The Indian medical education system graduates more than 20,000 doctors and nurses yearly, many of whom then go on to obtain additional or advanced training in the U.K. or the United States.

The basic medical degree is the MBBS, while physicians who have specialized with additional post-graduate training are awarded an MD or MS degree. All doctors must be registered with the Medical Council of India, while only those physicians with specialty training may register with the Association of Plastic Surgeons of India.

There are only about 2,000 formally registered plastic surgeons in the entire country, most of whom devote much of their time to reconstructive surgery. Registered plastic surgeons in India's large metropolitan centers are widely respected as well-educated, experienced, skilled in the most modern and safest techniques, and are reputable.

As in other less developed countries throughout Asia and elsewhere, this same level of professionalism is not always found in the outlying towns and smaller cities, where regulations are not well-enforced and some practitioners resemble salesmen catering to desperate dreamers.

Predatory advertising and graphic posters covering clinic walls remind a less privileged patient base of their common fears such as trouble finding a mate, saving a failing marriage, or obtaining better employment. Low prices but intense upselling caters to some with unrealistic dreams of escaping to the glitter of far-off Bollywood. Volume at such clinics can be very high, and even potential patients from the big cities or medical tourists can be enticed by what may appear to be a bargain.

A third tier of cosmetic surgery providers outnumber all the rest by far: back-alley unlicensed practitioners with little or no formal training offering a crude level of care in unsanitary and unsafe facilities.