IT is not exactly a new trend, but it is newly widespread. Over the past decade the world had seen women’s faces chiselled and carved to build better noses and more defined chins. Lines have been filled with fat from the belly and eyebrows lifted by similar techniques.

The aging starlets of Hollywood and the smiles that stare back from popular reality shows sport a near indistinguishable look: wildly puffy lips, eyes drowning in all the newly plumped flesh, noses reshaped and bosoms amplified. One would think that the visibly artificial nature of this look would be a turn-off, an argument against women getting such procedures done on themselves — but that would be wrong.

What’s good for Hollywood and the rich housewives of New York is, of course, welcomed with open arms in Pakistan. The first slew of Botox Begums included the very wealthy women who summered in London or New York and were able to access the procedures secretly enough. Their plumped cheeks and tightened skin attracted attention no doubt, but it remained a matter of conjecture — did she or didn’t she, the whisperers would wonder when confronted by the newly youthful visage of this or that society wife. For the very rich, one could conclude, youth was forever.

What’s good for Hollywood and the rich housewives of New York is, of course, welcomed with open arms in Pakistan.

Those were the old days. It is now possible for the barely rich and even the not-so-rich women of Pakistan to become a Botox Begum. Clinics administering any one of the many brands of collagen or Botox fillers first popped up in the fancy areas of Karachi and Lahore and they have now spread just about everywhere. The cleverest ones are adept at using their patients as advertisements. I know of ladies-only teas and brunches where the hostess arranges for an aesthetician to come and provide Botox injections for all her friends. To encourage this sort of fad promotion, the owners of these variously titled beauty or spa or aesthetic clinics hold similar events themselves, so that their existing and would-be patients can meet and mingle.

Once a begum of whatever means has saved up the cash from her household expenses, borrowed it from a friend or coaxed it out of her husband she can be a patient. And once a patient forever a patient, or at least that is the intention of many of these clinics.

A lady who purchases an initial filler package can then be sold perhaps a nose restructuring or a chin redefinition. The slightly pudgy can be talked into getting intravenous infusions of vitamins etc that allegedly increase the metabolism. Then there are the treatments that speak to Pakistani society’s particular insecurities. One startling one that I saw was called ‘lip lightening’ in which purplish tinge of lips could be whitened by a permanent tattoo.

And we all know whitening and the insane craze for it isn’t limited to the lips. Many women, these aesthetic clinics realise, have innumerable insecurities and there is money to be made of each and every one of them. So the women come, some wear full burqas, anxious mothers toting their daughters who have been deemed plain by the marriage market, older women who want to look ‘fresh’ at a nephew’s shaadi — all of them flock to the clinics handing themselves over to these purveyors of everlasting youth and beauty.

There are many scam businesses in Pakistan, one could say, why worry about this one. The reason is simple — while there are qualified dermatologists that are running these clinics, most procedures are carried out by the staff. At the same time, the business model requires a high volume of procedures be carried out so that they can make a profit. While it is perhaps true that most fillers, the Botox and other injections that eliminate wrinkles, are safe, they are only safe in the hands of trained and licensed aestheticians working under the supervision of plastic surgeons. Botched filler jobs are not uncommon and can cause blisters and blackened skin with lumps under it, and accompanied by pain in the area.

One woman who had the injections in the lower eyelid area to prevent under-eye wrinkles ended up with complications for quite some time. In other cases, filler injections resulted in cheekbones so high that the patient looked like a caricature. She had to have a series of injections to dissolve the filler.

Aestheticians who have had only minimal training in anatomy tend not to be properly knowledgeable about where facial and other nerves are. Currently, Pakistan does not appear to have any proper special licensing programme for nurse aestheticians. This means that many poorly trained aestheticians are going around with filler injections ready to administer them. A common disaster caused by just this is nerves around the mouth that freeze the face so that the patient cannot smile. Sometimes, this results in one side of the face being frozen and a crooked smile. There may be nothing wrong with plastic surgery procedures if they are provided by trained dermatologists, plastic surgeons and nurse aestheticians. At the same time, the droves of women marching up to these clinics to get whitening and slimming and plumping treatments are worrisome given the particular predilections of Pakistani society; the emphasis on a woman’s looks, the constant communal commentary on them, their underlying insecurities and all the emotional and cultural baggage attached to the latter.

In this sense it is the combination of these widely proliferating quasi-medical procedures and a gendered and misogynistic society where looks are the sum total of a woman’s worth that is responsible for botched procedures. One way to prevent them is for the government to immediately introduce licensing procedures and oversight of these clinics carrying out quasi-medical procedures. That effort may well be the only thing that can save the Botox Begums of Pakistan.

The writer is an attorney teaching constitutional law and political philosophy.

rafia.zakaria@gmail.com

Published in Dawn, February 10th, 2021