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Cosmetic Surgery, Evolution & Kolkata

In the last fifteen years, there has been a dramatic change in the medical scenario. From the age-old teaching of ‘in my experience’ it has evolved on to one of ‘evidence based medicine’, i.e. has it, the desired result, as has been described?  With advent of modern newer techniques the cost of medical treatment has also increased. There is no substitute for quality treatment, but at a price. If you want quality you have to pay the price. Each and every person wants the best. But where is that money, which is going to give the best come from?

Kolkata is not economically strong enough for the government to cater to this advanced quality medical care where consumables are expensive. With this newer concept in mind there has been an outgrowth of private hospitals, which are in no way inferior to any of the leading centres in India and the world. They have got the amenities, but you have to pay for it. There has also been an influx of foreign trained medical personnel, equipped with the latest methods of treatment. In short there is facility in Kolkata like any other metropolis in the world; and both from equipment point of view and expertise. Now to avail this quality medical care, which is available in Kolkata, a common man is faced with the burden of excess expenses, which they sometimes wrongly attribute to the corporate sector overcharging, which is not always the case.

When treating a patient there is no “second cheaper alternative’, because that compensates on quality. For example a simple K-wire used for fracture might be the cheapest but in no way the best. To avoid osteomyelitis (bone infection) on a broken bone, you need a rigid fixation. Stainless steel plates might be cheaper, but again is a compromise. If we have to put titanium plates, which are the best with the least problems, it costs. In plastic surgical scenario there have been a lot newer modalities that have emerged in the last few years. From liposuction to microsurgery to laser to radiofrequency rejuvenation, all are available in Kolkata, as per international standards, as well as expertise too. But a microsurgical stitch is ten times more expensive than an ordinary stitch, and it does involve long hours of surgery, which escalates the cost of consumables.

In the present day economic scenario of Kolkata, no government can provide this service ‘free’. Yet a significant amount of population is at lower socio-economic strata. Just like we have to buy food, clothing and shelter, so also in modern medicine, we have to buy health. The only alternative is to take out an insurance policy, to cover these medical expenses.

There has also been a socio-cultural change in the philosophy of life. With the wide prevalence of the electronic and print media, bombarding at our doorstep and the insurance companies securing our future, the philosophical outlook towards life has also changed from ‘securing for future’ to ‘living for the present’. It is either a holiday to Maldives or Bangkok, booking the latest car or having a ‘boob job’. It is the philosophy ‘I want it’. We cannot deny the fact that for elementary living, we need two square meals a day, a roof over our head and a little bit of cloth to cover our shame. The rest is a question of ‘desire’ – I want, and I want to live the way I want. It is a state of mind as to what gives you happiness. If it does, go for it. Today’s young lady is no longer dictated by parents, as when they should come back home or what dress they should wear. A housewife is no longer ‘an element’ to cater to her husband’s and family’s needs. She has a mind and independence of her own. She has got her own likings. She has to go out to earn money and she can herself afford her own luxury tit-bits.

If she wants to look beautiful by enhancing her breasts or is unhappy with her nose, or wants to get rid of the facial scars, she is ready to go under the knife. There has been an outbreak of beauty parlours and fashion shops to fulfil her primary wishes. But the question arises- do these beauty parlours have sufficiently trained personnel to look at their wishes? Why not go to a grocery shop owner to have your eyebrows corrected rather than an extravagant untrained beauty parlour. It will be cheaper. “Cosmetic” is word that sells. Anyone can put a tag in their name and call themselves a ‘cosmetologist’. But the real truth is it is only the plastic surgeons, who are trained in this science are qualified to practise this medicine.

In the past, to marry an ugly looking daughter, the father had to shell out dowry, to get a suitable groom. With the dowry system gone to oblivion, the humble parents have to resort to the plastic surgeons, to make their daughter acceptable to the be-fitting groom. The dress culture has undergone a radical metamorphosis – from the sari clad, half face covered housewife, to a modern lady wearing designer tops and partly revealing fashion dresses. With exposition of more and more bare skin and curvature, to get that curvature corrected has become an accompanying necessity- so also has there been a rush for cosmetic surgery. Even a poor housewife from a village would have it done, if she can afford it. And it is affordable too. The realm has shifted from people in showbiz to the girl next door. Maybe she will be in the television tomorrow.

With the family being more and more consolidated to nuclear structure, the housewife has her independence too. She has to convince her husband and no one else. If he is convinced, she can have it done.

