Operation Beauty

by ANNE RENZENBRINK

FROM ISSUE # 200 (August 2012) | IN THIS ISSUE
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Dr Raju Raj Pandey's clinic looks like any regular clinic from the outside, however, once inside you are greeted by photographs of Nepali noses, eyes, foreheads and other body parts, before and after surgery. Pandey is a cosmetic surgeon.

All over the world cosmetic surgery is an emerging business. Especially in Western countries, celebrities are getting older by looking younger. Noses are shrinking, breasts are growing, wrinkles are vanishing, the skin is tightening, and the tabloids keep us up-to-date about which super star tried out the latest facelift method. 
In Nepal, however, cosmetic surgery is still in its infancy. "We do about three to four upper eyelid surgeries per week," says Pandey who is the founder of the Nepal Plastic Surgery Hospital. "In centres in Bangkok they performed about 50 to 100 eyelid surgeries per day."

Although in Nepal cosmetic surgery is still an unknown concept to many, demand is gradually growing. Especially young girls knock at Pandey's door, asking for bigger eyes and smaller noses. "It takes time, but slowly people are coming," Pandey says.

Plastic surgery can be divided into two broad categories: reconstructive and cosmetic surgery. Reconstructive surgery helps after accidents, for example to treat burn injuries. In Nepali villages, where open fire cooking is common, children playing around open fire often become victims. Reconstructive surgery is sometimes necessary for survival.

Cosmetic surgery, on the other hand, is a surgical intervention based on the patients' wish to modify a part of their body for aesthetic reasons and usually unnecessary for survival.

Insurance plans in Nepal don't cover cosmetic surgery and patients need to pay out of their own pockets. Some hospitals financed by aid organisations provide reconstructive surgery for people in Nepal who cannot afford the treatment. The Sushma Koirala Memorial Hopsital in Salambutar, Sankhu, is one example.   

The most popular among cosmetic surgeries in Nepal is the 'Mongolian eyelid surgery', says Pandey, who studied medicine in India, earned a master in surgery in Nepal and went to Bangkok for special training in plastic surgery. During the surgery, fat, excess skin and muscle from the eyelid are removed to make the eyes appear bigger.

Dr Jaswan Shakya (pictured left) earned a bachelor in medicine and a master in surgery in Russia and got special plastic surgery training from South Korea. He works part-time at the Nepal Skin Hospital, where certain types of cosmetic surgery are offered. Shakya says Nepalis living abroad in the UK or US come back to Nepal for the surgery. "It is more than five times cheaper here in Nepal than in Europe or the US," he says.

Costing between Rs 20,000 and 30,000, the Mongolian eyelid surgery is not only the most popular but also the cheapest surgery in Nepal. It is considered a very simple surgery. Lasting about one hour, the patient can walk normally home on the same day. 

Botox, in turn, a very popular method in Western countries to reduce wrinkles, is very uncommon in Nepal. Instead of a surgery, it requires the injection of expensive medicine. A botox injection costs Rs 10,000 to 12,000 and needs to be repeated every three to five months. "For celebrities, it is okay, they earn for their faces, but from normal people, it is too expensive," Shakya says.

Other cosmetic surgeries in Nepal, mainly offered at Nepal Skin Hospital are nose surgery, hair transplantation, face lift, breast implants, ear surgery, scar revision or tattoo removal.

Pandey says the reasons why patients want cosmetic surgery are manifold. Those coming for a Mongolian eyelid correction are often young girls around 20 or 22. He says some of them want to work as stewardess and think they need the correction. "New eyelids doesn't mean that they will automatically get the air hostess job," Pandey warns.

However, he agrees that for some jobs, a little correction can be helpful. "You might apply for a job and the employers might tell you that you are too old for the job, because of your receding hairline. In such cases we offer hair transplantations," Pandey says.

Some girls even bring pictures of models to his office. "They tell me 'make me look like this model'," Pandey says. "But I usually tell them that it is not possible. Everyone has a unique face structure that we cannot change."

But it isn't just young girls who are rushing to cosmetic surgery clinics. Men are interested in nose corrections or hair transplantations. Both men and women above 50 perform upper eyelid corrections because of their age. "For them it's functional," Pandey says.

Based on his experience with patients, Shakya says cosmetic surgery patients in Nepal are still not under as much societal pressure to look a certain way as people in the West. "This is the difference between Europe and Nepal," he says. "In Nepal they do the surgery out of their own will, in the US or in Europe, they are pressurised to follow certain trends and look like celebrities. But I am sure this obsession to look like celebrities will soon be felt in Nepal."

Both Pandey and Shakya have had patients who had second thoughts about surgery. Every surgery entails risks such as bleeding or swellings and Shakya says he meets patients at least three or four times where he talks to them in detail about the procedure and side-effects and precaution. "Cosmetic surgery is not an emergency surgery. The patient must understand the situation," he says.

Shakya recommends his patients to watch videos and read articles about cosmetic surgeries first before making a decision they might regret later on. "If there are complications after breast surgery, we might have to remove the implant, and the patient loses 2000 Euros," he says.

Pandey also tells his patients to reconsider cosmetic surgery and 25 per cent of them eventually change their mind.

Despite being a plastic surgeon, Pandey still believes in natural beauty. "I believe that it is the nature which makes you who you are," he says. "You can't challenge nature, you can only modify things."