Kajal Thaker was born with the kind of skin people dream about-fair and unblemished. But in November, the 25-year-old Mumbai software professional developed a few blackheads on her cheeks. Eager to regain her flawless complexion, she consulted her neighbourhood skin specialist. Since he charged Rs 400 per visit, she figured he must be good. He prescribed antibiotics and a topical treatment-Adaserin gel to be followed by Clindac gel if boils developed. In a few days, painful pus-filled boils replaced the blackheads. When Thaker went to the doctor again, he changed the application to Erytop, another gel with the same active ingredients as Clindac. In three days, the boils were on her forehead. She then rushed to another skin specialist, who concluded that the boils were a direct result of the topical treatments. Kajal eventually had to take eight antibiotic injections on her face and oral antibiotics for over two months. Last month she went to Lokmanya Tilak Government Hospital to have a patch test done. After she tested positive for reactions to both drugs, she filed a complaint in the Consumer Court, the Medical Council and with the Mumbai Police. But a judgement in her favour cannot remove the scars on her face. "This is something I have to live with forever," she says.

SKIN STRESS: Microdermabrasion (skin peeling or bleeding) treatment under way

Vivacious socialite Nina Pillai suffered similar consequences nine months ago after a beauty treatment at a Mumbai clinic. They aren't alone. Sulekha Chitnis, a 30-year-old Mumbai professional, opted for laser treatment to get rid of the hair on her legs. The process, ostensibly a permanent solution, was to be completed in 10 sessions costing Rs 1,000 each. But after the seventh session, she developed white patches caused by excess laser exposure. She is currently undergoing skin repairing treatment. "Even if I get compensation, what about the emotional trauma I have undergone?" she asks.

A question that 42-year-old Mumbai businessman Ashwin Shah also asked when, prior to his daughter's wedding, he went to a salon in South Mumbai to get the grey out of his hair. As the dye was applied, he complained of a burning sensation but the hairdresser dismissed it as an initial reaction. Within 10 minutes however, Shah's scanty hair was coming out in clumps and his scalp had turned pink. He recovered in three months but his hair never grew back.

Beauty has become a big business in India in the past decade. The powerful matrix of multinationals, media and beauty contests has created millions of beauty consumers. What was once the prerogative of the rich has percolated down to the lower-middle classes. As urban Indians rush lemming-like to enhance their looks, the lines between cosmetic surgeons, dermatologists and beauticians are blurring. There are thousands of practitioners offering a plethora of treatments-from Botox injections to bio-lifting-but the After picture is not always better than the Before. The explosive growth combined with the lack of monitoring bodies and legislation and ignorant consumers is leading to physical and psychological damage. The pursuit of beauty is leaving life-long scars.

What Can Go Wrong?
When the prettification bandwagon runs off the rails-because of inferior products and low hygiene levels followed by inadequately trained practitioners-ugly accidents are the result
Nails Thickened, split or discoloured nails may be the end result of a manicure or pedicure for which implements have not been sterilised. To avoid this, all implements must be washed in surgical antiseptics or sterilised in a glass-bead steriliser. The use of substandard ointments and poor hygiene could also cause unwanted side effects such as fungal and bacterial infections.
	Skin ELECTROLYSIS: If the procedure is done incorrectly, the needle may go in too deep, causing skin pigmentation. Doing electrolysis too often can have the same result.
	WAXING: A normal waxing procedure can cause folliculitis if instead of disposable wax strips, cloth is used and it is not sterilised between clients or if an unclean knife is used.
Hair Ignorance about hair products can cause scalp burn and hair damage during perming or straightening. The duration of chemical application should be followed strictly; lapses can lead to severe damage. Unsterilised hairstyling tools can cause eruptions, flaking or fungal infections.
Colouring Poor training or substandard products can make hair rough and dry and cause easy breakage. Patch tests must be done to check for allergies. Face CLEANSING: A facial or clean-up can cause warts if the instruments used, such as a pimple extractor, are unsterilised. The beautician can pass these on if she is not wearing gloves. FACIALS: Lack of hygiene and the use of inferior creams could cause warts or mollusca, viral infection, pimples, whitehead-like eruptions, rashes, flaking, itching or burning. All skin types don't respond similarly to creams. If a cream is too harsh for the client's skin type, it can result in rashes. Patch-tests must be done before doing a facial.
	Lasers Lasers must only be used by qualified doctors. If the frequency is too high or if the skin is not in correct contact with the laser, the client can be burnt. Incorrect use may also cause white patches.
Laser procedures are often used for permanent hair removal; it is imperative that these are performed by doctors trained in the technique.

