The demand for invasive and non-invasive cosmetic procedures within the country is on the rise, be it a tummy tuck, a nose job or a face lift. This comes as a surprise as India, once known to be a conservative nation, has broken the realms of all old guards to become one among the top five most popular destinations in the world for cosmetology procedures. The evolution of cosmetic surgery in India is mainly backed by the changing outlook of the country. Gone are the days when they were known to be just a high class hangover- an option only meant for celebrities or for highly beauty conscious men and women of the affluent class. Today, being conscious about one’s looks is in vogue even among the lower rungs of the society, especially the middle class. Men, women and even teenagers are opting for these surgeries to get lucrative jobs, best possible marriage partners and primarily to get rid of any deformity that has a negative impact on their self confidence and self-esteem.
Market watch
Changing perspectives of people and increasing demand for cosmetic procedures have turned the cosmetic procedures sector into a full fledged industry that has been witnessing accelerated growth. Currently, the size of the Indian cosmetic surgery industry is approximately $5.7 billion, as per various research reports. The key drivers for growth are rapid urbanisation, rising economic capacity, changing lifestyle of people, growing awareness of cosmetic procedures and availability of better infrastructure. Non-surgical face lifts, botox treatments, derma fillers, instant teeth brightening, ultrasonic lipolysis, chemical peels, body contouring, abdominoplasties, breast surgeries, nose surgeries, body contouring following bariatric surgeries for massive weight loss; laser hair removal, microdermabrasion, sclerotherapy, breast augmentation, liposuction, nose reshaping, eyelid surgery, and tummy tucks are some of the procedures that have huge demand. India is now looking to further its reputation in the services sector by targeting the $36 billion global market for cosmetic medical services, or cosmetic surgery, which is growing at over five per cent annually, states an industry report released by IBI Partner, an Asia-focused market research agency.
 “Absence of an accreditation body for recognising such courses restricts the development of training institutes and deters prospective students from considering this as a career alternative.” Dr Manjiri Patankar Puranik Founder, InstaSculpt |
“India is viewed as one of the most progressive countries for cosmetic procedures and this trend is expected to continue in the near future. This is mainly due to the fact that cosmetic procedures has evolved beyond the traditional concept of being a ‘risky’ or ‘impractical procedure’ that was demanded by women who were overly conscious about their appearance. Today, people in India understand that cosmetic procedures are highly specialised and advanced niche of aesthetic procedures which help people attain happiness with fewer risks and greater affordability,” informs Dr Manjiri Patankar Puranik, Founder, InstaSculpt.
 “With Indians becoming increasingly conscious about their appearance, the cosmetic procedures industry is very soon going to see a healthy increase in the number of people who opt for such procedures.”Dr Abraham Zachariah Seven Hills Hospital |
“Cosmetic surgery market is a burgeoning segment of the healthcare industry in India. With Indians becoming increasingly conscious about their appearance, as is evident from the way the wellness industry is booming, the cosmetic procedures industry too is very soon going to see a healthy increase in the number of people who opt for such procedures – both for medical purposes as well as otherwise,” feels Dr Abraham Zachariah, a leading cosmetic surgeon from Seven Hills Hospital. “Today, cosmetology has evolved to a great extent in India. I have clients coming from middle class families who are ready to pay even Rs 5000 per session in order to avail these treatments,” chips in Dr Bindu Sthalekar, Consultant Dermatologist and Cosmetologist, Harkisondas Hospital.
 “The cost of the procedures are very competitive in India. The procedure can be done any time without long waits for a consultation appointment as in US or Europe.”Dr Charu Sharma Head, Aesthetics & Skin Trainings, VLCC Institute |
Observing the upswing within the cosmetic procedure market, Dr Charu Sharma, Head, Aesthetics and Skin Trainings, VLCC Institute points out, “There has been a notable surge in the Indian cosmetic or aesthetic procedures during the past five years, mainly because of the increasing demand for aesthetic procedures from people in the urban cities of Mumbai, Delhi, Kolkata, Chennai, Bangalore, Pune and Chandigarh.” Some major players in this segment are Kaya, VLCC, Yash Birla-owned Evolve Med Spa, Fortis, Apollo, Max Healthcare. Seeing the potential of the sector more and more cosmetic and aesthetic clinics have sprung up within metros and even in tier-II cities and towns. Many leading hospitals in India have also opened their doors to cosmetology within their hospital set-ups by establishing a separate department for such procedures. The market dynamics of this sector has been carefully studied by many analysts and various reports and surveys conducted indicate that the cosmetic surgery market holds immense growth potential in the coming years. A global survey conducted by the International Society of Aesthetic Plastic Surgery (ISAPS) reveals that India was ranked fourth with 894,700 surgical and non-surgical cosmetic procedures in 2010, thus accounting for 5.2 per cent of all procedures done worldwide. Comparing the Indian market with its immediate competitors, IBI Partners state that the Indian cosmetology and aesthetic surgery market is now 14 times larger than Thailand’s cosmetic surgery market. RNCOS on the hand estimates that the industry is poised to expand at a CAGR of around 17 per cent between 2013-2015. Kuick Research, a market research company based in Delhi, also observes an upsurge of cosmetic procedures in India. According to a report published by Kuick Research, the cosmetics surgery market is witnessing more than 30 per cent annual growth in recent years.
