In the Bonesetter's Waiting Room (7 page)

As it turned eleven a.m. the influx of clients began, and while Rashmi juggled consultations and preparation for medical procedures with perfect ease, I sat in her waiting room and watched the passing show. As I leafed through the coffee table magazines in the waiting room, admiring yachts, poring over the articles in
Millionaire Asia
, dermatology journals and women's magazines, a receptionist offered me a patient form to fill in. ‘Oh, I'm just here to interview Rashmi,' I explained, as she apologised and took the paperwork away. I can't say it wasn't tempting: at thirty-nine, I was probably already nearly two decades older than some of her clients and after looking at images of what filling, sculpting, lifting and plumping could do I had started to see things wrong with my face that I hadn't noticed before.

Perhaps it was due to watching those droves of people come and go as if they were simply visiting a dentist or a hairdresser, that the whole thing was starting to appear completely normal. I took a moment to post a status update on Facebook about how easy it would be to have some filler. If there had been a ‘dislike' button, it would have saved my friends the time they took to write lengthy comments asking whether I'd gone mad and pleading with me not to do it.

My temptation (which I conquered) clearly wasn't an isolated one – I had first come across Rashmi while reading an article in the
Times of India
headlined ‘Mumbai's got a serial cosmetic surgery club'. As the headline suggests, it reported how the quest for the Bollywood ideal of bodily perfection had become all-consuming, both inside and outside the industry. I had noticed that many of Rashmi's clients were middle-aged women, presumably in search of rejuvenation. Surely, though, there must be a downside?

‘People understand the risk, yes, they do, but they say let's go ahead and do it,' Rashmi told me. ‘The next woman from the party has become thinner, let's do it. Thin is very desirable – to the extent that women try to get into their teenage daughters' clothes – but older women need a fat percentage: your overall weight distribution changes with age. But they all want to maintain a waistline. We are fighting the natural [ageing process] – they cut down on carbs so much they come to me with hair falling out, with dark circles under their eyes …'

I could see how it could easily become a vicious circle and how quick-fix procedures would become desirable, even necessary, to people whose lives were not lived in front of audiences of hundreds of millions.

‘My patients are mostly from the film industry, but there are also bank employees, teachers, housewives – today everyone wants to look beautiful. I have lots of male patients now too. Before, if there was one scratch to their car men would get annoyed, yet they didn't seem to care about how they themselves looked,' Rashmi joked.

Indeed, though I didn't see any men in Rashmi's waiting room while I was there, most of my companions were just ordinary citizens – an older woman, probably in her late fifties, wearing a bindi on her forehead and a traditional salwar kameez; another woman in her late twenties maybe, in jeans; another in her early thirties wearing a mini skirt; and a fourth girl in ripped jeans and comfortable loafers.

While I waited, I chatted with a woman in her twenties who had moved to Mumbai from Tanzania to go to medical school. ‘I think in this period in time we are very self-conscious,' she told me. ‘Even as a doctor, when a patient comes to you, they look up to you and if I have pimple, they think, why doesn't she take care of herself? Or if we tell them to lose weight, then we have to be fit too. Even my mother is a patient here. She has Botox. She was sceptical the first time, so Rashmi did half her face to show her how it would compare. Rashmi does not want her to look unnatural – she says you should age gracefully. And every year my mother comes from Tanzania to see her.'

One of the more interesting improvements Rashmi offered was skin lightening. Cosmetic skin-lightening products are a sizeable industry in India, with ‘before and after' advertisements on billboards across the country and pages of classified bridal ads in the
Times of India
every Sunday seeking ‘Slim, Fair, B'ful girl'; ‘beautiful, professionally qualified, fair Hindu girl'; ‘seeking cultured fair beautiful girl'; ‘Qualified, Fair, Slim girl'; ‘Beautiful tall girl for very fair, handsome vegetarian boy' …

