May 22, 2003

In the world of the beauty conscious, plastic and cosmetic surgeries can assure a new you but with some side- effects, writes Shanaz Ramzi

Beauty, they say, is skin deep. But in a world that has become increasingly conscious of appearance, skin is now of paramount importance. More and more people are beginning to spend, time, energy and money on maintaining, nay, improving their looks. The consciousness has caught on locally, too, making plastic surgeons and cosmetic dermatologists the most sought after in the beauty world, who do not feel the pinch in a flagging economy.

Before one dwells on the various aspects of the facilities on offer, it might be apt to distinguish between the three facets of cosmetology — plastic surgery, cosmetic surgery and cosmetic procedures — in vogue these days.

Plastic surgery, to begin with, is not a new concept to this part of the world. Basically making its genesis in the subcontinent, it was introduced by one Shustra as far back as 230 BC, primarily for the reconstructing of the nose using flaps and drafts. Receiving an impetus after World War II for obvious reasons, today, plastic surgery is synonymous with reconstructive surgery. For the purpose of this article, however, it is the other two facets that we will be concentrating on.

Cosmetic surgery, unlike plastic surgery, aims to make a normal-looking person appear better. Such surgeries have been carried out for years by general surgeons, who in the days of yore were trained to perform all kinds of procedures.

However, with time, as specialization became the buzzword, these surgeries have also become the domain of plastic or reconstructive surgeons. Among the cosmetic surgeries in vogue today are liposuction, tummy-tuck, body contour surgery, nose job, facelift, eye-bag correction, skin fillers, earlobe correction, eye-lid reduction, brow-lift, dermabrasions and breast surgery.

While both plastic surgery and cosmetic surgery are invasive, in that the procedures entail cutting, bleeding and stitching, cosmetic procedures are regarded by cosmetic dermatologists as non-invasive.

These procedures are carried out without the use of a knife, so there is no bleeding and stitching. Popular cosmetic procedures include laser hair removal, laser skin resurfacing; skin peeling; removal of moles, birthmarks, scars, warts and facial pigmentation; and botox and collagen implants for facial lines. While plastic surgeons also conduct these procedures, they are being widely offered by cosmetic dermatologists.

Says Dr Shaista Effendi, head of the Plastic Surgery and Burns Department in Dow Medical College and Civil Hospital, and the only female and senior-most practising consultant plastic and cosmetic surgeon in the country, “There is hardly any part of your body that you cannot change these days. In fact, the neck and the back of your hands are virtually the only portions that you need to really look after now, as nothing can be done to stem their aging process.”

According to Dr Afzal Lodhi, one of the leading cosmetic dermatologists, practising in Karachi for the last nine years, there has been a radical increase in awareness over the last four or five years of the kind of facilities available to transform one’s appearance. “The result is that more and more people are clamouring for them. My patients are mostly women from the age group of 30 to 50 years, coming in for various cosmetic procedures, which we call “lunchtime procedures” since they are so quick and hassle-free. They are absolutely non-invasive since there is no cutting, bleeding and stitching involved and no anaesthesia, so people are not scared of getting them done.”

However, Dr Mazhar, a plastic surgeon who has been practising in Karachi for the last four years, prior to which he has been a consultant of plastic surgery in New Castle, and had his own private clinic in London, opines: “People here are admittedly as aware of cosmetic surgeries and procedures as in England. The difference is that often they don’t know that the facilities are being offered locally, too. If they do know, they are often wary of availing them here as they are not as confident of local treatments.”

Dr Lodhi is of the opinion that cosmetic procedures have no side-effects other than a hole in one’s wallet. In fact, he even rejects any misgivings about the controversial botox injections, the paralytic effects of which have been written about in the west. “The botox injection taken to soften facial wrinkles is FDA approved, and its only side-effect is that it relaxes the muscle. It is used all over the world and I have never seen any side-effect related to loss of sensation. Only if an unqualified person were to give the injection could such a rare phenomenon occur. The thought never crosses my mind even for a second when I offer botox injections, and they are, by the way, the most commonly carried out cosmetic procedure anywhere in the world.”

However, Dr Effendi is not so sanguine about side-effects to cosmetic procedures and claims, “We must remember that our skin is given to pigmentation easily, and all procedures — whether acne treatment, skin peeling, botox injections, collagen fillers or laser treatment — increase the risk of pigmentation by either making it more or less.