With the sun rising in the eastern horizon, Kolkata is also rising to evolution of modernisation in every form. There is a future, a future for prosperity, progress and dominance. There are some steps to go towards this dominance. The para-medical training and professionalism has to increase more to bring it up to international standards. The academic scenario has to improve where Kolkata can itself generate its own successors in the field of medicine, rather than trained personnel from other places. And the unheard of avenues of medical treatment brought to the awareness of masses. We have the set-up for dealing with cranio-facial problems, where skull bones fuse to impair normal development of brain. If these bones are re-modelled making more space for brain to develop, some mentally retarded children can develop into normal human beings. Birth defects are not covered by insurance. It is high time for the insurers to look into these deficiencies of cover, to give the policyholders more versatility of choice.

If a nerve is damaged above shoulder, we term it as ‘brachial plexus injury’. This can be treated by surgery. Of the four trained surgeons in India, we have one in Kolkata. Only they must know where to go.

The treatment of congenital defects starts from the day when the baby is born, not when it has become a necessity. Please consult a plastic surgeon; the next day the baby has a birth defect. He may guide you to the right modalities of treatment. Sometimes delay can be a disaster.

In the last one-year, new techniques of cosmetic surgery have emerged. Three years back, we introduced Botox to Kolkata in a seminar held at Apollo Clinic (Theatre Road). Since then Botox has been immensely popular to the extent, anyone in Kolkata started doing Botox treatment at a much cheaper price than qualified plastic surgeons. The competition became so intense at reducing the prices that the treatment price fell below the cost price of a Botox vial!!! Botox works well, but the only disadvantage was it lasts for 4 months.

In the last year, a new method of permanent treatment of forehead wrinkles and lifting chin has come up in western world and now available in Kolkata. This is by process of introducing special threads called CONTOUR THREADS or APTOS THREADS.  It can be done under local anaesthesia and probably slightly more expensive than Botox. Though, thread lift can be done as an alternative to face lift, I still feel its role in facial rejuvenation is limited to those who are not trained to carry a SMAS or a composite lift, whose results have been proved to have long lasting value.

We were using collagen fillers as Restylane in the past, but this also like Botox lasts for 4 to 6 months. We had tried fat injections, but they dissolve in one years’ time. As a permanent solution, I was not using either of these techniques. I was injecting Artecol, as Lemperle, who is the inventor of Artecol, had trained me. This need special training otherwise results can be disastrous. Recent reports have revealed they form granulomas in the long run. A more recent solution to this is use of Reviderm, which lasts for 5 years, or Aquamid, which lasts for 10 years, which again needs training but have not been reported to have adverse effects.

In breast reduction and mastopexy there has been a continuous metamorphosis of technique. The aim has been to reduce scars and give a better shape. As cosmetic surgery involves fighting gravity, newer modifications of breast reduction and mastopexy technique have come up to fight the gravitational element. Will the breast remain lifted even after 5 years? The techniques practised by us are aiming at that, but time can only confirm its authenticity.

People have misconception about liposuction. Liposuction has nothing to do with obesity. Obesity is combined approach between a physician, dietician and plastic surgeon. Liposuction corrects body contour problem. The old theory of liposculpture preached throughout the world has disappeared owing to its incompletely trained abuse leading to serious contour problems. However, in trained hands, it still has a role.

Lip enhancement techniques have emerged for those who want to make it prominent.

With CONTOUR OR APTOS threads, a depressed look in the eyes can get a brighter appearance.

Practice of medicine is a process of evolution. Fashions change and with that, new techniques evolve to replace the old. Some stay, others, which cannot pass the test of time and clinical consistency wither away. Only what is genuine, authentic and proven lingers on.

Kolkata has a lot to offer. No point in thinking of going to Chennai or Vellore for better treatment. Maybe the person treating you in these places is fifteen years junior to his counter-part in Kolkata and maybe not as up-to date and experienced compared to the one in Kolkata. The question is finding the right person. It is better to rely on medical advice as that knows the job, than rely on family friends and relatives advising you, when you are puzzled. If the people understand this, you will find the surgeon next door is good enough. The other words of caution- beware of the ‘flying doctors’, advertising and coming for a weekend consultation. They may be a worse choice than a doctor next door, who will take care of you at 2 o’clock in the morning, if there is problem.

They said one day ‘The Sun never sets in Britain”. With the fast expansion in the healthcare sector, already we are getting foreigners flocking into Kolkata for quality healthcare at an affordable price. With the rising of Kolkata, maybe tomorrow, with the dawn of a new era, Kolkata may become the “Mecca” of the healthcare of the world.