Dr Sherrell J Aston MD has grown rich from face-lifts. Fabulously rich. He charges in the region of $25,000 for each lift; a further $10,000 to lift the eyes, and $10,000 more to lift the brow.You thought a face-lift included the eyes and brow? In cosmetic-surgery terms, a lift focuses on the lower part of the face; in Aston's terms, it includes everything from the collarbone to the corner of the eyes; and everything above that point is à la carte. He performs up to three procedures in a day, achieves around 40 hours of surgery a week - which means, according to my simplistic but not entirely absurd estimates that, even allowing for the fact that he isn't constantly performing big-money lifts, Aston earns premiership-footballer money.

He is certainly rich enough to pursue sexily flamboyant lifestyle choices. He exists in a flurry of hand-tailored Brioni suits and Hermès ties. He has been called the Imelda Marcos of the tie world; he owns loads: 'Seventy-five per cent of which are red, not for any special reason'. His shirts are custom-made, as are his shoes. He drives a Porsche and he, his second wife - the brilliantly named Muffie Potter Aston, a philanthropist and one-time executive vice-president of Van Cleef & Arpels - and their three-year-old twin girls Bracie and Ashleigh, split their time between a home on Park Avenue and a countryside estate on Long Island - a weekend retreat where Aston rides the Arab horses he stables for his sister, who breeds them in Virginia.

Yes, face-lifts have made Aston extremely rich. But then Aston is said to do the best face-lifts in the world. 'It's my passion, my passion,' he says. He's the sixtysomething son of what Americans call a gentleman farmer - he grew up in Virginia and he speaks with a soft, considered, genteel Southern drawl that makes you think of Rhett Butler and pitchers of lemonade. He says 'A'ym' instead of 'I'm'. 'I get tremendous joy from doing the procedures, from seeing the results afterward,' he says. 'Really. Tremendous joy.'

You thought face-lifts were over? Killed off by a combination of Botox, and fear of winding up looking somewhat bride-of-Wildenstein? No! On the contrary, the face-lift is enjoying a renaissance, following the introduction of newer and newer techniques involving smaller scars and shorter recuperation periods.

'There's definitely been a big shift from breast surgery towards facial surgery,' says Dr Laurence Kirwan, a British surgeon who operates in London and New York. 'I think what's beginning to happen is that age is becoming irrelevant. Some people have face-lifts in their forties because they're ageing prematurely; but some people just never looked that great in the first place. Are your thirties too young for a face-lift? Not if you just weren't born looking great. Face-lifts and facial surgery will not be about ageing in the future; they'll be about aesthetics. I just gave Botox to a 24-year-old girl this morning!'

The UK's relationship with plastic surgery is altering at a giddying pace. The latest available figures, compiled by the British Association of Aesthetic Plastic Surgery, attest to a 44 per cent rise in face-lift procedures between 2005 and 2006; and a 48 per cent rise in (related, as we now know) eyelid surgery and brow-lifts. Dr Kirwan notes a democratising shift in the demographics of his patients. 'Not just in age range, either. You've got a lot of very high-powered people, City people, who are working their 90-hour weeks, making all their money and, by 40, they look like hell...' Big cosmetic-surgery companies such as the UK-based Transform offer the kind of flexi-finance opportunities on lifts that I associate with sofas: 'Nought per cent finance, nothing to pay until 2008, summer sale extended!' runs the banner ad on their website. Maybe this whole cultural movement wasn't kick-started by Aston alone. But he's certainly a major contributing factor.

His credentials are astounding. 'He does beautiful face-lifts,' says Wendy Lewis, the leading independent plastic-surgery consultant,whose new book Plastic Makes Perfect is out later this year. 'Absolutely no doubt about that.' He's pioneered a technique called FAME, which stands for Finger-Assisted Mylar Elevation. It involves the repositioning of not only the skin of the face, but the soft tissue beneath it, and is said to produce exceptionally natural results. He's also renowned for a uniquely indulgent brand of aftercare; he and his ex-model nurses and assistants ('Aston's Angels') are slavishly devoted to their patients.

Aston is the surgeon director and chairman of plastic surgery at New York's super-prestigious Manhattan Eye, Ear and Throat Hospital (MEETH); he is professor of plastic surgery at New York University. New York magazine rates him high in its annual Best Beauty Docs list; Vogue regularly features references to his work. But then maybe that's not surprising - among the very many big names rumoured to have availed themselves of his services (or 'had an Aston') are Anna Wintour, the editor of US Vogue; and also Tipper Gore, Catherine Deneuve, Bob Dole, Carolina Herrera and Mary Archer. Aston, of course, neither confirms nor denies having tended to these people, saying: 'Yes, I treat celebrities, but you know, I treat every one of my patients as though he or she were the most important person in the world... they are all celebrities to me.' However, it's worth noting that Aston's website archives a succession of magazine articles, some of which refer to those rumours. He clearly isn't desperate to quash them. He's a recurring specialist on Oprah. Earlier this year, he wound up on the cover of Italian style bible L'Uomo Vogue. He's regularly featured on Page Six, the New York Post's notorious gossip sheet. Aston is, in short, the world's first superstar face-lifter.

