In the Bonesetter's Waiting Room (6 page)

I was intrigued that what people are asking for were clearly expensive procedures. In Mumbai, a tummy tuck will set you back more than Rs200,000 – around £2,000. This is ten times cheaper than the United States in absolute terms (though when adjusted for the cost of living the affordability to someone earning an average middle-class Indian salary is probably similar). There'd be a similar price tag on breast augmentation, while a nose job starts at Rs100,000. Why were people willing to spend so much on procedures that, as Dr Arolkar said, would until recently have been seen as entirely unnecessary?

‘The thing is, people are becoming more aware of their exterior and showing more of their body, so blemishes get amplified,' Dr Arolkar told me. ‘I've had some very strange requests – like one lady asked me to move a mole to another part of her body. Another time, a girl came to me and asked if I could get rid of the smallpox vaccination scar from her upper arm. Then a boy came to me with slightly floppy ears. He was twenty-three. They really weren't all that bad so I told him to go away. He wouldn't, so I asked him for three times as much as it should cost, just to put him off. He turned up the next day with the money. He had sold the motorbike his father had given him.'

‘Do you understand why he was so desperate?' I asked.

‘Peer pressure. There was a man from a village in Gujarat who wanted six fingers! Turned out lots of people had that in his village. The thing is, you don't want to look out of the ordinary.' Satish told me how some actresses were asking for breast reductions even in their seventies. ‘In the old days, actresses were larger, they had full breasts – in India it was a good thing, it was a sign of fertility.' Traditional representations of the human form in India do seem to have an extensive history of fêting the rotund rather than the svelte. From the rounded stomachs of Harappan adult male and buxom female figurines, to corpulent personifications of scriptural heroes on the shikara of modern temples, beauty has seldom been the ripped abdominals of the classical Greek ideal.

In more recent decades, the perception of the ideal body, at least in Mumbai, has publicly undergone a seismic shift. Instead of looking like the boy next door (with a bit of puppy fat), movie heroes became sexy versions of the incredible hulk. Where actresses were once rounded and buxom, they began to follow a trend towards size zero. Bariatric (stomach stapling) surgeries are big business (and openly flaunted by politicians, according to Dr Arolkar). Then in 1991 unfavourable economic conditions forced devaluation of the rupee and an influx of foreign investment followed. In the ensuing decades the Indian economy almost quadrupled in size. Foreign capital flooded into Bollywood and Bollywood in turn became a global export. Western influence increased with the establishment of MTV and the arrival of international glossy fashion magazines such as
Vogue
. Now, India's fashionable were watching the world – and the world began looking back. Projected onto gigantic screens wherever its diaspora could be found, the exquisite faces and perfect bodies of the Mumbai film industry's celebrities were constantly before the public gaze – adoring, or critical. It makes perfect sense that Mumbai would embrace cosmetic surgery the way it has. Nowadays, of course, it's not just celebrities who are constantly observed: India also has 118 million active social media accounts. Staying current, including knowing what it means to be beautiful, has never been more immediate.

For those whose jobs require them to stay in the limelight, the pressures are even more acute. In an industry where appearance is everything, there is a particular vulnerability: adoration might turn to career-ending criticism without warning. The media are, of course, only too ready to ridicule anyone who either has surgery or who does not conform to their own version of perfection. It's a lose–lose situation. Unsurprisingly, many celebrities who do have procedures go to great lengths to keep them secret. Dr Arolkar had already cautioned me that talking to an Indian celebrity about their cosmetic surgery would be next to impossible, but I knew of two people who, early on, had broken ranks to speak publicly about plastic surgery: the actress Koena Mitra and one of Bollywood's few female film directors, Farah Khan.

Despite roles in several Bollywood films, Koena's fame as an actress was overshadowed by becoming an exemplar of the perils of plastic surgery. ‘She's sort of insignificant now,' a magazine editor told me. ‘Her entire career was ruined by bad surgery.' Though I was unable to secure an interview, she has previously commented extensively on her experience, speaking frankly about the choices she had made and the impact they had had on what could have been a significant career in Bollywood.

