, hanging flesh, which they then turn to cosmetic surgery to combat.

Not only has the rise in disposable youth income contributed to this trend, there is a much greater awareness about ‘look and presentation.’ It is possible that what has loosely been called the media blitzkrieg: a barrage of Bollywood glamour, western television shows (Nip/Tuck), reality shows (Extreme Makeover, The Swan, I Want A Famous Face), foreign films, international brands marketed in glossies are all reigning contributors to this phenomenon to look ‘fabulous’ but it is a more pervasive sociological trend: the desire to conform to someone else’s idea of beauty. Beauty remains a perception at best, and at worst it can be attributed to proportion – in comparison to the rest of you, things should just be proportionate. And taking that to an obsessive level, where you lose the attractiveness of slight imperfections and bury your individuality in lieu of a generic or clone-like notion of beauty is where the problem starts affecting your mind and can possibly lead to BDD – Body Dysmorphic Disorder.

Most surgeons admit that of all the patients that come to them for cosmetic surgery, there are enough there who at some level are battling insecurities and psychological weaknesses. Especially if the age of the patient is such that she is struggling with normal teenage anxieties that are manifesting themselves into a greater physiological desire for change – something which should be checked. Most reputed surgeons in India refuse to take in very young patients; they prefer to wait until they are at least over 18 or 19 years of age. In America, however, it is not uncommon to find young teenage girls being giving high school graduation gifts in the form of breast implants or for girls to save up money, or even work towards scholarships so that their education money can be put to ‘better’ use: body ‘improvements’.

Physician groups abroad tend to warn teenagers and their parents from resorting to surgery as a quick fix for a non-existent social life or lack of popularity or self-esteem. An article in the Washington Post, written by Sandra G. Boodman a few years ago, marking this trend in America, related the story of a 19-year-old student who wanted to get breast implants because she wanted to look like Julia Roberts in Erin Brockovich. While her parents were against it, her surgeon agreed to take the fee in instalments, and she went ahead with getting D-cup implants that made her look like ‘a porn star’. A few weeks later, she began experiencing shooting pain in her arms, followed by intense joint pain and crushing fatigue. After months of consultation she discovered she had rheumatoid arthritis possibly brought on by the implants. Her parents took out a loan to pay for removal surgery, post which, her health improved. While not all cases work out this way, it is important for patients to understand the ramifications of their choices and the complications that can ensue.

Dr Thomas, who has practiced in America for a number of years before moving his practice to India, believes it is the strong family system that keeps the teenagers in check here as compared to abroad. “The family atmosphere in India leads them to think collectively – they are prevented from taking decisions on a whim. In my experience, teens don’t come in as often as a rule – if they do, they would likely be victims of ridicule with people problems, psychologically traumatised. And we do realise that ridicule hurts a girl more than a boy.”

While the Chinese give in to a strong, overpowering desire to look fair and blemish-free, we find that young Indian girls choose to emulate the Caucasian woman – in being fairer, more sharp-featured, toned and with bodies that can carry the clothes meant for models. It is possible that we have stopped believing in a strong sense of Indian identity and Indian looks, but are so influenced by the worldwide acceptance of a generic Caucasian beauty that we choose to emulate that blindly, particularly as we get more globally mobile. Dr Thomas, on what he terms ‘the Michael Jackson effect’, received an Indian patient in her mid twenties with her dark hair bleached a strawberry blonde, her skin bleached a few shades lighter, and with a firm desire to look more Caucasian. This young girl is an IT professional working in Germany, and obviously feels more comfortable ‘blending in’ than standing out. Leading cosmetic physician, Dr Jamuna Pai also comes across patients who want to become 10 shades lighter than their own skin colour, or replicate the nose or pout of a famous movie star. “I’ve had parents who have come with a nine-month-old baby girl wanting to know what they could do right now to ensure that their baby remains fair!”

