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Medico - Legal Perspectives of Cosmetic Surgery in India

S. Patcheappan

24 May 2022

Needs Profound and Sufficiently Severe Regulation for the Profit-Centric Market

The plastic surgery and allied terms of the aesthetic surgery have become common phenomenon in recent years, with the proportion of people undergoing cosmetic operations constantly increasing. The regretful condition is prevalent not only in the film industry, but also is in vogue among the people we interact. Social media platforms like Instagram, whatsapp, facebook and twitter have infiltrated almost all sections of the society. Apart from the media influence, social platforms are also act as driving factors that instill the misperception of beauty among society. Instagram, in particular, includes built-in filters and other tools that amplify the appearance. Lured by the posts shared in the Instagram the viewers turn lowly about their outward appearance and believe that beauty is the be-all and end-all of human existence. The death of a 21-year-old aspiring Indian actress following liposuction surgery has shocked both the film industry and the general public. The case has thrown up concerns of pernicious effects of the plastic surgery and it does beg the question of legitimacy of such surgery.

Defining Plastic Surgery

There is no standard definition of plastic surgery due to the vast scope of the specialty. After reviewing the literature of existing definitions, a group of surgeons concluded that none of the definitions has evidenced the entire scope of plastic surgery. Hence, they devised a new definition to reflect the broad spectrum of the field. Thus, “Plastic surgery is a specialized branch of surgery, which deals with deformities, defects and abnormalities of the organs of perception, organs of action and the organs guarding the external passages, besides innovation, implantation, replantation and transplantation of tissues, and aims at restoring and improving their form, function and the aesthetic appearances [1].”

Draft notification on Clinical Establishments (Central Government) third Amendment rules, 2019 prescribing 'minimum standards for different categories of clinical establishments of Allopathy and AYUSH’ has used the term ‘Surgical Specialty’ instead of ‘plastic surgery’ which deals with reconstruction of missing parts, replacement of tissue, modification and changing of existing part and changing the appearance of person to improve aesthetic appearance [2].

Statistical data on Aesthetic/Cosmetic Procedures Performed In 2020

As per International Society of Aesthetic Plastic Surgery's (ISAPS's) 2018 global survey report on cosmetic procedures performed, India Ranks fifth in the list of 25 countries, while total procedures performed worldwide is 10,129,528. Total number of procedures in India is 524,064, out of which 255,528 cases are surgical procedures and 268,536 are nonsurgical procedures [3]. India also holds the 5th position in conducting 60,120 liposuction procedures.

India rank in Top 5 countries in conducting cosmetic surgical procedures, 2020
Source: Cosmetic Surgery Solicitors,

The below given chart exemplifies the figure of surgical procedures conducted in India and country-wise rank.

Statistics on Total cosmetic surgical procedures conducted for the year 2020 at global context
Source: Source: International Society of Aesthetic Plastic Surgery (ISAPS),

Medical Tourism: India Rank in cosmetic surgery
Source: Source: International Society of Aesthetic Plastic Surgery (ISAPS),

Regulation for Plastic Surgery – Status quo

At present, Clinical Establishments (Registration and Regulation) Act, 2010, is the only act that allows for the registration and regulation of all clinical establishments in the country, with the goal of establishing minimum standards for the facilities and services they provide. The Act covers all forms of clinical establishments (therapeutic and diagnostic) in the public and private sectors, as well as single doctor clinics, and applies to all recognised medical systems[4]. The National Council for Clinical Establishments (Central Government) Rules, 2012 have been notified by the Ministry under this Act by Gazette notifications dated March 19, 2012 and May 23, 2012.

The act is silent on regulating the plastic surgery; however, it does establish minimum criteria for the facilities and services offered by certified clinical establishments. Thus, the act authorizes only the registered clinical establishments to conduct medical procedures or surgical procedures.

Minimizing the risk factors

Prof. Niti Khunger in her research on Complications in Cosmetic Surgery finds that, “most authors report their best results, which are published while there are very few publications highlighting adverse events and complications. This gives a false erroneous impression that most cosmetic procedures are safe with few or minor complications. Even a simple procedure such as a skin biopsy may lead to complications, if not performed meticulously”. According to the professor, factors for consideration to minimise the risks are as follows- (1) Detailed history and examination of patient. Since, chronic smokers, patients with cardiovascular and pulmonary diseases are prone to high risk of complications; (2) Procedures should not be performed in salons, spas or by untrained persons[5].

Research results of group of surgeons reveals that the complications of the most common surgical procedures include liposuction, breast augmentation, abdominoplasty, and subcutaneous injections. Physiologic risks of plastic surgery procedures are comparably less than those of other surgical subspecialties. The study exposes that, “Aesthetic surgical procedures are typically elective and usually performed on an outpatient basis in relatively healthy patient populations. Despite these factors, significant risks exist for postoperative complications. Common complications include infections, local anesthetic systemic toxicity (LAST), electrolyte and hematologic abnormalities, intravascular fluid shifts, and wound complications. Postoperative complications may be immediate, such as LAST, or delayed up to months, as may occur with surgical site hematomas”.


Increasing number of cosmetic surgeries performed, rising cosmetic tourism, and lack of legal restrictions on plastic surgery procedures are the underlying causes for morbidity and mortality. Surprisingly, the majority of plastic procedures performed in India go unreported. In most situations, post-operative problems are also imperceptible. To bring down the curtain on such tragedies, legislative control and minimum criteria for performing plastic surgery are required.


[1] Chandra, R., Agarwal, R., & Agarwal, D. (2016). Redefining Plastic Surgery. Plastic and reconstructive surgery. Global open, 4(5), e706.

[2] Government of India, Ministry of Health & Family Welfare Department of Health & Family Welfare, Clinical Establishments (Central Government) third Amendment rules, 2019,

[3] International Society of Aesthetic Plastic Surgery (ISAPS), ISAPS INTERNATIONAL SURVEY ON AESTHETIC/COSMETIC PROCEDURES, 2020, available at:

[4] GoI, Ministry of health and Family Welfare, Clinical Establishments (Registration and Regulation) Act, 2010,

[5] Khunger N. (2015). Complications in Cosmetic Surgery: A Time to Reflect and Review and not Sweep Them Under the Carpet. Journal of cutaneous and aesthetic surgery, 8(4), 189–190.

Author S. Patcheappan is Assistant Public Prosecutor (APP), Puducherry

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