I meet Aston in his Park Avenue offices to gain insight into the perfect face-lift, what it involves, how long it'll be until it arrives in the UK, whether it's even remotely morally defensible - and whether or not I need one.

He's late, and I'm nervous. I've accumulated some gossip about him. Aston polarises people: he is either adored or loathed. No one who talks to me about him - either in New York, or London - will be identified. 'He strikes either love, or awe and fear, or hatred into the hearts of Manhattanites,' one beauty insider told me. 'I would tell you to go and talk to his colleagues about it, but they'd be too scared to tell you what they really think,' says another. 'At the same time, all those society women he's made beautiful, all that incredible TLC he dishes out in a city that doesn't normally have time for that kind of thing... well, that's won him a lot of powerful friends.' 'He's the society surgeon,' says a third. 'Big, big-name clients - the biggest - people with a lot of power.'

Furthermore, at the time I meet him, Aston is implicated in a scandal. He's two weeks away from giving evidence in a huge court case. In February 2004, 56-year-old Susan Malitz, a woman on whom Aston was scheduled to operate, died on an operating table at MEETH after reacting badly to the local anaesthetic Lidocaine, which had been administered by anaesthetist Dr Gary Mellen. Malitz's husband - Dr Alan Malitz - pursued Aston, Mellen and MEETH through the courts; a case which became more high-profile still because the novelist Olivia Goldsmith had died in similar circumstances and in the same hospital, a month before Malitz - though Aston was not Goldsmith's surgeon. (Since then, the hospital and Dr Mellen settled a $3.1 million suit on Alan Malitz between them, and Aston was not required to pay anything - an exoneration, according to his lawyer, Peter Kopff.) Aston himself has pointed out that these were the only two deaths that had occurred in this department, in its 40-year history.

I'm greeted at Aston's offices by Bernadette McGoldrick, director of operations for this private clinic; an affable, sweet fortysomething redhead, a card-carrying Aston's Angel.

She apologises effusively for his lateness, and gets me a Diet Coke. I snoop round his suite of rooms, which are ornate, mahogany, Baccarat-crystal and rich-rug strewn, the antithesis of the cold, sterile environments one expects from doctors' surgeries. There are tasteful antiques and objets, many of which, Bernadette explains, are gifts from grateful clients. On the walls are endless snaps of Dr and Mrs Aston and celebrity pals - with Prince Charles (in a kilt) at Buckingham Palace, with the Carters, with the Clintons...

Then Aston arrives. He's dressed in full double-breasted Brioni splendour, a look which enhances the mannered, Rhett Butler-ish dash. I am instantly charmed - just as his detractors and fans alike promised I would be. He's short, he's wiry, he's got a lot of hair, and a smooth face, but doesn't give away much either. He claims to be in his early sixties; and he doesn't drink, or smoke, or ingest caffeine ('well, the occasional Diet Coke. One every six months!'). He goes to bed early, and he gets up early to jog round Central Park with a personal trainer.

Dr Sherrell J Aston has been lifting faces for 35 years. 'I have done thousands of face-lifts,' he says. 'Thousands. I think you appreciate how to get the best results on individuals when you've done it a few thousand times.'

He didn't always want to be a plastic surgeon - he didn't really know that they existed - until he was in his final year at medical school. His grandmother spent a lot of time in hospital when he was young ('she had melanoma and, subsequently, metastasis') and he would visit her in hospital regularly. 'I guess there was a lot of talk of surgeons. By the time I was six, if you'd said to me: What are you going to do when you grow up? I'd reply: I'm going to be a surgeon.' At 18, he went to medical school at the University of Virginia. He was initially interested in cardiac surgery - 'because it was the early Sixties, around the time that it became meaningful' - but in his final year attended a lecture that changed everything. 'For the last 10-15 minutes of the talk, the surgeon giving the lecture talked about plastic surgery. Mostly reconstructive. But something happened, a lightbulb went on, and I knew that's what I would do for the rest of my life. Remember, this was at a time when, er, cosmetic surgery was not looked upon in the medical profession as being a worthy goal. Ha ha! But I knew! I knew!'

He trained as a general surgeon at UCLA, because 'I wanted to say, I can do all that! I done all that!' to any passing contemporary who belittled his decision to devote himself to plastics. After five years in LA, he moved to New York to finally begin training in plastic surgery. 'I got stuck here. I didn't mean to be here. I didn't plan to stay.' He's said that, at heart, he considers himself to be 'a farm boy from Virginia who is still trying to figure out how city life works'.

In the Seventies, Aston began developing the FAME technique, which would prove so popular among New York's rich crowd and would also secure his fame and fortune. 'October 1976. First time I did a lift with a procedure that tightens the underlying foundations.'

And now he's a leading light in Manhattan society. 'Ha! Some people say so! I just see myself as a surgeon, with a lot of friends.'

You're practically a celebrity...

'I don't really see myself as a celebrity. I see myself as a plastic surgeon who's trying, trying to get it right. In this business, it would not take very long, to become a... non-celebrity, if you started doing things that weren't good. I'm very conscious of the fact that you need to try to get it right, time after time after time after time. And everybody's got to be the most important person in the world to you.'