There is no quick fix, points out cosmetic surgeon Dr. Anil Tibrewala, who consults in Mumbai and the UK. “There is the danger of unrealistic expectations that arise out of ads and promos by unqualified people (in dailies and tabloids) who promise afternoon/lunch-break procedures. People need to understand that procedures are not immediate and there is a recovery period.” South Mumbai-based cosmetic surgeon, Dr Sunil Keswani chooses to spend a few sessions with every new patient understanding what makes her tick, involving the patient’s family and if possible close friends, to gauge the seriousness of her intentions.

While there are no lunch-break procedures, there are however, vacation nip-tucks! Many people choose to undertake procedures by taking time off for the entire process and its recovery phase. Dr Thomas has even set up a satellite office in Goa for the same, while Dr. Tibrewala finds a large number of patients coming to him from the UK for a ‘nip-tuck vacation in India.’ So, you take a week or ten days off, get the work done, rest and sightsee during the recovery period and go back ‘brand-new’. And if you are not on a vacation, you are on a mission. A large number of patients are looking for pre-nuptial or bridal treatments. Dr Thomas points out that the ‘feel-good factor’, attached to self-esteem issues is a huge factor. A young woman in her early 20s came to him for breast augmentation before getting married (four months before the wedding). She was very clear about her intentions: ‘I don’t live in a dream world. My partner will expect fullness in my breasts and I want to be able to give that to him. I want to be more feminine…to feel more complete.’

A girl has a deliciously positive reaction to the concept of a makeover – it always means something positive, better and in the Hollywood-version of it, generally more glamorous. So it’s not surprising that young women flock to cosmetic surgeons for ‘bridal makeovers’, not to mention ‘mummy makeovers’ (for post-pregnancy treatments like stretch-mark removal, vaginoplasty, fixing the skin looseness et cetera). A lot of the younger women tend to opt for Botox for thinning of the jaw, early crow’s feet and for preventing excessive sweating in the underarms, laser hair reduction, scar removal, skin lightening, dermal fillers for laugh lines, fillers to build the bridge of an otherwise flat nose, improving jaw contours, plumping of the lips et cetera, or increasing requests for hymenoplasty. Dr Thomas has discovered that in India, when talking about marriage, there are community-related issues that crop up: for instance certain rigid and conservative minority communities expect a hymen to remain intact before marriage, not realising that a physically (through sports) active woman may have disrupted her hymen even if she has abstained from sex.

Dr Keswani, who follows the “under-promising and over-delivering” mantra, believes that while there is a very discerning female population that comes in for treatments, “the expectations are high – they imagine a magic wand will be waved. Bringing down these unrealistic expectations is an important part of primary consultations.” A red flag, for instance, would be a patient coming in for repeated treatments for the same area. “It is dangerous if it is not necessary, as they get very persistent. Many of the patients actually need serious psychiatric help, as they become obsessed and biased. It tends to put the doctor in a quandary. In general, the Indian public is not ready for counselling, it needs to be done subtly.”

And sociologically speaking, beauty treatments and cosmetic surgery are no longer a class issue. While Dr Pai may have a celebrity client list that needs to maintain a high-profile look to match their lifestyle, she and the cosmetic surgeons have all concluded that it is now more need-based (whether real or perceived) than a luxury. Dr Keswani points out that even a lower-middle-class girl who might be working as a stenographer will come in for an estimate, save up from her salary every month and return a year later for the treatment.

Studies worldwide show that statistically, good-looking people earn more than plain-looking people, find it easier to get jobs and of course attract the opposite sex. In fact, better-looking criminals receive lighter sentences! It appears that human beings are hard-wired to respond more favourably to attractive people – what is known as the ‘halo effect’: good-looking people are often assumed to have a number of positive social traits. So if we assume that beauty is a factor which unconsciously influences our choices on a daily basis, are we – equally unconsciously – aiding in promoting a greater desire for ‘perfection’ in the way people look? Is it a sociological trend that is being manifested in the more insecure or sensitive people, people who don’t want to be left out in the greater scheme of things – those who wish not to be looked through or ignored, and are willing to be re-moulded to stand out? While the stigma associated with cosmetic surgery is no longer a factor in consideration as more people understand and accept it, it remains a decision that should be made judiciously at worst and truly need-based at best, after thoughtful consideration of all factors involved.

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