Moreover, as coloured people, we also have an inherent tendency for hypertrophy (the formation of scars, which become thick and itchy and could manifest themselves anytime between three weeks and three months after a treatment). Once formed, it is very difficult to get rid of these scars and they should never be cut into.”

According to Dr Effendi, before embarking on any facial cosmetic procedures, it is imperative to test the area behind the ears and wait for reactions for up to three months. She feels that collagen fillers in particular should not be taken lightly, as one could react to them, breaking out in ulcers and scars, and maybe even paralysis.

States the doctor, “There is no point in jumping into these things — whether invasive or non-invasive — without being aware of its pros and cons. Take something like breast augmentation, which seems innocuous enough but carries an element of risk as something alien is being incorporated in the body.

Then again, many people spend time and money getting liposuction done for generalized body fat, although it is only effective for localized fat. A fat person must lose weight gradually and sensibly, tone up the loose muscles and only when they are close to their ideal weight should they think of getting liposuction done.”

Among the most popular treatments sought by her female clients, says the surgeon, are liposuction, eyelid reduction, breast augmentation and removal of moles and scars. The men, on the other hand, come for hair transplant and face-lifts, although some also seek eye-lid reduction.

However, many of the surgeries Dr Effendi performs are also related to correcting the disasters wreaked on patients by other surgeons and physicians. She states that treatments, particularly those pertaining to cosmetic surgery, should be undertaken only after careful consideration.

“The fact is that often the desire to improve one’s image stems from a feeling of insecurity, and the patient actually has psychological problems that need to be addressed. If the surgeon blindly goes ahead at the insistence of the client and does not treat their emotional problems first, the client will never be satisfied with the treatment, and one might just end up compounding their problems.”

Often, admits Dr Effendi, she has refused to treat a client she felt was too psychologically pressured to cope with any physical changes, but later has had to wind up doing corrective surgery after they had sought treatment elsewhere.

The age group she caters to varies from young girls of 16 to 20 brought in by either worried mothers who want them married, or by their mothers-in-law, who want to see them look different, to women of 35-plus. “Husbands sometimes accompany those in the latter category. While many of the women who come in are not confident about their bodies, there are quite a few who are extremely health and appearance conscious, set in their social lives, and who come in for the sheer pleasure and satisfaction of looking and feeling better. These derive the best results.”

Many of Dr Lodhi’s clients come for collagen fillers to enhance the upper lip or remove laugh lines, or for dark eye rings. He claims, “Ninety-nine per cent of my patients come for face-related cosmetic procedures, of which removal of facial pigmentation is also very popular. Much as I hate to say it, many of my patients are obsessed with the idea of becoming fair.

Quite a few also come for the treatment of scars from acne or chicken pox, and for removal of their fine lines and wrinkles, while still others get laser treatment for hair removal. Skin peeling is also in demand, which essentially involves the removal of the upper layer of skin so that it can regenerate.”

Mostly leading high profile lives, Dr Lodhi’s patients are between 30 and 50 years of age. He admits though, that there are some who are emotionally disturbed — “Insecure housewives” as he puts it — who want to improve their appearance as a desperate attempt to hold on to errant husbands. Ten per cent of his patients are males who normally come in for skin resurfacing and removal of scars and pigmentation.

Dr Lodhi’s clinic also offers cosmetic surgery such as stomach tucks, removal of eye bags, nose jobs, earlobe beautification and liposuction, which are conducted by Dr Mazhar, who has a clinic in the same building. Dr Lodhi claims, however, that fewer people come in for these treatments — one or two in a month compared to the twenty-five patients per day that he sees for cosmetic procedures — as cosmetic surgeries entail hospitalization, taking anaesthesia, etc.

According to Dr Mazhar, most cosmetic surgeries mean that you are away from your job for a week to ten days, after which only light work can be undertaken for two to three weeks. Notwithstanding that, men are among Dr Mazhar’s patients, who normally come in for tummy tucks or enlarged breasts.