A former model (with a masters degree in psychology), it's hard to see what could have been improved upon before her surgery in 2011 – after all, that symmetrical face, wide almond eyes and enviable figure had already won her beauty crowns and catwalk gigs. By contrast, in the ‘after' photos her face seems more stiff, mask-like. But noticeable though the difference is, the true cost of her nose job was measured in more than aesthetics. Koena said that, after the rhinoplasty, her ‘bones started swelling up' and that a series of corrective operations ensued. She was left in severe pain and housebound, while rumours circulated that her face had been so disfigured that it was difficult for her even to smile.

The studios shied away and her career ground to a halt. In a 2014 interview she told the
Times of India
, ‘I sat at home initially. But I could not take it any more and started going out with that face of mine … I didn't hide anything. But people spoke and wrote the worst … about me.' She was also quoted in a film magazine talking about the scale of plastic surgery consumerism in Bollywood. ‘I can give you a long list of names with their long list of surgeries,' she said. ‘My list of surgeries is really tiny compared to many leading stars of the day. I at least had the courage to come out and talk.' And though her face has recovered, it is no longer one that mainstream Bollywood has since deemed attractive enough to cast.

Farah Khan, by contrast, has become a hero to some after owning up to post-pregnancy surgery of the sort Dr Arolkar says is increasingly popular: the ‘mommy-make-over'. Khan started as a choreographer before becoming one of Bollywood's biggest producer-directors (with blockbuster credits including
Om Shanti Om
). Though she has appeared on screen, Farah is not the type to be seen in hot pants or tiny sari blouses, as Bollywood's impossibly lithe starlets tend to. Rather, her figure is more like the average woman's. Usually undertaken by women who want no more children, the ‘mommy-makeover' comprises one or more procedures designed to counter the effects of pregnancy and active motherhood.

A few years after giving birth to triplets, and after researching the procedure thoroughly, she decided the hanging tummy she was left with and which dieting and exercise had failed to budge would have to go. When I spoke to her, her openness about double standards and women reclaiming their bodies after having children was refreshing. One of the ‘problems' of being a celebrity is the back catalogue of available photographs that provide the media with ready-made ‘before' and ‘after' comparisons.

Women do come under far closer scrutiny in this respect than men. Even when some of Bollywood's favourite male actors fall prey, they usually get off with the odd mentions of wrinkles filled. In India, as everywhere else, women's bodies are perceived as fair game, hotness before childbirth mutating into mummy yumminess after. But, as Farah has often stated, ‘There is nothing to hide.'

Celebrities who stand up for themselves post-surgery in the press or social media are still relatively rare, but they do exist. Actress Anushka Sharma spoke out recently ‘to end the noise', as she put it, after a barrage of tweets criticising her newly augmented lips. ‘I felt bullied. I didn't know that people could be so mean,' she told the newspapers. ‘Some of the stuff was quite funny but some of it was such pure vitriol that I cried. It's because we don't reply to them that people think they can get away with anything. I didn't think I had to inform the world before getting my lips enhanced. It's my body and my decision.' In 2015, Shilpa Shetty (actress and star of Celebrity Big Brother in the UK) also admitted to having had four nose jobs; and the legendary Zeenat Aman came out publicly in support of cosmetic surgery in general. ‘To each his own … I'm in favour of it,' she said.

Where Bollywood stars go, everyone else follows, from the older generations to what Dr Arolkar calls ‘nubile teenagers' who want ‘dream' bodies. But it's no longer just about the more complex surgeries allowing women (and men) to emerge with better breasts or smaller waistlines. The cultural change Dr Arolkar had described to me had also, in recent years, extended to an explosion in what he called ‘office-procedures' – faster, easier, cheaper and less risky quick fixes that take minutes instead of hours.

‘Once you look good, you only want to look better. Human nature! If something is available and affordable the beneficiary of a previous cosmetic procedure hankers for more. So people are opting more and more for these – like lasers for quick fixes, Botox and fillers.'

The first dermal filler approved for cosmetic use was collagen derived from cows. That was in the USA in 1981, since which time dozens of laboratory-made injectable filling agents have been developed. Botox was first used in Canada in 1992 and the big boom in ‘office procedures' started building in India around a decade later. Today, with China, India has the fastest-growing market in Asia for such off-the-shelf cosmetic work.