The growing pressure to look good can be measured in the growth of the Rs 11,000-crore cosmetic and beauty service industry. According to Jagjeet Kapoor, managing director of Samsika Marketing, the industry grew by 30 per cent last year. Style Speak-Salon & Spa, a recently launched magazine for image professionals, estimates that the Rs 700-crore salon market is registering a phenomenal 20 per cent growth every year. National figures are unavailable but regional numbers are evidence enough-in Mumbai last year, the Brihanmumbai Municipal Corporation (BMC) issued nearly 1,500 licences for "beauty centres" in C Ward alone (the city is divided into 24 wards). In Chennai, there are about 4,500 beauty parlours. The bravest consumers opt for the knife. The number of cosmetic surgeons (surgeons who do enhancement rather than reconstructive work) in India is still small-Dr Mohan Thomas of the Cosmetic Surgery Institute (CSI) in Mumbai estimates that country-wide, there would be less than a hundred-but the practice is growing. From basic services, cosmetic surgeons now offer procedures like autofat grafting and eyelid surgery.

But quantity doesn't equal quality. When dealing with human bodies, the McDonalds approach of quick, standardised service doesn't always work. Behind the promises of prettiness are the horror stories. Dr Bhavna Doshi, a Mumbai pharmacologist who runs Clin Pham Consultants, underwent a facelift and liposuction at a Mumbai hospital. Two days later, when the bandage was removed, she saw her "face twisted on one side with a crooked eye". Doshi had to undergo intensive physiotherapy to fix her face. She says: "I have paid a heavy price to learn that beauty is in the eyes of the beholder."

Evidently, many others do not believe in that dictum and are opting even for surgical measures aimed at beautification. The Medical Council of India does not list cosmetic surgery as a specialty. But as the field grows increasingly lucrative, more plastic surgeons are dabbling in cosmetic work and there is no grading system to help the consumer make an informed choice. Dr Rajesh Parikh, neuro-psychiatrist with Mumbai's Jaslok Hospital, believes cosmetic surgeons should screen patients for depression and related disorders before surgery, as is done in the US. He says, "A portion of individuals seeking cosmetic surgery are making a desperate attempt to annihilate a notion of themselves and construct in its place a hypothetical concept which fits into the prevalent norms of society. So unless a more holistic view is taken prior to wielding the knife, cosmetic surgery will leave a trail of disgruntled individuals."

With growing consumer demand, several non-surgical procedures have entered the market. But even these minimally invasive alternatives must be administered by trained and certified professionals. Botox, a brand name for the poison Botulinum toxin A, is the current rage-Dr Jamuna Pai, leading cosmetologist and consultant to Miss India contestants, administers three injections a day. Injected by experts like her, Botox can smoothen wrinkles and lines for three to six months. But as Dr Rekha Seth, dermatologist and founder president of the Cosmetic Society of India (CSI), points out, "If given in the wrong place, Botox can distort the face and even have a paralytic effect."

But perhaps the most disturbing aspect is that even routine beauty parlour procedures-pedicures, waxing, facials-aren't risk free. The beauty service industry is an unregulated business with no monitoring authorities. So the hygiene, level of expertise and quality of products used varies from salon to salon. "This is an area of grave concern," says Dom Daniel, editor-in-chief of Beauty & Salon magazine. "The general hygiene level is nowhere where it should be." Health activist Kewal Semlani, who runs the Universal Health Consultant, says beauty salons use "people as guinea pigs. Most are breeding grounds for disease". The prospects are horrifying (see box). Non-sterilised equipment, unwashed pedicure tubs, even the beautician's unwashed hands can cause infection.

Sometimes salons use indigenous products, which are often not tested under Food and Drug Administration (FDA) law. Says cosmetic consultant Dr S.G. Bhatt: "Products like hair oil made with herbal concoctions can cause fungus or skin irritation." Hair colours, which have contributed significantly to the market growth (currently there are 78 colours available), are often abused. A patch test is required before any colouring procedure to check for allergies but sometimes beauticians skip this critical step.

