Abstract
In recent years, India has witnessed an unprecedented rise in the demand for aesthetic surgery. Greater awareness, wider availability of expertise, higher disposable incomes, increasing social acceptance, and the influence of social media have all contributed to this trend. With 1.2 million procedures annually, India currently ranks 7th in the number of aesthetic plastic surgery procedures worldwide. 1
However, alongside this growth, we are confronted with the rise of unregulated cosmetic centres. Practitioners from multiple unrelated specialties are now marketing themselves as “cosmetic surgeons” or “aesthetic specialists,” often after attending short-term workshops, industry-sponsored courses, or purely observational experiences. Worse, a few of these “newly trained” individuals even claim to be pioneers in their field, attempting to expand into aesthetic surgery without the backing of a structured training curriculum.
While cross-disciplinary collaboration has its place, the question of who is best qualified to perform aesthetic surgery is non-negotiable. The answer, by training, by scope, by history, and by global practice, is unequivocal —
Historical Perspective: Plastic Surgeons as the True Custodians of Aesthetic Surgery
The modern history of aesthetic surgery can be traced back to Johann Friedrich Dieffenbach (1792–1847), one of the pioneers of plastic surgery, who described several facial aesthetic procedures in the mid-1800s. Mr Frederick Strange Kolle(1871–1929), a German-born American who practised plastic and cosmetic surgery in New York, authored and published a book titled Plastic and Cosmetic Surgery. This comprehensive book, released in 1911, had 512 pages with 522 illustrations, including ‘before and after’ pictures. 2
Sir Harold Gillies, regarded as the father of modern plastic surgery, underlined the importance of cosmetic surgery as an integral part of the discipline. In his book The Principles and Art of Plastic Surgery (1957), Gillies observed:
“A great percentage of private practice is beauty surgery. It is here that perfection is a necessity. Reconstructive surgery is an attempt to return to normal; cosmetic surgery is an attempt to surpass the normal. No man is a plastic surgeon unless he becomes adept at both. Many never do and are a menace. It is easier to reduce than produce, but in plastic surgery, it is nearly always necessary to remould after reduction. Thus, anyone can cut off a bit of a nose or breast, but not so many can turn out a satisfying result.” 2
By the mid-20th century, aesthetic plastic surgery had become firmly established as an integral branch of the plastic surgery speciality, with comprehensive textbooks and innovative techniques regularly published in international plastic surgery journals. In 1976, the journal Aesthetic Plastic Surgery was launched by the International Society of Aesthetic Plastic Surgery (ISAPS), dedicated exclusively to cosmetic plastic surgery.
India, the land of
Global and National Trends
The ISAPS Global Survey, compiled annually from plastic surgeons’ operative data, remains the only reliable longitudinal record of surgical aesthetic volumes worldwide. In 2023, plastic surgeons performed 15.8 million surgical and 19.1 million non-surgical aesthetic procedures, totalling 34.9 million — representing a nearly 40% increase compared with 2020. Recently, in June 2025, at the ISAPS Olympiad World Congress in Singapore, the latest survey figures were released, showing the numbers had approached 38 million in 2024 — underscoring the sustained growth of our specialty. 1
India’s contribution is particularly noteworthy. With over 1.2 million surgical and non-surgical procedures, the country now ranks 7th globally in total aesthetic procedures. Notably, India has achieved 2nd position worldwide in rhinoplasty and 3rd position in liposuction, reflecting both the demand and the leadership role of Indian plastic surgeons in shaping global aesthetic surgery trends.
Depth and Breadth of Training
The journey to becoming a plastic surgeon in India is long, rigorous, and comprehensive. After an MBBS degree and a full residency in General Surgery (three years), aspiring plastic surgeons undergo a formal three-year MCh or DrNB program in Plastic, Reconstructive, and Aesthetic Surgery. This curriculum is structured by the National Medical Commission (erstwhile MCI), which existed in universities running MCh courses for decades, encompassing the full spectrum of reconstructive and cosmetic procedures, microsurgery, craniofacial surgery, hand surgery, burns, and congenital anomaly correction, and so on. 9
In every advanced healthcare system, be it the United States, the United Kingdom, or Australia, aesthetic surgery is integral to plastic surgery.10,11 The American Board of Plastic Surgery, for example, oversees both reconstructive and cosmetic surgery, holding its diplomats to the highest training and ethical standards. Similar recognition exists with the Royal College of Surgeons (UK) and the Australian Society of Plastic Surgeons.
In India, regulation has not kept pace with the growing demand and is still evolving. This has allowed inadequately trained practitioners to market themselves as cosmetic surgeons, creating confusion, engaging in unsafe practices and tragic outcomes. In the absence of clear-cut guidelines from the NMC on the practice of aesthetic surgery, and given its limited authority to regulate other health systems, there has been unrestricted and aggressive growth of unrelated specialities. Those calling themselves “cosmetic surgeons” create confusion for the public and undermine patient safety. However, it is encouraging to note that some state medical councils have begun taking remedial steps; for example, the Telangana Medical Council recently issued specific notifications on hair transplant practice.
Aesthetic surgery: not an isolated skill
Aesthetic surgery is not only about altering appearance; it is about achieving harmony between form and function. As Sir Harold Gillies pointed out, plastic surgeons, because of their reconstructive background, have a comprehensive and balanced approach. Whether it is a facelift, rhinoplasty, breast surgery, or body contouring, each patient is holistically treated, adapting techniques to anatomical and cultural needs. Applying reconstructive principles, a plastic surgeon can anticipate and prevent complications and manage them effectively when they arise. However, by contrast, practitioners from other fields may only have focused exposure to a narrow segment of procedures. A brief fellowship or hands-on course cannot replace the cumulative years of operative experience that plastic surgery residency mandates.
Reinforcing Leadership
It is imperative that we, as a community of plastic surgeons, not only assert but also demonstrate our leadership in aesthetic surgery. This means:
The growing aesthetic market in India is both an opportunity and a responsibility. If we do not actively occupy this space, others with lesser training will, to the detriment of patients and to the dilution of our speciality. The future of our field depends not only on technical excellence but also on our collective efforts to protect its integrity, educate the public, and regulatory authorities.
Footnotes
Conflict of Interest and declaration
None