An aesthetic journey unveiled!

Dr Ajay Hariani, Senior Plastic, Cosmetic & Laser Surgeon, Vasudhan Plastic, Laser & Cosmetic Surgery, a veteran in aesthetic medicine, shares 29 years of insights and evolution in the field, in a candid conversation with Shriyal Sethumadhavan.

After completing his MCH training in plastic surgery from Grant Medical College, JJ Hospital in 1995, Dr Ajay Hariani began my career working alongside the late Dr Narindra Pandya, a renowned celebrity cosmetic surgeon, at Breach Candy Hospital in Mumbai. At that time, cosmetic surgery procedures were limited, mostly involving rhinoplasty, breast augmentation, and liposuction. During his training at the government institute, cosmetic procedures were rare, with only a few instances of liposuction observed – approximately two or three cases. After about four to five years, he collaborated with Dr Lakshyajit D Dhami, a trailblaser in mega liposuction and laser techniques. That is when his journey in aesthetic studies truly commenced. He shares, “Our practice encompassed both surgical and non-surgical procedures, marking a journey of almost 29 years in the field of cosmetic and plastic surgery.” Excerpts from his journey:

How have you seen the evolution of aesthetic medicine treatments in your 25-year career, and what significant advancements or changes have you witnessed?

Initially, our focus was mainly on plastic and breast augmentation surgeries. Then, we entered the era of mega liposuction, body contouring, Blepharoplasty, and laser treatments. However, in the last decade, there has been a remarkable surge in non-surgical aesthetic procedures like thread lifts, facial rejuvenation, and laser resurfacing. There is a growing interest in office-based procedures with minimal downtime as people strive to enhance their appearance. The emergence of Hypho, MNRF, botanical toxins, injectable fillers, Lipolysis, and various non-invasive facial rejuvenation methods caters to younger generations seeking confidence-building treatments. The field has shifted from predominantly invasive procedures to a wide array of non-invasive options, showcasing continuous and expansive growth. Many clients are inclined towards office procedures, emphasising minimal downtime while seeking a rejuvenated, glowing facial profile. Often, this requirement aligns with professional demands and the desire to maintain an appealing appearance. The growing demand for such procedures is certainly noticeable.

Who typically seeks surgical procedures from you in the present day? Are celebrities or high-net worth individuals more common among your patients?

The patient base primarily consists of high-net-worth individuals, occasionally with some celebrities seeking treatments. However, the majority of patients belong to the younger generation, roughly between 20 to 35 years old. Specifically, many young men in this age range are seeking surgical intervention for gynecomastia, desiring solutions to feel confident in situations where they might want to go shirtless or wear fitted clothing. This demographic constitutes a significant portion of the patients coming in for procedures.

How do you manage patient expectations to ensure a balance between their desires and realistic outcomes in aesthetic surgery?

Patient expectations and the reality of therapeutic outcomes often run parallel. Aesthetic practitioners frequently face the challenge of meeting every patient’s demands. Occasionally, even when the treatment achieves optimal results, patients might remain dissatisfied, based on their perception of the treatment’s outcome. There is an old saying that beauty lies in the eye of the beholder. Many clients have notably high expectations and tend to compare themselves to celebrities, disregarding the fact that all skin types vary. I emphasise that medical science is not absolute; otherwise, there would be no advancement. Sometimes the equation in medicine is not straightforward; it is not always 2 plus 2 equals 4; occasionally, it is 3, and occasionally, it is even an excellent 5. Building a good rapport with patients and explaining these nuances usually mitigates issues surrounding expectations.

“Many clients are inclined towards office procedures, emphasising minimal downtime while seeking a rejuvenated, glowing facial profile.”

” As someone with considerable expertise in this field, what challenges do you see confronting aesthetic medicine today, and how can these challenges be tackled?

Aesthetic medicine operates at the intersection of medical science and technology, where technological advancements play a pivotal role. The primary challenge lies in fostering awareness. While technologies like lasers, injectables, fillers, and implants deliver impressive results, they lack a universal formula for beauty or guaranteed outcomes. Competing not just with counterparts but also high-end beauty salons offering similar treatments at steep prices poses another challenge. We are in a constant struggle over pricing and services, and patients often compare these factors. Unfortunately, the public does not always differentiate between qualified and unqualified practitioners. This lack of distinction occasionally tarnishes the reputation of qualified surgeons due to mishaps caused by unqualified practitioners, leading to misconceptions about certain procedures. For instance, a hair transplant performed at a beauty salon resulted in a patient fatality, painting a negative picture of the entire procedure. It is crucial to emphasise the importance of seeking qualified professionals for such treatments. Moreover, there is a growing trend for immediate results, driving some individuals to opt for quick solutions from unqualified sources before turning to qualified experts.