"There are many salons using hair perming and straightening products," says Dilshad Pastakia, hairstylist for actors like Shah Rukh Khan and Hrithik Roshan. "But for this you must be trained. Even if the chemical is kept on for 10 minutes longer, the damage can be irreversible." Hair designer Harry of Delhi's popular Harry and Shanti salon says that every week, the salon does "fix-up jobs on clients who come with hair burns and damaged hair after going to small semi-trained parlours."

Facials are another potential disaster area. Delhi-based natural beauty specialist Suparna Trikha says that 60 per cent of the clients at her centre Aaveda have had bad experiences elsewhere. "Disaster management is what we often do," she says. "Most clients still think that a facial is only about cleansing, massage, steam and packs but the fact is that not all faces can be given a massage." A view borne out by the study titled "Rejuvenating facial massage-a bane or boon?" conducted by Dr Neena Khanna and Dr Siddhartha Datta Gupta of the All India Institute of Medical Sciences (AIIMS). Published in the July 2002 issue of the International Journal of Dermatology, the study looked at the effects of facials on 142 women aged 17-63 years. The women, who had facials at some of the top parlours in Delhi, were observed for a period of 12 weeks. The study found that an astounding 33 per cent of them suffered acne eruptions and 36 per cent developed puffiness.

Even waxing can be hazardous. Sudha Mehta, a 34-year-old Delhi professional, waxed her back because she loved to wear low back blouses. She developed burning rashes, which were diagnosed as an infection from unclean waxing strips. She had to use oral steroid creams and anti-allergic medication for six months.

Not all beauty parlours are bacterial time bombs-quality varies widely. At one end of the spectrum are premium salons like Seth's Iz in Mumbai. Iz uses hospital grade antiseptics and trains in-house beauticians for six months. On the other end are parlours run out of homes and garages by bored housewives and small-time operators. "The normal doctor's sterilisation kit costs just Rs 500," says Sunita Makhija, a cosmetologist who runs the Schnell Hans salons. "And a UV sterilisation costs only Rs 1,200 but it's just a lack of will."

POTENTIAL PERILS: Even a routine facial could be damaging if substandard products are used

The new beauty jargon further confuses consumers. The beauty business is no longer run by beauticians but also includes cosmetologists, dermatologists, beauty therapists, image enhancers and cosmetic physicians. All these titles come with differing levels of training and expertise. Pai, who calls herself a cosmetic physician and runs three "cosmetic clinics", seeing over 40 clients a day, has only an MBBs degree. She says she is happy to refer the more complex cases to dermatologists but clearly, clients prefer her and are willing to wait up to three months for an appointment.

The government minimally monitors these services. In Mumbai, anybody with a 100 sq ft space can pay a nominal licence fee (Rs 370 per 100 sq foot), get a trade licence (Rs 400) and start a salon. The law states that brushes, scissors and blades should be made of good material and should be sterilised after every use, but these rules are not enforced. Though Maharashtra has the maximum number of health inspectors-121 against the sanctioned 159-there isn't enough manpower to inspect every unit every three months, as the law requires. This is because health inspectors are responsible for all areas of public health. Says BMC's Dr P.C. Mehta: "It is physically impossible to keep a tab on the increasing number of beauty joints. We have other important jobs to do."

Cosmetic manufacturing is covered by the Food and Drug Control Department but there is no agency for health-related service areas. Says N. G. Wagle, a member on the cosmetic committee of the Bureau of Indian Standards: "The haphazard growth of beauty enhancing services has put consumers on the razor's edge. Despite phenomenal expansion, salon service is not considered important enough to be put under a regulatory body." So what recourse does an aggrieved consumer have? Very little. The courts present a long, expensive and arduous battle. Besides, the stigma and secrecy attached to beauty treatments make it difficult for people to air their grievances. Pritee Shah, editor of the consumer magazine Insight, believes the Government should create legislation similar to the Hospital and Nursing Home Registration Act. "This would compel salons to maintain hygiene and also control the kind of people getting into the business." The entry of multinationals into the service industry is helping raise standards. Lakme has 44 beauty salons in 22 cities and gets about 15 enquiries a month for franchises.

Each Lakme salon is audited annually by Pivot Point India, an independent body, to ensure that it is adhering to international beauty care standards. Beauty education also promises to get a fillip when the CSI starts a certification course with Mumbai University in April 2003. However, until legislation, training and aware consumers raise the beauty bar, self-monitoring is the only option. Professionals must hold themselves to a higher standard. Because beauty is not just skin-deep.

— With inputs from Shefalee Vasudev and Kavitha Muralidharan