Cosmetic surgery gets a lift

Christian Cotroneo, Foreign Correspondent

• Last Updated: May 24. 2008 10:23PM UAE / May 24. 2008 6:23PM GMT

Dr Lokesh Kumar, a plastic surgeon specialising in liposuction, says his services are in great demand. J Adam Huggins for The National

NEW DELHI // In a stylish waiting room, magazines on a glass table tout the latest fat-busting procedures while an Indian family anxiously awaits an appointment with Dr Lokesh Kumar, a cosmetic surgeon.

Flanked by her parents, the teenage woman, has already managed to shed considerable weight. But now she wonders what can be done about the stretch marks.

“We can’t remove them completely, but we can improve upon them,” Dr Kumar said.

The woman’s parents are anxious to help their daughter, for their own benefit as much as hers.

“Social pressure is there,” Dr Kumar said. “They want their daughters to be married.”

Indeed, that pressure, combined with a booming middle class and some of the cheapest cosmetic surgery rates in the world – a liposuction procedure costs around Dh4,340, a tenth of what is charged in the United States — are conspiring to change the stereotypical image of the portly Indian.

The waiting-area coffee table of Dr Kumar’s office. J Adam Huggins for The National

Since opening the Delhi Aesthetic Clinic in 2002, Dr Kumar’s client base has steadily increased.

“Obesity was always there,” he said. “But I think people are coming forward more and more, probably because they can afford it.”

Most notably, it is the nature of his work that has changed.

When Dr Kumar, 51, opened his practice in 2002, the vast majority of his patients required reconstructive surgery following disfiguring accidents. Today, only about 10 per cent of his work is reconstructive and the rest is cosmetic.

Cosmetic surgeons in India may also have genes to thank for their surging success. This month, a team of British researchers found genetic variations in Indian adults that cause obesity and an increased susceptibility to diabetes.

On average, Indians with such genetic variations are 3.8kg heavier than people born of European ancestry and their waistlines are typically 2.8cm larger.

The study also found that the same people are far more resistant to insulin – a discovery that does not bode well for the country’s spiralling diabetes rate.

Since 1972, diabetes among urban Indians has skyrocketed 600 per cent, according to a February study conducted by the World Health Organisation and the Indian Council of Medical Research. The study pegged the diabetes rate among city dwellers at 14.6 per cent.

“It is getting worse due to rapid change in lifestyle which includes both dietary change and sedentary habits,” said Ambrish Mithal, a senior consultant at Indraprastha Apollo Hospital’s Endocrinology and Diabetes department.

A major reason for the surge, said Dr Mithal, was the mass movement of people from rural areas to big cities, where high-fat, low-fibre diets and sedentary lifestyles prevail.

Dr Kumar agreed, and said that the prevalence of public transport in Delhi was also a contributing factor. “If you go to a small town people walk a lot more, but in Delhi they take public transport or use a car,” he said.

“They’re working most of the time and they’re eating pizza and burgers and all those things.”

Census figures from 2001 indicate a swell of Indians moving to cities in the last 30 years, from 107 million people in 1971 to 286 million – a leap from 19.91 per cent to 27.8 per cent of the overall population.

Pharmaceutical companies are taking note. Late last year, Eli Lilly introduced a Type-2 diabetes fighter called Byetta, and Merck, a rival company, plans to introduce its own product. The insulin medication industry is estimated to be worth US$4 billion (Dh14.7bn), with 10 per cent annual growth.

Cosmetic surgery is also frequently cited as a less subtle diabetes combatant – although the verdict among professionals remains unclear.

Dr Kumar, who performs about 10 liposuction procedures a month, believes that the treatment has similar benefits to losing weight as diet and physical activity and can stave off diseases such as diabetes.

“It helps tremendously,” he said. “And then they are encouraged to exercise.”

That opinion contradicts a 2004 study published in The New England Journal of Medicine, which suggested liposuction does not reduce the risk of heart disease or diabetes, India’s number one and number two causes of death, respectively.

“Sucking it out does not give metabolic benefits,” wrote Samuel Klein, the first author of the study and director of the Center for Human Nutrition at the Washington University School of Medicine in St Louis.

Diabetes, however, may be the last thing on the minds of Dr Kumar’s affluent clientele, keen to seize on the cosmetic benefits of surgery.

“The new generation is pretty fit,” Dr Kumar said. “They’re aware of their fat.”

“A lot of disposable income is there. [People] are earning more and they want to spend on themselves.”

And with each procedure costing a fraction of what it costs in the United States, Indian cosmetic surgeons are also cutting into the international market, with customers from image-conscious Australia, the US and Europe.

“It’s starting now,” Dr Kumar said. “It’s a new market.”

ccotroneo@thenational.ae