How do you, as medical professionals, work on raising awareness and educating patients regarding these concerns?

With my patients, I always stress upon the importance of scrutinising a doctor’s qualifications when seeking treatment. A doctor’s credentials are paramount; if there is any doubt about their qualifications, it can significantly impact the quality of care received. Often, clinics with flashy exteriors or enticing offers might lack the necessary expertise. It is a form of false advertising that misleads patients. To counter this, we must maintain a direct and honest conversation with patients, carefully educating them about their treatment plans. I have encountered instances where prescriptions lacked a doctor’s credentials, leading to complications during treatment elsewhere. Compromising on treatment quality for the sake of quick, one-time procedures can lead to severe repercussions. Educating patients about these risks is crucial.

Getting Candid

• Your most preferred or popular treatment option: Surgically, its liposuction and breast augmentation, and non-surgically it’s facial rejuvenation treatment for scars, acne scars, or even pigmented lesions.

• One challenging case that you recall: Handling a challenging case of a 13-year-old girl with a hypertrophic breast condition was notably difficult. Her breasts were disproportionately large, reaching down to the mid-thigh level. The procedure was intricate and timeconsuming, yet the outcome brought satisfaction to the patient.

• Amemorable experience with a patient: I remember a patient who wished for dimples similar to Preity Zinta’s. They came in with a clear desire for that specific feature, explaining that they wanted the dimples to resemble hers. I asked her to get Preity Zinta to my clinic and I will study her dimple and have it done. It’s always intriguing when patients have such specific requests based on celebrities or public figures.

• Your passion: Cycling. I do it in the morning from 4 to 7am for about 80-90 km every Sunday. I have covered almost the whole of Mumbai cycling.

“I emphasise that medical science is not absolute; otherwise, there would be no advancement. Sometimes the equation in medicine is not straightforward.”

How do you stay updated with the latest advancements in aesthetic surgery?

As amember of organisations like IAAPS, the Indian Association of Aesthetic Plastic Surgeons, I actively engage in creating awareness and staying informed. There are numerous international and Indian congresses, webinars, hands-on workshops, and video libraries where we share and learn from each other’s experiences. Additionally, keeping up with aesthetic medicine updates and reading journals helps immensely. I firmly believe it is crucial to stay updated rather than risk being outdated in this field.

“Honesty guides our interactions – we do not manipulate images or mislead patients. If something does not go as planned, taking responsibility and rectifying it is key.”

” Do you notice differences in how newer surgeons approach patients compared to earlier practices?

Certainly, the younger generation tends to be more tech-savvy, focusing on platforms like Instagram and Facebook. However, there is a shift in spending less time with patients. Ideally, building rapport before treatment is crucial, which sometimes seems rushed with the younger surgeons. Communication is key in healthcare, ensuring a better relationship and enhancing patient safety.

Yes, patient safety and ethical practices are paramount in aesthetic medicine…

I often emphasise that errors often stem from system flaws rather than character flaws. No doctor aims to harm a patient, but around 95 per cent of patient errors are not due to carelessness or lack of concern. Sometimes machinery malfunctions, patients do not comply, or healing varies among individuals. I believe, if someone claims to have never faced complications in their work, they might not be operating. It is within the realm of any system for things to occasionally go wrong.

Do you have specific measures in place to ensure patient safety throughout their journey at your clinic – from the initial consultation to post-procedure care?

We ensure thorough explanations right from admission, pre-op procedures, and detailed discussions well in advance. Informed consent is crucial, covering both photography and treatment. It is about respecting patient autonomy and always adhering to the principle of doing good and avoiding harm. Confidentiality is paramount; we prioritise patient privacy and dignity, steering clear of displaying celebrity photographs or morphed images. Honesty guides our interactions –we do not manipulate images or mislead patients. If something does not go as planned, taking responsibility and rectifying it is key.

What advice would you offer to aspiring professionals venturing into the evolving field of aesthetic medicine?

India is becoming a global hub for healthcare, skin treatments, and cosmetic procedures due to advanced facilities and costeffective care. The market’s growing, and there is no slowing down. Embrace change, but before diving in, attend workshops, hands-on sessions, and conferences. Learn from others, ask questions, and drop the ego. Remember, learning from someone else’s mistake is much better than making your own. When testing new techniques or machines, see results firsthand, adjust parameters for diverse skin types, and be cautious with expenses, especially consumables. Do not just follow Western standards; adapt them to suit Indian skin types. Assess your clientele before investing in equipment. Also, ensure proper financial management, pay taxes, keep records – it not only helps with GST but also secures better loan opportunities with audited accounts.

“When testing new techniques or machines, see results firsthand, adjust parameters for diverse skin types, and be cautious with expenses, especially consumables.”