‘The ideal of beauty is light skin,' Rashmi explained to me. ‘Actually you can look like a frog. But the ideal bride is a woman with light skin; at front desks in offices the receptionist should have light skin. We are not one “race” in India – we have so called Aryan, Mongolian, Dravidian types. So we are used to working with different skin. Even in south India, where people are thought of as darker-skinned, the Iyengars [high caste Brahmans] are lighter; in Mangalore people are lighter. I used to think the desire to be lighter was socio-economic but now I don't – we don't get lower economic groups at our practice. But the thing is, if you are dark, it is harder to maintain an even skin tone, so I think it's more about that than a particular shade. The biggest thing people come to me for is skin tone or colour. But tone can change with facial structure. For example, the area below the eye can get sunken with age and that can give the appearance of dark circles. So changes on the skin cannot be addressed by changing the actual skin tone alone – I have to also look at the tissue and face structure. You need to work beyond the skin with all the layers to get an even skin tone.'

Though that was what Rashmi's clients came to her to address, in India there is undeniably a very deeply rooted worship of light skin colour, as the matrimonials illustrate. I remember an English friend of mine being taken aback when I told him that Bollywood actors were actually Indian. ‘But they're all so white,' he said. ‘Are you sure?' Today, of course, they're not all Indian. A few have one south Asian and one white parent; many films have formulaic nightclub scenes with backing dancers who are entirely European – and generally also all blonde.

In terms of ideals of beauty, in India people with light skin and/or eyes occupy a place of privilege for a variety of perceived reasons: dark skin is associated with poverty because the poor are more likely to work in the harsh sun; it may also be associated with underprivileged classes or castes. Blame is variously laid with the Persians, Aryans, or the British, or Westernisation. They point to the traditionally dark skin colour of certain Hindu gods; the description in ancient epics of dark-skinned princesses celebrated as great beauties in a time before white was right.

The reality, as Rashmi had alluded to, is that outward appearance and status in a country as populous as India is far more nuanced by geography and genetics. A friend of mine, a doctor from a so-called low ‘untouchable' caste, is not dark skinned at all (and has green eyes). My mother's family consists of nine siblings and close relatives who vary from having extremely dark skin to almost white. Among them they also have a pick and mix of dark brown, hazel, green and blue eyes. None the less, however flawed the reasons that link whiteness with desirability might be, the fact is that it still exists.

There are those who hope to bring down this chromatocracy and several activist movements (whose membership lists include some Bollywood stars) have united against the products and advertisers, while the non-Bollywood film industry produces many thoughtful films employing more natural-looking actors. There is also the ‘Dark is Beautiful' campaign, launched in 2013 by actress and producer Nandita Das, which aims to promote the celebration of ‘beauty beyond colour'.

It could be a losing battle. A 2012 BBC news story reported more sales of skin-lightening creams in India than Coca-Cola and featured a shower gel that claimed to whiten the genitals of Indian women. It was promoted with a television advert showing a (fair-skinned) wife, first ignored by her handsome husband and then ecstatically reunited with him after using the product. The skin-whitening industry is now worth an estimated £283 million. Even-handedly, it doesn't exclude those without vaginas: like the ‘Fair & Lovely' skin-lightening cream marketed to women, ‘Fair & Handsome' has hired heavyweight brand ambassadors in the form of Bollywood megastars Shah Rukh Khan and Hrithik Roshan. Nor does the marketing stop with ‘fairness' products. There is an amusing, often politically-incorrect range of tonics, potions and even exercise equipment that reek of quackery, targeted at the uncritical. I'd even seen an ad campaign for a product promising to ‘increase your height or your money back', pasted on the backs of auto-rickshaws. The watchdogs are reacting. In 2015 the Food and Drug Administration issued notices for, and physically seized two steroid-containing fairness creams: UB Fair for men and No Scars cream for women. The products contained steroids like fluocinolon acetonid and mometasone as well as skin bleaching agents, the side effects of which include skin thinning, rashes, and even excess facial hair growth over time.

Knowing the risks, and thinking of those ubiquitous and miraculous billboard transformations I had seen, I was curious to hear from Rashmi why so many people persist in using them, and whether these creams really work.