But you've met Prince Charles!

'Yeah, I thought you'd recognise him! Ha ha! And that's the Carters, that one's actually taken at Highgrove. Obviously, I've been there a number of times over the years...'

Obviously.

How do you have a conversation about the ethics of plastic surgery with a plastic surgeon? Particularly one who is so incredibly good at it, who has such an overwhelming passion for it? You can't. Aston doesn't think there's anything suspect about his business. He has his own justifications for his work, and he is entirely happy with them.

'I think obviously [cosmetic surgery] can be unhealthy if it's taken to extremes by an individual. But the reason it's growing so much is because there are so many individuals who want to do it! And I think it's part of the culture, you know... about 20 years ago, you wouldn't find a store with jogging shoes every four blocks, and the number of gymnasiums were relatively few. But now, in every major city, there are gymnasiums all around, people have gymnasiums in their home... And people, many times, they tell me they just want to look as good as they feel. I think, you know, as far back in recorded history as we can find, and in all cultures, people were interested in making themselves look good with various make-ups and paints. In some cultures scarification of the body, stretching the earlobes out, putting rings in the nose, stretching the neck... so people have always been interested in looking good. But it's gotten very sophisticated.'

There are practices in his industry that don't play well with him. He has concerns about Botox. 'I think for people that do it over and over, this is worrying... we have seen some of these people already. A lot of these injectibles were available in Europe, you know, about six years ago. So I've seen ladies now, who started at that time, who are having some skin changes.' His voice drops, as if he's predicting a major tragedy. 'And that's what's going to make us start to look very carefully at everybody who is showing the effect.'

He has, he says, turned people down for surgery. 'Oh sure. Oh sure. I tell people go away, all the time. Yeah. It's my feeling that this is not good for you, and I don't want to do it.' And they beg you to reconsider? 'Sometimes. Oh yes. And some people will just go somewhere else and have it done anyway, I suppose. But I can only do what I feel is going to be good for the individual. It's got to be a good result for the individual, to be good for me.' And he appreciates that there are bad plastic surgeons at large. 'Well, you know... cosmetic surgery is like any speciality in medicine. Or like, like artists! There are some who have better vision, and are considered by the public for whatever reason to be better than the next one. And that's why we go in our museums, there are a limited number of artists showing, and then there are others, who are selling their paintings on the streets outside the museum...' He laughs. 'There are some people who just have better judgment, better sense, or with surgeons, better hands or better judgment than others. And I just consider myself as being fortunate that some people think that I have a... combination, that makes things work out.'

I point at a silver-framed picture of his beautiful baby daughters. I ask him how he'd feel if they wanted plastic surgery. He doesn't flinch.

'I think if, you know, when they get old enough... if they had... features, that they would feel better about if they were refined, then I would see no reason why they shouldn't do it. Certainly if they need go see the orthodontist, if the need to go straighten their teeth, when they're teenagers, well...' he laughs. 'We're gonna do it! And while you wouldn't think so today, if one of them had a nose that was too prominent or too wide or whatever, I would certainly, er, want her to do that.'

Would he do the work himself?

'Oh yes. Absolutely. Absolutely.'

Will Aston's face-lifts find a place in high profile, upmarket British society, setting the standard for all other face-lifts, cranking the whole face-lift frenzy in the UK up a gear? It's possible. New Yorkers share a cosmetic-surgery aesthetic with the British, according to Wendy Lewis. 'Unlike LA, where no one cares about looking natural or being secretive about having surgery, New Yorkers and the British are secretive, they want subtlety in the end look, and privacy throughout.' Furthermore, increasing amounts of UK clients are flying to New York for their surgery, because the dollar exchange rate makes it worth their while. Dr Kirwan says he charges market rate in both London and New York, and that that represents a 30 per cent discount in New York.

None of which makes a face-lift morally defensible; nor does it mean that a culture which is increasingly accepting of cosmetic surgery, is remotely healthy.

Aston says he takes one look at a person's face, and knows immediately how to improve it 'in the way, I guess, a fashion designer looks at a dress, and knows if it is well-cut, or if it is badly cut, I think it's like a sixth sense... Plastic surgery is part art, and part science. And the artistic part is extremely important to me.' I ask him what he'd do to me, he says: 'Oh. I don't think you need anything right now,' which is kind of nice - I have in the past spoken to cosmetic surgeons who did suggest work - but then, there's that 'right now', which is ominous. Aston's assessed me, he knows what's going to droop first, what going to sag and bag and pouch out. He knows where he'd cut first, how he'd insert the first blade, and in exactly how many years' time he'll need to start the cutting...

Would I 'have an Aston' when the time came? Would I let him slice into the flesh on my face, peel my skin back like a Halloween mask, rootle about with tissue beneath it, repositioning and readjusting it? All because I can't face the fact of ageing? Would I? I actually don't know. I'll get back to you.

&#183draston.com
drkirwan.co.uk
Wendy Lewis: wlbeauty.com