Medicosnext
Look in the mirror, and what do we want to see? We all want the most beautiful version of ourselves, even if it includes, perhaps, a smaller nose, fuller lips, or flawless skin. This is a desire that we all share, as evidenced by the meteoric rise of the beauty industry that is now valued at an estimated $532 billion dollars worldwide and is growing every year. This desire for beauty is leading ever more people to opt for different medical procedures, including surgeries. Medicos Next sat down with Dr. Dharmendra Karn of Cutis Care to get an in-depth view of cosmetic surgery in Nepal.
What is cosmetic surgery?
Although it is used almost synonymously, cosmetic surgery and plastic surgery are not the same. Cosmetic surgery, or aesthetic surgery, as Dr. Karn prefers to call it, is a simpler procedure that is less invasive and requires no extensive surgical procedure. The procedure only requires local anesthetics and no overnight stay at the hospital. Plastic surgery, on the other hand, is extensive surgery that requires the patient to be put under general anesthesia, and often results in an extended stay at the hospital. Surgeries that mold parts of the body into a different shape than before, or grafts skin from one part of the body to another, comes under plastic surgery. On the other hand, smaller procedures like laser treatment, fillers, Botox, etc. are categories under cosmetic surgery.
The term cosmetic surgery itself may not be used in the medical community for much longer. “Aesthetic surgery is the more scientific term. Cosmetic is a term used more by the beauticians. Slowly, we are transitioning to the term aesthetic surgery,” Dr. Karn states.
Scope of cosmetic surgery
Cosmetic or aesthetic surgery, as the name itself suggests, deals with enhancing the existing features without extensive surgery, using only minimally invasive procedures. It works with the texture and color of the skin for beautification. There are two components: aesthetic surgery and aesthetic dermatology. You can enhance your appearance using only creams and ointments, which comes under aesthetic dermatology, while actual surgical procedures come under aesthetic surgery.
Cosmetic surgery has been growing in leaps and bounds in the last few years. Due to growing industrialization and globalization, many sectors, such as banking, retail, etc. have flourished, and it has also affected the lifestyle of the employees. Employers are now image-conscious and look for employees with good soft skills, manners, and appearance to go with their brand. “The beauty industry has grown exponentially in the last ten years, because of factors like job opportunity—jobs that are service-oriented need employees who are confident and have an attractive appearance in terms of their looks and dressing,” explains Dr. Karn. While an employee’s sector-specific knowledge and skills are essential for the job, the image they portray with their language, manners, style, and appearance, and its impact on the brand they represent is also becoming vital.
Another factor that is driving clients towards cosmetic surgery is their increased economic capacity. As the living standard of Nepalis is increasing, their ability to afford cosmetic interventions is also increasing, as is their exposure to the options available. This has led them to increasingly opt for cosmetic intervention to enhance their appearance.
However, as far as possible, people still prefer simple cosmetic surgery to more invasive surgical procedures like plastic surgery. “In order to look good, people are not willing to go for bigger surgeries that require them to get admitted to the hospital, or is very invasive,” states Dr. Karn. “They want procedures with less down time.”
Currently, there are several issues that patients regularly come in for. “Among the young generation, common complaints they come with are moles, birthmarks, and scars. These can be easily removed by laser treatment. Similarly, other common procedures include hair removal, tattoo removal, etc.
Hair transplant is also a very popular intervention that patients seek. “It’s not only men that come in for hair transplant. We’ve had women come in to have hair transplants, especially women with high frontal lines, and people with burn scars, where hair growth stopped. We also get a lot of people who seek eyebrow transplant to get thicker eyebrows.”
Besides enhancing appearance, aesthetic surgery also plays some role in addressing serious concerns like burns, which helps patients reclaim their lost look. While aesthetic surgery can address such serious issues, treatment more often than not comes under plastic surgery. “In case of burns, the treatment depends on the type of burn. For a superficial or minor burn, we can help them using aesthetic surgery. But, for deeper burn cases, they need the help of a plastic surgeon,” says Dr. Karn. “I recently had a case where someone came in with extensive facial burns. We referred them to a plastic surgeon, because that does not come under the scope of aesthetic surgery. However, dealing with the scar marks that will remain even after the plastic surgery, that comes under aesthetic surgery, and it’s something we can help the patient with,” he further explains.