‘Yes, they do. Companies have a responsibility to stand behind their claims, but the extent of change customers get can be very, very small. Usually, creams include some form of sunscreen. Plant extracts such as liquorice, mulberry or any of the acids that block enzymes of the melanin pathway. Also hydroquinone, which actually bleaches the skin, or light reflective particles. Product engineering has improved so much now that you get that instant satisfaction. There are gold and glitter particles to make skin look like it's glowing. And then people get to like the glow so they keep using it.'

Hydroquinone is recommended for the gradual bleaching of areas of hyper-pigmented skin – spots of uneven skin tone, for example – although many, even most, users of the product apply it to their whole face. The effect is not permanent and, though the compound is approved for human use, laboratory and animal tests indicate that possible side effects may include some cancers or DNA modification.

Many of the women of typically marriageable age in Rashmi's clinic did seem to be there for various skin issues, though at least they were consulting a professional rather than taking the DIY route.

Occasionally, well-off teenagers will ask Rashmi to carry out even more invasive procedures.

‘I tell them to go away,' she said. ‘Here, even kids have access to money. The parents give it and no one asks them how they spend it. It's like maybe how we went to a hairdressers or a beauty salon, they go to the cosmetic surgeon. They haven't finished growing yet and their faces are going to change. They ask for very specific things some of them, sixteen-year-olds wanting certain parts of their faces sculpted or filled. “Make it thinner here, put in fillers there.” I ask them why and they say, “Because I don't like my face at that angle. It doesn't look good in selfies.”'

When I thought about it, it made a lot of sense that teens were feeling an increased pressure to go to extremes in the name of appearance. Like the rest of the world, Indian teenagers post ‘fat-shaming' photos on Facebook and some young victims have been driven to suicide. For the selfie generation, everyone is in the limelight.

As I left Rashmi to her continuing influx of patients the very beautiful, Brooklyn-born, half-Czech Bollywood actress Nargis Fakhri was due through the door. Seeing her on the Cannes red carpet a few weeks later, statuesque, with her characteristic filler-plumped lips, brought to mind her endorsement of Rashmi's book
Age Erase
: ‘There's always extra pressure when it comes to being in the limelight. Not to mention just being a woman who will inevitably go through life's processes. We all want to look and feel young …' In an interview on the web, she made her reflections on cosmetic surgery even clearer. ‘Things fall, gravity happens,' she said. ‘You kind of need an extra something as you get older … so listen, I think technology is great, you know … I think it's nice to have that option. And I think, why should we not look as hot as a twenty-five-year-old when we are forty-five.'

Rashmi Shetty and Satish Arolkar's Mumbai patients would surely have agreed, but such ideas have their critics too. In the words of one protester in Bangalore, ‘If a woman is judged only by the size of her breasts and her hips, then it is shameful not just to Indian women, but to women all over the world.' But if the projections for the unrelenting rise of the most commercialised area of Indian medicine hold true, then there is no turning back now.

In the meantime, across India's great cities, a phenomenon even newer than cosmetic surgery is also gaining pace: the rapid rise of smartly outfitted gym franchises that provide a slower, tougher but healthier route to making the body changes we now crave. Although India's largest gym chain started (in Mumbai) as long ago as 1932, within the last 5 years Talwalkars has more than doubled the number of its offerings, now with 146 ‘ultramodern branches' across 80 Indian cities. Toward this expansion into India's new urban demographics, in 2012, it partnered with Britain's David Lloyd Leisure Group, with whom they consulted on providing leisure and sports clubs in high-end residential developments, gated community townships and corporate campuses. Fitness First launched in 2008, followed by Gold's Gym and other independent five-star offerings that included women's-only areas or sessions and the type of yoga classes restyled for the West and reintroduced to the new world of fitness in India alongside new staples such as Pilates and Zumba. Even today the concept still has a beautiful novelty. Talwalkars alone now has in excess of 125,000 members who contribute to the company's 28 million USD revenues, but there is much more growth to come: as a nascent fitness market, only around 0.05 per cent of urban Indians have a health club membership, compared to 3.11 per cent in the Asia-Pacific region, 13.2 per cent in Britain, and 17.5 per cent in the USA.