Sanjay, 16, was so embarrassed to discuss his problem with his parents that he tried to end his life. Later, doctors advised his parents to take him to a plastic surgeon.
This summer, he headed to see a cosmetic surgeon in Chennai. He wanted to go under the knife for gynecomastia or surgery for male breast reduction before college reopens.
Hundreds of teens, especially students, who are studying in high schools or have just completed, take appointments with cosmetic surgeons during their summer vacation - between April and June.
Surgeries in summer
Doctors see a 20-30 percent increase in the number of surgeries done on students during summer.
"During this season, I get 35-40 enquiries every month, resulting in about 10-15 consultations and 5-10 surgeies," Dr Anup Dhir, secretary of Indian Association of Aesthetic Plastic Surgeons, said.
Students usually come to see surgeons mainly for breast reduction, breast reconstruction, nose correction or rhinoplasty and liposuction. "Boys as young as 13 have come for these procedures flanked by their parents," said Dr Mohan Thomas, senior cosmetic surgeon at Breach Candy Hospital, Mumbai.
Dr Karthik Ramaswamy, chief surgeon at Chennai Plastic Surgery, says it is safer for men and women above 18 years to undergo cosmetic surgery, though often he gets requests from teens as young as 13-14, especially for liposuction.
"I often send back teens who think liposuction can help them in weight loss," Dr Ramaswamy said.
However, doctors agree to conduct surgery for male breast reduction for students who are in their early teens, as it can be a mental agony for them, according to Dr Ramaswamy, who has done gynecomastia for over 10 students in the last five days.
Boys like Sanjay shy from removing their shirts in front of friends and even family members. It becomes even more difficult when they live in hostels and have to undress in front of friends.
"They try not to participate in sports and avoid going to temples that demand them to remove shirts before entering the sanctum sanctorum," Dr Ramaswamy said.
Moreover, plastic surgery is no more considered an option available only for the elite. Though it is expensive, people from lower middle-class families are also willing to go under the knife.
"I get requests from people across the entire socioeconomic spectrum. We try and accommodate everybody so they all feel 'light'," Dr Anusham A Anantharam, consulatant plastic surgeon at Columbia Asia Hospital, Bengaluru, said.
In India, a tummy tuck can cost anywhere between Rs 2-2.5 lakh ($3,500-4,400), breast augmentation between Rs 2-3 lakh ($3,500-5,300), while a nose job Rs 1 lakh ($1,700) and a botox shot Rs 400-500 per unit ($7-8.5).
But again these are just mean averages and vary from each city and hospital, and parents try maximum to help their children from facing any embarrassment by paying the cost necessary.
Though metros like New Delhi, Mumbai, Chennai and Bengaluru top this trend, students from villages and interior parts of the country also make appointments with cosmetic surgeons.
Seema, a 17-year-old girl from a village near Chennai, had very large breasts and wanted to avoid ugly stares. She also suffered from severe back pain and had inferiority complex.
"Since the reconstruction cost was above her family's affordability [Rs 1.5 lakh or $2,650], they agreed to pay the sum in installments," Dr Ramaswamy said.
Students prefer summer as they get enough time to recuperate. Breast reduction requires two days to heal after the stitches are removed five days later, while rhinoplasty takes two to three weeks longer.
'Facebook facelift'
Most often, students want to avoid judgment from their high school peers. They want to enter colleges with a straightened nose or dimple on cheeks, or without any scars on their face.
Some want to get corrections not just because of peer pressure, but also because they want a perfect face for their social media picture.
"I feel more confident now as my scar has been removed from my cheek," said Shalini G, who recently got not only her scar removed, but also paid around Rs 50,000 ($880) for work on her eyebrows, who wanted to look good even on her profile picture.
Known as "Facebook Facelifts", the trend is getting popular equally among men. "People want to look attractive and teens are coming forward to get aesthetically pleasing looks," Dr Dhir said.
While young women mostly approach Dr Dhir for rhinoplasty or nose job, lip injection or eyebrow lift, young men prefer laser treatments to remove unwanted hair and scars.
"Women also come for chemical peeling, botox and body contouring to get attractive looks," Dr Dhir said.
Neeraja, a college student in Mumbai, had nose correction surgery to look good on Facebook. "I get so many compliments after my nose job. Now, I have a glowing skin after chemical peeling. My relatives and friends have started noticing and appreciating me."
The trend is disturbing as cosmetic surgery procedures alter the body shape significantly and students are not mature enough to evaluate the risk/benefit potential of these more invasive procedures.
"It is more important for a student to become comfortable with themselves as individuals and get through the sometimes awkward teen years before having cosmetic surgery to alter their appearance," Dr Thomas said.
Beauty pageants have helped the market to extend and make teens feel that some work done is always an investment.
"Teens need to be realistic. Cosmetic surgery is only one among many aspects to help them improve. They may have physical changes, but the real change lies within," Dr Dhir said.
Agrees Dr Thomas who also feels that surgery is not the answer to instant popularity or success, but rather is "capable of making them look better (not perfect but better) on the outside".
Global destination
Though in existence in India - a country where there are around 1,500-2,000 cosmetic surgeons - for about four decades, cosmetic surgery was always referred to in hush-hush tones, but now it is shedding its taboo tab.
Out of the 15 million people worldwide who resorted to plastic surgery in 2011 to enhance their looks, there were no fewer than 466,231 Indians, according to the reports by the International Society of Aesthetic Plastic Surgeons (ISAPS), making India to hover between fourth and fifth place in the top five global destinations for medical tourism, cosmetic surgery being a part of it.
However, the Government of India predicts that India's $17-billion annual health care industry could grow 13 per cent in each of the next six years, boosted by medical tourism, which most experts say is growing at 30 per cent annually.
Though the exact number of tourists who visit India every year just for cosmetic surgery is not clear, some 50-60 percent of the total cosmetic surgery tourists annually end up in Mumbai, India's entertainment capital, making it India's cosmetic surgery capital.
Overall, the percentage of procedures done in India in 2012 was 1.14 million, which amounted to 6.2 per cent of the world's cosmetic surgeries - a big jump for India which was not even in top 20, 10 years ago.
[Note: Some names have been changed to protect the identity]