I decided to meet a doctor who had filled, layered smoothed and sculpted Mumbai's elite without ever lifting a scalpel. As my taxi pulled up outside her Bandra apartment on a pretty, tree-lined street, Dr Rashmi Shetty waved to my daughter and me, guiding us up from her second-floor balcony. Around forty, with clear skin, lustrous black hair and a conventional Indian beauty, she could easily be mistaken for an actress or model herself, an image which must also have been an excellent advertisement for her own practice.

Though she had been an accomplished dancer, Rashmi's real talent was in medicine. I had been corresponding with her by email, trying to find a time when she wouldn't be studying for further professional qualifications, writing articles for medical journals or lecturing at national or international conferences and seminars. We'd managed to find a slot and met over breakfast. Disarmingly friendly and whip-smart, she made the interview feel more like a relaxed conversation with a good friend than a rushed session with a woman who had everyone who was anyone in Bollywood knocking at her clinic door.

‘I always wanted to be a surgeon,' Dr Shetty began as we, and our daughters tucked into aloo parathas and chai. ‘I got into general surgery and my initial postings were in plastic surgery – that's where I started liking tissue reconstruction, realising how we can put a face back together in a beautiful way. I realised how important looks were to people. To a patient, that small mark on a face could be a reminder of abuse, or a burning, or a disease. For many people beauty is not just vanity. The way you look can change your whole life course.'

As Rashmi recounted stories from her surgical training and of her voluntary work for Smile Train – a charity providing corrective surgery for children with cleft lips and palates – she also alluded to the rapidly growing appetite of Mumbaikars for cosmetic surgery. Fourteen years earlier, when she stopped working as a surgeon proper and first set up as an ‘aesthetic physician', ‘I sat there for six hours a day and not a patient turned up. So gradually I went down to two hours a day on alternate days,' she said. ‘A few years later patients started spilling over. I never advertise, I don't even have a board outside my clinic. Now, I see up to sixteen patients a day. A consultation takes twenty minutes and the treatments, if they decide to have one, take twenty minutes to an hour.'

Rashmi's clientele includes some of Bollywood's biggest names, male and female, and they have not been shy in praising what ‘Bollywood's favourite aesthetic physician' has been able to do for them. On the ratings-topping chat show
Koffee with Karan
, Rakhi Sawant, a Mumbai celebrity best known simply for being famous, declared, ‘My doctor is Rashmi Shetty … as they say, what God didn't give, the doctor gives instead.' ‘But that was at the time I did her face,' Rashmi clarified, laughing. ‘Now she has had other procedures done –
not
my work.'

Even those willing to admit to cosmetic procedures seem reluctant to go into detail. Shilpa Shetty (no relation), wrote about how she trusted Rashmi's knowledge of skin; Sania Mirza, a world number one women's doubles tennis player, praised her for producing results that other doctors couldn't; and Anita Dongre, one of India's best known fashion designers added, ‘What kept me from going to aesthetic doctors was my apprehension for anything invasive and drastic. [Rashmi] just fixed me with the least that there can be.' There are many, many endorsements in this vein, but needles don't get a single mention.

Such vagueness is perhaps intended to maintain a myth of beauty naturally enhanced, rather than medically manipulated. Ethically, of course, Rashmi could disclose no individual details, but her website makes clear the procedures on offer, ranging from simple skin treatments such as laser and retexturing to fillers that would pump up lips, sculpt facial features and iron out wrinkles, plus, naturally, Botox and treatments for baldness.

I visited her clinic in nearby Santa Cruz, where Rashmi told me about the ‘vampire facelift' – a bizarre procedure familiar to some from the ‘after' shots of their blood-smeared faces posted online by both Kim Kardashian and Israeli model Bar Refaeli. The procedure uses the patient's own blood, separating out the fraction containing the platelets, growth factors and stem cells and then injecting what's left into multiple sites on the face. The initial result is a gruesome mess, but it remains a favourite of celebrities in the West, allegedly helping the body to repair itself, rebuilding collagen and thus rejuvenating the skin. I couldn't imagine any of Rashmi's Mumbai celebrity clients showing off their bloodied and swollen faces so freely; that would hardly fit the immaculate image most Bollywood actors project, even if the procedure is helping them maintain it.