In spite of her profession, Dr Effendi feels that unless it is strictly necessary, one should not tamper with nature. “God has done his homework when he created us in a certain way and whether we like it or not, we should accept our bodies the way they are and learn to respect them. Even the smallest surgeries leave a scar, and anyway, often clients are not thrilled with the drastic alterations they make to their looks because they weren’t able to visualize themselves accurately with the change, prior to the surgery. Another disadvantage is that one cannot see the end result of a cosmetic surgery immediately. It takes a whole year for the result to actually set in.”

Having said that, she also admits that if a person goes through the surgery sensibly, for the right reasons — and not because someone forces them to — and is mentally prepared for the consequences, then cosmetic surgery can be a wonderful procedure.

Dr Lodhi concurs with Dr Effendi that as a rule nature should not be tampered with, particularly when the objective is to just look as young as one’s daughter, but concedes that certain procedures are a blessing, radically changing the psychological well-being of the patients. A case in point is hair removal by laser, which has come as a boon to those with extra thick growth of facial hair. “Otherwise, cosmetic treatment should be subtle and one should learn to age gracefully,” says the doctor.

Nonetheless, the number of people for whom the treatment signifies a licence to the fountain of youth is increasing by the day. Not that people are blatantly admitting to using these beauty aids. Far from it, in fact. Effendi laughs, “Often, if I meet my clients socially, they don’t even acknowledge my presence, lest people figure out how we know each other.”

However, when this writer went to interview Dr Lodhi, a young model and a TV actress were waiting patiently for their turn, and didn’t seem at all ruffled by my presence. Apparently, one had come in for botox and the other for collagen filler. While one confidently made her exit through the reception area after the procedure, the other chose to leave through the back door after her treatment.

During her non-stop banter with them, the receptionist dropped names of TV stars and models that regularly visited the clinic and the genial attitude of the “seniors” as compared to that of their younger counterparts.

So, for better or for worse, it seems that cosmetic surgeries and treatments are here to stay. Hence, the next time you see a person looking ten years younger or with a nose that looks like it should be on somebody else’s face, don’t be surprised! In this age of consumerism, beauty has become just one more product!

 

Pros and cons of popular local cosmetic procedures   INJECTABLE FILLERS: Artificial fillers are commonly used to pump up skin and give it a youthful look. In Pakistan, collagen is most commonly used, a filler that is fast losing popularity abroad because of the allergic reactions it is known to cause. In the west, it has been replaced largely by Perlane or Restylane, made of more biocompatible material and so less likely to cause allergic reactions, and longer lasting. On an average, the effects of a collagen shot could last from three to six months. Although it takes only a few minutes to treat an area with collagen injection, the procedure is not entirely painless and its immediate side-effect is redness and swelling at the site of the injection for up to 24 hours for most people. Other side-effects could include scarring and/or pigmentation. BOTOX: Botox is not a filler, but a muscle freezer. It does not relax the muscles, but paralyzes them. It is used to soften wrinkles or prevent them from forming in the first place. Giving the face a refreshed, rejuvenated appearance without surgery, it works best on frown lines and crow’s feet. The injection takes a few minutes, but a topical anaesthetic might be required and it is recommended to remain seated in position for several hours afterwards to allow the botox to settle. Effects are not instant — it can take from two days to two weeks for the final result to be visible — and they last from three to six months. Side-effects could be pigmentation and/or scarring. LASER SKIN RESURFACING: Removes the superficial layer of skin by burning it with laser to give a fresh look. However, for three months, care should be taken not to expose the area to direct sunlight, otherwise there is a high chance of ending up with untreatable pigmentation or heavy scarring. REMOVAL OF MOLES, BIRTHMARKS, SCARS, WARTS AND FACIAL PIGMENTATION: Popularly done by laser or radio surgery, the latter is a less expensive proposition. There seem to be two schools of thought on the wisdom of getting any of the above removed by a process that does not entail a clean cut. One feels that biopsies are a must before getting rid of moles, warts, etc. by excision only (clean cut) while the other feels that there is no reason to adopt obsolete methods of removal, such as cauterization or cutting, and biopsies are only necessary if there are symptoms of malignancy. LASER HAIR REMOVAL: Hair follicles are burnt from their roots by laser to remove hair. Depending on the area, the thickness of growth and the hair follicle growth stage, repeated treatments are required and fresh growth could occur in the same area. Pigmentation could be a possible side-effect.—S.R.

Please Visit our Sponsor (Ads open in separate window)