An edge over others
With several factors working in favour of the cosmetic surgery sector, India certainly has an advantage over its competitors. Firstly because India has around 2,500 certified plastic surgeons and their number is fast growing. Among these, a sizeable number of these doctors have been trained in the US, the UK and Germany and have been certified by the American Board of Plastic Surgery. Many of these doctors have had long careers in various international cosmetology institutes before returning home to practice. Secondly, India today has the best of medical technology needed to perform complex cosmetic surgeries. Says Dr Sharma,“India is at par with any other part of the globe. We have the best of technology available, almost everything which a doctor uses in the US.”
Expertise is another area that has attracted a lot of people to opt for highly advanced cosmetic surgery in India. For example, Dr Zachariah has constantly been in news for performing a successful trans-umbilical breast augmentation (TUBA) method of breast augmentation at Seven Hills, Mumbai. He was personally trained by the American inventor of this procedure—Dr Gerald Johnson of Houston.
Tapping medical tourists
 “The cosmetology segment in India will have to be monitored as there are many new non-proven procedures being brought into the market by companies who have no approvals for these procedures.”Dr Mohan Thomas Sr Cosmetic Surgeon, Breach Candy Hospital |
The influx of medical tourists has also helped the cosmetic surgery market to cash in a lot of profits. In line with a report published by Deloitte, as many as 10 million Americans were seeking medical remedies abroad last year despite the economic slowdown faced by them, and India had its eyes trained on them. Explaining how the growth of the cosmetology and aesthetic procedures market has brought a positive impact on medical tourism in India, Dr Mohan Thomas, Senior Cosmetic Surgeon, Breach Candy Hospital brings out, “In the past five years, the number of people travelling from the West or from the Middle East has increased tremendously. This has happened because of the expertise of the Indian doctors, being up to date with recent advances in cosmetology and also because of the procedures being provided at a cheaper cost as compared to their countries. Further on, with increased interest of people in Indian culture and tourism, more and more people are coming in as tourists and add on cosmetic procedures to the package. Bringing up the cost factor, Dr Sharma points out, “The cost of the procedures are very competitive in India. Most of the procedures are available in India. The procedure can be done any time without long waits for a consultation appointment as in US or Europe.” Dr Thomas goes on to quote from a report published by the Planning Commission of India that shows the huge cost advantage that India has. The report reveals that in general, a plastic surgery procedure that will cost $20,000 in the US and $10,000 in Britain, will be $3,500 in Thailand will only cost $2,000 in India. Speaking about the advantage of being a hub for alternative medicine, Dr Thomas continues, “Besides cost-competitiveness, India also has a unique advantage that could catapult it ahead of its peers Thailand or Singapore. It has its tradition of Ayurveda and yoga, both Indian-origin practices that are now being perceived the world-over as complementary rehabilitative practices to modern surgical procedures. With increased interest of people in Indian culture and tourism, more and more people are coming in as tourists and add on cosmetic procedures to the package.” Moreover, analysts within the industry also note that there are scores of entrepreneurial plastic surgeons and travel websites in India who are now using the Internet as a tool to tap the cosmetic procedure market. They call it the ‘nip and tuck’ or ‘pop for an op’ market in the online space. With their web advertisements they highlight how these prospective medical tourists can avail highly specialised cosmetic services during their travel at best available price.
Going for the gold
The growth of the Indian cosmetic surgery sector has also led to a tug-of-war between global and domestic players. Shedding some light on the same, Dr Puranik explains, “Global (cosmetic surgery) brands are up against tough competition in the Indian market, as domestic players have decades of consumer loyalty and knowledge of the market. There is cut-throat competition due to the presence of large number of domestic players. Moreover, there is a surge in the number of established foreign brands who have already entered or are trying to enter Indian market to tap the immense growth potential.”