Benefits and risks of cosmetic surgery
Cosmetic surgery has shown great benefits for its patients. As Dr, Karn states, the impact that he has seen cosmetic surgery have on his patient’s self-esteem and general mental wellbeing, especially among his younger clients, is incredible. “I love working with young clients, as they are my happiest clients,” he says. Cosmetic surgery can have great positive impact on the lives of the patients, including better self-esteem, self-image, and greater opportunity in the professional world due to improved image in an image-conscious world.
However, there are risks to cosmetic surgery, as well. Doctors are only human, and there is always a slim possibility of accidents or human errors. As Dr. Karn describes it, “Even when you drive carefully, there’s always a slim chance that you’ll get into an accident.” Besides, there is also the possibility of unmet expectations. “I am very selective about the patients I take in,” he says. “Some patients come in with unrealistic expectations, so I prefer to under-promise and over deliver.”
Counseling the patients is another major part of cosmetic surgery. Doctors should not rush into procedures, but rather, start with counseling and simple interventions like creams and ointments, before moving to bigger procedures to address the issues that the clients have come to cure.
With the increasing numbers of doctors, Dr. Karn advises that any patient coming in to address an issue be aware and do some research about the procedure and the practitioners who perform it before choosing one.
Technology in cosmetic surgery
The technology used in cosmetic surgery has grown in leaps and bounds in the last few decades. “Twenty years back, if one wanted to get rid of wrinkles, they would have to perform a facelift, where the doctor cuts your skin and stretches it to remove the wrinkles,” says Dr. Karn. But now, aesthetic surgery has come up with better alternatives, such as Botox, injection, laser treatment, and fillers, which do the same job without an extensive and invasive surgical procedure.
There are several procedures that are used in cosmetic surgery. The most commonly known procedures include laser treatment for different issues, including scar removal, spot removal, hair removal, wrinkle removal, etc. Similarly, Botox, injections, fillers, etc. are also used as a routine part of cosmetic surgery.
Even among these procedures, there are a lot of technological options. For example, in case of fillers, one can opt for artificial fillers as well as natural fillers, where they take the fat from one part of your body and inject it into another part to give it a fuller appearance. This procedure is called fat transfer. Another similar procedure is liposuction, where unwanted fat is removed from certain parts of the body.
Similarly, the equipment and technologies are also ever evolving. “It’s like mobile phones these days. Every year they come up with slightly better versions,” Dr. Karn says. The ever-evolving technology also has a financial impact, as practitioners like Dr. Karn have to balance introducing the new technologies with the ability of the consumers and patients to absorb the cost of introducing the technology.
Dr. Karn has also been personally involved in the introduction of new aesthetic surgery technology in Nepal, and has seen the growth in technology within cosmetic surgery. “When I started my practice in 2007, there was nothing here in Nepal. I introduced aesthetic surgery here. Back then, I’d have to import everything I needed from abroad. We started with chemical peels and then introduced Intense pulse light laser, Fractional laser, long pulse laser, diode laser, and more,” he recalls. He has since introduced other technologies, such as fat transplant and melanocyte transplant (for treatment of vitiligo), as well.
Prevention vs. cure
While Dr. Karn acknowledges the leaps made in aesthetic surgery and its ability to address any issue related to skin and appearance, he still advises prevention rather than cure. “For example, when you’re dealing with acne, if you intervene in time, it can be cured. But if that acne is not taken care of, it can lead to scarring of skin and similar issues. Now, to address the scarring, we’ll need to opt for procedures like laser treatments and minor surgeries.”
A major problem these days is that people are not conscious and don’t know who to seek to get the intervention they need. A point of frustration for dermatologists like Dr. Karn is that people take skincare advice from friends, beauticians, and non-medical professionals, rather than coming to trained dermatologists. “Just like you go to a psychiatrist for counseling, you need to visit a dermatologist to take care of your skin,” he explains. Many of the younger generation do come to Dr. Karn for skincare counseling and preventive care, many of whom have seen the adverse effects of bad skincare on their mother’s skin. “You don’t just see a dermatologist when you have a skin disease. My focus is always on care and prevention, rather than cure,” he says.