Future growth prospects
In the years to come, experts predict that the Indian cosmetic surgery market will continue to grow. Dr Thomas feels, “In the coming five years, the cosmetology market will more than double and the increase primarily would be in the non-surgical segment. With more and more people wanting changes on the go, undergoing major surgical procedures with an associated downtime would be left to the end. If current growth rates continue into the next decade, the future demand in cosmetic surgery will be driven largely by non-surgical procedures. The growth of surgical procedures will be met by trained surgeons. However, meeting the projected growth in non-surgical procedures could be a potential challenge and a potential area for increased competition.” “Non invasive solutions are a major trend that will continue into the year 2013. Consumers seem to seek innovative products that provide multifunctional benefits. With many people living the fast-paced lifestyle consumers are drawn to more simplicity and how they can enhance their at-home treatments. The increasing acceptance, availability and affordability of many non-invasive cosmetic treatments will be fostering,” reckons Dr Puranik.
Thorns in the rosy picture
Although India’s thriving cosmetic and aesthetic surgery market has opportunities galore; however, there are many shackles to break. Inspite of having many factors that work in India’s favour, industry experts notice that there are many deterrents as well. The biggest concern is the lack of legal bindings on the practice and lack of regulations, especially when it is about the safety of patients seeking such treatments.
Dr Thomas warns us about the legal issues that hospitals and cosmetologists may have to face. He goes on saying, “Unlike mainstream medicine there are no standards of care and the end point is subjective as well as dependent on the expectations of the patient. A great deal of time is required with the patient, which may not be feasible in a hospital setting. Effective communication, assessment of the patient needs, patient selection, psychological evaluation and compliance of the patient contribute to the final outcome as well as acceptance by the patients. Conflicts are bound to occur along with stand-offs which need to be managed quickly, effectively and in a sensitive manner. Globally speaking we live in a litigious society, however, fortunately in this country the legal awakening has been slow. While the reprieve is temporary, one must gear up for it. Legal hassles may also include questions about the area of care and where the doctor and the paramedical staff pick up and leave after the treatment is initiated. There will be several grey areas regarding areas of expertise, onus of responsibility and instructions about discharge. Patient compliance which is essential needs to be assessed and documented and may be the weak link in the chain of care. Comprehensive patient counselling, windows for addressing of complaints or dissatisfaction and binding arbitration may be ways to prevent long and expensive litigation. Medical records become extremely important for any adjudication.”
“There is a general feeling amongst medical tourists that the mechanisms in place to address complaints may be non-existent or long drawn out. In their minds patients’ bill of rights is neither well defined nor is there a scope for legal recourse. The legal recourse seems muddled and long drawn out. This now becomes a control issue for people seeking such treatments as mentioned above. The feeling of being helpless or having no rights cannot be accepted by overseas patients,” he adds. Dr Puranik talks about what restricts potential healthcare providers and professional from exploring this sector, “Absence of an accreditation body for recognising wellness courses restricts the development of good quality training institutes. This also deters prospective students from considering such courses as a viable career alternative. There is a clear need to motivate private players to participate in wellness education and training. Lack of sufficient incentives has limited the number of participants in this space,” she says.
 “Opportunities are several. The problem is aggressive marketing which is actually banned by the Medical Council. Also, there are misleading ads, and there are many non qualified people who are advertising impossible cures and solutions.”Dr Mukund Jagannathan Consultant Cosmetologist, Kohinoor Hospital, Mumbai |
Highlighting certain illegal practices within the sector, Dr Mukund Jagannathan, Consultant Cosmetologist Kohinoor Hospital Mumbai alludes, “Opportunities are several. The problem is aggressive marketing which is actually banned by the Medical Council. Though quacks and non-qualified people are marketing themselves extensively, making tall claims and promises, it is illegal. The basic problem is too many specialities doing large portions of cross sections of procedures. There are misleading ads, and there are many non-qualified people who are advertising impossible cures and solutions. Basically more and more people are now aware of these procedures and are looking for solutions, but most of them don’t have a clear direction in which to ensure that they are treated by the correct person.” In addition to this, Dr Jagannathan also notes that with the government levying an additional 12.5 per cent service tax for cosmetic procedures, the overall bill has been pushed up. This has forced several people to hide these procedures or mark it under a different name, which again is an illegal practice.
Dr Thomas further urges industry players to keep a close watch on new procedures that are introduced. “This segment will have to be monitored as there are many new non-proven procedures being brought into the market by companies who have no approvals for these procedures. These have not been studied long term nor have been peer reviewed hence patients should always be wary of new non-surgical techniques, new chemicals or new lasers which have not been studied and compared,” he advises.
In conclusion
Well, keeping guard against all that is taboo according to our legal system is a must. There is a dire need for market players to strictly follow the law of the land and work towards building strategies that will help augment the growth of cosmetic surgery as a field of expertise in India, as well as the industry at large. Moreover, emphasis needs to be given to education in this field so that with increasing demand India will also have enough experts to cater to the demand.
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